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Lordosis: Causes, Symptoms & Treatment

Lordosis refers to the natural or abnormal inward curvature of the spine, primarily in the neck and lower back. Excessive lordosis can cause pain and mobility issues.

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Things worth knowing about "Lordosis"

Lordosis refers to the natural or abnormal inward curvature of the spine, primarily in the neck and lower back. Excessive lordosis can cause pain and mobility issues.

What is Lordosis?

Lordosis describes an inward curvature of the spine. A certain degree of lordosis is completely normal and even essential for healthy posture: the human spine naturally curves inward in the cervical (neck) region and the lumbar (lower back) region. This natural double-S shape allows the spine to absorb shock and distribute body weight efficiently during movement and standing.

However, when this inward curve becomes excessively pronounced, it is referred to as hyperlordosis or pathological lordosis. In such cases, the condition can lead to pain, reduced range of motion, and long-term damage to the vertebrae, intervertebral discs, and surrounding muscles.

Causes

Excessive lordosis can develop due to a variety of factors:

Muscle imbalances: Weak abdominal or back muscles, as well as shortened hip flexors, frequently contribute to hyperlordosis in the lumbar region.
Physical inactivity and poor posture: Prolonged sitting and consistently poor body posture increase the risk of an exaggerated inward curve.
Obesity: Excess abdominal weight shifts the body's center of gravity forward, placing additional strain on the lumbar spine.
Pregnancy: The growing abdomen alters the body's center of gravity and can cause temporary hyperlordosis.
Medical conditions: Rickets, osteoporosis, spondylolisthesis (vertebral slippage), or congenital malformations can also lead to pathological lordosis.
Neurological conditions: Disorders such as cerebral palsy or muscular dystrophy can affect spinal alignment.

Symptoms

Physiological lordosis does not cause any discomfort. However, excessive or pathological lordosis may produce the following symptoms:

Pain in the lower back or neck
Muscle tension in the back and gluteal region
Restricted movement, especially when bending or straightening
Tingling or numbness in the arms or legs (if nerves are affected)
Visibly protruding abdomen or buttocks due to altered posture
Increased fatigue when standing or walking for extended periods

Diagnosis

Lordosis is typically diagnosed using the following methods:

Physical examination: A physician assesses the shape of the spine while the patient is standing and moving.
X-ray imaging: A lateral (side-view) X-ray of the spine allows precise measurement of the curvature angle, often using the Cobb method.
MRI or CT scan: If disc damage, nerve compression, or structural changes are suspected, advanced imaging techniques are used.

Treatment

Treatment depends on the underlying cause and severity of the lordosis:

Conservative Treatment

Physiotherapy: Targeted exercises to strengthen the abdominal and back muscles, along with stretching of the hip flexors, are the most important therapeutic measure.
Posture training: Ergonomic guidance and learning correct body posture for daily activities help correct lordosis over time.
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) or heat therapy can relieve acute pain.
Weight reduction: In cases of obesity, weight loss is an essential component of treatment.
Orthoses or bracing: In certain cases, particularly in children and adolescents, wearing a supportive brace may be recommended.

Surgical Treatment

Surgery is rarely required for lordosis and is only considered in cases of severe structural deformity or significant nerve involvement. Procedures such as spinal fusion (spondylodesis) may be used in these situations.

Prevention

Regular physical activity, targeted back-strengthening exercises, ergonomic workstation design, and avoiding prolonged periods of sitting without movement breaks are the most effective preventive measures against pathological lordosis.

References

Niethard, F. U., Pfeil, J., Biberthaler, P.: Duale Reihe Orthopädie und Unfallchirurgie. Thieme Verlag, 8th Edition, 2017.
Bogduk, N.: Clinical and Radiological Anatomy of the Lumbar Spine. Churchill Livingstone, 5th Edition, 2012.
World Health Organization (WHO): Musculoskeletal conditions. Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (accessed 2023).

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