What Causes Lordosis

What Are the Types of Lordosis?

Lordosis is a condition where the lower back curves forward or backward. It may cause pain when walking, sitting, bending over, lifting something heavy from a chair or getting into a car seat. Some people with lordotic posture have no other problems and do not need treatment. Others experience discomfort while doing everyday activities such as driving, standing up straight or even sleeping.

Common Causes of Lordosis:

1) Weak hip flexors (gluteus medius, gluteus minimus).

These muscles help keep your pelvis upright during movement. If these muscles become weak they will allow the lower back to curve forward.

2) Weak abdominal muscles (abdominals).

Abdominal weakness can lead to lordosis if it does not include the rectus abdominis muscle which helps pull the belly button in.

3) Poor mobility of certain joints.

For example, poor flexibility of the knees or ankles can result in lordosis. A tight hip flexor could also contribute to lordosis due to its ability to lengthen and shorten.

4) Poor motor control of the lower back, glutes and hip flexors.

5) Upper body posture.

An anterior tilted pelvis (tail tucked under) can result in a forward curved spine or sway back posture.

6) Poor breathing mechanics.

Weak abdominal muscles can alter breathing patterns leading to a sway back posture and lordosis.

What Are the Symptoms of Lordosis?

Pain and discomfort in the lower back, buttocks and hips. This can be relieved by sitting or standing with your back curved (sway backed) or hunched forward (rounded shoulder posture).

How is Lordosis Diagnosed?

Your doctor will usually diagnose lordosis from a description of your symptoms and a physical examination. Imaging tests may be ordered to rule out other possible causes of your symptoms such as cancer, fractures or infections. These may include an x-ray, CT scan, MRI or bone scan.

What Are the Risk Factors of Lordosis?

While anyone can develop lordosis, the following factors may increase your risk:

1) Being female.

The pelvis is typically wider in women than in men. This makes it more difficult to keep the pelvis in a vertical position, especially during activities such as lifting or pushing a vacuum cleaner.

2) A sedentary lifestyle or one that involves repetitive motions that do not engage the core muscles.

3) Obesity or being overweight.

Excess weight can put more stress on the spine and cause muscles to fatigue more quickly.

4) Age.

Osteoarthritis which typically affects people over the age of 40 can contribute to spinal degeneration and increased risk of back injury.

5) Abnormal bone structure.

Kyphosis or excessive curvature of the spine can cause a sway back posture or rounded shoulders in people of any age.

6) History of smoking.

Smoking can lead to decreased blood flow to the discs of the spine.

7) History of back injury or previous episodes of back pain.

Back strains may repeat if not rehabilitated properly or if one reinjures their back.

8) Certain jobs or hobbies may increase your risk of repetitive strain and injury.

These include: assembly line work, sewing, lifting, painting, gardening and other jobs or hobbies that require prolonged standing or sitting.

How is Lordosis Treated?

For most patients, stretching the hip flexors, strengthening the abdominals and gluteal muscles, improving your posture and practicing good body mechanics will alleviate pain and discomfort caused by lordosis. Common treatments may include:

1) Stretching the hip flexors.

Tight hip flexors put increased strain on the lower back. To stretch these, lie on your back with knees bent. Slowly lift one leg up while keeping the knee straight. Hold this position for 10 seconds then relax. Switch legs and repeat.

2) Strengthening abdominal and gluteal muscles.

Abdominal and buttock (gluteal) exercises can help to support the lower back and provide greater stability to the pelvis. To strengthen these muscles, lie on your stomach with your legs together. Lift your head and upper body while keeping your arms flat on the floor. Breathe in as you lift then breathe out as you lower. Aim for 3 sets of 10 repetitions.

3) Improving your posture.

One of the best ways to alleviate back pain is to correct your posture. The following are tips for improving your posture:

a) Keep shoulders back but not pinched together.

b) Tilt your head so that your ears are over your shoulders. Do not bend your neck sideways.

c) Keep your hips and knees bent at a 90 degree angle. Do not lock your knees.

d) Keep one or both feet on the floor if sitting in a chair with no footrest.

e) Distribute your weight evenly between both feet if standing or sitting on an unstable surface such as a yoga ball or exercise ball.

f) Keep a book between your knees while sitting to remind you to keep your knees bent.

4) Changing the way you perform daily activities.

Certain ways of performing daily activities can strain the lower back. In particular, lifting something improperly or carrying a heavy item without proper body mechanics may strain the lower back. Be sure to:

a) Bend your knees when lifting a heavy item from the floor.

b) Keep the heavy item close to your body when lifting.

c) Use the large muscles of your legs to lift the item rather than just your back.

d) When carrying the item, keep your elbows bent and tucked in toward your body.

e) When carrying the item, keep it as close to your body as possible.

When should I see a doctor?

If you have severe lower back pain that does not improve with self care over 3-4 days, it is best to be examined by a physician.

Why?

