Hyperlordosis and Triathlon Training

author : AMSSM

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One of the common types of excessive natural curvatures is hyperlordosis of the lumbar spine. Many times lordosis requires no treatment if it is not causing any symptoms.

Member Question

Are there any success stories in getting rid of lordosis of the back? It sounds like strengthening of the core and back muscles is the treatment but I'm wondering how much that will really get rid of the problem?  I have had it at least for the last 10-12 years but possibly longer.  I had a sit-down job a lot of the year but I try to limit my chair time as much as I can. I haven't actually seen a doctor regarding it, but it's really obvious that I do have it. A friend of mine is a sports therapist, and immediately upon meeting me she said that she noticed the excessive curve in my lower spine, and I know that it gets in the way of my running form.  What do you suggest I do?  Any information on this issue would be greatly appreciated.

Answer from Caitlyn Mooney, MD 
Member AMSSM

The vertebral column is made up of vertebra as well as intervertebral disc which lie between the vertebra. Protected within these structures is the spinal cord, which is the part of the nervous system that relay signals from the brain down to the other areas of the body. There are several areas of the spinal cord including the cervical spine (neck), thoracic spine (upper back), lumbar spine (lower back), and the sacrum and coccyx which make up the lowest part of the back and tailbone.  Each level of the spine has a natural curvature which is either inward/concave curvature otherwise known as lordosis or a outward/ convex curvature known as kyphosis. Both the cervical spine as well as the lumbar spine have a lordotic or concave curve. Overall the natural curvature results in an S-shaped spine. Natural curvature is essential for shock absorption, range of motion, and balance.   Variations of the natural curvature can result in either having the wrong type of curve at a location or have an accentuated natural curve. One of the common types of excessive natural curvatures is hyperlordosis of the lumbar spine which is also known as sway back or hollow back.  Often times it is noticed as the individuals buttocks is often more prominent as the pelvis is tilted forward.  

There are a number of causes of hyperlordosis as abnormalities of the vertebra or bone themselves can result in changes the spinal curvature as well as muscular imbalances or soft tissue abnormalities. A flexible curve will correct or lessen with changing posture such as bending or straightening the spine. A flexible curve can be caused by postural changes, muscle imbalances, obesity, or poor core strength. Hyperlordosis is not common in the pediatric population and curvatures often become more prominent during puberty and may not be noted until the twenties. Flexible curves can be noted by the patient or family members but often do not result in symptoms.

Hyperlordosis which results in a fixed curvature meaning that it cannot be altered by postural changes such as bending forward or backward are more likely to be caused by skeletal abnormalities. These skeletal abnormalities are not common causes of hyperlordosis but include osteoporosis, spinal fractures, disc inflammation such as discitis, and achondroplasia. Spondylolisthesis, a condition in which fractures occur on both sides of the spine thus resulting in one vertebra slipping relative to the vertebra above or below it.

As with any medical concern a visit with your doctor can help determine whether an intervention or test is necessary.  At the visit, a history of any back problems, neurologic problems, and when the abnormality was noticed will likely be obtained.  An exam may include a general exam as well as an examination of your back and nervous system. Visible signs of lordosis include an abnormally increased arch of the back and the appearance that the person is puffing out his stomach or buttocks.  Diagnosis usually would include a physical exam and possibly x-rays to measure the curvature.   If there are any concerns rarely a CT or MRI would be obtained by your physician if they have a specific concern about your spine or nervous system.  Rarely they may test the nerve function, do a bone scan, or do additional tests.  

Often times lordosis requires no treatment if it is not causing any symptoms.  As there are numerous causes not all cases will be treated in the same way.  If treatment for muscular causes is desired for pain, cosmetic concerns, performance concerns, or neurologic concerns, physical therapy can help.  Therapy will target weak hip muscles with strengthening.  Stretching will also often help and be added to the therapy routine.   It will be important to continue the exercises after therapy to prevent reoccurrence. Medications may be prescribed for pain including NSAIDS. Narcotics and muscle relaxants may be used if pain is severe but should be only used for a limited time.  Rarely a brace will be recommended for children to try to control the growth in the right direction.  Additionally weight loss can help.  Rarely surgery is necessary.  Manipulative therapy may play a role also in decreasing associated pain that may occur with lordosis however it may not correct the excessive lordosis itself. In the absence of pain, weakness, or other issues that point to a problem with the spine or spinal cord I would be hesitant to do anything more aggressive than therapy including strengthening or stretching.

Caitlyn Mooney, MD 
Primary Care Sports Medicine Fellow 
Case University Hospitals/ Rainbow Babies 

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date: August 31, 2015