How does lordosis work and when does it become excessive?
The spine has four physiological curves: the cervical and lumbar curves are directed forward, the thoracic and sacral curves are directed backward. This shape works like a spring. Hyperlordosis is said to occur when the lumbar curve is more pronounced than normal and the pelvis is persistently tilted forward. Functional hyperlordosis is associated with muscle imbalance and changes when changing position or tightening the abdomen. Fixed remains in any position and is associated with structural changes in the vertebrae or joints.
- Functional - muscle imbalance, changes with posture correction
- Fixed - persistent, associated with changes in bones and ligaments
- Compensatory - response to changes in the thoracic region or hip joints
- Congenital - with malformations of the vertebrae
Causes and risk factors
Most often, excess deflection develops gradually. Sitting for a long time shortens the iliopsoas and hip flexors, and the abdominal and buttock muscles weaken - the pelvis moves forward. During pregnancy, the center of gravity shifts and the lower back bends more; usually after childbirth the situation is restored. In children, a temporary increase in lordosis occurs during periods of rapid growth. Less commonly, the cause is spondylolisthesis, dysplasia and contractures of the hip joints, consequences of rickets or neuromuscular diseases.
- Weakness of the abdominal and buttock muscles
- Shortening of the iliopsoas and hip flexors
- Overweight and big belly
- Pregnancy
- Prolonged sedentary work and wearing high-heeled shoes
- Spondylolisthesis, hip dysplasia
- Neuromuscular diseases in children
Symptoms
The main symptom is a noticeable arch in the lower back: if you lie on your back on a hard surface, a large gap remains under the lower back. Complaints do not appear immediately. Usually this is a nagging fatigue in the lower back after a long period of standing or walking, stiffness in the morning, a desire to lean on something. The pain is relieved by lying down with legs bent. When the form is severe, the gait also suffers: the person walks, slightly tilting the body back.
- Noticeable arching of the lower back and protruding belly
- Fatigue and aching pain in the lower back at the end of the day
- Stiffness after sleeping or sitting for a long time
- Fatigue when walking and standing
- Tight, painful lower back muscles
- Sometimes - pain in the hip joints and knees
Diagnostics
They start with an examination: the doctor evaluates the side posture, the position of the pelvis, the mobility of the spine, checks the length of the legs and the flexibility of the hip flexors. Simple tests show whether deflection is being actively corrected—this differentiates a functional form from a fixed form. An X-ray of the lumbar spine in a standing position allows you to measure the angle of curvature and exclude spondylolisthesis and vertebral anomalies. An MRI is ordered if there is pain radiating down the leg, numbness or weakness to evaluate the discs and nerve roots.
- Posture examination and pelvic tilt assessment
- Hip flexor shortening test
- X-ray of the lumbar region in a standing position
- Plain radiography of the spine in combination with scoliosis
- MRI of the lumbosacral region for radicular symptoms
- Examination by a neurologist for numbness and weakness in the legs
Treatment and prevention
The basis of treatment is regular exercises selected by a doctor or exercise therapy specialist. The goal is simple: stretch shortened hip flexors and psoas and strengthen the abs, glutes, and deep stabilizer muscles. The first changes are usually noticeable after 6-8 weeks of daily exercise. Additionally, weight loss, breaks during sedentary work, and comfortable shoes without high heels help. Massage and physical therapy relieve muscle tension but are not a substitute for exercise. Painkillers are used for a short course and only as prescribed by a doctor. Surgical treatment is needed very rarely - for developmental defects or severe spondylolisthesis.
- Daily gymnastics: strengthening the abs and gluteal muscles
- iliopsoas and hamstring stretch
- Weight control
- Breaks every 40–50 minutes when working sedentarily
- Lumbar massage and physiotherapy as an addition
- Swimming and walking as a supporting load
- Avoiding constant wearing of high heels