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Lordosis is historically defined as an ''abnormal'' inward curvature of the lumbar spine. However, the terms ''lordosis'' and ''lordotic'' are also used to refer to the normal inward curvature of the
lumbar In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
and
cervical In anatomy, cervical is an adjective that has two meanings: # of or pertaining to any neck. # of or pertaining to the female cervix: i.e., the ''neck'' of the uterus. *Commonly used medical phrases involving the neck are **cervical collar **cerv ...
regions of the human spine. Similarly,
kyphosis Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result fr ...
historically refers to ''abnormal'' convex curvature of the spine. The normal outward (convex) curvature in the
thoracic The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
and
sacral Sacral may refer to: *Sacred Sacred describes something that is dedicated or set apart for the service or worship of a deity; is considered worthy of spiritual respect or devotion; or inspires awe or reverence among believers. The property ...
regions is also termed ''kyphosis'' or ''kyphotic''. The term comes from the Greek lordōsis, from ''lordos'' ("bent backward"). Lordosis in the
human spine The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...
makes it easier for humans to bring the bulk of their mass over the
pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...
. This allows for a much more efficient walking
gait Gait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency. Di ...
than that of other
primates Primates are a diverse order of mammals. They are divided into the strepsirrhines, which include the lemurs, galagos, and lorisids, and the haplorhines, which include the tarsiers and the simians (monkeys and apes, the latter including huma ...
, whose inflexible spines cause them to resort to an inefficient forward leaning "bent-knee, bent-waist" gait. As such, lordosis in the human spine is considered one of the primary physiological adaptations of the human skeleton that allows for human gait to be as energetically efficient as it is. ''Lumbar hyperlordosis'' is excessive
extension Extension, extend or extended may refer to: Mathematics Logic or set theory * Axiom of extensionality * Extensible cardinal * Extension (model theory) * Extension (predicate logic), the set of tuples of values that satisfy the predicate * E ...
of the lumbar region, and is commonly called ''hollow back'', ''sway back'', or ''saddle back'' (after a similar condition that affects some horses). ''Lumbar kyphosis'' is an abnormally straight (or in severe cases flexed) lumbar region.


Types


Lumbar lordosis

Normal lordotic curvatures, also known as ''secondary'' curvatures, result in a difference in the thickness between the front and back parts of the
intervertebral disc An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, to act as a ligament to hold t ...
. Lordosis may also increase at puberty, sometimes not becoming evident until the early or mid-20s. In
radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
, a ''lordotic view'' is an X-ray taken of a patient leaning backward.


Lumbar hyperlordosis

Lumbar hyperlordosis is a condition that occurs when the
lumbar In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
region (lower back) experiences stress or extra weight and is arched to point of muscle pain or spasms. Lumbar hyperlordosis is a common postural position where the natural curve of the lumbar region of the back is slightly or dramatically accentuated. Commonly known as swayback, it is common in dancers. Imbalances in muscle strength and length are also a cause, such as weak
hamstring In human anatomy, a hamstring () is any one of the three posterior thigh muscles in between the hip and the knee (from medial to lateral: semimembranosus, semitendinosus and biceps femoris). The hamstrings are susceptible to injury. In quadrupeds, ...
s, or tight
hip flexors A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb ''flectere'', to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one ...
(psoas). A major feature of lumbar hyperlordosis is a forward
pelvic tilt Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. The pelvis can tilt towards the front, back, or either side of the body. Anterior pelvic tilt and posterior pelvic tilt are very common abnormal ...
, resulting in the pelvis resting on top of the
thigh In human anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb. The single bone in the thigh is called the femur. This bone is very thick and strong (due to the high proportion of bone ...
s. Other health conditions and disorders can cause hyperlordosis.
Achondroplasia Achondroplasia is a genetic disorder with an autosomal dominant pattern of inheritance whose primary feature is dwarfism. In those with the condition, the arms and legs are short, while the torso is typically of normal length. Those affected ha ...
(a disorder where bones grow abnormally which can result in short stature as in dwarfism),
Spondylolisthesis Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or t ...
(a condition in which vertebrae slip forward) and
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
(the most common bone disease in which bone density is lost resulting in bone weakness and increased likelihood of fracture) are some of the most common causes of hyperlordosis. Other causes include obesity, hyperkyphosis (spine curvature disorder in which the thoracic curvature is abnormally rounded), discitits (an inflammation of the intervertebral disc space caused by infection) and benign juvenile lordosis. Other factors may also include those with rare diseases, as is the case with Ehlers Danlos Syndrome (EDS), where hyper-extensive and usually unstable joints (e.g. joints that are problematically much more flexible, frequently to the point of partial or full dislocation) are quite common throughout the body. With such hyper-extensibility, it is also quite common (if not the norm) to find the muscles surrounding the joints to be a major source of compensation when such instability exists. Excessive lordotic curvature – lumbar hyperlordosis, is also called "hollow back", and "saddle back" (after a similar condition that affects some horses); swayback usually refers to a nearly opposite postural misalignment that can initially look quite similar. Common causes of lumbar hyperlordosis include tight low back muscles, excessive
visceral fat Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular en ...
, and pregnancy.
Rickets Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications may ...
, a
vitamin D Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...
deficiency in children, can cause lumbar hyperlordosis.


