Hyperlordosis

hyperlordosisDefined as excessive curvature of the spine, which typically occurs in the lumbar area, but may also be found in the cervical region. The term lordosis describes the normal shape of the spine – which has a mild curve in the neck and lower back. When the level of curvature is abnormal and falls outside of the normal range, it is medically referred to as hyperlordosis. It is also known informally as sway back, hollow back or saddle back.

Hyperlordosis is associated with lower back pain and varies in extremity – in mild cases causing only minimal discomfort, however in more severe cases, hyperlordosis can provoke considerable pain and disability.

Causes

Natural spinal curvature is essential for the body to be able to maintain an upright position. If the lumbar spine were straight rather than curved, its connection to the pelvic region would force the body into a forward position. However a congenital spinal deformity, or other medical conditions or poor practices can cause abnormal curvature of the spinal vertebrae.

Poor Posture and Injury

Hyperlordosis is associated with musculoskeletal injuries, often seen in dancers and gymnasts – many of which begin their training at a very young age, and work for long periods of time in certain postures, this can increase any potential negative impacts on their health. General long term poor posture can lead to the formation of hyperlordosis as well as other back related issues.

Muscular Imbalances

Muscles abnormally short in length may also contribute to hyperlordosis, as well as muscle imbalances or severe muscle weakness.

Discitis

A condition defined as a bacterial or viral infection of the vertebrae which as extended into the intervertebral discs – it may also be a result of inflammation caused by autoimmune diseases. Amongst other complications, discitis can cause excessive curvature of the spine.

Kyphosis

Also known as a humpback syndrome, kyphosis causes the top of the spine to become excessively rounded. The spine naturally has some curvature in the thoracic region, but outwards curvature of more than 45° is considered excessive. Kyphosis can cause a number of symptoms including other spinal issues as the lower spine has to compensate for the abnormality.

Osteoporosis

Brittle porous bones are weaker and more fragile making them prone to compression fractures, these depending on where they occur, may provoke hyperlordosis.

Spondylolisthesis

A condition which predominantly occurs in the lower back, where one of the vertebrae slips forwards or backwards causing amongst other symptoms, excessive curvature.

Achondroplasia

A form of short limb dwarfism, demonstrating a disproportionately short stature caused by a genetic mutation – lumbar hyperlordosis is a common characteristic.

Obesity

Carrying an excessively large amount of abdominal fat can lead to abnormal strain on the spine and surrounding muscle tissues.

Symptoms

The typical symptoms of hyperlordosis include primarily the physical appearance of a curved back, which is often accompanied by lower back pain – the pain may vary in severity and worsen with movement.

Diagnosis

Diagnosis can be difficult as there is massive variation of lumbrosacral angle amongst the population, anything between 39 °and 53° is considered to be within the normal threshold. Other factors such as gluteal prominence may also lead to a false impression of lumbar lordosis.

Accurate measurement of the lumbar angle is essential as are accurate measurements of any sagittal deviations – X-Ray is used to help measure the curvature, MRI and CT scans may be useful to investigate any soft tissue abnormalities.

Physical examination may test movement and muscle extension, it is also important to rule out any possible red flags.

Treatment

Lower back pain is an extremely common problem in modern society, as there are numerous possible reasons for painful symptoms. Treatment of hyperlordosis will depend on the underlying cause, however as with most chronic pain related conditions, conservative treatment methods are usually the first port of call, involving the use of pain relief medication, physiotherapy and postural correction.

Physiotherapy techniques can be highly beneficial – through physical manipulation, specific strengthening, stretching and stabilising exercises, the excessive curvature can in some cases see a substantial recovery.

Bracing is sometimes used as a corrective measure, especially in children and adolescents where the spine is still growing.

In more severe cases, where other treatments have failed, surgical correction may be necessary.

The Pain Management Clinic

A pain management consultant will be able to advise patients on all aspects of the management of painful symptoms and devise an individualised treatment plan which may involve a combination of different types of medical care all of which take into consideration the patient’s personal circumstances.

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