The next time you stand up, take notice of your posture. Is your head positioned over your pelvis, or is it slightly forward or backward? The answer could indicate an issue related to the curve of your spine, or lordosis.
What is lordosis?
Your spine has natural, gentle curves that make it an “S” shape, from the cervical spine (the neck) to the thoracic spine (the base of the neck to the abdomen) to the lumbar spine (the lower back). Lordosis refers to two of those curves—the ones at the top and bottom. The middle curve is called kyphosis. (Note that, by definition, lumbar lordosis refers to the curve in the lower region of your back, not a disorder.)
As the body’s central support structure, your spine is made up of an intricate arrangement of bones and discs, surrounded by ligaments and soft tissue, all of which work efficiently together to handle maximum load. It is also designed to allow you to bend forward and backwards. Having the correct curvature in the lower part of your spine—the correct lordosis—is extremely important for maintaining the ideal posture, where your head is centered over your pelvis.
The discs in your lower back help to create this natural curve—five discs in the lumbar (lower) spine are wedge-shaped specifically for that purpose. The degree of spinal curve varies from person to person, ranging from 40 degrees up to about 50 degrees in the average adult (the “average adult” being someone who has reached skeletal maturity; for males it is usually age 16+ and for females age 14+, on average).
Variations outside the normal curvature range are as follows:
- Hypolordosis refers to a decrease in curvature.
- Hyperkyphosis is where the upper back (thoracic spine) becomes rounded and the head and neck protrude out.
- Hyperlordosis is an increase in curvature at the lower back. This condition is highly unusual.
Note that in some cases, back pain as a result of a herniated disc or some other condition may also cause people to artificially lean forward or sideways in an effort to open up the space where a nerve may be getting pinched. This unusual posture is not a permanent issue with mobility; it is a temporary condition due to compensate for the injury. Either therapy and stretching or a surgical procedure to address the herniated disc should solve the issue, and posture will return to normal.
Are you worried about permanent changes to your posture as a result of fusion? Read about an alternative to fusion that will help restore your spinal health.
Is lordosis related to scoliosis?
In general, the term “scoliosis” refers to an abnormally curved back (some would say more than 10 or 20 degrees outside the norm). Hyperlordosis and hypolordosis are technically types of scoliosis. But it’s most commonly associated with the type of sideways curvature that develops in children. In some cases a brace can affect the curve to a small degree and may prevent it from progressing as the child grows.
Sometimes, adults also develop scoliosis as a result of wear and tear to their facet joints and discs. Excessive degeneration of these spinal elements—usually in the lumbar spine—may make them unable to support a person’s spinal structure, which leads to abnormal curvature and back pain. That condition is referred to as degenerative scoliosis, and treatment options vary.
What happens to negatively affect your lordosis?
There are things that can cause your lordosis to change in an unnatural way, often resulting in back pain. The two most common reasons for change are aging of the spinal column and fusion.
Aging Of The Spinal Column
The most common cause of curvature change in the lumbar region is simply aging of the spinal column. Most people get some degree of hypolordosis as they go through life.
The reason for that is simple: 65% of the curve in our lower back comes from the bottom two discs, and it just so happens those are the same discs that typically experience the most change as a result of the normal aging or degenerative process. Through natural wear and tear, the discs slowly lose their wedge shape and become more flat and rectangular; they also lose height. Losing that angle leads to a decrease in lordosis, which causes you to bend forward so your head is no longer centered over your shoulders, and you body trunk is no longer over your feet. People with a small degree of hypolordosis compensate by bending their hips and knees and may be able to function normally, whereas a more significant loss of lordosis puts tremendous strain on the body.
Hypolordosis As A Result Of Fusion
Natural wear and tear isn’t the only cause of hypolordosis. Many times the curve is altered—and the degeneration of your spine is accelerated—as the result of surgical treatment for a spinal condition. It’s particularly common in patients who have received a lumbar fusion.
Most fusions are done at one of two levels: L4-L5, and L5-S1, the lowest levels of the lumbar spine with the most wedge-shaped discs. In a single-level fusion, the surgeon removes one of those discs and replaces it with a cage, often flattening out the natural curve. The surgery also changes the normal tension of the muscles that surround your spine. This condition is referred to as flat back syndrome, which causes a painful tendency to lean forward after the surgery.
Most patients who have undergone a fusion experience some degree of hypolordosis. Fusion often necessitates further surgery, as a result of the added stress placed on the levels adjacent to where the fusion is located. Further fusions at different levels only increase the stiffness in the spine, ultimately resulting in a major procedure called a degenerative deformity or adult deformity correction in many patients.
As you might imagine, surgeons try to avoid flat back syndrome. A variety of high-tech fusion cages are available to help, such as expandable cages. These work like car jacks, where the surgeon turns a knob to expand the cage into the desired shape. Problem solved? Unfortunately, we are learning that these “lordotic” procedures can be even more damaging than flat back syndrome.
Why? Because the amount of lumbar lordosis you have naturally changes all day long, as you go from a standing position to a sitting position to a slumped position. When you’re standing upright you have more of a curve than when you’re sitting. And when you’re sitting slumped (like when you’re watching TV on the couch), you lose an even greater degree of curvature. A fused hyperlordotic spine places tremendous stress on the back sitting and, particularly, slouching. (Even though our grade school teachers told us to sit up straight, most of us slouch all the time.) As surgeons have learned more about the mechanics of the spine, it’s become clear how important it is to maintain balance in all postures, including allowing the spine to relax and flatten while sitting.
Is there a treatment for loss of lordosis?
If your change in lumbar lordosis is brought on by natural degeneration, there are exercises you can do to bring you closer to your natural curvature and help address pain associated with your condition. (Loss of curvature reduces the space available between your vertebrae for nerves; pinched nerves are painful.)
Your body naturally tries to correct abnormal posture—that means your muscles have to work harder to pull you back so your head is up. Your hamstrings, iliopsoas muscle (made up of the iliacus and psoas hip muscles), and abdominal muscles will likely experience tightness and spasms that lead to pain and/or fatigue. The right type of exercises, including those that strengthen your core, can help overcome these kinds of muscle deficiencies.
If a change in your lumbar lordosis is caused by fusion, there’s little you can do to reverse the situation. In extreme cases, an osteotomy may be an option—a surgical procedure that attempts to correct spinal alignment by removing a wedge from a section of spinal bone. But, just like with a fusion, this unnatural change in lordosis will also likely leave you better off standing than sitting.
Prevent further loss of curvature with BalancedBack®.
Whether you’ve already had a fusion or are considering fusion surgery to alleviate back and leg pain, there is another treatment option that can help prevent further loss of lordosis.
BalancedBack® is an advanced, new procedure that preserves the mobility of the spine and helps retain its natural curvature. Different than fusion or disc replacement (though it addresses most of the same issues), it is a total joint replacement that replaces the function of both the damaged disc and the facet joints, which enable movement. As a result, BalancedBack® patients can move naturally, allowing the spine to assume the position it wants to be in with every movement. And even if you’ve already had a fusion, BalancedBack® can be used in place of future fusion surgeries as long as there’s an open disc space above or below for the joint replacement implant.
Would you like to know more about BalancedBack®?
BalancedBack® is the only implant that allows the spine to rebalance itself and recreate the normal lordosis of the spine. If you’d like to find out more about this procedure—and whether you’re a good candidate for it—schedule a complimentary call with our clinical coordinator today.