Lordosis
is the inward curvature of a portion of the lumbar and cervical
vertebral column.[1] Two segments of the vertebral column, namely
cervical and lumbar, are normally lordotic, that is, they are set in a
curve that has its convexity anteriorly (the front) and concavity
posteriorly (behind), in the context of human anatomy. When referring to
the anatomy of other mammals, the direction of the
curve
is termed ventral. Curvature in the opposite direction, that is, apex
posteriorly (humans) or dorsally (mammals) is termed kyphosis. Excessive
or hyperlordosis is commonly referred to as swayback or saddle back, a
term that originates from the similar condition that arises in some
horses.
A major factor of lordosis is anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs
A major factor of lordosis is anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs
Cause:
A consequence of the normal lordotic curvatures of the vertebral
column, (also known as secondary curvatures) is that there are
differences in thickness between the anterior and posterior part of the
intervertebral disc. Lordosis may also increase at puberty sometimes not
becoming evident until the early or mid-20s. Imbalances in muscle
strength and length are also a cause, such as weak hamstrings, or tight
hip flexors (psoas).
Excessive lordotic curvature is also
called hyperlordosis, hollow back, saddle back, and swayback. Common
causes of excessive lordosis include tight low back muscles, excessive
visceral fat, and pregnancy. Although lordosis gives an impression of a
stronger back, incongruently it can lead to moderate to severe lower
back pain. Rickets, a vitamin D deficiency in children, can cause lumbar
lordosis
Treatment
Lordosis of the lower back 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. Too much importance has been attributed to the abdominal muscles in maintaining a neutral spine position[citation needed]. They may help by pushing the internal organs against the spine hence alleviating the lumbar curvature but they can't rotate the pelvis backward while in a standing position. Also the lumbar erector spinae is not able to rotate the pelvis forward while standing, hence its strengthening is not to be avoided during lordosis treatment. 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 or inflatable ball will strengthen all the posterior chain and will treat lordosis. 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. Strengthening of the hip extensors, which are on the back of the thighs, and optionally stretching of the hip flexors, which are on the front of the thighs, will be enough to treat a lordosis in quite a short time. Anti-inflammatory pain relievers may be taken as directed for short-term relief. Physical therapy effectively treats 70% of back pain cases due to scoliosis, kyphosis, lordosis, and bad posture.[citation needed] Measurement and diagnosis of lumbar lordosis 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.[2][3] Hypo-lordosis is more common than Hyper-lordosis. Hypo-lordosis can be corrected non-surgically through rehabilitation exercises. Many different techniques exist to accomplish this correction. These exercises, if done correctly, may reduce symptoms in those with the typical presentation in 3-6 months. The type of practitioner that usually offers this type of treatment is usually a Chiropractor, some physical therapists do this type of rehab but it is not very common.
Treatment
Lordosis of the lower back 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. Too much importance has been attributed to the abdominal muscles in maintaining a neutral spine position[citation needed]. They may help by pushing the internal organs against the spine hence alleviating the lumbar curvature but they can't rotate the pelvis backward while in a standing position. Also the lumbar erector spinae is not able to rotate the pelvis forward while standing, hence its strengthening is not to be avoided during lordosis treatment. 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 or inflatable ball will strengthen all the posterior chain and will treat lordosis. 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. Strengthening of the hip extensors, which are on the back of the thighs, and optionally stretching of the hip flexors, which are on the front of the thighs, will be enough to treat a lordosis in quite a short time. Anti-inflammatory pain relievers may be taken as directed for short-term relief. Physical therapy effectively treats 70% of back pain cases due to scoliosis, kyphosis, lordosis, and bad posture.[citation needed] Measurement and diagnosis of lumbar lordosis 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.[2][3] Hypo-lordosis is more common than Hyper-lordosis. Hypo-lordosis can be corrected non-surgically through rehabilitation exercises. Many different techniques exist to accomplish this correction. These exercises, if done correctly, may reduce symptoms in those with the typical presentation in 3-6 months. The type of practitioner that usually offers this type of treatment is usually a Chiropractor, some physical therapists do this type of rehab but it is not very common.