Lumbar hypolordosis

Being less common than lumbar hyperlordosis, hypolordosis (also known as flatback) occurs when there's less of a curve in the lower back or a flattening of the lower back. This occurs because the vertebrae are oriented toward the back of the spine, stretching the disc towards the back and compressing it in the front. This can cause a narrowing of the opening for the nerves, potentially pinching them.


Signs and symptoms

Lumbar hyperlordosis (also known as
anterior pelvic tilt Pelvic tilt is the orientation of the pelvis in respect to the thighbones and the rest of the body. The pelvis can tilt towards the front, back, or either side of the body. Anterior pelvic tilt and posterior pelvic tilt are very common abnorma ...
) has a noticeable impact on the height of individuals with this medical issue, a height loss of 0.5–2.5 inches (1.27–6.35 centimeters) is common. For example, the height loss was measured by measuring the patient's height while standing straight (with exaggerated curves in the upper and lower back) and again after the patient fixed this issue (with no exaggerated curves), both of these measurements were taken in the morning with a gap of 6 months and the growth plates of the patient were checked to make sure that they were closed to rule out natural growth. The height loss occurs in the torso region and once the person fixes their back, the person's Body Mass Index will reduce since the person is taller and the stomach will also appear to be slimmer. A similar impact has also been noticed in
transfeminine A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assigned at birth. Many transgender people experience dysphoria, which they seek to alleviate through ...
people who have weaker muscles in the lower back due to increased estrogen intake and other such treatments. However, the cause of height loss in both situations is a little different even though the impact is similar. In the first scenario, it can be due to a genetic condition, trauma to the spine, pregnancy in women, increased
abdominal fat Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular en ...
or a sedentary lifestyle (sitting too much causes muscle imbalances and is the most common reason for this issue) and in the second scenario, the estrogen weakens the muscles in the area. Merely slouching doesn't cause height loss even though it may make a person look shorter, slouching may lead to perceived height loss whereas lumbar hyperlordosis leads to actual and measured height loss. To make it easier to understand the difference, people losing a vertebra (which is around 2 inches or 5 centimeters in height) in the spine will be shorter regardless of posture. Lumbar hyperlordosis, of course, doesn't make you lose a vertebra but it bends them in such a way that your spine's vertical height is reduced. Although lumbar hyperlordosis gives an impression of a stronger back, it can lead to moderate to severe
lower back The human back, also called the dorsum, is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral column runs ...
pain. The most problematic symptom is that of a herniated disc where the individual has put so much strain on the back that the discs between the vertebrae have been damaged or have ruptured. Technical problems with dancing such as difficulty in the positions of attitude and arabesque can be a sign of weak
iliopsoas The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usua ...
. Tightness of the iliopsoas results in a dancer having difficulty lifting their leg into high positions. Abdominal muscles being weak and the
rectus femoris The rectus femoris muscle is one of the four quadriceps muscles of the human body. The others are the vastus medialis, the vastus intermedius (deep to the rectus femoris), and the vastus lateralis. All four parts of the quadriceps muscle attach to ...
of the
quadriceps The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...
being tight are signs that improper muscles are being worked while dancing which leads to lumbar hyperlordosis. The most obvious signs of lumbar hyperlordosis is lower back pain in dancing and pedestrian activities as well as having the appearance of a swayed back.


