• Physioqinesis

Lumbar Hyperlordosis



What is Lumbar Hyperlordosis?


Humans are the most successful primates on the earth; when humans stood

upright, they took a spine that had evolved to be stiff for climbing and moving

in trees. Another challenge was to balance a head on top, without obstructing

the birth canal and to get the torso balanced above our feet, the spine has to

curve inwards (lordosis), creating the hollow of our backs, hence creating a ‘S’

shaped curve.

Human spine has three curvatures namely the neck inwards curve called as

cervical lordosis, the mid back reverse curve called as ‘thoracic kyphosis and

the hollow curve inwards called ‘lumbar lordosis’.

In lumbar hyperlordosis there is an exaggeration of the lower hollow curvature

of the spine.



When our pelvis tilts forward, our halves of the pelvis are rotated in an

forward/anterior direction .The increased pelvic tilt also causes an exaggeration

of the lumbar lordosis. Several factors may contribute to an anterior pelvic tilt,

but typically it is from an imbalance of muscles pulling on the pelvis

and lumbar region which may lead to lumbar hyperlordosis {1} .


What causes lumbar Hyperlordosis?



Obesity is characterized by a generally reduced ROM of the spine, due to a

reduced mobility at both pelvic and thoracic level; a static postural adaptation

happens which may lead to an increased anterior pelvic tilt. Increase in anterior

pelvic tilt causes lumbar hyperlordosis {2} .


Pregnancy



During pregnancy, a woman’s body weight increases by 15 to 25 percent; this

signifies a greater burden on the tendons, ligaments, and joint. Furthermore,

relaxin and estrogen loosen the ligaments. The enlarged uterus and the increase


in breast volume shift the body’s center of gravity to the front. The pelvis is

tilted simultaneously and lumbar lordosis increases {3} .


Spondylolisthesis



Spondylolisthesis is the condition in which vertebra slips out of its place. There

are 5 types of spondylolisthesis Congenital, Isthmic, Degenerative, Traumatic

and Pathological. Isthmic type of spondylolisthesis occurs when there is stress

fracture which weakens the vertebra and it slips out of place. Spondylolysis and

isthmic spondylolisthesis, on the other hand, showed positive significant

association with lumbar lordosis angle {4} .



Muscle density is an expression of degeneration of the muscles and reflects the

number of muscle fibers, the area of the individual muscle fiber, and the

packing of the contractile material. Muscle density of multifidus is an indication


of muscle fitness, hence inhibition/ decreased density in the muscle has a

significant association with the higher lumbar lordosis angle {4} .


What are the symptoms?


Excessive change in lower lumbar curvature leads to pain in lower back region

as there are mechanical imbalances at the lower lumbar area. Muscles

overcorrect, as the muscles struggle to overcompensate, they may begin to

tighten and spasm causing limited, painful movement in the lower back and

upper back. Muscle weakness due to inhibition of deep core muscles. In severe

cases neurological symptoms such as numbness or tingling; pain that

resembles electrical shocks may be present.


How to treat lumbar hyperlordosis?


The primary aim while treating a patient with lumbar hyperlordosis as a

structural finding on the x ray is managing the pain. To manage the low back

pain elicited due to hyperlordosis is mainly to correct mechanical imbalances at

the lower lumbar region.

Correction of excessive anterior pelvic tilt-



Posterior pelvic tilts in supine lying and in All 4s




Strengthening exercises –activation of transverse abdominus muscle and

progressing to advanced core exercises. Gluteus maximus, gluteus medius and

multifidus activation exercises to correct the muscle weakness.



Stretching exercises for erector spinae and hold relax technique to iliopsoas

muscle. A study suggests that the hold relax technique of the iliopsoas muscle

reduced pain and lumbar lordosis angle, enhanced transverse abdominus

activation, and increased length of hip flexor in chronic non-specific low back

pain with lumbar hyperlordosis {5} .

Lumbar hyperlordosis can be easily prevented by breaking up your postures.

Putting a reminder in your phone to periodically correct and break your posture,

keeping your spine correctly aligned will prevent stress on your neck, hips, and

legs. Maintaining your BMI (Body mass index) and having a regular exercise


and stretching routine will definitely help you to prevent this hollow back.

‘Maintaining good posture requires practise until it becomes habituated’.


References-

1] Whitney Lowe LMT,  Leon Chaitow ND DO, in  Orthopedic Massage

(Second Edition) , 2009.

2] Vismara L, Menegoni F, Zaina F, Galli M, Negrini S, Capodaglio P. Effect of

obesity and low back pain on spinal mobility: a cross sectional study in

women. J Neuroeng Rehabil. 2010;7:3. Published 2010 Jan 18.

doi:10.1186/1743-0003-7-3.

3] Schröder G, Kundt G, Otte M, Wendig D, Schober HC. Impact of pregnancy

on back pain and body posture in women. J Phys Ther Sci. 2016;28(4):1199-

1207. doi:10.1589/jpts.28.1199.

4] Kalichman L, Li L, Hunter DJ, Been E. Association between computed

tomography-evaluated lumbar lordosis and features of spinal degeneration,

evaluated in supine position. Spine J. 2011;11(4):308-315.

doi:10.1016/j.spinee.2011.02.010.

5] Malai S, Pichaiyongwongdee S, Sakulsriprasert P. Immediate Effect of Hold-

Relax Stretching of Iliopsoas Muscle on Transversus Abdominis Muscle

Activation in Chronic Non-Specific Low Back Pain with Lumbar

Hyperlordosis. J Med Assoc Thai. 2015;98 Suppl 5:S6-S11.

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