Lordosis is a spinal curvature in the anterior direction. Hyperlordosis represents a common deformity of posture.
What is lordosis?
Lordosis is a curvature of the spine that runs in the anterior direction. It is the counterpart of kyphosis, in which the spinal curvature is in the posterior direction. In the overall shape of the spine, lordosis appears in the neck region, while kyphosis appears in the thoracic region. In addition, lordosis also occurs in the lumbar vertebra section. Thus, a distinction must be made between lumbar lordosis and cervical lordosis. If the lordosis leads to poor posture, medical science refers to it as hyperlordosis or hollow back. It is manifested either in the cervical spine or in the lumbar spine. Hyperlordosis is the term used to describe a malposition in which there is an excessive curvature of the spine in the anterior direction. The exaggerated curvature becomes noticeable through damage to the spine and back pain. While the spine curves excessively forward, there is a simultaneous curvature of the abdomen in the anterior direction, while the thorax is displaced behind the axis of the body. In this way, the affected person adopts a stable posture and does not tilt forward. In addition, the abdominal muscles prevent the person from falling over in the rear direction. It is not uncommon for affected individuals to appear as if they are carrying a heavy abdomen, as if pregnant.
Causes
The causes for the development of pathological lordosis vary. In some cases, hyperlordosis is already congenital, but this is rather rare. In most patients, the hollow back forms as a result of incorrect postures that persist for a long time. Sometimes these incorrect postures are also the result of certain diseases, which include spondylolisthesis or Pomarino’s disease. However, in most sufferers, lordosis is caused by a muscular imbalance. This is caused by incorrect postures such as permanent sitting or standing or by lack of movement. Unergonomic sitting in particular is often responsible for the development of hyperlordosis. This can be traced back to the rapid slackening of the abdominal muscles. Together with the back and buttock muscles, however, the abdominal muscles are important for stabilizing the spine. In addition, those affected not infrequently suffer from a fundamental lack of exercise, which in turn has a negative effect on muscle strength. For this reason, an efficient compensation of the lordosis is no longer possible, which can lead to a persistent malposition. Sometimes a shortening of the hip flexor also causes a hollow back to develop, if at the same time the extensor muscles are weak. Because tendons and ligaments shorten because of this, the lower back becomes increasingly immobile over time. The result of this is eventually the appearance of hyperlordosis, which is almost always seen in the lumbar spine.
Symptoms, complaints and signs
Not in every case, an exaggerated lordosis immediately leads to severe complaints. Thus, some sufferers initially only suffer from tension that occurs from time to time. As time goes on, the muscle weakness causes increasing pain in the back and lower back, the intensity of which increases over time. Another typical symptom is restricted movement, for which the shortened tendons and ligaments are responsible. Another problem can be the wearing of the intervertebral discs, which is often accompanied by hyperlordosis. For this reason, the risk of herniated discs and damage to the spine increases. The lordosis also sometimes leads to narrowing of the spinal canal, so that the back pain also radiates to the legs, which is called lumboischialgia. This can also cause sensory disturbances such as tingling and insensitivity.
Diagnosis and course of the disease
The diagnosis of hyperlordosis can be made by the examining physician mostly already by a physical examination. Especially the forward tilting of the pelvis as well as the arching of the spine toward the abdomen are considered clear indications of a hollow back. In order to be able to determine its extent as well as possible damage to the spine, an X-ray examination is usually performed. It is also important to identify the triggering cause.The further course of a lordosis depends on which treatment measures are undertaken. For example, the patient must train the affected muscle groups quickly and consistently to counteract possible secondary diseases. If the therapy is carried out quickly and professionally, the hyperlordosis usually takes a positive course.
Complications
First and foremost, lordosis leads to a very unhealthy and, above all, incorrect posture of the patient. This posture has a very negative effect on the patient’s health. In most cases, those affected suffer from tension, which can occur in various regions of the body in the process. This also leads to muscle weakness, so that the resilience of the affected person decreases significantly and there are limitations to the quality of life. Movement restrictions can also occur. The risk of a so-called herniated disc increases significantly due to lordosis. Likewise, various sensory disturbances and insensations can occur on the body, resulting in an unpleasant tingling sensation or numbness in the patient. The quality of life is significantly limited and reduced by the lordosis. It is not uncommon for patients to develop psychological complaints as a result of the disease and to appear irritable. The pain can also lead to sleep problems, especially at night in the form of pain at rest. The treatment of lordosis is carried out by various physiotherapy measures. This can limit most of the complaints. As a rule, the patient’s life expectancy is not affected by lordosis.
When should you go to the doctor?