Causes

Possible causes that lead to the condition of lumbar hyperlordosis are the following: * Spine – Natural factors of how spines are formed greatly increase certain individuals' likelihood to experience a strain or sprain in their back or neck. Factors such as having more lumbar
vertebrae The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
allowing for too much
flexibility Stiffness is the extent to which an object resists deformation in response to an applied force. The complementary concept is flexibility or pliability: the more flexible an object is, the less stiff it is. Calculations The stiffness, k, of a bo ...
, and then in cases of less lumbar the individual not reaching their necessity for flexibility and then pushing their bodies to
injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...
. * Legs – Another odd body formation is when an individual has a leg shorter than the other, which can be immediate cause for imbalance of hips then putting strain on the posture of the back which an individual has to adjust into vulnerable positions to meet aesthetic appearances. This can lead to permanent damage in the back. Genu recurvatum (sway back knees) is also a factor that forces a dancer to adjust into unstable postures. * Hips – Common problems in the hips are tight
hip flexors A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb ''flectere'', to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one ...
, which causes for poor lifting posture, hip flexion contracture, which means the lack of postural awareness, and thoracic hyperkyphosis, which causes the individual to compensate for limited hip turn out (which is essential to dances such as ballet). Weak psoas (short for iliopsoas-muscle that controls the hip flexor) force the dancer to lift from strength of their back instead of from the hip when lifting their leg into
arabesque The arabesque is a form of artistic decoration consisting of "surface decorations based on rhythmic linear patterns of scrolling and interlacing foliage, tendrils" or plain lines, often combined with other elements. Another definition is "Foli ...
or attitude. This causes great stress and risk of injury, especially because the dancer will have to compensate to obtain the positions required. * Muscles – One of the greatest contributors is uneven muscles. Because all muscles have a muscle that works in opposition to it, it is imperative that to keep all muscles protected, the opposite muscle is not stronger than the muscle at risk. In the situation of lumbar lordosis,
abdominal muscles The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...
are weaker than the muscles in the lumbar spine and the
hamstring muscles In human anatomy, a hamstring () is any one of the three posterior thigh muscles in between the hip and the knee (from medial to lateral: semimembranosus, semitendinosus and biceps femoris). The hamstrings are susceptible to injury. In quadrupeds, ...
. The muscular imbalance results in pulling down the pelvis in the front of the body, creating the swayback in the spine. * Growth spurt – Younger dancers are more at risk for development of lumbar hyperlordosis because the lumbar fascia and hamstrings tighten when a child starts to experience a growth spurt into adolescence. Technical factors * Improper lifts – When male dancers are performing
dance lift Dance partnering is dancing performed by a pair of dancers, typically a male and a female, in which the pair strives to achieve a harmony of coordinated movements so that the audience remains unaware of the mechanics. It relies on the application ...
s with another dancer they are extremely prone to lift in the incorrect posture, pushing their arms up to lift the other dancer, while letting their core and spine curve which is easy to then hyperlordosis in a dancer's back. * Overuse – Over 45% of
anatomical Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...
sites of injury in dancers are in the lower back. This can be attributed to the strains of repetitive dance training which may lead to minor trauma. If the damaged site is not given time to heal the damage of the injury will increase. Abrupt increases in dance intensity or sudden changes in dance choreography do not allow the body to adapt to the new stresses. New styles of dance, returning to dance, or increasing dance time by a great deal will result in exhaustion of the body.


Diagnosis

Measurement and diagnosis of lumbar hyperlordosis can be difficult. Obliteration of vertebral end-plate landmarks by interbody fusion may make the traditional measurement of segmental lumbar lordosis more difficult. Because the L4–L5 and L5–S1 levels are most commonly involved in fusion procedures, or arthrodesis, and contribute to normal lumbar lordosis, it is helpful to identify a reproducible and accurate means of measuring segmental lordosis at these levels. A visible sign of hyperlordosis is an abnormally large arch of the lower back and the person appears to be puffing out his or her stomach and buttocks.


Scanning


X-ray

Precise diagnosis is done by looking at a complete medical history, physical examination and other tests of the patient.
X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 Picometre, picometers to 10 Nanometre, nanometers, corresponding to frequency, ...
are used to measure the lumbar curvature. On a lateral X-ray, a normal range of the lordotic curvature of between 20° and 60° has been proposed by Stagnara et al., as measured from the inferior endplate of T12 to the inferior endplate of L5.p. 769
in:
The Scoliosis Research Society has proposed a range of 40° and 60° as measured between the upper endplate of Th12 and the upper endplate of S1. Individual studies, although using other reference points, have found normal ranges up to approximately 85°. It is generally more pronounced in females. It is relatively constant through adolescence and young adulthood, but decreases in the elderly.


MRI and CT

Bone scans are conducted in order to rule out possible fractures and infections, magnetic resonance imaging (MRI) is used to eliminate the possibility of spinal cord or nerve abnormalities, and computed tomography scans (CT scans) are used to get a more detailed image of the bones, muscles and organs of the lumbar region.


