Hollow back or hyperlordosis is the term used to describe the excessive forward curvature of the spine. This creates a pronounced abdominal line, while at the same time the back is arched inward. The incorrect posture causes pain and damage to the spine, which is altered by the hollow back.
What is a hollow back?
In a hollow back, the spine curves far forward in the abdominal area. Hyperlordosis is usually not congenital. It results from permanent incorrect posture, which can also occur as a result of other diseases. A healthy spine has the appearance of an elongated “S” when viewed from the side. In a hollow back, on the other hand, the lower outward arch is pushed far forward. People who suffer from a hollow back give the impression that they are carrying a particularly heavy load on their own abdomen. The load on the vertebrae is uneven in a hollow back and promotes premature wear of the intervertebral discs. The spinous processes at the back of the vertebrae may touch if the hollow back is severe.
Causes
Among the diseases in which a hollow back occurs is Pomarino’s disease. In this case, walking occurs only through the front foot. Affected individuals develop a hollow back due to the atypical gait pattern. In many cases, incorrect posture is the cause of hyperlordosis. Sitting on ergonomically inadequate seating changes the posture. A lack of movement causes the muscles to slacken and promotes the development of a hollow back. In this combination, the musculoskeletal system lacks the necessary strength to withstand the changed shape of the spine. This leads to permanent poor posture. The load on the vertebrae changes adversely with a hollow back. Usually, due to the special shape of the spine, it is evenly distributed among the individual sections. In the case of a hollow back, the even load balance is omitted.
Symptoms, complaints and signs
A hollow back can usually be recognized externally by the posture of the affected person. In people with a hollow back, the pelvis shifts forward when standing, causing the abdomen to bulge outward and the upper body to shift backward. At the beginning, a hollow back usually does not cause any discomfort, but if the bad posture lasts longer, the abdominal and back muscles are weakened and the hollow back becomes more and more noticeable through back pain. Because the ligaments and tendons are shortened by the poor posture, mobility is also restricted. Those affected find it increasingly difficult to bend forward and lift an object. In addition, a hollow back puts a lot of strain on the intervertebral discs in the lumbar spine, which can promote herniated discs. Prolonged incorrect loading can lead to a narrowing of the spinal canal, in which important nerves are located. When the spinal canal is narrowed due to poor posture, nerves can be affected or crushed, causing sufferers to feel pain in the lumbar spine that radiates down to the legs. If the hollow back also causes atlas misalignment, headaches and dizziness may also occur.
Diagnosis and course
A hollow back can already be detected during a simple visual examination. The typical forward posture with the pelvis tilted forward is unmistakable when viewed from the side. For a more detailed determination of the extent and damage that has occurred, the hollow back is visualized by imaging techniques. In the initial stage, the muscles change first in a hollow back. The abdominal muscles become weaker. In the back, the lower back shortens, while the posterior thigh muscles are stretched. However, the muscles show increased tension due to the atypical continuous strain. Without postural change and treatment, changes in the spine occur later on. Thus, the intervertebral discs are compressed on one side and the risk of a herniated disc increases. The vertebral canal, through which the spinal cord passes, can narrow in the case of a pronounced hollow back. The spinous processes on the backs of the vertebrae meet painfully in a hollow back.
Complications
A hollow back usually does not cause any major discomfort at the beginning. If the poor posture persists, however, severe vertebral damage can develop. A chronic hollow back mainly stresses the intervertebral discs and, in extreme cases, leads to a herniated disc.Likewise, an untreated hollow back can lead to narrowing of the spinal canal. In the long term, this can lead to damage to the nerve tracts and subsequently to nerve inflammation and sensitivity disorders. Rarely, an impairment of the nerves can lead to bladder problems and diseases of the genitals (irritable bladder, incontinence). Accompanying this, a hollow back causes tension and pain that increases in intensity and duration as it progresses. In addition, there are usually movement restrictions and paralysis symptoms. If the hollow back remains untreated, the pain eventually radiates to the legs and sometimes also leads to insensations and muscle tension in the lower back. The muscles most affected are the rear thigh muscles, which stretch in the case of a hollow back, and the lower back, which shortens. These malpositions are usually accompanied by other physical complaints and also represent a considerable psychological burden in the long term. If the hollow back is detected and treated early, complications are unlikely.
When should you go to the doctor?
You should always go to the doctor, preferably an orthopedist, if you regularly suffer from severe back pain that leads to restricted movement. Especially if you can see signs of poor posture even in the mirror, which can not be stopped by normal gymnastic exercises and conscious posture correction. If the cause lies in weak abdominal muscles, one can first try to strengthen them through specific exercises to counteract the hollow back and correct the bad posture by consciously standing upright. If these measures do not help, an orthopedist should be consulted, because if a severe hollow back is left untreated for a long period of time, a herniated disc may be imminent. In the case of symptoms such as paralysis, sensory disturbances or nerve inflammation, it is necessary to consult a doctor immediately, especially if there are accompanying bladder and incontinence problems. Persistent muscle tension despite sufficient movement can also be an indication of a malposition, which must be corrected by specific physiotherapeutic measures. Likewise, visible malposition, which often causes back pain, should be examined and treated by a doctor in any case.
