Low Back Pain Related to Hyperlordosis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
<div class="editorbox"> | |||
'''Original Editors ''' - [[User:Leen Meylemans|Leen Meylemans]] | '''Original Editors ''' - [[User:Leen Meylemans|Leen Meylemans]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
</div> | </div> | ||
== Is there a relationship between low back pain (LBP) and hyperlordosis? == | |||
== Is there a relationship between low back pain (LBP) and hyperlordosis? == | |||
Is there a relationship between low back pain (LBP) and hyperlordosis? | Is there a relationship between low back pain (LBP) and hyperlordosis? | ||
| Line 16: | Line 10: | ||
A 2004 study<ref name="2">Norton B.J., Sahrmann S.A., Van Dillen L.R. Differences in Measurements of Lumbar Curvature Related to Gender and Low Back Pain. J Orthop Sports Phys Ther. 2004;34(9):524-534. Score: B</ref> and a 2003 study<ref name="3">Murrie V.L., Dixon A.K., Hollingworth W., Wilson H., Doyle T.A. Lumbar lordosis: study of patients with and without low back pain. Clin Anat. 2003 Mar;16(2):144-7. Score: B</ref> found that there is no significant difference in lumbar lordosis between people with LBP and people without LBP. A 1999 study<ref name="4">Tüzün C., Yorulmaz I., Cindaş A., Vatan S. Low back pain and posture. Clin Rheumatol. 1999;18(4):308-12. Score: B</ref> concluded that there were no statistically significant differences in thoracic kyphosis, lumbar lordosis and sacral inclination between people with acute LBP, people with chronic LBP and a control group. Also a 2 other studies<ref name="5">Nakipoğlu G.F, Karagöz A., Ozgirgin N. The biomechanics of the lumbosacral region in acute and chronic low back pain patients. Pain Physician. 2008 Jul-Aug;11(4):505-11. Score: B</ref><ref name="6">Evcik D., Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int. 2003 Jul;23(4):163-5. Epub 2003 Jan 18. Score: B</ref> found no statistical difference in sacral inclination angle, lumbosacral angle, sacral horizontal angle and total and segmental lordosis angles between acute LBP patients and chronic LBP patients. Another study<ref name="7">Nourbakhsh M.R., Arab A.M. Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sports Phys Ther. 2002; 32(9):447–460. Score: B</ref> concluded that there is a relationship between LBP en muscle weakness, but they also concluded that structural factors – such as the size of the lumbar lordosis and the pelvic tilt – are not associated with LBP. Also Kim HJ et al.<ref name="8">Kim H.J., Chung S., Kim S., Shin H., Lee J., Kim S., Song M.Y. Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J. 2006 Apr;15(4):409-14. Epub 2005 Sep 7. Score: C</ref> concluded that an imbalance in trunk muscle strength can influence the lumbar lordosis. Furthermore this study also found that it is generally assumed that these muscles affect the shape of the lumbar spine and might be one risk factor for potential low back pain. But we also found a study<ref name="9">Tsuji T., Matsuyama Y., Sato K., Hasegawa Y., Yimin Y., Iwata H. Epidemiology of low back pain in the elderly: correlation with lumbar lordosis. J Orthop Sci. 2001;6(4):307-11. Score: B</ref> that concluded that the lumbar lordosis was significantly less in the LBP group compared with the group without LBP. | A 2004 study<ref name="2">Norton B.J., Sahrmann S.A., Van Dillen L.R. Differences in Measurements of Lumbar Curvature Related to Gender and Low Back Pain. J Orthop Sports Phys Ther. 2004;34(9):524-534. Score: B</ref> and a 2003 study<ref name="3">Murrie V.L., Dixon A.K., Hollingworth W., Wilson H., Doyle T.A. Lumbar lordosis: study of patients with and without low back pain. Clin Anat. 2003 Mar;16(2):144-7. Score: B</ref> found that there is no significant difference in lumbar lordosis between people with LBP and people without LBP. A 1999 study<ref name="4">Tüzün C., Yorulmaz I., Cindaş A., Vatan S. Low back pain and posture. Clin Rheumatol. 1999;18(4):308-12. Score: B</ref> concluded that there were no statistically significant differences in thoracic kyphosis, lumbar lordosis and sacral inclination between people with acute LBP, people with chronic LBP and a control group. Also a 2 other studies<ref name="5">Nakipoğlu G.F, Karagöz A., Ozgirgin N. The biomechanics of the lumbosacral region in acute and chronic low back pain patients. Pain Physician. 