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Hollow Back: Causes, Symptoms and Treatment

A hollow back (hyperlordosis) is an excessive inward curvature of the lumbar spine. It can cause lower back pain and contribute to postural problems.

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Things worth knowing about "Hollow back"

A hollow back (hyperlordosis) is an excessive inward curvature of the lumbar spine. It can cause lower back pain and contribute to postural problems.

What is a Hollow Back?

A hollow back, medically known as lumbar hyperlordosis, refers to an excessive inward curvature of the lumbar spine. The spine naturally has several gentle curves that act as shock absorbers. When the lumbar curve becomes too pronounced, the condition is called a hollow back. This causes the pelvis to tilt forward, the abdomen to protrude, and the lower back to appear excessively arched.

Causes

A hollow back can develop from various factors. It most commonly results from a combination of muscle imbalances, poor posture, and insufficient physical activity. Common causes include:

Shortened hip flexors: Prolonged sitting often leads to tightening of the hip flexor muscles, pulling the pelvis forward.
Weak abdominal and gluteal muscles: Insufficient core and pelvic stability encourages excessive lumbar curvature.
Pregnancy: The shift in the body's centre of gravity during pregnancy can cause or worsen a hollow back.
Overweight: A prominent abdomen shifts the body's centre of gravity and increases stress on the lumbar spine.
Congenital spinal abnormalities: In rare cases, structural malformations of the spine are responsible.
High-heeled shoes: Regular wearing of high heels can alter posture over time.

Symptoms

Many people with a hollow back initially experience no discomfort. Over time, the following symptoms may develop:

Lower back pain, especially after prolonged standing or sitting
Muscle tension in the lumbar region and buttocks
Early fatigue of the back muscles
Radiating pain into the buttocks or legs (when nerves are involved)
Visible postural deviation with a forward-tilted pelvis and protruding abdomen

Diagnosis

A hollow back is typically diagnosed through a physical examination by a doctor or physiotherapist. Posture, range of motion, and muscle balance are assessed. In certain cases -- such as suspected structural causes or severe symptoms -- an X-ray or MRI of the spine may be performed to measure the degree of curvature and rule out other conditions.

Treatment

In most cases, a hollow back can be effectively treated with conservative measures. Surgical intervention is only necessary for severe structural causes.

Physiotherapy and Exercise

Physiotherapy is the cornerstone of treatment. Targeted exercises strengthen the weak muscles (abdominals, gluteals) and stretch the shortened muscles (hip flexors, lumbar extensors). Well-known approaches include Pilates and functional strength training.

Postural Correction

Consciously practising a neutral, upright pelvic position in everyday life is essential. Ergonomic adaptations in the workplace -- such as height-adjustable desks and ergonomic chairs -- also help significantly.

Pain Relief and Physical Therapy

For acute pain, anti-inflammatory pain relievers (e.g. ibuprofen) may be used in the short term. Heat therapy and massage can relax the musculature and alleviate discomfort.

Weight Reduction

In cases of overweight, weight loss can significantly reduce stress on the lumbar spine and improve posture.

References

Kapandji, I.A.: The Physiology of the Joints, Volume 3: The Spinal Column. Churchill Livingstone, Edinburgh 2008.
World Health Organization (WHO): Global recommendations on physical activity for health. WHO Press, Geneva 2010.
Kendall, F.P. et al.: Muscles: Testing and Function with Posture and Pain. 5th edition. Lippincott Williams & Wilkins, Baltimore 2005.

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