Misalignments of the back should always be examined by a physician. If upper body misalignments are noticed during the growth process or in adulthood when sitting, walking or standing, a physician should be consulted. If there is a permanent bad posture of the back or hips, further complications may develop, which should be prevented in time. A doctor should be consulted in the event of complaints affecting the musculature, pain or tension. If the usual level of performance drops, everyday tasks can no longer be performed or lifting light objects is no longer possible, a doctor is needed. Sensory disturbances on the skin, numbness or disturbances in sensitivity should be examined and treated by a physician. A tingling sensation on the skin or circulatory disorders must be clarified by a physician. If there are sleep disturbances, a restriction of leisure activities or if professional tasks can no longer be performed, a doctor should be consulted. If psychological problems arise as a result of the symptoms, the affected person needs medical and therapeutic support. In case of gait instability or dizziness, the general risk of accidents increases. A visit to the doctor is necessary to prevent further illnesses. If pain at rest sets in at night or during daily breaks, medical advice should be sought.
Treatment and therapy
As part of therapy for lordosis, it is critical to improve the patient’s posture and provide adequate exercise. Adopting a correct sitting position is also considered exceedingly important. Experts therefore recommend what is known as dynamic sitting. This involves the affected person keeping their upper body straight and regularly changing from an upright to a reclining sitting posture. This effectively relieves the strain on muscles and intervertebral discs. The use of ergonomic seating furniture is also considered to be useful. Another therapeutic measure is attendance at a back school. There, physiotherapists show the patient special exercises that serve to stretch and strengthen the muscles. These exercises can also be performed at home. If diseases such as spondylolisthesis or Pomarino’s disease are the trigger of lordosis, it is important to treat their causes.
Outlook and prognosis
The prognosis for curvature of the spine depends on when the affected person seeks medical treatment and how severe the curvature is. In addition, the patient’s cooperation in improving his or her health is imperative. The earlier the consultation with a doctor and physiotherapeutic trainings take place, the better the further healing process.If the exercise units learned are also performed continuously outside of treatment, relief of the existing complaints can be documented. In addition, education about optimal posture should be provided and risk factors or conditions of physical stress should be avoided in everyday life. If the growth process of the affected person has already been completed and the spine is severely curved, there may be permanent restrictions on the range of motion. In addition, impairments of the muscular system and insensations are possible. In particularly severe cases, surgical interventions become necessary. These are a challenge and can cause consequential damage. If the operations proceed without further complications, an improvement in the quality of life can be documented. Nevertheless, the posture must be changed by the affected person in the long term in order to promote health maintenance. The performance of physical activities and sports activities must be adapted to the conditions of the human organism. Supportively, the muscles must be trained regularly so that sufficient stability is built up.
Prevention
To prevent hyperlordosis from occurring in the first place, sufficient exercise should always be ensured. Fitness training, walking or swimming are considered helpful. Also preventive is the adoption of a healthy posture.
Aftercare
Lordosis, as a physiological phenomenon in itself, only requires therapy and subsequent aftercare if it is too pronounced and causes discomfort. Aftercare is designed in cooperation with the orthopedist or physiotherapist, but requires the cooperation of the patient for success in many cases. This applies above all to exercises learned during physiotherapy, which are consistently continued at home. These serve to gently stretch the shortened muscles in the area of the chest in order to counteract the unhealthy forward curved posture in the long term. On the other hand, the muscles in the area of the upper back are strengthened, which promotes a physiological straightening of the spine if the exercises are performed regularly. In the gym or rehabilitation sports, training can be done on equipment that precisely guides the exercises required for targeted strengthening. This increases efficiency and noticeably reduces the risk of injury. In addition, it is important during follow-up care for lordosis to also pay attention to an upright posture. This also includes the ergonomic design of the workplace. Especially the bending forward of the upper body at the desk should not be too strong and should also be interrupted again and again by active breaks. Yoga or Pilates are suitable due to the gentle movements to sensitize for a straight back.
This is what you can do yourself
The treatment of lordosis is essentially aimed at improving the posture of the affected person and ensuring sufficient movement. This is only possible with the active assistance of the patient. Therefore, lordosis is one of those conditions where the patient can do more for himself than the doctor. First of all, the patient should learn to adopt a healthy sitting position. Which one is optimal for the affected person also depends on the respective activity. The affected person should clarify this with his attending physician and his physiotherapist and also adhere to the recommendations made. The latter is often difficult, as we usually adopt an unhealthy posture unconsciously and out of habit. A few little tricks can help here. If you share an office with colleagues, you can take one of them into your confidence and ask him to regularly draw your attention to poor posture. If you have an office to yourself, you can activate the monitoring function of your webcam and watch the recordings regularly. In most cases, however, the small red light from the camera is enough to constantly remind the person concerned of his or her posture. Ergonomic seating furniture can additionally support the re-education. In addition, it is usually necessary for the affected person to attend a back school and complete special exercises several times a week for at least twenty to thirty minutes. It is also extremely important to integrate regular exercise into everyday life, for example by consistently climbing stairs.
