Standing, sitting, or lying prone
If you wish to palpate on the skin, provide a private room. If you think this is necessary, the patient is asked if he/she is willing to lower his/her pants, if needed, for direct palpation of the sacrum or for intervention. While the skin can not be viewed with clothes covering the area, the sacrum could be palpated to assess motion or pain response over clothing. For intervention, realignment of the sacrum may be possible over clothing.
Posterior to the patient.
Possible trauma or damage to the pelvic bones can be evaluated more accurately if you lower your pants (and demonstrate the level, which is to the level of the sacroiliac joint). Would you feel comfortable doing this? May I touch the back of your hip bones? (or point to the area).
The sacroiliac joint is composed of the articulation of the sacrum with the ilium. With the patient relaxed and after asking permission to touch, gently place your fingers on the iliac crest. Follow posteriorly along the iliac crest toward the posterior superior iliac spine. Move your fingers medially as they sink anteriorly toward the sacrum. Follow superiorly and inferiorly along the sacroiliac joint.
VH - Sacroiliac joint