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Paraspinal muscles, also known as erector spinae, are three muscle groups that support your back. They are located on the left and right side of your spine and are responsible for movements like leaning to one side, arching your back, bending forward, or twisting your torso. These muscles can be palpated to assess for abnormalities or issues like muscle strain or injury. Palpation involves gently feeling the muscles with your fingers to detect any tension, tenderness, or swelling. It is important to use slow and gentle movements during palpation to avoid causing discomfort to the person being examined.
| Characteristics | Values |
|---|---|
| Definition | The paravertebral muscles are the "action" muscles of the back. They are also known as the erector spinae. |
| Location | The paravertebral muscles run alongside the spine on both sides, from the skull to the pelvis. |
| Function | These muscles support the spine and power and stabilize its movement, including extension, rotation, and side bending. |
| Examination | To palpate the paravertebral muscles, use gentle pressure and slow, deliberate movements. Feel for any muscle tension, tightness, tenderness, or swelling, as these could indicate issues such as muscle strain or injury. |
| Abnormalities | Spasm, tenderness, and altered tissue texture may be detected through palpation and can indicate underlying issues such as muscle dysfunction, inflammation, or injury. |
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What You'll Learn
Palpate the neck and facet joints
To palpate the neck and facet joints, begin by asking the patient to sit down. Identify the most prominent musculoskeletal structure in the neck, the spinous process of C7. This structure will be even more prominent if the patient flexes their neck forward slightly.
Next, palpate the cervical vertebrae, noting any bony tenderness. Move your palpation laterally to the paraspinous muscles. Then, ask the patient to turn their head to the side so you can palpate the sternomastoid muscle on the opposite side. Also, palpate the trapezius muscle, evaluating for tenderness or palpable muscle spasms. Ask the patient to flex their head forward as far as possible—the chin should be able to touch the anterior chest.
The facet joints are not truly palpable, but the examiner should palpate along the paravertebral regions and directly over the transverse processes to localize and reproduce any point tenderness, which is usually present with facet joint-mediated pain. This pain can be a sign of facet joint disease, or facet syndrome, where the facet joints of the spine become a source of pain. Facet joint disease is the most common in the elderly, with changes at the joints developing with age. It is also associated with obesity and a history of heavy work before the age of 20.
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Check for vertebral step-offs in the lower lumbar area
To check for vertebral step-offs in the lower lumbar area, begin by locating the lower lumbar region of the spine. This region is found in the lower back and is composed of small bones called vertebrae, which are stacked on top of one another to create the natural curves of the back.
Once you have located the lumbar region, start by observing the spine for any visible abnormalities. Look for any vertebrae that appear to be unusually prominent or recessed in relation to the others. This can indicate a vertebral step-off, which may be a result of a slipped vertebra, also known as spondylolisthesis. Spondylolisthesis is a condition where a vertebra slips forward and out of place, and it is most commonly found in the lumbar spine.
Next, palpate the area by gently applying pressure with your fingers. Feel for any tenderness, tightness, or swelling, as these could indicate underlying issues such as muscle strain or injury. Use slow and gentle movements to avoid causing any discomfort to the person you are examining, and maintain open communication throughout the process to ensure their comfort.
Finally, you may wish to percuss the spine by thumping gently with the ulnar surface of your fist. This can help identify any tenderness or soreness that may not be visible. Additionally, ask the patient to bend forward, backward, and side-to-side to assess their range of motion and identify any movements that cause pain. If vertebral step-offs or other abnormalities are detected, further evaluation or treatment may be required, and imaging tests such as X-rays or MRIs may be ordered by a qualified healthcare professional.
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Identify muscle tension or tenderness
To identify muscle tension or tenderness in the paravertebral muscles, you should begin by locating the trapezius muscle. This is a large, triangular muscle that runs from the base of the skull to the middle of the back. Start at the top of the shoulder and move your fingers upward along the muscle until you reach the base of the skull.
Next, palpate the paravertebral muscles, which are the muscles that run alongside the spine on both sides. Use your fingers to feel for any muscle tension or tenderness along the length of the spine. Use gentle pressure and slow, deliberate movements to avoid causing any discomfort to the person you are examining.