2008 Jul-Aug;11(4):505-11. Score: B</ref><ref name="6">Evcik D., Yücel A. Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int. 2003 Jul;23(4):163-5. Epub 2003 Jan 18. Score: B</ref> found no statistical difference in sacral inclination angle, lumbosacral angle, sacral horizontal angle and total and segmental lordosis angles between acute LBP patients and chronic LBP patients. Another study<ref name="7">Nourbakhsh M.R., Arab A.M. Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sports Phys Ther. 2002; 32(9):447–460. Score: B</ref> concluded that there is a relationship between LBP en muscle weakness, but they also concluded that structural factors – such as the size of the lumbar lordosis and the pelvic tilt – are not associated with LBP. Also Kim HJ et al.<ref name="8">Kim H.J., Chung S., Kim S., Shin H., Lee J., Kim S., Song M.Y. Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J. 2006 Apr;15(4):409-14. Epub 2005 Sep 7. Score: C</ref> concluded that an imbalance in trunk muscle strength can influence the lumbar lordosis. Furthermore this study also found that it is generally assumed that these muscles affect the shape of the lumbar spine and might be one risk factor for potential low back pain. But we also found a study<ref name="9">Tsuji T., Matsuyama Y., Sato K., Hasegawa Y., Yimin Y., Iwata H. Epidemiology of low back pain in the elderly: correlation with lumbar lordosis. J Orthop Sci. 2001;6(4):307-11. Score: B</ref> that concluded that the lumbar lordosis was significantly less in the LBP group compared with the group without LBP. | ||
Despite the conclusion of this last study, it is – based on all the above studies – not reasonable to conclude that there is a relationship between LBP and the size of the lumbar lordosis. On the other hand it is likely that trunk muscles weakness can influence the shape of the lumbar lordosis and might be a cause of LBP. | Despite the conclusion of this last study, it is – based on all the above studies – not reasonable to conclude that there is a relationship between LBP and the size of the lumbar lordosis. On the other hand it is likely that trunk muscles weakness can influence the shape of the lumbar lordosis and might be a cause of LBP. | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
The lumbar spine has an inward curvature or lordosis. A normal lumbar lordosis is characterized by a lumbosacral angle of 140°<ref name="1">Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum.</ref>. However, when the curvature of the lumbar spine is very pronounced, we talk about hyperlordosis or swayback. In case of hyperlordosis the lumbosacral angle increases and the lumbar index (the chord of the lumbar lordosis) also increases<ref name="1">Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum.</ref>. The causes of a hyperlordosis vary: [[Congenital Spine Deformities|congenital spine deformities]], an anterior tilt of the hip, short back muscles and thigh and hamstrings that are too weak. | The lumbar spine has an inward curvature or lordosis. A normal lumbar lordosis is characterized by a lumbosacral angle of 140°<ref name="1">Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum.</ref>. However, when the curvature of the lumbar spine is very pronounced, we talk about hyperlordosis or swayback. In case of hyperlordosis the lumbosacral angle increases and the lumbar index (the chord of the lumbar lordosis) also increases<ref name="1">Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum.</ref>. The causes of a hyperlordosis vary: [[Congenital Spine Deformities|congenital spine deformities]], an anterior tilt of the hip, short back muscles and thigh and hamstrings that are too weak. | ||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
It is uncertain that the shape of the lumbar spine differs between gender and different ethnic origins (Masharawi Y et al.<ref name="10">Masharawi Y., Salame K., Mirovsky Y., Peleg S., Dar G., Steinberg N., Hershkovitz I. Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging. Clin Anat. 2008 Jan;21(1):46-54. Score: B</ref> and Mosner EA et al.<ref name="11">Mosner E.A., Bryan J.M., Stull M.A., Shippee R. A comparison of actual and apparent lumbar lordosis in black and white adult females. Spine (Phila Pa 1976). 1989 Mar;14(3):310-4. Score: A2</ref>).<br> | It is uncertain that the shape of the lumbar spine differs between gender and different ethnic origins (Masharawi Y et al.<ref name="10">Masharawi Y., Salame K., Mirovsky Y., Peleg S., Dar G., Steinberg N., Hershkovitz I. Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging. Clin Anat. 2008 Jan;21(1):46-54. Score: B</ref> and Mosner EA et al.<ref name="11">Mosner E.A., Bryan J.M., Stull M.A., Shippee R. A comparison of actual and apparent lumbar lordosis in black and white adult females. Spine (Phila Pa 1976). 1989 Mar;14(3):310-4. Score: A2</ref>).<br> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
