Defining Lordosis

Lordosis are normal curves in your neck and lower back, coming from the Greek word lordōsis, from lordos meaning “bent backward”. The lordosis curvature is necessary to absorb and dissipate weight and compression forces and stress during movement. With excessive lordosis, the spine cannot distribute forces so easily, with reduced tensile strength loss of full balance.

Hyperlordosis – Swayback

If you back arches too far inward, it’s called hyperlordosis, or anterior pelvic tilt, but many people refer to this condition as simply ‘lordosis’. Swayback, arched back, hollow back or saddle back are other terms for lordosis.

Hyperlordosis affects mainly the lower back and, less commonly, the neck. It can lead to excess pressure on the spine.  Often it is simply a normal variant and gives no symptoms. At times it can cause pain and stiffness.  As Lordosis affects weight distribution and balance, it stresses muscles and ligaments and can help to cause back injury, disc injury and nerve compression along with inflammation and general fatigue in the back.

Causes of lordosis

Lordosis can affect people at any age.

• Excessive extension training when young – in dancers and gymnasts especially
• Poor posture, with tight lower back extensor muscles
• Muscles weakness and imbalance. The abdominal muscles are weaker and the lumbar spine and the hamstring muscles over tight. The imbalance causes the pelvis to pull down anteriorly, increasing lordosis
• Increased kyphosis in the middle back
• Obesity –  excess anterior weight pulling the spine forward
• Pregnancy; With the increased weight, the centre or gravity moves forward, pulling the lumbar spine into lordosis. After childbirth the centre of gravity should move back and the lordosis reduce to normal

Medical Conditions:

• Spondylolisthesis – where one vertebra slips forward on another
• Achondroplasia – a common type of dwarfism
• Osteoporosis –  loss of bone density
• Osteosarcoma –  a bone cancer
• Discitis
• Pelvic hip injury or spinal surgery
• One short leg can cause hyperlordosis as well as scoliosis, a side-ways curve.

Other rare conditions:

Hip dislocation from injury, cerebral palsy, myelomeningocele with spinal cord protrusion, muscular dystrophy with muscle weakness/ spinal muscular atrophy, arthrogryposis with lack of joint movement.

Diagnosis of lumbar lordosis

X-rays and CT of the spine can show the more precise measurements of the lordosis.  There are several methods for measuring the angle of lordosis. The lumbar angle is just one method.

Physical exam

Lying supine (on your back) on a firm surface, there should be little space under the lower back. If you slide a hand under the back, with excessive lordosis there is a pronounced curve and extra space between the back and the surface.

Standing, there can be a visible C-like arch, with the abdomen and buttocks sticking out.

Height loss of up to about 6 centimeters is common.

Symptoms of lordosis

• Pain from the tightened lumbar spine muscles that are in spasm.
• Stiffness in the lower back
• Pain on prolonged standing

Lordosis in children

Benign juvenile lordosis, without a known cause, can occur, possibly due to weak muscles around the child’s hips, pelvis and lumbar spine. It usually self-corrects as the child grows.

Growth spurts in children can cause the lumbar fascia and hamstrings to tighten and develop increased lordosis.

Treatment

Mostly, lordosis does not require medical treatment. Much of the time people are asymptomatic and have no pain at all. Generally if your lower back curve reverses or corrects itself when you flex the spine or bend forward, then there is no medical issue as the curve is flexible or adaptable, and you do not need treatment if it is asymptomatic. It’s all about maintaining a healthy spine with movement and flexibility.  If there is pain or postural tiredness then the condition needs to be treated and managed, along with the principles of treating chronic back pain.

Chiropractic treatment for lordosis

Chiropractic adjustments to realign the spine can have a profound change on the balance of the joints and the pull on the muscles.  This can hugely relieve any pain associated with the lordosis, and also improve the function and dynamics. Over time, with care and exercise this can reduce the pressure on the hyperlordosis.

Postural changes are necessary to help the Chiropractic adjustments maintain longer term. The chronic, long-term nature of Lordosis makes this a requirement, to rebalance the stresses on the spine. Alexander Technique is a very good approach to learning the body awareness of the pelvic changes from the lordosis, and learning how to balance more freely with less stress on the spine can help greatly, along with learning when to rest the spine as lordosis will fatigue the back more quickly.

Strengthening or rehabilitation exercises are commonly given, although I personally do not feel this is a healthy approach for several reasons: it can cause patients to tense and strain the back, and excessive sit-ups can cause back pain.

Medical treatment of lordosis

Surgery for lordosis is not usually considered unless it is severe with neurological complications, compromising the spinal cord or nerve roots.

Braces in children and teens can sometimes be given.

Prevention of lordosis

Sitting significantly increases compression on the lumbar spine. Taking breaks, using a sit-stand desk and a fully supportive floating tilt chair can help. Using a ‘move’ stool which allows for core movement whilst working is also useful for some of the day. Core strengthening exercises must be done very carefully with the careful emphasis on correct technique. Consider some of the following:

• Yoga can release the tightness in the back, but especially also the pelvic, hip and leg muscles, and can make a big difference.
• Pilates aims to strengthen the core, learning to relax the spine into more ‘pelvic neutral’ which can reduce the lordosis.
• Tai Chi can help with pelvic posture, balance and core strength development pressure off the spine
• Weight loss, to decrease the anterior pull on the lumbar spine
• Nutritional supplements like vitamin D, calcium and bone strengthening supplements can be given.

Dancing and hyperlordosis

Various injuries with dancers can occur.

• Lower back pain
• Psoas or Iliopsoas muscle tightness or weakness prevents high leg lifts and creates difficulties with postural positions and arabesque.
• Weak abdominal muscles or tight quadriceps muscles (rectus femoris) can lead to imbalance during training and to lumbar hyperlordosis.
• Tight hip flexors muscles creates poor lifting posture, lack of postural balance, and thoracic hyperkyphosis, which causes the individual to compensate for limited hip turn out (which is essential to dances such as ballet). This causes stress and predisposes injury, due to the compensation mechanisms to hold the posture and required positions.
• Male dancers lift lifting improperly, with over use of the arms and upper back, can cause the the core muscles to weaken and increase the hyperlordosis.
• Lower back pain accounts for 45% of dance injuries, due to repetitive dance training. Injuries that do not heal fully will lead to adaptive movements and once again increased lordosis.

Dancers need to avoid excessive strain during both training and performances.