Manual palpation of lumbo-pelvic landmarks: a validity study

Manual palpation (MP) is commonly used for the assessment of patients with neuromusculoskeletal dysfunction. During assessment of lumbo-pelvic disorders in particular, it may be used not only to explore pain and resistance in the region, but also to evaluate the symmetry and movement quality of the area. Whilst reliability of MP has been extensively investigated, its validity remains relatively under researched. The aim of this study was to explore the accuracy of MP of lumbo-pelvic bony points. Ultrasound images of three bony landmarks [4th lumbar spinous process (L4), left and right posterior superior iliac spines (PSIS)] were acquired from models (n = 3) in the prone position and the points marked with an ultra-violet (UV) pen. Nine musculoskeletal physiotherapists were asked to identify the bony landmarks using MP. Measurements (mms) were taken between the UV marks and the palpators' marks. The mean error (standard deviation) (mm) for MP of L4, LPSIS, RPSIS were 15.63 (3.89), 20.07 (4.60), 20.59 (2.79) respectively. Bland and Altman analysis gave a mean value of 0.173, with 95% limits of agreement ranging from -27.8 to 26.3. This study suggests that MP of specific lumbo-pelvic bony points has limited validity.