Lordosis

vertebral column (Lumbar/Cervical)

The term lordosis refers to the normal inward lordotic curvature of the lumbar and cervical regions of the human spine.[1] The normal outward (convex) curvature in the thoracic and sacral regions is termed kyphosis or kyphotic. The term comes from the Greek lordōsis, from lordos "bent backward"[2]

Lordosis in the human spine makes it easier for humans to bring the bulk of their mass over the pelvis. This allows for a much more efficient walking gait than that of other primates, whose inflexible spines cause them to resort to an inefficient forward leaning "bent-knee, bent-waist" gait. As such, lordosis in the human spine is considered one of the primary physiological adaptations of the human skeleton that allows for human gait to be as energetically efficient as it is.[3]

Lower spine disorders occur when lumbar lordosis is excessive (lumbar hyperlordosis), minimal, or is reversed into lumbar kyphosis. Lumbar hyperlordosis is commonly called hollow back or saddle back (after a similar condition that affects some horses). These conditions are usually a result of poor posture and can often be reversed by learning correct posture and using appropriate exercises.[4]

Lumbar lordosis

Normal lordotic curvatures, also known as secondary curvatures, results in a difference in the thickness between the front and back parts of the intervertebral disc. Lordosis may also increase at puberty, sometimes not becoming evident until the early or mid-20s.

In radiology, a lordotic view is an X-ray taken of a patient leaning backwards.[5]

Lumbar hyperlordosis

Lumbar hyperlordosis
Lumbar hyperlordosis
Classification and external resources
Specialty Orthopedics
ICD-10 M40.3-M40.5, Q76.4
ICD-9-CM 737.2,754.2
MedlinePlus 003278

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 hyperlordosis 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.[6] Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tight hip flexors (psoas). A major feature of lumbar hyperlordosis is a forward pelvic tilt, resulting in the pelvis resting on top of the thighs.

Other health conditions and disorders can cause hyperlordosis. Achondroplasia (a disorder where bones grow abnormally which can result in short stature as in dwarfism), Spondylolisthesis (a condition in which vertebrae slip forward) and osteoporosis (the most common bone disease in which bone density is lost resulting in bone weakness and increased likelihood of fracture) are some of the most common causes of hyperlordosis. Other causes include obesity, hyperkyphosis (spine curvature disorder in which the thoracic curvature is abnormally rounded), discitits (an inflammation of the intervertebral disc space caused by infection) and benign juvenile lordosis.[7] 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 partial or full 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.

Excessive lordotic curvature – lumbar hyperlordosis, is also called hollow back, and saddle back (after a similar condition that affects some horses); swayback usually refers to a nearly opposite postural misalignment that can initially look quite similar.[8][9] Common causes of lumbar hyperlordosis include tight low back muscles, excessive visceral fat, and pregnancy. Rickets, a vitamin D deficiency in children, can cause lumbar lordosis.

Signs and symptoms

Although hyperlordosis gives an impression of a stronger back, incongruently it can lead to moderate to severe lower back pain. The most problematic symptom is that of herniated disc where the dancer has put so much strain on their back 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 rectus femoris of the 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.[10]

Causes

Possible etiologies that lead to the condition of Lumbar hyperlordosis are the following:

• Spines-Natural factors of how spines are formed greatly increase certain individuals' 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 the individual 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 an individual 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 unstable 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 individual 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.[11]

• 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 dance 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.[12]

Diagnosis

Measurement and diagnosis of lumbar hyperlordosis can be difficult. Obliteration of vertebral end-plate landmarks by interbody fusion may make the traditional measurement of segmental lumbar lordosis more difficult. Because the L4-L5 and L5-S1 levels are most commonly involved in fusion procedures, or arthrodesis, and contribute to normal lumbar lordosis, it is helpful to identify a reproducible and accurate means of measuring segmental lordosis at these levels.[13][14]

A visible sign of hyperlordosis is an abnormally large arch of the lower back and the person appears to be puffing out his or her stomach and buttocks. Precise diagnosis is done by looking at a complete medical history, physical examination and other tests of the patient. X-rays are used to measure the lumbar curvature, bone scans are conducted in order to rule out possible fractures and infections, magnetic resonance imaging (MRI) is used to eliminate the possibility of spinal cord or nerve abnormalities, and computed tomography scans (CT scans) are used to get a more detailed image of the bones, muscles and organs of the lumbar region.[15]

Treatment

Since lumbar hyperlordosis is usually caused by habitual poor posture, rather than by an inherent physical defect like scoliosis or hyperkyphosis, it can be reversed.[4] This can be accomplished by stretching the lower back, hip-flexors, hamstring muscles, and strengthening abdominal muscles.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.[16]

Lumbar hyperlordosis may be treated by strengthening the hip extensors on the back of the thighs, and by stretching the hip flexors on the front of the thighs.

