I remember a patient, let’s call him Mark, who came in a while back. He’d always been active, loved hiking on the weekends. But lately, he’d been noticing this persistent, dull ache in his lower back after his walks, and his wife mentioned his posture looked… different. “My stomach seems to stick out more,” he said, a bit self-consciously, “and my back has this real dip in it.” He was worried, and rightly so; it’s always good to check these things out. What Mark was describing, and what we eventually talked about, is something called lordosis.
So, let’s chat about lordosis. It sounds like a big, scary medical term, doesn’t it? But really, it’s just the name for the natural, gentle inward curve we all have in our neck (that’s your cervical spine) and in your lower back (your lumbar spine). A little bit of this curve is perfectly normal and actually super important. It acts like a built-in spring, helping you stand upright, maintain your center of gravity, keep your balance, and absorb shock when you move. Without these curves, our spines would be rigid rods, making walking and running incredibly jarring.
The issue arises when this curve becomes more pronounced than usual. That’s when we might call it an excessive lordotic curve, hyperlordosis, or simply lordosis in a clinical context. You might have heard the term “swayback” – that’s often used to describe lordosis in the lower back. Just for context, in the neck, a curve of about 30 to 40 degrees is typical. In the lower back, it’s usually around 40 to 60 degrees. If it goes beyond that, we start looking a bit closer to understand why.
It’s also different from other spine conditions you might have heard of. Kyphosis is an excessive outward curve, often in the upper back, which can give a “hunched” appearance. Scoliosis is when the spine curves and twists to the side, like an “S” or “C” shape. Lordosis is specifically that C-shaped inward curve in the neck or lower back.
Who Gets Lordosis and What Causes It?
Honestly, lordosis can affect anyone, from young children to older adults. We do see it a bit more commonly in a few groups, like adults over 50 (due to age-related changes in the spine), kids going through those big growth spurts, and sometimes during pregnancy due to the body’s changing mechanics to accommodate the growing baby.
Now, as for what causes it… well, a lot of the time, especially in children, lordosis is idiopathic. That’s just our fancy medical way of saying we don’t have a specific, identifiable cause. It just develops. Sometimes, though, an exaggerated lordosis can be linked to other underlying conditions or postural habits.
| Cause Category | Specific Examples and Explanations |
|---|---|
| Postural & Muscular Imbalances | This is a very common cause. Weak abdominal muscles (your core) and tight hip flexor muscles can cause the pelvis to tilt forward, increasing the curve in the lower back. This is often seen in people who sit for long periods. |
| Structural Spine Conditions | Spondylolisthesis: This is when one of your lower back bones (vertebrae) slips forward onto the bone below it, forcing the spine to curve more to compensate. Discitis: Inflammation of the disc space between vertebrae can cause pain and postural changes. |
| Bone & Growth Conditions | Achondroplasia: A common cause of dwarfism, affecting how bone grows and often leading to a pronounced lumbar lordosis. Osteoporosis: When bones become weaker and more brittle, vertebrae can compress and change shape, altering the spine’s curves. |
| Neuromuscular Conditions | Conditions like muscular dystrophy or cerebral palsy can cause muscle weakness and imbalances around the spine and pelvis, leading to postural changes like lordosis. |
| Obesity | Excess weight, particularly in the abdominal area, can pull the pelvis forward and put extra strain on the lower back, accentuating the lordotic curve. |
What Might You Notice? Signs and Symptoms of Lordosis
Many people with lordosis don’t actually have any symptoms at all! You might not even realize your spine has that extra curve unless a doctor notices it during a routine check-up. When symptoms or signs do appear, they’re often related to posture and muscle strain:
- Your head and neck might seem to lean further forward than usual (in cervical lordosis).
- If it’s lumbar lordosis (swayback), your hips and pelvis might be pushed forward. This can make your stomach appear to stick out and your bottom seem more prominent, even if you don’t have a lot of body fat.
- A classic little test: if you lie flat on your back on a hard surface, is there a noticeable, C-shaped gap under your lower back that you can easily slide your whole hand through?
- If the lordosis is more severe, it can put extra strain on the muscles and ligaments of the back, sometimes leading to persistent neck pain or low back pain. You might find it a bit harder to move as freely as you normally would, with feelings of stiffness.
- In very rare, severe cases, an extreme curve could potentially put pressure on nerves, leading to symptoms like numbness, tingling, or weakness in the legs, or even interfere with bladder or bowel control. I want to stress these are uncommon scenarios.
How We Figure Out If It’s Lordosis
When you come into the clinic with concerns about your back or posture, the first thing we’ll do is have a good chat and a thorough physical exam. I’ll observe your posture from the front, back, and side. I’ll gently examine your spine, feeling for any unusual curves. A key thing we check is whether the lordotic curve is flexible – does it change or straighten when you bend forward? A flexible, non-painful curve is often less of a concern than a rigid, fixed one. If I suspect lordosis, or if you’re experiencing pain, we might suggest some imaging tests to get a clearer picture:
- X-rays: These are great for seeing the bones and allowing us to precisely measure the angle of the curve (the Cobb angle).
- MRI (Magnetic Resonance Imaging): This gives detailed pictures of soft tissues like the spinal cord, nerves, and intervertebral discs.
- CT scan (Computed Tomography scan): This provides more detailed, cross-sectional images of the bones than X-rays.
What Can We Do About Lordosis?
Here’s some good news: most people with lordosis don’t need any specific medical treatment. This is especially true for kids with flexible curves, as it often corrects itself as they grow and their spine develops.
If you are having symptoms like neck or back pain, we usually start with conservative, non-invasive approaches:
- Physical Therapy: A physical therapist can be a fantastic ally. They can teach you specific exercises to strengthen the muscles that support your spine – think your deep core abdominal muscles, your glutes (butt muscles), and your hamstrings. They will also guide you in stretching tight muscles, like your hip flexors and lower back extensors. While exercises won’t magically straighten a fixed structural curve, they are excellent for improving posture, reducing pain, and preventing the curve from worsening due to muscular imbalances.
- Medication: For pain flare-ups, over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen can help manage discomfort and reduce inflammation.
- Weight Management: If excess weight is a contributing factor, working towards a healthy weight can significantly reduce the strain on your lower back.
- Bracing: In some cases, particularly in adolescents whose bones are still growing and whose curve is progressing, a customized brace might be recommended. This brace supports the spine and aims to prevent further curving.
- Surgery: It’s quite rare to need surgery for lordosis. However, if the curve is very severe, continues to get worse despite other treatments, or is causing significant problems like nerve compression, your doctor might recommend a spinal fusion. This procedure helps to straighten the spine and lessen the curve, often involving rods, screws, and bone grafts to help the fused segments heal into a single, solid bone.
Take-Home Message
- Lordosis refers to the natural inward curve in your neck and lower back; it becomes a point of attention if this curve is excessive (“swayback”).
- Many individuals with lordosis experience no symptoms and don’t require treatment.
- When symptoms do occur, they are often related to posture and muscle pain.
- Often, the cause is unknown (idiopathic), but it can be linked to postural habits or underlying medical conditions.
- When treatment is needed, it usually focuses on managing symptoms with options like physical therapy to strengthen the core and improve flexibility.
So, if you’ve been told you have lordosis, or if you’re looking in the mirror and feeling a bit worried about the curve in your back, please don’t immediately assume the worst. The best first step is to come in and have a chat with us. We can take a look, understand what’s going on, and figure out a plan together.