add text here<br><br> | add text here<br><br> | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
| Line 44: | Line 38: | ||
== Examination == | == Examination == | ||
As we assume that the muscles around the lumbar spine (abdominal, extensors of the spine, hip flexors, hamstrings and quadriceps) have an influence on the lumbar spine, it may be useful to measure and/or inspect the lumbar lordosis. An inspection can provide valuable information on muscle weakness. Therefore, it is recommended not to skip the inspection. We look at the depth of lumbar lordosis and any sagittal deviations. But an inspection remains subjective, therefore we also can use a number of instruments to measure the lumbar lordosis, such as the flexible ruler. However, several studies indicate that the reliability of this instrument remains a matter of debate. Bryan JM et al.<ref name="12">Bryan J.M., Mosner E., Shippee R., Stull M.A. Investigation of the flexible ruler as a noninvasive measure of lumbar lordosis in black and white adult female sample populations. J Orthop Sports Phys Ther. 1989;11(1):3-7. Score: B</ref> concluded that the flexible ruler a poor validity has in the assessment of actual lumbar lordosis. And Franklin W Lovell et al.<ref name="13">Lovell F.W., Rothstein J.M., Personius W.J. Reliability of Clinical Measurements of Lumbar Lordosis Taken with a Flexible Rule. Physical Therapy/Volume 69, Number 2/February 1989. Score: B</ref> concluded that the flexible ruler might be reliable as clinical measurement of lumbar lordosis, but only if it is taken by the same therapist over a short period of time.<br> | As we assume that the muscles around the lumbar spine (abdominal, extensors of the spine, hip flexors, hamstrings and quadriceps) have an influence on the lumbar spine, it may be useful to measure and/or inspect the lumbar lordosis. An inspection can provide valuable information on muscle weakness. Therefore, it is recommended not to skip the inspection. We look at the depth of lumbar lordosis and any sagittal deviations. But an inspection remains subjective, therefore we also can use a number of instruments to measure the lumbar lordosis, such as the flexible ruler. However, several studies indicate that the reliability of this instrument remains a matter of debate. Bryan JM et al.<ref name="12">Bryan J.M., Mosner E., Shippee R., Stull M.A. Investigation of the flexible ruler as a noninvasive measure of lumbar lordosis in black and white adult female sample populations. J Orthop Sports Phys Ther. 1989;11(1):3-7. Score: B</ref> concluded that the flexible ruler a poor validity has in the assessment of actual lumbar lordosis. And Franklin W Lovell et al.<ref name="13">Lovell F.W., Rothstein J.M., Personius W.J. Reliability of Clinical Measurements of Lumbar Lordosis Taken with a Flexible Rule. Physical Therapy/Volume 69, Number 2/February 1989. Score: B</ref> concluded that the flexible ruler might be reliable as clinical measurement of lumbar lordosis, but only if it is taken by the same therapist over a short period of time.<br> | ||
== Medical Management <br> == | == Medical Management <br> == | ||
| Line 60: | Line 54: | ||
== Clinical Bottom Line == | == Clinical Bottom Line == | ||
Add text here<br> | Add text here<br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
| Line 72: | Line 66: | ||
see [[Adding References|adding references tutorial]]. | see [[Adding References|adding references tutorial]]. | ||
<references /> | <references /> | ||
<br> | |||
[[Category:Condition]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]][[Category:Lumbar]] | |||
Revision as of 17:31, 7 April 2013
Original Editors - Leen Meylemans
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Is there a relationship between low back pain (LBP) and hyperlordosis?[edit | edit source]
Is there a relationship between low back pain (LBP) and hyperlordosis?
