Lordosis, Its cause, Its Implication and Its Correction
A normal spine, when viewed from behind, appears straight. From the side, the spine normally curves at the neck, the torso and the lower back area. The normal lordotic curvatures of the spine (secondary curvatures) are caused by differences in thickness between the anterior and posterior part of the intervertebral disc. This positions the head over the pelvis naturally and these curves also work as shock absorbers that distribute the stress that occurs during movement. Normal spinal contours are essential for the correct biomechanics of the spine. In a spine affected by hyper or excessive lordosis, the vertebrae (back bones) of the lumbar (lower back) area are curved, giving a swayback appearance. Lordosis is the inward curvature of a portion of the lumbar and cervical (upper back) spine. A major factor of lordosis is anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs (thigh bones).
When lying on your back on a hard surface, a large degree of lordosis will appear as a space beneath the lower back and the surface. Excessive lordosis may also increase at puberty sometimes not becoming evident until the early or mid 20s.
Excessive or hyperlordosis is commonly referred to as hollow back, sway back or saddle back, a term that originates from the similar condition that arises in some horses.
More common than hyperlordosis, Hypolordosis means the vertebrae are oriented toward the back, stretching the disc posteriorly and compressing it anteriorly and can cause a narrowing of the opening for the nerves, potentially pinching them.
Symptoms of Lordosis
Hyper (too much) or Hypo (too little) lordosis can lead to moderate to severe lower back pain and can cause pain that affects the ability to move. If the curve is flexible (reverses itself when the person bends forward), there is little need for concern. If the curve does not change when the person bends forward, the lordosis is fixed or locked and treatment is needed.
Causes of Lordosis
Hyperlordosis affects people of all ages. It is common in dancers gymnasts and certain conditions can contribute to lordosis, including achondroplasia, discitis, kyphosis, obesity, osteoporosis and spondylolisthesis. Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tight hip flexors. Rickets, a vitamin D deficiency in children, can also cause lumbar lordosis. Common causes of hyperlordosis include tight lower back muscles, excessive visceral fat (belly fat), and pregnancy. Excess belly fat pulls the pelvis to the front and makes the pelvis tilt. Hypolordosis can be congenital, acquired from sitting with bad posture, or from trauma. A common cause is whiplash trauma to the cervical spine. Hypolordosis is commonly found in Adolescent Idiopathic scoliosis (AIS) patients.
To diagnose lordosis the patient’s medical history (when the excessive or diminished curve became noticeable, if it is getting worse, whether the size of the curve seems to change etc) and a physical examination are necessary. The patient is asked to bend forward and to the side to see whether the curve is flexible or fixed, how much range of motion the patient has and if the spine is aligned properly. The doctor may feel the spine to check for abnormalities. A neurological assessment may be necessary if the person is having pain, tingling, numbness, muscle spasms or weakness, sensations in his or her arms or legs or changes in bowel or bladder control. X-rays may be taken of the whole and the lower back.
Treatment for Lordosis
Lordosis treatment involves building strength and flexibility to increase range of motion. Lumbar lordosis treatment consists of strengthening of the hip extensors (group of muscles that extend the thigh) on the back of the thighs and stretching the hip flexors (group of muscles that flex the thigh) on the front of the thighs. The muscles on the front and on the back of the thighs can rotate the pelvis forward or backward while in a standing position because they can discharge the force on the ground through the legs and feet. Back hyperextensions on a exercise ball will strengthen all the posterior chain and help lordosis. Stiff legged deadlifts and supine hip lifts and other similar movement strengthen the posterior chain without involving the hip flexors in the front of the thighs. Neuromuscular re-education techniques are used to specifically target the problem.
It is postulated that hypolordosis accompanies scoliosis. That may be due to instability in the spine caused by a lack of the normal curve. Part of scoliosis care must be to protect and augment the normal spinal contours. A problem of scoliosis bracing and scoliosis surgery is that they both exacerbate hypolordosis in both the neck and back which weakens the spine.
If the hyperlordosis is the result of excess belly fat then weight loss may be required to reverse the curve.
Hypolordosis can be corrected non-surgically through rehabilitation exercises and if done correctly, symptoms can be reduced in 3-6 months.
Only the most severe cases of lordosis require surgery: spinal instrumentation, artificial disc replacement and kyphoplasty.
As with AIS, early detection is key to treating lordosis.