Lying prone
If you wish to palpate on the skin, provide a private room for assessment. Ask the patient if he/she is willing to uncover the area ñ removing the shirt for men and wearing a halter top, bathing suit, etc. for women. A shirt can be rolled up to uncover the lower back area.
Posterior to the patient.
(Guide the patient to drape appropriately.) Please lie down on your stomach with the pillow under your abdomen. May I touch the bones along your back? (or point to the area).
Guide the patient to drape appropriately and then lie down on his/her stomach with the pillow under his/her abdomen. Position yourself so that you can place your thumbs on either side of the spinous processes. Firmly and gradually press deeper until you feel a resistance to the ìgiveî or deformation of the soft tissue under your thumb. Press on the right and then the left to assess symmetry or depth of the push on each side. Move to other vertebrae as needed.
VH ñ Skeleton of the spine and head, anterior view
On one side, add the erector spinae, splenius, semispinalis, mulifidus, rotators, intertransversarii superior oblique and inferior oblique of the suboccipital triangle muscles