Lumbar hyperlordosis

Lumbar hyperlordosis is a condition that occurs when the lumbar region (lower back) experiences stress or extra weight and is arched to point of muscle pain or spasms. Lumbar lordosis is a common postural position where the natural curve of the lumbar region of the back is slightly or dramatically accentuated. Commonly known as swayback, it is common in dancers.^[1]

Causes

Other Factors

Other factors may also include those with rare diseases, as is the case with Ehlers Danlos Syndrome (EDS), where hyper-extensive and usually unstable joints (e.g. joints that are problematically much more flexible, frequently to the point of subluxation and even dislocation) are quite common throughout the body. With such hyper-extensibility, it is also quite common (if not the norm) to find the muscles surrounding the joints to be a major source of compensation when such instability exists.

Anatomical factors

• Spines -Natural factors of how spines are formed greatly increase certain individual’s likelihood to experience a strain or sprain in their back or neck. Factors such as having more lumbar vertebrae allowing for too much flexibility, and then in cases of less lumbar having the dancer not reaching their necessity for flexibility and then pushing their bodies to injury.

• Legs and Knees -Another odd body formation is when an individual has a leg shorter than the other, which can be immediate cause for imbalance of hips then putting strain on the posture of the back which a dancer has to adjust into vulnerable positions to meet aesthetic appearances. This can lead to permanent damage in the back. Genu recurvatum (Sway back knees) is also a factor that forces a dancer to adjust into un-stable postures.

• Hips -Common problems in the hips are tight hip flexors, which causes for poor lifting posture, hip flexion contracture, which means the lack of postural awareness, and thoracic hyperkyphosis, which causes the dancer to compensate for limited hip turn out (which is essential to dances such as ballet). Weak psoas (short for iliopsoas-muscle that controls the hip flexor) force the dancer to lift from strength of their back instead of from the hip when lifting their leg into arabesque or attitude. This causes great stress and risk of injury, especially because the dancer will have to compensate to obtain the positions required.

• Muscles -One of the greatest contributors is uneven muscles. Because all muscles have a muscle that works in opposition to it, it is imperative that to keep all muscles protected, the opposite muscle is not stronger than the muscle at risk. In the situation of lumbar lordosis, abdominal muscles are weaker than the muscles in the lumbar spine and the hamstring muscles. The muscular imbalance results in pulling down the pelvis in the front of the body, creating the swayback in the spine.^[2]

• Growth Spurt -Younger dancers are more at risk for development of lumbar hyperlordosis because the lumbar fascia and hamstrings tighten when a child starts to experience a growth spurt into adolescence.

Technical Factors

• Improper Lifts -When male dancers are performing lifts with another dancer they are extremely prone to lift in the incorrect posture, pushing their arms up to lift the other dancer, while letting their core and spine curve which is easy to then hyperlordosis in a dancers back.

• Bad Dance Floors -Dancing on too hard of dance floors like concrete or pavement can be bad for lower limbs and joints. In comparison dancing on too soft of floors such as carpet gives no support for ankles.

• Overuse -Over 45% of anatomical sites of injury in dancers are in the lower back. This can be attributed to the strains of repetitive dance training may lead to minor trauma. If the damaged site is not given time to heal the damage of the injury will increase. Abrupt increases in dance intensity or sudden changes in dance choreography do not allow the body to adapt to the new stresses. New styles of dance, returning to dance, or increasing dance time by a great deal will result in exhaustion of the body.^[3]

Symptoms

The most problematic symptoms is that of herniated disc where the dancer has put so much strain on their back from hyperlordosis, that the discs between the vertebrae have been damaged or have ruptured. Technical problems with dancing such as difficulty in the positions of attitude and arabesque can be a sign of weak iliopsoas. Tightness of the iliopsoas results in a dancer having difficulty lifting their leg into high positions. Abdominal muscles being weak and the rectu femoris quadriceps being tight are signs that improper muscles are being worked while dancing which leads to lumbar hyperlordosis. The most obvious signs of lumbar hyperlordosis is lower back pain in dancing and pedestrian activities as well as having the appearance of a swayed back. All of these are signs that damage is being done, and preventative action needs to take place. ^[4]

Treatment

Since lumbar hyperlordosis is not a fixed condition like scoliosis and kyphosis, it can be reversed.^{[citation needed]} This can be accomplished by stretching the lower back, hip-flexors, hamstring muscles, and strengthening abdominal muscles.^{[citation needed]}

Dancers should ensure that they don't strain themselves during dance rehearsals and performances. To help with lifts, the concept of isometric contraction, during which the length of muscle remains the same during contraction, is important for stability and posture.^[5]

Stretches

Hamstring Stretch -to stretch your hamstring muscle group and the upper attachment of the calf muscle.

Stork Stretch -to stretch the quadriceps muscle group, especially the rectus femoris muscle, also stretches the iliopsoas muscle, and hip flexor. Especially helps with lumbar lordosis

Spine Flattener -to stretch the long extensors of the spine and to assist in the remediation of an abnormal lordotic curve of the neck and lower back.

Mad Cat -to strengthen abdominal, shoulder, and back muscles and to assist in the remediation of lumbar lordosis and inflexible lower back.

Chair Hip Flexor Stretch -to stretch the hip flexors and to assist in the remediation of forward pelvic tilt and lumbar lordosis.

Facedown Thigh and Hip Flexor Stretch -to stretch the quadriceps muscle group, specifically the rectus femoris muscle and the iliopsoas hip flexor muscle; may also assist in remediation of lumbar lordosis.

Braces

The Boston brace is a plastic exterior that can be made with a small amount of lordosis to minimize stresses on discs that have experienced herniated discs.

In the case where Ehlers Danlos Syndrome (EDS) is responsible, being properly fitted with a customized brace may be a solution to avoid strain and limit the frequency of instability.

References