There are several medical conditions that can mimic the symptoms of chronic back pain. These include epidural fibrosis, spondylolisthesis, and spinal stenosis. If any of these conditions are present, it is important to receive treatment before the condition worsens.

When should I seek immediate care?

If you have sudden onset of severe lower back pain that is interfering with your ability to function, you should seek immediate care.

If you are unable to urinate, have numbness/weakness in your legs, or experience other neurologic complaints (such as decreased sensation, incontinence, or difficulty walking), seek immediate care. These symptoms can be signs of a serious spinal cord condition and may require emergency care.

What are the treatment options for my back pain?

Non-surgical Treatment

The first line of therapy in patients with acute or subacute low back pain is typically non-pharmacologic therapy, such as activity modification, rest, heat, and physical therapy.

Opioid therapy is not typically used as first-line treatment in non-cancer chronic pain. Opioids, however, may be considered in patients with subacute or chronic pain who haven’t experienced adequate pain relief with non-opioid therapies.

Are there any restrictions to the use of back braces?

Braces are usually reserved for patients who have sustained specific types of injuries, such as spinal fractures or dislocations. The benefit of a brace is that it can limit spinal motion and reduce the amount of stress being exerted on the injured tissues.

Braces are not designed to be worn during activity.

Traction is not typically used as a first-line therapy in non-spinal conditions. It is reserved for patients who have recalcitrant (not improved) signs and symptoms of spinal conditions that are not improving with other treatments such as bed rest, specific exercises, etc.

Do back braces prevent injury or make you stronger?

The purpose of a back brace is to immobilize the spine to prevent injury or make you stronger. A healthy spine does not typically require bracing.

The benefits of bracing should be weighed against the possible risks, such as decubitus ulcers, infection, and fractures from falling due to a false sense of security.

What is the treatment for epidural fibrosis?

Epidural fibrosis is treated symptomatically. Bed rest, physical therapy, analgesics (prescription pain medications), and anti-inflammatories are all used to manage this condition. If there is any indication that nerve roots are being compressed or damaged, surgical intervention may be necessary.

What is Spondylolisthesis?

Spondylolisthesis is a condition in which one of the spinal bones (vertebrae) slips out of position and rests or balances on the bone below it.

Spondylolisthesis most commonly occurs in the lower back. There are two types:

Type I – The vertebra slips forward on the bone below. This type typically occurs in the lumbar (lower back) area and is more common in adolescents.

Sever’s disease – This condition is an overuse injury that most commonly affects young athletes. As the name implies, it affects young people and primarily occurs in the spine. (Orthopedics are particularly good at naming conditions). It typically results in pain, but no loss of spinal motion or other abnormalities.

Children and adolescents are more likely to have idiopathic scoliosis. Most cases of idiopathic scoliosis are detected in children or teenagers, but the condition can also occur in adults. This type of scoliosis tends to progress slowly and not be painful.

What is spondylolysis?

Spondylolysis is a defect or fracture (break) in one of the bones in the spine (vertebrae). It is a fairly rare condition.

Spondylolysis typically occurs in the lumbar (lower back) area. It can cause pain and problems with spinal motion, but it rarely causes nerve damage or other abnormalities.

Who is at risk for spinal diseases?

Anyone can develop a spinal disease; however, certain factors put you at increased risk. These factors include:

Adolescence and young adulthood, especially males

Obesity (being extremely overweight)

A family history of back problems

Jobs or hobbies that require a lot of heavy lifting or bending over

A prior history of spinal disease

Overweight males in their teenage or young adult years are at greatest risk for compression fractures. A compression fracture occurs when one of the vertebrae collapses due to the stress of the excess weight.

The more bone mass you have, the harder it is for a compression fracture to occur. This is because the more bone mass you have, the stronger (and heavier) the vertebrae are. So, if you are obese, you are at greater risk for a compression fracture. This is especially the case in young males as they tend to have the most bone mass.

Sources & references used in this article:

The role of lordosis. by L Beckers, J Bekaert – Acta orthopaedica belgica, 1991 – ncbi.nlm.nih.gov

Film analyses of lordosis in female rats by DW Pfaff, C Lewis – Hormones and Behavior, 1974 – Elsevier

Lumbar lordosis by E Been, L Kalichman – The Spine Journal, 2014 – Elsevier

Expandable lordosis stabilizing cage by JW Simmons Jr – US Patent 7,879,098, 2011 – Google Patents

Straightened cervical lordosis causes stress concentration: a finite element model study by W Wei, S Liao, S Shi, J Fei, Y Wang, C Chen – Australasian physical & …, 2013 – Springer

Association of a lordosis-scoliosis-kyphosis deformity in gilthead seabream (Sparus aurata) with family structure by JM Afonso, D Montero, L Robaina, N Astorga… – Fish Physiology and …, 2000 – Springer

Epidemiology of low back pain in the elderly: correlation withlumbar lordosis by T Tsuji, Y Matsuyama, K Sato, Y Hasegawa… – Journal of orthopaedic …, 2001 – Elsevier