Pay attention to any areas of muscle tightness, tenderness, or swelling, as these could indicate underlying issues such as muscle strain or injury. Communicate with the person you are examining throughout the process to ensure they are comfortable and informed about what you are doing.
In the neck, also palpate the facet joints that lie between the cervical vertebrae about 1 inch lateral to the spinous processes of C2-C7. These joints lie deep to the trapezius muscle and may not be palpable unless the neck muscles are relaxed.
In the lower lumbar area, check carefully for any vertebral "step-offs" to determine if one spinous process seems unusually prominent or recessed in relation to the one above it. You may also wish to percuss the spine for tenderness by thumping gently with the ulnar surface of your fist.
Remember that palpation for tenderness is more reliable than palpation for tissue texture change.
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Palpate the sacroiliac joint
To palpate the sacroiliac joint, it is important to first understand its anatomy and function. The sacroiliac joint (SIJ) is the joint connection between the spine and the pelvis. It is a large diarthrodial joint formed by the sacrum and the two innominates of the pelvis. The main function of the SIJ is to provide stability and attenuate forces to the lower extremities. It acts as a shock absorber for the spine and converts torque from the lower extremities into the rest of the body.
To palpate the SIJ, begin by identifying the location of the joint. The SIJ is situated in the lower back, specifically where the spine and the pelvis meet. Ask the patient to lie on their back with their knees bent and feet flat on the surface. This position will help to relax the lower back muscles and facilitate easier palpation.
Next, locate the posterior superior iliac spine (PSIS), which is a bony landmark that can be felt just below the waist on either side of the lower back. The PSIS is an important reference point for palpating the SIJ. Place your fingers on the PSIS and follow the bony ridge towards the midline of the body. The SIJ is located just anterior to the PSIS.
When palpating the SIJ, use gentle pressure and slow, deliberate movements. Feel for any tenderness, swelling, or abnormalities in the area. Communicate with the patient throughout the examination to ensure they are comfortable and to determine if they are experiencing any pain or discomfort. Ask the patient to provide feedback on any sensations they may be feeling, such as tenderness or pain, as this can help identify any issues.
Additionally, you may wish to percuss the spine for tenderness by gently thumping with the ulnar surface of your fist. This can help identify any areas of soreness or inflammation. Remember that palpation of the SIJ can be challenging due to the anatomical depth and position of the joint, as well as the presence of overlying tissue layers.
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Percussion of the spine
The paravertebral muscles, which run alongside the spine on both sides, can be examined through palpation and percussion. Palpation involves using the fingers to gently apply pressure and feel for any muscle tension, tightness, tenderness, or swelling along the length of the spine. It is important to use slow, deliberate movements and communicate with the patient to ensure their comfort. Muscles in spasm may feel firm and knotted and could indicate underlying issues such as muscle strain or injury, or anxiety.
When performing percussion of the spine, it is important to note that this technique should trigger pain in patients with serious back pain pathology, such as vertebral malignancy or a spinal infection. In contrast, percussion is not expected to exacerbate discogenic pain, back strain, or muscular spasm. Therefore, the clinician can use this information to differentiate between benign and dangerous conditions.
Additionally, the presence of significant focal spine tenderness to percussion can raise suspicion for worrisome pathology. This technique is useful because bone conducts vibration extremely well, and percussion irritates deep space pathology. By following these steps and staying attentive to the patient's feedback, clinicians can effectively examine the spine and paravertebral muscles to identify any abnormalities or issues requiring further evaluation or treatment.
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Frequently asked questions
The paravertebral muscles are the "'action'" muscles of the back. They are also known as the erector spinae. They run lengthwise along the spinal column, from the skull to the pelvis, and help to move the spine into extension, rotation, and side bending.
The paravertebral muscles run alongside the spine on both sides. They are located on the left and right side of the spine and are made up of three groups: the iliocostalis, the longissimus, and the spinalis.
Use your fingers to feel for any muscle tension or tenderness along the length of the spine. Use gentle pressure and slow, deliberate movements to avoid causing any discomfort to the person you are examining.
Pay attention to any areas of muscle tightness, tenderness, or swelling, as these could indicate underlying issues such as muscle strain or injury. Communicate with the person you are examining throughout the process to ensure they are comfortable and informed about what you are doing.