Treatment


Exercises

Some corrective exercises can be done to alleviate this issue, it may take several months to fix (provided that the person sits less, stands with a neutral pelvis and sleeps on their back). Since lumbar hyperlordosis is usually caused by habitual poor posture, rather than by an inherent physical defect like
scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...
or
hyperkyphosis Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result fr ...
, it can be reversed. This can be accomplished by stretching the lower back, hip-flexors, quads and strengthening the abdominal muscles, hamstrings and glutes. Strengthening the gluteal complex is a commonly accepted practice to reverse excessive lumbar lordosis, as an increase in gluteals muscle tone assist in the reduction excessive anterior pelvic tilt and lumbar hyperlordosis. Local intra-articular hip pain has been shown to inhibit gluteal contraction potential, meaning that hip pain could be a main contributing factor to gluteal inhibition. Dancers should ensure that they don't strain themselves during dance rehearsals and performances. To help with lifts, the concept of isometric contraction, during which the length of muscle remains the same during contraction, is important for stability and posture. Lumbar hyperlordosis may be treated by strengthening the hip extensors on the back of the thighs, and by stretching the hip flexors on the front of the thighs. Only 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. Abdominal muscles and erector spinae can't discharge force on an anchor point while standing, unless one is holding his hands somewhere, hence their function will be to flex or extend the torso, not the hip. Back hyper-extensions on a
Roman chair The Roman chair is a piece of exercise equipment. The equipment is mainly used for the lower back, but can also target the gluteal muscles, hamstring and abdominals. The definition of the equipment, and what 'Roman chair exercise' specifically m ...
or inflatable ball will strengthen all the
posterior chain The posterior chain is a group of muscles on the posterior of the body. Examples of these muscles include the hamstrings, the gluteus maximus, erector spinae muscle group, trapezius, and posterior deltoids. Exercises The primary exercises f ...
and will treat hyperlordosis. So too will stiff legged deadlifts and supine hip lifts and any other similar movement strengthening the posterior chain ''without involving the hip flexors'' in the front of the thighs. Abdominal exercises could be avoided altogether if they stimulate too much the psoas and the other hip flexors. Controversy regarding the degree to which manipulative therapy can help a patient still exists. If therapeutic measures reduce symptoms, but not the measurable degree of lordotic curvature, this could be viewed as a successful outcome of treatment, though based solely on subjective data. The presence of measurable abnormality does not automatically equate with a level of reported symptoms.


Braces

The
Boston brace The Boston brace, a type of thoraco-lumbo-sacral-orthosis (TLSO), is a back brace used primarily for the treatment of idiopathic scoliosis in children. It was developed in 1972 by M.E "Bill" Miller and John Hall at the Boston Children's Hospital i ...
is a plastic exterior that can be made with a small amount of lordosis to minimize stresses on discs that have experienced herniated discs. In the case where Ehlers Danlos syndrome (EDS) is responsible, being properly fitted with a customized brace may be a solution to avoid strain and limit the frequency of instability.


Tai chi

While not really a 'treatment', the art of
tai chi chuan Tai chi (), short for Tai chi ch'üan ( zh, s=太极拳, t=太極拳, first=t, p=Tàijíquán, labels=no), sometimes called " shadowboxing", is an internal Chinese martial art practiced for defense training, health benefits and meditation. T ...
calls for adjusting the lower back curvature (as well as the rest of the spinal curvatures) through specific re-alignments of the pelvis to the thighs, it's referred to in shorthand as 'dropping the tailbone'. The specifics of the structural change are school specific, and are part of the jibengong (essential technique) of these schools. The adjustment is referred to in tai chi chuan literature as 'when the lowest vertebrae are plumb erect...'T'ai Chi Ch'uan: A Simplified Method of Calisthenics for Health & Self Defence. By Manqing Zheng p. 10


See also

*
Hyperkyphosis Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result fr ...
*
Kyphoscoliosis Kyphoscoliosis describes an abnormal curvature of the spine in both a coronal and sagittal plane. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of ...
*
Lordosis behavior Lordosis behavior (), also known as mammalian lordosis (Greek lordōsis, from ''lordos'' "bent backward") or presenting, is the naturally occurring body posture for sexual receptivity to copulation present in females of most mammals including rod ...
*
Pott's disease Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected. It causes a kind of tuberculous arthrit ...


Footnotes


References

* * *


External links


What is Lordosis?





Ways To Treat Lordosis
{{Congenital malformations and deformations of musculoskeletal system Human back Deforming dorsopathies Congenital disorders of musculoskeletal system Symptoms and signs: musculoskeletal system