What is the role of palpation in the evaluation of low back pain (LBP)?

Updated: May 15, 2018
  • Author: Bradley J Sandella, DO, ATC; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

The physician can use palpation for two purposes during examination of the lumbar spine—to help locate tender areas and, more importantly, to confirm findings previously demonstrated in the examination.

Palpation is begun with the patient seated. The physician should start with the spinous processes. Location can be estimated when the physician’s hands are at the level of the iliac crest. This imaginary line corresponds with the L4-L5 interspace. Palpation along the midline is used to check for bony tenderness and for deformity. Next, the physician moves his or her hands to the muscles just lateral to the spinous processes. The muscles of the erector spinea are palpated for tender points or spasms. With the examiner’s hands in this position, the transverse process, positioned deep to the erector spinea, can also be appreciated.

Once the posterior lumbar spine is evaluated, the patient is instructed to lie prone. From this position, the sacrum, sacral base, sacroiliac joints, and posterior superior iliac spine can be palpated. With the patient in this position, the piriformis and hamstring insertion at the ischial tuberosity also require evaluation.

The patient is instructed to lie supine, and the anterior superior iliac spine, anterior inferior iliac spine, and pubic bones can be palpated.

The role of evaluative palpation in a patient with acute low back pain is discussed in the video below.

Overview of palpation in the examination of a patient with acute low back pain.

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