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Manual palpation is commonly used for the assessment of patients with neuromusculoskeletal dysfunction[1]. Many pelvic landmarks are easily palpable on physical exam eg the iliac crest, the anterior superior iliac spine (ASIS), posterior superior iliac spine (PSIS). These landmarks are instrumental in physical examinations by allowing practitioners to quickly and simply identify anatomy for both diagnostic and therapeutic measures.[2]
Iliac Crest
You can find the iliac crests by placing the sides of your forefinger/hand in the fleshy part of the waist at the level of the umbilicus, move inferiorly and the first hard lumps you feel on each side are the iliac crests. [3]
Move inferior from the iliac crests down the most lateral part of the hip. The first hard lump you feel is the greater trochanter of the femur. You can check by rotating the leg[3].
ASIS
In supine from the anterior midline of the thighs move superior. The first lump you feel will be the ASIS on each side[3].
The ASIS is the most anterior portion of the iliac crest and is the attachment point for the sartorius muscle as well as the inguinal ligament which connects to the pubic tubercle.
The ASIS also becomes helpful in identifying leg length discrepancies, as pelvic rotation often accommodates these differences while standing and walking. Therefore, leg length is measured from the ASIS to the medial malleolus[2].
PSIS
The PSIS marks the posterior edge of the iliac crest and manifests in some individuals as dimples on the lower back, colloquially called “dimples of Venus.” [2]
In prone, easily found by moving superior and medially with the thumbs from the mid part of the fleshy part of the buttocks. Try to feel up and under the PSIS on each side. You are at the level of S2.[3]
Move inferior from the umbilicus it will be soft and then you will eventually feel the bones of the pubic arch. Often easier to get the client to find it for you.
Other
Sacral spines: The sacral spines can usually be felt easily on the midline.
Coccyx: The outline of the coccyx can be felt in the cleft of the buttocks[3].
Validity
A study to determine the validity of manual palpation (MP) of specific landmarks in the lumbo-pelvic area (using US) found that MP may have acceptable validity when used for applying manual therapy. However, the degree of measurement error found in this study may be unacceptable when assessing for pelvic symmetry.[1]
