Atlas of Acupuncture

3.4 Spine and Sacroiliac Region

3.4.3 Lumbar Spine

Iliac crest, Tuffier’s Line (
Figs 3.71, 3.72)

The iliac crests and the associated Tuffier’s line are major refer-

ence points in the lumbar region. The Tuffier’s line is located by

palpating along the iliac crests from the centre in a lateral direc-

tion until their highest points are reached. The Tuffier’s line is an

imaginary horizontal line connecting those two points. The junc-

tion of this line with the spine generally marks the level of the

spinous process of L4. For quick location in clinical practice,

both hands are placed directly superiorly or laterally to the high-

est points of the iliac crests, then the thumbs are joined in the

centre above the lumbar spine. However, it should be noted that

layers of muscle and skin between the crests and the praci-

tioner’s hands may shift the Tuffier’s line in a cranial direction.

Caution: The position of the patient (standing, sitting, prone), as

well as the individual anatomy of the pelvis and lumbar spine,

can significantly influence the level of the lumbar vertebrae in

relation to the pelvis. Thus the Tuffier’s line will cross the spine

at varying levels depending on whether the patient is sitting or in

a prone position, or if a standing patient presents with hyper-

lordosis of the lumbar spine and pelvic anteflexion, or with

hypolordosis of the lumbar spine, pelvic retroflexion and short-

ened ischiocrural musculature.

Addendum:I. Hosbach (University of Bochum, Germany)

investigated the effect of a prone position (as common in

acupuncture treatments) on the level of the Tuffier’s line in rela-

tion to the lumbar spine. It seems that in this position the line

‘moves’ further down the spine to the level of the upper border

of L5 or the space between L4/L5. However, the low number of

cases studied does not merit a conclusive evaluation.

To ensure the proper identification of L4 it is always recom-

mended to use additional points of reference such as the space

between L5 and the sacrum (
Lumbosacral joint) etc.

Du-3

Spinous

Level of process L4

the iliac

crests

BL-23 Du-4 BL-52

Tuffier’s line

Clavicle

Humerus

2nd rib

12th rib

L1

Ilium

Femur

C6

C7

T1

Scapula

Sacrum

Coccyx

Ischial tuberosity

11th rib

Tuffier’s line

Fig. 3.71

Fig. 3.72