Treatment and therapy
Treatment for hollow back depends on the stage of the impairment that has occurred. In the initial stage, it is sufficient to treat the hollow back by simple back school measures. The patient learns a correct posture and simple exercises to counteract the hollow back. If the patient is sedentary, care must be taken to ensure that the seating meets the requirements for ergonomic design. The longer the patient has already suffered from a hollow back, the more cautious the approach. The therapy is aimed at stretching the shortened muscles again. Only in this way is correct posture possible again. This is accompanied by pain therapy to enable the necessary movements to be made in the first place and to provide the patient with relief. If the changes caused by the hollow back have progressed so far that movement therapy no longer brings about any improvement, some of the symptoms can be treated surgically. These include widening of a narrowed spinal canal or herniated discs. In any case, conservative treatment methods should be exhausted first in the case of hollow back and subsequent symptoms.
Outlook and prognosis
In the case of a hollow back, the prognosis is unfavorable without treatment and specific training. The symptoms gradually increase in intensity and the damage develops into irreparable impairment. With early and comprehensive treatment, significant improvements in the symptoms that have occurred can be achieved. Physiotherapeutic exercises are used to strengthen the back. The build-up of muscles as well as corrections of the posture lead to a visual change of the skeletal system in the course of time. Regular checks of posture while sitting, walking or standing can lead to relief of symptoms. In some cases, complete freedom from symptoms is achieved. This is especially possible in patients who are in the early stages. The hollow back is minimized and the pain is reduced. This requires the cooperation of the patient.In addition, increased vigilance must be developed so that the posture of the spine is checked and corrected several times in everyday life. The later therapy begins, the worse the chances of recovery. In severe cases, surgery must be performed or a permanent stabilization measure for the back must be worn. Although pain relief is also seen with these treatment options, full recovery is not expected with these methods. The treatment plan aims to prevent further increase in discomfort.
Prevention
In the vast majority of cases, a hollow back can be prevented with little effort. Already in children, importance should be attached to good posture, ergonomically shaped seats and compensatory sports. Adults who spend a lot of time sitting due to their professional activities can find compensatory sports to suit their personal tastes. In many cases, the statutory health insurers offer preventive back schools for their members, so that a hollow back cannot develop in the first place.
Aftercare
In most cases, the person affected by a hollow back has only a few options for aftercare. In this case, the disease must be detected and treated by a doctor at an early stage, so that there are no further complications or a further worsening of the symptoms in old age. In general, an early diagnosis of the disease has a very positive effect on the further course of the disease and can prevent a further worsening of the symptoms. The affected person should therefore contact a doctor at the first symptoms or signs of the disease. In most cases, the discomfort of a hollow back can be alleviated by physiotherapy measures or by physiotherapy. In this context, the affected person can also perform some exercises in his own home, and the information from the back school should also be used in everyday life. Postures that could increase a hollow back should be avoided. In some cases, surgical intervention may also be necessary to alleviate the symptoms. After such an operation, bed rest should be observed in any case. The body should also not be subjected to unnecessary strain. As a rule, a hollow back does not reduce the life expectancy of the affected person.
What you can do yourself
A hollow back is almost always the result of a permanent bad posture. Initially, the disorder causes little discomfort, but in the medium term, an impairment of the quality of life is to be expected. Especially when severe vertebral damage develops. For example, a chronic hollow back puts particular strain on the intervertebral discs and, in extreme cases, causes a herniated disc. Furthermore, there is a risk of a narrowing of the spinal canal if the hollow back is not treated professionally. Those affected should therefore consult a specialist, preferably an orthopedist, at the first signs of a hollow back. In the early stages, a hollow back is treated conservatively. The patient is usually prescribed physiotherapy and recommended a series of behavioral adjustments. Regular participation in physical therapy and implementation of the necessary behavioral adjustments represent the most important self-help measures. In most cases, patients must complete certain gymnastic exercises on a regular basis, often daily in the beginning. Those who are not disciplined enough to exercise regularly on their own should enroll in a gym for guidance. In addition, changes in the workplace are usually necessary. Those who work in a seated position should have their desk adjusted to the correct individual height and make sure they have a high-quality chair with a good backrest that supports and relieves strain on the back. Those who have wooden or cork floorboards at home can also occasionally lie down on the floor to sleep. This is best done with a thick yoga mat as a base.
