Anatomy: A Tale of a Bone called Coccyx

Breaking News… the coccyx is no longer a bone that only Women’s Health Specialists are concerned about.  As physical therapists, we spend a significant amount of time treating the spine and dysfunctions of the pelvis, pelvic floor and lower extremities.  What these areas all have in common is this one little bone that we don’t think too much about… the coccyx.

Normalization of a dysfunctional coccyx enhances objective signs in other lumbopelvic girdle structures.  Conversely, when related structures (sacrum, innominate, lumbars spine and hips) are treated, coccygeal dysfunctions rarely improve. – Gregg Johnson (Wise 2015)

Inner Body’s Graphic

The Coccyx

  • Many consider it to be the key structure for the lumbopelvic girdle (Wise 2015)
  • has important muscle attachments that influence the body beyond the pelvic floor
    • Gluteus Maximus
    • Levator Ani
    • Coccygeus
  • Has important ligamentous attachments:
    • The anococcygel ligament helps with the functioning of the anus by holding the external anal sphincter in place. (Taylor 2017)
  • is the anchor for the inferior part of the spinal cord & meninges within the spinal canal
    • Serves as the distal attachment of the filum terminal (extension of the meninges) (Moore 2014).
  • Is involved in functional activities:
    • when we are sitting, the body weight rests on the coccyx posteriorly (Taylor 2017)
    • in women, the coccyx extends to create more space for the child in the birthing process (Taylor 2017)
  • Anatomical differences in males & females (Taylor 2017)
    • males:  aligned more anteriorly
    • women: aligned more inferiorly

The Dirty Details from Moore’s Clinically Oriented Anatomy (2014).

The Pelvic Girdle: This is the ring of bones that essentially connects the spine to the femurs, bears the weight of the upper body in sitting, and provides many attachments for the muscles used for locomotion and posture.  The girdle also houses the pelvic viscera and inferior abdominal viscera. And in women, this area supports the growing fetus.

  • specifically, the coccyx makes up the pelvic outlet which is the inferior pelvic aperture.  This ring consists of the pubic arch, ischial tuberosities, inferior margins of the sacrotuberous ligament and the tip of the coccyx.
  • It also makes up the lesser pelvis which includes the pelvic cavity and the deep pars of the the pelvic floor.
    • Pelvic Floor (pelvic diaphragm): separates the pelvic cavity form the perineum

Ligamentous Attachments

  • Sacrotuberous ligament: a massive ligament that connects the posterior margin of the ilium along the scarum & coccyx to the ischiums, which helps to form to the sciatic foramen.
  • Sacrospinous ligament: this ligament further divides the sciatic foramen into the greater and lesser sciatic foramina.
    • the piriformis muscle passes through the greater sciatic foramen
    • The Inferior gluteal a. (supplies muscles and skins of the buttocks and posterior surface of the thigh) and superior gluteal a.(gluteal mm) runs through the greater sciatic foramen
    • pudendal nerve leaves the pelvis through the greater sciatic forament
    • Superior glutetal nerve: supplies motor to the mm in the gluteal region
    • Inferior gluteal nerve: glut max

These two ligaments together help to counterbalance the weight of the body when the vertebral body sustains a sudden increase in force or weight (while jumping, running, lifting weights etc.).  The superior end of the sacrum is pushed inferiorly and anteriorly, while the ligament prevents the superior and posterior rotation of the sacrum anchoring the sacrum to the ischium (Moore 2014).

  • Sacrococcygeal ligament: reinforces the sacrococcygeal joint

Muscles that attach to the coccyx:

  • Coccygeus muscles (Ischiococcygeus):
    • forms a small part to the pelvic diaphragm that supports pelvic viscera
    • flexes the coccyx
    • origin: inferior sacrum and coccyx
    • insertion: sacrospinous ligament
  • Levator ani (puborectalis, pubococcygeus and iliococcygeus)
    • forms most of the pelvic diaphragm that supports the pelvic viscera
    • resists intra-abdominal pressure
  • Pubococcygeus
    • origin: posterior aspect of the pubis and anterior tendinous arch
    • insertion: coccyx and anococcygeal body (ligament between the anus and coccyx (aka Levator plate))
  • iliococcygeus: 
    • origin: arch and ischial spine
    • insertion: blends with anococcygeal body posterior


