Meningeal Release Coccyx

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Meningeal Release - Coccyx

• What is it?
• Therapy localization
• Testing
• Correction
• Pelvic Floor

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What is Meningeal Release?

• The dura mater is firmly attached
• inside the cranial bowl,
• Atlas, Axis and third cervical
• by the filum terminale into the dorsum of the
  first coccygeal segment
  

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What is Meningeal Release?

• In coccyx imbalances, abnormal stress can be
  applied to the dura mater causing reflex muscle
  tension along the spine.
  
• Goodheart has described the coccyx as a take up
  mechanism to keep constant tension on the dura
  mater.
  
• Tension on the dura appears to be controlled by
  the coccyx

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Symptoms

• Increased muscle contraction along the spine from
  the lumbars through the cervicals
  
• Increased pterygoid pocket tenderness
• Leg edema - tenderness
• Visceroptosis
• Dropped bladder - uterus
• Open ICV

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Spinal Length

• Goodheart noted that healthy patients had the
  same spinal length, within 14 mm. (use rolling
  tape measure from coccyx to occiput)
  
• If they were measured in the supine, sitting and
  standing positions.
  
• Patient's with chronic problems have dramatic
  differences in the length of their spines.

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Causes

• hemi-pelvis
• Fall on the pelvis
• Cycling
• Prolonged sitting with leg crossed
• Child birth
• Poor sitting posture

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Therapy Localization

• The patient is asked to therapy localize to the
  coccyx and apply inferior pressure. A strong
  muscle is tested for weakening.
  
• Palpation of the paravertebral muscles will show
  tenderness on one side of the spine
  
• Cervical paravertebrals are always present

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Challenge

• Palpate the associated muscle tenderness
• Contact over the coccyx and traction the skin
  cephalad
  
• Vary the vector until the greatest reduction in
  pain is found

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Correction

• Contact the skin over the coccyx and pull in the
  challenge direction found above.
  
• Apply this pressure in a cephalad direction
  while the patient inspires.
  
• Simultaneously, contact the atlas and pull
  inferior.
  

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• Repeat this five to seven times
• Palpate for reduction in muscle tenderness
• Remeasure the spinal length for normalization

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Pelvic Floor

• Test in cases of leg edema, increased venous
  pressure, obturator syndrome, general
  visceroptosis

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Pelvic Floor

• Tests are similar to the gluteus maximus starting
  position.
  
• These were developed by Beardall
• The leg is tested in a neutral position and with
  the leg internally and externally rotated 30
  degrees

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Pelvic Floor

• If any of the three tests shows weakness
• Challenge the coccyx for a position that
  strengthens the muscle
  
• Correct in the challenge position

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Coccygeus

• Coccygeus is often described as the muscular
  belly of the sacrospinous ligament with which it
  is fused to on its pelvic aspect.
  
• The coccygeus is occasionally absent, in which
  case the sacrospinous ligament is more
  prominent.
  
• Proximal Attachment
• This triangular sheet of muscle arises from the
  pelvic surface of the ischial spine and
  sacrospinous ligament.
  

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Coccygeus

• Proximal Attachment
• This triangular sheet of muscle arises from the
  pelvic surface of the ischial spine and
  sacrospinous ligament.
  
• Distal Attachment
• Its base is attached to the lateral aspect of the
  coccyx and the fifth sacral segment.
  

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Coccygeus Nerve Supply

• A branch of the sacral plexus, derived from the
  ventral rami of S4 and S5 supplies coccygeus.
  

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Coccygeus Action

• The coccygeus muscle functions with the levator
  ani forming the majority of the pelvic diaphragm,
  which supports the pelvic viscera.
  
• When the coccygeus and the levator ani contract
  with the muscles of the abdominal wall, they help
  to raise intra-abdominal pressure in such
  processes as coughing, vomiting and forced
  expiration.
• They can also become involved in inspiration
  during respiration.
  

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Sacrotuberous ligament

• Has an extensive attachment to the posterior
  superior and posterior inferior iliac spines, the
  posterior surface of the sacrum (where it blends
  with the posterior (dorsal) sacro-iliac
  ligaments), the lateral aspect of the lower
  sacrum and to the upper surface of the coccyx.
• The fibers converge as they pass downwards and
  laterally. They twist on themselves and then
  diverge to attach to the medial margin of the
  ischial tuberosity and the lower margin of the
  ischial ramus.
• Distal fibers of gluteus maximus attach to the
  ligaments posterior surface.