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 practice 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.