Lordosis - Meaning, Causes, Symptoms, Pictures, Treatment

Every person’s spine curves a little in the neck, upper and lower back. These S-shaped curves in your spine are called lordotic in the neck and lower back and kyphotic in the upper back. They help your body absorb shock, move and blend flexibly, support the head’s weight, and stabilise its structure. Lordosis or swayback refers to the exaggerated inward curve of the spine in the neck or lower back. The condition generally does not cause any symptoms. However, if severe, you may experience pain and require surgery. 

Disease Name	Lordosis
Alternative Name	Lumbar Hyper Lordosis
Symptoms	Muscle pain, Swayback, Back and Neck Pain, Numbness, Sciatica Weak Bladder
Causes	An imbalance between the pelvic bones muscles
Diagnosis	X-ray, MRI, Bone scan
Treated By	Orthopaedic Surgeon
Treatment options	Medications, Lifestyle Changes, Nonsurgical Options, Laminectomy, Kyphoplasty

Lordosis can be of five types:

1. Postural lordosis: Being overweight and lacking stomach and back muscle conditioning can cause postural lordosis. Your back pulls forward when you carry excess weight in the stomach area. Moreover, when the stomach and back muscles are weak, they cannot support the spine. As a result of the pull from the weight, the spine curves forward. 
2. Congenital or traumatic lordosis: An injury or trauma to the connecting links of the spine can cause a fracture, resulting in pain in the lower spine. A defect in the connecting links during growth can also cause the spine to become misshaped and weak. The vertebrae can slip forward and pinch the spinal nerves if not healed. 
3. Post-surgical laminectomy hyperlordosis: When a laminectomy is performed at several levels in the spine, the procedure can cause the spine to become unstable and increase the normal curve, leading to a swayback appearance. 
4. Neuromuscular lordosis: It is characterised by the presence of a larger neuromuscular condition such as cerebral palsy, muscular dystrophy, or spina bifida. These neuromuscular conditions cause a disconnect between your brain and the muscles that offer support and stabilisation to the spine. 
5. Lordosis secondary to hip flexion contracture: It involves the hip joints' contracture, causing the spine's misalignment. A contracture can result from several reasons, such as an injury, infection, or muscle imbalance. 

Lordosis can cause the stomach and buttocks to protrude depending on their location. Lordosis can alter a person’s appearance, but it usually causes no symptoms. However, in severe cases, the symptoms of lordosis may include:

1. Muscle pain in the neck, shoulders, and upper back
2. Back or neck pain
3. Appearing swayback (exaggerated posture with belly and buttocks being more pronounced)
4. A gap between the lower back and floor when lying on your back
5. Numbness
6. Tingling
7. Weakness
8. Weak bladder or bowel control
9. Difficulty maintaining muscle control (the curve causes the neck or back muscles to work harder)
10. Sciatica (pain that radiates into legs and feet)
11. Electric shock pains

Lordosis is often caused due to an imbalance between the pelvic bones’ muscles. Hip flexors (weak muscles used to lift the leg upward towards the body) combined with back extensors (tight muscles allowing you to bend forward, stand upright, and lift objects) can increase the pelvic tilt, limiting your lower back’s movement. Having a bad posture is the most common cause of lordosis. Other causes include:

Health Conditions

1. Obesity
2. Spinal injury, such as a fracture
3. Rickets (weakening or softening of bones in children)
4. Kyphosis or scoliosis (another type of spinal curve)
5. Weak core muscles
6. Neuromuscular diseases, including muscular dystrophy or cerebral palsy

Activity

1. Sitting or standing for prolonged periods
2. Wearing high-heeled shoes for prolonged periods

Lordosis in Children and Pregnant Women

Usually, lordosis in children, called benign juvenile lordosis, occurs without any known cause. The condition typically corrects itself as the child grows up. It can also be a sign of hip dislocation if your child has fallen or been hit by a car. Other muscle and nervous system problems that can cause lordosis in children include:

1. Cerebral palsy (a disorder that affects the ability to maintain balance and posture)
2. Muscular dystrophy (an inherited disorder that leads to muscle weakness)
3. Spinal muscular atrophy (an inherited disorder that causes involuntary movements)
4. Myelomeningocele (an inherited condition where the bones of the spine do not form completely and the spinal cord sticks through the gap between the bones)
5. Arthrogryposis (a condition that develops at birth that affects the joints)

Many pregnant women experience the signs of lordosis, such as back pain and protruding buttocks and stomach. But according to research, lordosis during pregnancy is your spine realigning the centre of gravity. The pain may be due to altered blood flow and will likely get better after birth. 

The factors that increase your risk of lordosis include:

1. Spondylolisthesis is a spinal condition in which one vertebra slips forward over another, which can cause lordosis. 
2. Osteoporosis is a bone disease where the bone weakens and becomes brittle with age, increasing the risk of fractures. 
3. Achondroplasia (the most common dwarfism) is a problem with spine development during childhood that can affect cartilage growth, leading to lordosis. 
4. Osteosarcoma is a bone cancer that begins in your shinbone or thighbone near the knee or your upper arm bone near the shoulder.

