Lordosis - Cause of Back Pain

The human spine has four curves which have the effect of cushioning the back against the forces of gravity as we sit up, stand, walk, and bear forces as we lift things. Together, the spinal curves and the discs between the vertebrae have a cushioning effect that protects the back against injury. These curves are normal - within a certain range. When the spinal curvatures bend excessively beyond a healthy range, the medical terms for these conditions are known as lordosis and kyphosis. Lordosis is an excessive curve in the lumbar and cervical spine. Kyphosis is an excessive curve in the thoracic spine and in the sacrum/coccyx. The condition of lordosis may cause back pain as the spinal ligaments are stretched and damages, as well as putting pressure on the spinal nerves that exit at this level of the spine.

In the Cervical spine, a normal curvature is between 20 to 40 decrees. In the lumbar spine, a normal curvature is between 40 to 60 degrees. This type of spinal curve is known as a lordotic curve, or lordosis. This can be a bit confusing since the term lordosis may be used to describe an anatomical section of the spine or the excessive curve pathology. A lordotic curve is convex anteriorly and concave posteriorly, which means that it angles towards the back of the body.

Lordosis - Cause of Back Pain: As a pathological term, lordosis is described as an excessive inward curve of the spine. To quantify this diagnosis, doctors will observe if the curvature is in excess of 40 degrees in the cervical spine and 60 degrees in the lumbar spine. Due to the excessive bends of the curvatures, the spine may not be able to bear the mechanical loads placed on the spine due to gravity and work of the body, and certain structures in the spine may be prone to injury.

Lordosis is a condition that may affect people of all ages, and both genders. This condition may develop due to congenital conditions, injury, or certain lifestyle factors. When this condition occurs in the lumbar spine (lower back), it may be described as swayback. People with swayback that is apparent to the naked eye have an exaggerated posture in which their buttocks jut out in a more prominent way. Patients may or may not have pain related to this condition, depending on how excessive it is and how well the body responds to these changes in the spine. Symptoms related to this condition may include back pain and limitation of movement. This condition is more likely to occur in the lumbar spine, though it may also occur in the neck as well. This condition may require treatment if it causes moderate to severe symptoms as mentioned above or if the curvature continues to become more exaggerated.

Causes of lordosis and contributing factors: Certain medical conditions may cause the curvatures in the spine to change. In addition, changes in one part of the spine may cause other parts of the spine to become unstable, or to change to change to compensate for the instability in other parts of the spine. Spinal conditions and medical conditions that may contribute to lordosis include spondylolisthesis, osteoporosis, obesity, kyphosis, and discitis:
  • Spondylolisthesis occurs when one vertebra slips forward in relation to the ones above and below it. These abnormal vertebral movements usually occur in the lumbar spine.
  • Osteoporosis may make the vertebral bones prone to fractures or changes to their normal shape. These changes to the bones may warp the structural integrity and shape of the spine.
  • Obesity usually results in large bellies, which cause the spine to be pulled forward at this level of the body. This extra weight in the front of the body requires people to lean backward to maintain their balance. This negatively affects a person's posture and shape of the lower spine.
  • Kyphosis in the thoracic spine may cause the lumbar spine to change compensate to restore the balance of spine.
  • Discitis is the inflammation of one or more of the intervertebral discs.
Diagnosis and Treatment: doctors may use a physical examination as well as possible X-rays and MRIs to determine the severity of the problem, as well as possible causes. The doctor will want to know when this problem was first discovered through observation or the onset of symptoms. The doctor will want to know if the curve has become worse since it was first noticed by the patient or others. Doctors will use various tests to determine the baseline angle of curvature and the degrees of progress or regression after subsequent visits or treatment sessions. The doctor will feel for spinal abnormalities during a hands on physical examination. The doctor will instruct the patient to perform range of motion movements while looking for asymmetries as well as physical limitations. The physician will instruct patients to perform spinal rotations, flexion and extension, and lateral bending.