A 2004 studyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and a 2003 studyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title found that there is no significant difference in lumbar lordosis between people with LBP and people without LBP. A 1999 studyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title concluded that there were no statistically significant differences in thoracic kyphosis, lumbar lordosis and sacral inclination between people with acute LBP, people with chronic LBP and a control group. Also a 2 other studiesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title found no statistical difference in sacral inclination angle, lumbosacral angle, sacral horizontal angle and total and segmental lordosis angles between acute LBP patients and chronic LBP patients. Another studyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title concluded that there is a relationship between LBP en muscle weakness, but they also concluded that structural factors – such as the size of the lumbar lordosis and the pelvic tilt – are not associated with LBP. Also Kim HJ et al.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title concluded that an imbalance in trunk muscle strength can influence the lumbar lordosis. Furthermore this study also found that it is generally assumed that these muscles affect the shape of the lumbar spine and might be one risk factor for potential low back pain. But we also found a studyCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title that concluded that the lumbar lordosis was significantly less in the LBP group compared with the group without LBP.
Despite the conclusion of this last study, it is – based on all the above studies – not reasonable to conclude that there is a relationship between LBP and the size of the lumbar lordosis. On the other hand it is likely that trunk muscles weakness can influence the shape of the lumbar lordosis and might be a cause of LBP.
Clinically Relevant Anatomy[edit | edit source]
The lumbar spine has an inward curvature or lordosis. A normal lumbar lordosis is characterized by a lumbosacral angle of 140°Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. However, when the curvature of the lumbar spine is very pronounced, we talk about hyperlordosis or swayback. In case of hyperlordosis the lumbosacral angle increases and the lumbar index (the chord of the lumbar lordosis) also increasesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The causes of a hyperlordosis vary: congenital spine deformities, an anterior tilt of the hip, short back muscles and thigh and hamstrings that are too weak.
Epidemiology /Etiology[edit | edit source]
It is uncertain that the shape of the lumbar spine differs between gender and different ethnic origins (Masharawi Y et al.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and Mosner EA et al.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title).
Characteristics/Clinical Presentation[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
As we assume that the muscles around the lumbar spine (abdominal, extensors of the spine, hip flexors, hamstrings and quadriceps) have an influence on the lumbar spine, it may be useful to measure and/or inspect the lumbar lordosis. An inspection can provide valuable information on muscle weakness. Therefore, it is recommended not to skip the inspection. We look at the depth of lumbar lordosis and any sagittal deviations. But an inspection remains subjective, therefore we also can use a number of instruments to measure the lumbar lordosis, such as the flexible ruler. However, several studies indicate that the reliability of this instrument remains a matter of debate. Bryan JM et al.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title concluded that the flexible ruler a poor validity has in the assessment of actual lumbar lordosis. And Franklin W Lovell et al.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title concluded that the flexible ruler might be reliable as clinical measurement of lumbar lordosis, but only if it is taken by the same therapist over a short period of time.
Medical Management
[edit | edit source]
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
http://www.nlm.nih.gov/medlineplus/ency/article/003278.htm
http://bigbackpain.com/posture.html#swayback
Clinical Bottom Line[edit | edit source]
Add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