Only the muscles on the front and on the back of the thighs can rotate the pelvis forward or backward while in a standing position because they can discharge the force on the ground through the legs and feet. Abdominal muscles and erector spinae can't discharge force on an anchor point while standing, unless one is holding his hands somewhere, hence their function will be to flex or extend the torso, not the hip. Back hyper-extensions on a Roman chair or inflatable ball will strengthen all the posterior chain and will treat hyperlordosis. So too will stiff legged deadlifts and supine hip lifts and any other similar movement strengthening the posterior chain without involving the hip flexors in the front of the thighs. Abdominal exercises could be avoided altogether if they stimulate too much the psoas and the other hip flexors.

Controversy regarding the degree to which manipulative therapy can help a patient still exists. If therapeutic measures reduce symptoms, but not the measurable degree of lordotic curvature, this could be viewed as a successful outcome of treatment, though based solely on subjective data. The presence of measurable abnormality does not automatically equate with a level of reported symptoms.[17]

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.

Tai chi

While not really a 'treatment', the art of tai chi chuan calls for adjusting the lower back curvature (as well as the rest of the spinal curvatures) through specific re-alignments of the pelvis to the thighs, it's referred to in shorthand as 'dropping the tailbone'. The specifics of the structural change are school specific, and are part of the jibengung (body change methods) of these schools. The adjustment is referred to in tai chi chuan literature as 'when the lowest vertebrae are plumb erect...' [18]

See also

Footnotes

  1. ↑ Medical Systems: A Body Systems Approach, 2005
  2. ↑ "Lordosis". Wordnik. Retrieved December 15, 2013.
  3. ↑ http://www.algoless.com/pdf/human_gait.pdf
  4. 1 2 McKenzie, Robin (2011). Treat Your Own Back (Ninth ed.). New Zealand: Spinal Publications New Zealand, Ltd. ISBN 978-0-9876504-0-5.
  5. ↑ "Lordotic Chest Technique".
  6. ↑ Solomon, Ruth. Preventing Dance Injuries: An Interdisciplinary Perspective. Reston, VA: American Alliance for Health, 1990.p.85
  7. ↑ "Types of Spine Curvature Disorders". WebMD. Retrieved 8 December 2013.
  8. ↑ "Sway back posture". lower-back-pain-management.com/. Retrieved 17 August 2014.
  9. ↑ Cressey, Eric. "Strategies for Correcting Bad Posture – Part 4". EricCressey.com. Retrieved 17 August 2014.
  10. ↑ Solomon, Ruth. Preventing Dance Injuries: An Interdisciplinary Perspective. Reston, VA: American Alliance for Health, 1990.p.122
  11. ↑ Howse, Justin. Dance Technique and Injury Prevention. Third Edition. London: A&C Black Limited, 2000.p.193
  12. ↑ Brinson, Peter. Fit to Dance?. London: Calouste Gulbenkian Foundation, 1996.p.45
  13. ↑ Schuler Thomas C (Oct 2004). "Segmental Lumbar Lordosis: Manual Versus Computer-Assisted Measurement Using Seven Different Techniques". J Spinal Disord Tech. 17 (5): 372–9. doi:10.1097/01.bsd.0000109836.59382.47.
  14. ↑ Subach Brian R (Oct 2004). "Segmental Lumbar Lordosis: Manual Versus Computer-Assisted Measurement Using Seven Different Techniques". J Spinal Disord Tech. 17 (5): 372–9.
  15. ↑ "Lordosis". Lucile Packard Children's Hospital.
  16. ↑ Arnheim, Daniel D.. Dance Injuries:Their Prevention and Care. Second Edition. St. Louis, Missouri: C. V. Mosby Company, 1980.p.36
  17. ↑ Harrison DD, et al. (1994). J Manipulative Physiol Ther. 17 (7): 454–464. Missing or empty |title= (help)
  18. ↑ T'ai Chi Ch'uan: A Simplified Method of Calisthenics for Health & Self Defence | By Manqing Zheng | Page 10

References

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