Lordosis of the lumbar spine

Lumbar lordosis is a special condition of the spine, which is observed both in the norm and in pathology. It is worth noting that in natural conditions the spine is not absolutely straight. It has both bends and protrusions that form irregularities. This is of great physiological importance, since a straight spine is more susceptible to injury. Natural bends act as shock absorbers that soften impacts and pressure on the spine.

Lumbar lordosis norms

Normally, each person has a fairly well-defined lumbar lordosis. It is represented by a curve in the opposite direction in the lumbar region. It functions as a shock absorber and protects the spinal cord from mechanical damage. But if this curve is excessively expressed, it is a pathological condition.

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Epidemiology

According to statistics, lumbar lordosis, as a natural physiological condition, occurs in about 95% of cases, while in 5% of cases this bend is not observed at all, which is abnormal. As for excessively pronounced lordosis, which is considered a pathology, it is observed in about 32% of cases. As practice shows, it is possible to get rid of excessively pronounced lordosis in the lumbar region with the help of specially selected physical exercises, as well as with the help of physiotherapy, massage, manual therapy. It is believed that every fifth adult on earth suffers from lumbar lordosis. However, this disease occurs both in old and young people. In our country, there are over 25 million people who suffer from lumbar lordosis, which is accompanied by displacement of the vertebrae, pinched nerves. Moreover, in this case, the disease is accompanied by pain syndrome. Most patients are registered with a dispensary due to the fact that the disease acquires chronic features. Different stages and types of pathology can last for quite a long time, for years and decades. Periodically, exacerbations may occur. Some stages may proceed latent and asymptomatically.

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Causes lumbar lordosis

Lordosis in the lumbar region can go beyond the norm for various reasons. This can be a long stay in the wrong position. In general, each person is initially born without any curves. They are formed gradually, during the first year of life and form natural curves, which subsequently provide the most comfortable and effective body position during walking, sitting, physical activity.

It can be said that a person's being in an upright position is in itself a cause and prerequisite for the development of lordosis. The first lordosis is formed in a child due to the ability to hold the head in an upright position. The second bend is associated with upright walking and is formed when the child learns to walk and stand. It is at this time that the second bend is formed in the lumbar region, which is aimed at unloading the spine and ensuring the optimal position of the spine.

Another common cause of lumbar lordosis is insufficient load on the musculoskeletal system. Previously, it was believed that lordosis was caused by excessive load on bones and muscles, but later it was shown that this is not the case. Only hypodynamia and low levels of physical activity lead to low levels of physical activity. It is the lack of constant, systematic loads on the spine that has a negative effect. Lack of long walks, running, frequent use of transport, insufficient level of physical education, sports.

Indirect causes of lordosis include hormonal imbalance, decreased immune processes, and other associated pathologies. Lordosis can increase with age due to the development of degenerative and dystrophic processes in the body. Vitamin deficiency can lead to weakening of the skeletal muscles, paravertebral muscles. The skeletal system and joints also weaken, become less mobile, more fragile, and more susceptible to injury and damage.

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Risk factors

The risk factor group primarily includes low levels of physical activity. Thus, risk factors are those factors that increase the likelihood of developing the disease. Thus, the risk group includes people who lead a sedentary lifestyle, who are prone to hypodynamia. These are people who, due to their professional duties, are forced to spend a long time in one position: sit for a long time, or be in a standing position. For example, the risk group includes people of such professions as accountants, economists, cashiers, operators, programmers, creative people who spend a lot of time near the computer. Another characteristic feature is that people who do not engage in any sports, do not do any exercises or gymnastics, spend little time outdoors are at significant risk. People with various injuries and damages also belong to the risk group due to the fact that they are forced to lie down or sit for a long time. The mobility of a person suffering from diseases of the musculoskeletal system and other organs and systems largely limits the mobility of a person, which can also be attributed to risk factors.

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Pathogenesis

The pathogenesis is based on the violation of the normal curvature of the spine in the lumbar region, in which it sharply bends forward, which has a very unnatural appearance. It is worth noting that with lumbar lordosis, there is high mobility of the lumbar spine. In addition, muscle tone in the muscles along the spine is disrupted, which entails displacement of the vertebrae, impaired blood circulation and innervation of the vertebrae and intervertebral discs. It develops especially often at a young age due to the fact that the body has high mobility and plasticity. Due to the lack of loads and forced body position, characteristic restructurings are noted.

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Cervical and lumbar lordosis

They are formed as natural curves of the spine. Cervical lordosis is formed when the child learns to hold his head straight. Lumbar lordosis is formed in connection with the ability to walk and stand straight. It has an important protective value, occupies a natural position of the body, and also acts as a shock absorber.

Pathological cases that require timely treatment and diagnostics are also often observed. Diagnostics are primarily based on instrumental research methods. The essence of these methods is that they allow detecting displacement or excessive curvature of the spinal column. The main research method is the X-ray method. Functional tests are also used. For example, the Ferguson method is used to assess lumbar lordosis, which allows measuring the angle of deviation of the scoliotic curvature of the spine. It is carried out on the basis of an X-ray image. Other methods are practically not used, since they are uninformative.

