Lying prone
If you wish to palpate on the skin, decide whether you need a private room. Ask the patient if he/she is willing to uncover the back ñ removing the shirt for men and for women, either wearing a halter top or two piece bathing suit, etc. or rolling the shirt up to uncover at least the lumbar area. While the skin can not be viewed with clothes covering the area, the erector spinae muscles may be palpable over clothing.
Posterior to the patient.
(Guide the patient to drape appropriately.) Please lie on your stomach. May I touch your back? (or point to the area). Please stretch your arms out above your head and then lift your upper body. (If needed, hold in this position while I try to push you down.)
Guide the patient to drape appropriately and then lie prone. With the muscles relaxed initially, place your fingers on the erector spinae muscle group. Guide the patient to flex the shoulders, reach forward with the upper limbs and then extend the spine. Lifting the upper body with the shoulders extended will activate the superficial latissimus dorsi muscle and mask the contraction of the erector spinae muscles. With unclear muscle activity, increase the contraction of the erector spinae muscles by asking the patient to hold while you gently try to push the upper body toward the support surface.
The erector spinae muscles are composed of three columns of muscles, which together span about a palmís width lateral to the spinous processes.
The spinalis muscle group is most medial, has the least width, and has thoracis, cervicis, and capitis portions, i.e. is muscular in the thoracic, neck, and head regions.
The longissimus muscle group is intermediate or in the middle, and has thoracis, cervicis, and capitis portions, i.e. is muscular in the thoracic, neck, and head regions.
The iliocostalis muscle group is lateral, and has lumborum, thoracis, and cervicis portions, i.e. is muscular in the lumbar, thoracic, and neck regions.
The muscle group is attached by the thick lumbar portion of the thoracolumbar fascia to the posterior sacrum and iliac crests, the spinous processes and supraspinal ligaments of the lumbar and lower thoracic vertebrae.
The erector spinae muscles are composed of three columns of muscles, which together span about a palmís width lateral to the spinous processes.
The spinalis muscle group is most medial, has the least width, and has thoracis, cervicis, and capitis portions, i.e. is muscular in the thoracic, neck, and head regions.
The longissimus muscle group is intermediate or in the middle, and has thoracis, cervicis, and capitis portions, i.e. is muscular in the thoracic, neck, and head regions.
The iliocostalis muscle group is lateral, and has lumborum, thoracis, and cervicis portions, i.e. is muscular in the lumbar, thoracic, and neck regions.
The muscle group is attached by the thick lumbar portion of the thoracolumbar fascia to the posterior sacrum and iliac crests, the spinous processes and supraspinal ligaments of the lumbar and lower thoracic vertebrae.
VH - Spine skeleton with the erector spinae muscle and tendon
On the other side add splenius, semispinalis, multifidus, rotatores, interspinalis, intertransversarii muscles and tendons