  • Median Sacral a: blood supply for the inferior lumbar vertebrae, sacrum and coccyx

Adjacent Nerves:

  • Coccygeal plexus: formed by the rami of S4 and S5 plus the coccygeal nerves.
    • supplies: coccygeus, levator ani, sacrococcygeal joint
  • Anococcygeal nerves: pierces coccygeus and anococcygeal ligament to supply the small area of skin between the coccyx and the anus.
  • Ganglion impar (sympathetic chain) lies on the anterior aspect of the coccyx
  • Filum Terminale: the caudal part of the spinal cord that serves as an anchor of the inferior end of the spinal cord and the spinal meninges.

Positional Faults of a dysfunctional Coccyx

– From Gregg Johnson’s Functional Mobilization Approach (Wise 2014)
  • Sacrococcygeal Junction
    • Compression
    • Rotation
    • Posterior Shear: often seen after childbirth
    • Anterior Shear: result of a direct fall.
    • Lateral Translation: can be right or left
  • Dysfunctions of the Coccyx body
    • Deviation
    • Extension
    • Flexion

There are treatment strategies outlined in Wise’s book.  For more information, I recommend looking into courses by the Institute of Physical Art, specially Functional Mobilization I. (See their Schedule here.)


  1. Wise, Christopher H. Orthopaedic Manual Physical Therapy: from Art to Evidence. Philadelphia, PA, F.A. Davis Company, 2015.
  2. Taylor, Tim. “Coccyx.” InnerBody, Accessed 2 Sept. 2017.
  3. Moore, Keith L., et al. Clinically Oriented Anatomy. Philadelphia, Wolters Kluwer, 2014.


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  24. there are not many betting sites in Indonesia that may hold the
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    Are as follows.

    Complete Game
    Though it is more generally known as an internet gambling slot web site, BandarUsernesia
    also offers other types regarding gambling games these kinds of as soccer wagering, casino gambling, online poker, and many other exotic gambling video games that you
    may find on this specific site.


  25. For anyone who have merely joined the globe of online gambling, it is
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    For professional online gambling players, of course , they already
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    The most popular online gambling web site and provides many
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    In this article are some on-line gambling games that will you can choose and play
    inside Usernesia.


  26. 24-hour online slot site and online casino – JudiUsernesia
    JudiUsernesia is a site for playing online
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    Online Slot Gambling Agent with a Deposit of 25 Thousand
    For lovers of online slot gambling games throughout Indonesia,
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    The online games available here are also not arbitrary games because they come
    from popular providers such as Habanero Systems, Pragmatic Play, Microgaming, and many


  27. Userbola Agent Sportsbook Trusted
    The football gambling game is so popular in Indonesia. Besides
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    You must first register to become a member of a football gambling agent.
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    Submit Deposit Form
    Demand via our SMS MIDDLE at + 62-821-6182-5555
    Demand via Whatsapp + 62-821-6182-5555
    Request via Live Conversation Userbola immediately
    Please use the steps above to avoid irresponsible individuals on behalf of Userbola.
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    Congratulations on joining the Indonesian Trusted Football Wagering Agent community.
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  28. Depo168 The Most Total Slot Site
    The reason why is it required to use Depo168 to play slots online?
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    Away there are not websites that provide complete facilities.

    Typically only offer benefits in the form of bonus payments at the starting of joining.
    In addition, many members actually experience losses.

    Assessing the criteria for the completeness of the facilities of a slot
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  29. Indonesia’s Trusted and Established Online Slot Real estate
    Agendepo168 is the best trusted slot machine game agent which was accredited by PAGCOR within Indonesia.
    Agendepo168 is usually also supported by the completeness regarding slot bookies that will already have an recognized Malta
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    Agendepo168 who works as a trustworthy actual money online slot machine agent that guarantees paying
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