There are not any prevention guidelines for lordosis. However, performing some exercises can help maintain good posture and spine health. These exercises include:

1. Neck side tilts
2. Shoulder shrugs
3. Leg raises
4. Yoga poses, such as bridge and cat pose
5. Pelvic tilt on a stability ball

Additionally, make sure:

1. To take sitting breaks
2. That your chair has enough back support
3. To maintain a healthy weight

For the diagnosis of lordosis, the doctor will check your medical history, ask about your symptoms, and perform a physical exam. During the physical test, they will ask you to bend forward and to your side to:

1. Check the range of motion.
2. Look for abnormalities.
3. Examine the flexibility of the curve.
4. Check whether your spine is aligned. 

Apart from a physical exam, the doctor may conduct some additional tests:

1. X-ray of the spine: The test is used to examine the angle of your lordotic curve.
2. MRI or CT scan: These scans can indicate the extent of the curve in the spine.
3. Bone scan: Imaging test used to determine the cause of bone pain or inflammation, examine changes in the joints, and detect bone disease and tumours. 
4. Other tests: The doctor may also conduct other tests to rule out the disorders causing the condition.

How to Prepare for the Doctor Consultation?

While preparing for the doctor consultation, make sure to:

1. Take a prior appointment
2. Make a list of your symptoms
3. Note down the questions for the doctor

Here’s what you can expect from your doctor:

1. What symptoms are you experiencing?
2. When did you first notice the exaggerated curve in your back?
3. Where do you feel pain?
4. Is the curve getting worse?
5. Is the curve changing its shape?

Here’s what you can ask your doctor about lordosis:

1. What has caused lordosis?
2. Are there any risks involved?
3. What symptoms should I note?
4. Is surgery needed?
5. Can it be managed without surgery?
6. What are the other treatment options?
7. Which treatment do you recommend?

Most people with mildly exaggerated lordosis do not require medical treatment. In severe cases when treatment is required, the approach depends on the severity of your curve and the presence of other symptoms. Treatment options may include:

Medications

1. Non-steroidal anti-inflammatory drugs, such as ibuprofen, to reduce pain and swelling

Lifestyle Changes

1. Weight loss to help improve posture

Nonsurgical Options

1. Physical therapy for strengthening muscles and improving range of motion
2. Back braces for a child with lordosis to prevent the curve from progressing

Surgery

1. Surgery, such as a laminectomy, can be performed in severe cases of neurological concerns. Also known as decompression surgery, laminectomy creates space by removing the lamina. The procedure enlarges your spinal canal, relieving pressure on the spinal cord and nerve.
2. Kyphoplasty involves inserting a balloon inside the spine to stabilise and straighten the affected area. 

Exercises

Exercises are usually the most effective treatment option for lordosis. Your healthcare professional may recommend a physical therapist who specialises in treating these conditions. Exercises for people with lordosis include:

1. Cat-Cow Pose
   1. The Cat-Cow or Chakravakasana is a yoga pose to improve posture and balance, especially beneficial for people with back pain. 
   2. Begin with your hands and knees in a table pose, aligning your wrists underneath the shoulder and knees underneath your hip. 
   3. Use your abdominal muscles to move the spine in a neutral position. 
   4. Inhale and move into a cow pose by lifting your sit bones upwards, pressing your chest forward, and allowing your belly to sink. Lift your head, relax your shoulders, and gaze straight ahead. Hold the position for 10-15 seconds. 
   5. As you exhale and come into a cat pose, round your spine outward, tuck in your tailbone, and draw your pubic bone forward. Drop your head and gaze at your navel. Hold the position for 10-15 seconds.
   6. Return your spine to a neutral position. 
2. Hip-Flexor Stretches
   1. Begin with a kneeling position on a yoga mat or a soft surface. 
   2. Place your right foot in front of you and bend your knee, creating a 90° angle. 
   3. Straighten your upper body and put your hands on your right knee for balance and support. 
   4. Extend your left leg behind, press your left knee into the mat, and rest the top of your left leg on the mat. 
   5. Lean forward into the right hip by keeping your left knee on the ground and the pelvis facing forward. 
   6. Hold the stretch for 30-45 seconds and repeat 2-5 times for each hip. 
3. Glute Bridge
   1. The exercise can help you strengthen your core muscles and glutes. 
   2. Begin by lying on your back, bend your knees at a 90° angle, and your arms flat against the ground by your sides. 
   3. Push into the surface with the feet and lift your hips by squeezing your glutes until your knees and shoulders are in a straight line. 
   4. Hold the position for a couple of seconds and return to the starting position. 
   5. Start by doing one or two sets of 15 reps. Gradually increase it to three sets as you build your core strength. 

Please note: The treatment approach for lordosis is selected based on your condition and your doctor’s opinion.