Low Back Pain Related to Hyperlordosis

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Original Editors - Leen Meylemans

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The lumbar spine has an inward curvature or lumbar lordosis. When this curvature is very pronounced, we talk about hyperlordosis or swayback. A normal lordosis is characterized by a lumbosacral angle of 140 °. In a hyperlordosis this angle increases and the lumbar index (the chord of the lumbar lordosis) also increases. The causes of a hyperlordose vary: congenital, an anterior tilt of the hip, short backmuscles and thigh and hamstrings that are too weak.
What is the relationship between hyperlordosis and low back pain (LBP)? Mohammad Reza Nourbakhsh et al. found a significant correlation between LBP and a reduced endurance of the extensors of the back, a reduced strength of the hip flexors, adductors and abdominal muscles and a reduced length of the back extensors. The relationship between LBP and the shape of the lumbar spine has not been demonstrated. They found no relationship between the strength and length of the muscles and a hyperlodosis or a tilt of the hip. Kim HJ et al. found a strong relationship between the strength and endurance of the muscles and the lumbar lordosis. It remains a point of discussion, but it is generally assumed that these muscles affect the shape of the lumbar spine. Barbara J. Norton et al. found no relationship between the incidence of LBP and lumbar lordosis.
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 or inspect the lumbar lordosis. We look at the depth of lumbar lordosis and any sagittal deviations. But an inspection remains subjective. It is uncertain that the shape of the lumbar spine differs between gender and different ethnic origins (Masharawi Y et al Mosner and EA et al.). We can use a number of instruments to measure the lumbar lordosis, such as the flexible rule. The reliability of this instrument remains a matter of debate (Bryan JM et al, Franklin W Lovell et al).
In practice it is recommended not to skip the inspection. Despite the subjectivity, it can provide valuable information.

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http://www.nlm.nih.gov/medlineplus/ency/article/003278.htm
http://bigbackpain.com/posture.html#swayback

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<references /• Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum
• Relationship Between Mechanical Factors and Incidence of Low Back Pain. Mohammad Reza Nourbakhsh, Amir Massoud Arab. J Orthop Sports Phys Ther. 2002; 32(9):447–460.
• Influences of trunk muscles on lumbar lordosis and sacral angle. Kim HJ, Chung S, Kim S, Shin H, Lee J, Kim S, Song MY. Eur Spine J. 2006 Apr;15(4):409-14. Epub 2005 Sep 7.
• Differences in Measurements of Lumbar Curvature Related to Gender and Low Back Pain. Barbara J. Norton, Shirley A. Sahrmann, Linda R. Van Dillen. J Orthop Sports Phys Ther. 2004;34(9):524-534
• Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging. Masharawi Y, Salame K, Mirovsky Y, Peleg S, Dar G, Steinberg N, Hershkovitz I. Clin Anat. 2008 Jan;21(1):46-54.
• A comparison of actual and apparent lumbar lordosis in black and white adult females. Mosner EA, Bryan JM, Stull MA, Shippee R. Spine (Phila Pa 1976). 1989 Mar;14(3):310-4.
• Investigation of the flexible ruler as a noninvasive measure of lumbar lordosis in black and white adult female sample populations. Bryan JM, Mosner E, Shippee R, Stull MA. J Orthop Sports Phys Ther. 1989;11(1):3-7.
• Reliability of Clinical Measurements of Lumbar Lordosis Taken with a Flexible Rule. Franklin W Lovell, Jules M Rothstein, Walter J Personius. Physical Therapy/Volume 69, Number 2/February 1989 >