In this commentary, we illustrate the need to consider the clinical anatomy of an examination procedure that is intended to directly palpate the iliolumbar ligament.
It has been suggested that the iliolumbar ligament is one such potential source of pain, with the 'iliolumbar ligament syndrome' characterised by local tenderness over the attachment site of the ligament on the iliac crest (Broadhurst 1989; Brukner and Khan 2001; Cashman 1986; Collee et al.
As a search of the clinical literature revealed that the anatomical basis of this technique was not discussed, the aim of this paper is to present the relevant clinical anatomy of the iliolumbar ligament.
The iliolumbar ligament is described in the anatomical literature as having from one to five bands of connective tissue (Bogduk 1997).
To evaluate the biological rationale of iliolumbar ligament palpation the ligament must be considered in situ, not as an isolated structure as it is commonly portrayed in clinical texts.
It is worth noting that access to the iliolumbar ligament from either direction can only occur through the quadratus lumborum muscle.
An examination of the relevant anatomy of the lumbar spine reveals the depth and type of tissues that lie between a palpating finger and the iliac attachment of the iliolumbar ligament.
Palpation of the iliolumbar ligament is confounded by the overlying soft and bony tissues.
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