Low Back Pain Related to Hyperlordosis
Original Editors - Leen Meylemans
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Search Strategy[edit | edit source]
I used following information sources:
- A bookCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Database Pubmed
Keywords: low back pain, lumbar lordosis, hyperlordosis, swayback, measurement
Definition/Description[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]
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Characteristics/Clinical Presentation[edit | edit source]
When the curvature of the lumbar spine is very pronounced, we talk about hyperlordosis or swayback. In a hyperlordosis this angle increases and the lumbar index (the chord of the lumbar lordosis) also increases.[1]
The causes of a hyperlordose vary: congenital, an anterior tilt of the hip, short backmuscles and thigh and hamstrings that are too weak.
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Key Research[edit | edit source]
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Resources
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http://www.nlm.nih.gov/medlineplus/ency/article/003278.htm
http://bigbackpain.com/posture.html#swayback
Clinical Bottom Line[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 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 a.[2]l Mosner EA et al.[3]). 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 (ref), Franklin W Lovell et al[4]).
In practice it is recommended not to skip the inspection. Despite the subjectivity, it can provide valuable information.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Bewegingsleer, de romp en wervelkolom. I.A. Kapandji. 2009, p76-77, Bohn Stafleu van Loghum
- ↑ 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. Score: B
- ↑ 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. Score A2
- ↑ 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. Score: B
