Sacrum posterior tender points

Posterior lumbar tender points are generally located on the spinous process, between the spinous processes, or over a transverse process. There are some points located in the buttocks or, for lower pole L5, on the sacrum. Figure 50-6 shows the iocations of the posterior tender points. 

This tender point is palpated by pushing the monitoring finger medially on the lateral edge of the sacrum at the midpoint between the posterior superior iliac spine (PSIS) and the sacral apex. This is at the site of the piriformis attachment to the sacrum and probably represents a second piriformis tender point, it is often found in association with the tender point in the belly of the muscle. 

This tender point is located on the posterior surface of the sacrum. It is one and three-fourths inches inferior and one-half of an inch medial to the lower surface of the PSIS. It is frequently associated with coccygodynia. 

Physical examination revealed a slightly obese woman in obvious discomfort. She preferred to stand rather than sit on the examination table. The sacrum was freely movable and no somatic dysfunctions of the lumbar spine were noted. The coccyx was markedly lender to palpation and ihe soft tissues around il were tense and lender. There was a high flare-out tender point on the posterior surface of ihe sacrum. Rectal examination confirmed tenderness of the coccyx, but it was not severe enough to indicate a fracture and the coccyx was not dislocated. 

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