The term lordosis means inward curving of a part of the lumber and cervical vertebral column. Excessive lordosis is termed as swayback or saddle back. There are three types of curves which can be present in the human spine1,2:
Scoliotic curves- sideways curvature of the spine; it is always abnormal
Lordotic curves- inward curve of the lumbar spine just above the buttocks
Kyphotic curves- outward curve of the thoracic spine at the level of ribs
A small degree of lordosis and kyphoysis is normally present in the spine. If kyphoysis is too much, it causes round shoulders and is termed as Scheuermann’disease. If lordotic curving is too much, it is termed as swayback or lordosis that makes the buttocks more prominent.
Children suffering from too much lordosis will have a space beneath their lower back when lying on their back on a hard surface. When lordotic curve is flexible, it is generally not a concern. When the curve does not move, medical evaluation is needed. Lumber and cervical segments of the vertebral column are normally lordotic (convexity anteriorly and concavity posteriorly). Anterior pelvic tilt is a major factor of lordosis. Patients with lordosis often show a visible arch in their lower backs. When we look at them from the side, their lower back forms a defined C-shape.
People with lordosis seem to be sticking out their stomachs and buttocks. During examination of the patient with lordosis, ask the patient to lie on his or her back on a hard surface. Can the patient can slide his or her hand under lower back, with a little space to spare? If the patient has lordosis, he or she will have extra space between his or her hand and lower back2,3.
Causes of Lordosis
There are many medical conditions that cause the spine to curve more than normal. These conditions include2,3:
- Achondroplasia- bones do not grow normally, leading to the short stature.
- Spondylolisthesis- the vertebrae in the lower back slip forward.
- Osteoporosis- vertebra become fragile and can easily be broken.
- Obesity- can cause lordosis.
- Kyphoysis- can lead to lordosis
- Discitis- the inflammation of intervertebral disc
- Benign juvenile lordosis
- Tight lower back muscles
- Excessive visceral fat
Symptoms of this abnormality depend upon the severity of the disease. Lordosis symptoms may include:
- C-shape back when seen from a lateral aspect, with the buttocks being more prominent
- A large gap between the lower back and the floor when lying on one’s back
- Pain and discomfort in the lower back
- Problems in moving in certain ways4
It is difficult to measure and diagnose lordosis. The traditional measurement of lumber lordosis is difficult because of the obliteration of the vertebral end plate landmarks by interbody fusion. L4 –L5 and L5- S1 levels are mostly involved in fusion process, and contribute to normal lumber lordosis. It is useful to identify an accurate means of measuring lordosis at these levels1.
Treatment of lordosis includes:
- Pain killer medications to relieve the discomfort and back pain
- Wearing a back brace
- Weight loss
- Vitamin D supplementation
- Lordosis exercises
There are many postural and muscle related factors that contribute to lordosis. These are weak core muscles, tight hip flexors, poor exercise techniques and weak gluteal muscles. Some of these problems may be corrected with lordosis exercises. These include:
Pelvic tilt- pelvic tilt position is the position exactly opposite of the “arched back position”. It can help to correct lordotic posture if applied daily. The patient must lie on his/ her back with his/her knees bent and feet flat on the floor. Then he/she should inhale properly. After that, he/she should exhale and tilt the lower part of pelvis simultaneously. Twenty repetitions of this exercise must be performed daily.
Stability Ball Bridge- this exercise strengthens the gluteal muscles. Lie on your back with your calves draped over the ball. Start with a pelvic tilt and the squeeze your butt until a bridge position is obtained. When you roll down, try to feel that each vertebra is touching the floor. Your lower back should touch the floor before your pelvis. Make 12 repetitions daily.
Knees to Chest Stretch and Heel Slide- lie on your back with your knees bent and then lift both legs from the floor and draw the knees to your chest. After that, lower one heel to the floor. Keep the opposite knee close to your chest. Rotate the other heel along the floor until the leg is straight. Make 8 repetitions daily5.
- Lonstein JE. Congenital spine deformities: scoliosis, kyphosis, and lordosis. Orthop Clin North Am 1999;30(3):387-405.
- Lordosis [Internet]. [last updated 2012 Feb 1; cited 2013 Aug 20]. Available from:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003762/.
- Gabbey ME. Lordosis [Internet].[cited;2013Aug20]. Available from:http://www.healthline.com/health/lordosis.
- Types of Spine Curvature Disorders [Internet]. [last updated 2012 Sep 3;cited 2013 Aug 20]. Available from:http://www.webmd.com/back-pain/guide/types-of-spine-curvature-disorders.
- Mercer L. Postural Exercises for Lordosis. [Internet]. [last updated 2013 Aug 12;cited 2013 Aug 20]. Available from: http://www.livestrong.com/article/24157-postural-exercises-lordosis/.