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Symptoms lumbar lordosis

The main symptoms of lumbar lordosis include an unnatural, excessively pronounced forward curvature of the spine. As a rule, there is no pain or discomfort in this condition. Some patients note that they feel slight discomfort, which manifests itself as pain in the lumbar region, as well as a feeling as if there is an excessive forward bend of the body. The body takes on an unnatural position. If this occurs, the spine bends and the vertebra shifts, which affects the nerves, intervertebral structures. With a strong shift, intervertebral discs can become pinched, and the spinal cord can be damaged.

The first signs of lumbar lordosis are visual changes, the essence of which is that the spine is excessively bent forward. It is worth noting that if such a person is placed against a wall and asked to press himself as close to his back as possible. If you try to place your hand between the back and the wall, you can do it quite easily. The more severe the pathology, the more pronounced the bend, and the greater the distance between the wall and the lower back. Pain is rarely felt, mainly with advanced pathology. Gradually, as the pathology intensifies, the stomach moves forward as much as possible.

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Lumbar lordosis in children

In children, lumbar lordosis develops from the period when the child begins to walk and stand. This means that as the load on the lumbar column increases, a corresponding curvature of the spine appears. Since the child's spine, like all other bones, is quite mobile and labile, as well as soft, elastic, lordosis in children develops much faster.

It is worth noting that due to the high mobility and flexibility of the spine, it is also easy to correct. For this, special exercises are used to prevent lordosis. I would like to emphasize that there is one pattern: the more often you exercise, the more adequate and systematic the load, the less likely the pathology is to develop. In addition, during training, the impact is not only on the spine itself, but also on nerve fibers, blood vessels, muscles, which creates a reliable framework and prevents further deterioration of the condition, fixing the spine in one position.

It is necessary to consult a doctor if you suspect the development of pathology. So, if you feel that your spine is bending unnaturally, you should consult a doctor. An orthopedist or surgeon will help best. If you have been injured, you should consult a traumatologist. Differential diagnostics are important. Most often, it is necessary to differentiate lumbar lordosis from scoliosis, thoracic kyphosis, spinal curvatures or injury. In addition, it is extremely important to determine whether lordosis is a natural physiological condition or a pathological condition. It is also important to determine the angle of deviation.

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Stages

Conventionally, three stages of lumbar lordosis formation are distinguished. The first stage is conventionally considered a normal variant, in which a natural physiological curve develops. During the second stage, an excessive curve develops, in which the spine begins to bend forward too much and form a pathological curve. In the third stage, the stomach moves forward strongly, a depression forms in the spine, and the spine moves forward. The second stage is easiest to correct, while the third requires long-term treatment and special correction.

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Forms

There are two types of lumbar lordosis - normal and pathological. Normal is a natural physiological curve that every person should have to ensure the normal state of the body. As for the pathological condition, it means excessive forward bending of the spine, in which the abdomen also moves forward, and the sacrum area goes back.

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Physiological lumbar lordosis

A child under one year of age develops a natural physiological curve, which is formed due to the fact that a load is created on the spine. Lumbar lordosis is designed to relieve the lower back, remove excessive load. Evenly distribute it across all parts of the spine.

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Smoothed lordosis of the lumbar region

By smoothed lordosis of the lumbar region is meant the curvature of the spine in the lumbar region, which is not expressed clearly enough, is smoothed out by other sections, as well as with the help of muscles. A special role is played by the muscles located along the spine, the lumbar muscle, as well as the latissimus dorsi.

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Flattened lumbar lordosis

Flattened lumbar lordosis means that the spine in the lumbar region is smoothed out and becomes flatter. Accordingly, the configuration of the entire spine changes. All other parts of the spine look different.

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Absence of lumbar lordosis

There are cases when lumbar lordosis is completely absent. This is due to the fact that a person sits for a long time or is in one position. It should be taken into account that the absence of lordosis can negatively affect the condition of the spine as a whole, as well as the condition of the body as a whole. A characteristic feature is that the spine has an absolutely straight appearance, or there is a bend only in the cervical spine. In addition to increasing the load on the spine, the pressure and load on the internal organs also increases.

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Lumbar lordosis is preserved

Most people should normally have a moderate lumbar lordosis. It is a curve in the lumbar spine. In this case, in the lordosis zone, the front part of the discs and vertebral bodies is higher than the back. The curve provides springy movements in the lordosis area, which is very important for softening the shocks and impacts transmitted along the spine when walking, running, jumping.

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Lumbar lordosis is increased and pronounced

Many people may notice an increase in lumbar lordosis. This is a condition in which the curvature is quite pronounced. At least three main forms of this condition can be distinguished. Firstly, there is a strong tension and compression of the membranes of the spinal cord and spinal nerve roots. This may lead to pinching of the dura mater of the spinal cord. Usually, this condition is accompanied by severe pain that occurs at the moment when tension and movement occur. The pain may stop if the pathology is treated correctly. But usually in such a case, increased sensitivity develops, which almost never completely disappears and is difficult to treat.

The second form is much less common and occurs due to a special reaction of the immune system. Autoimmune aggression develops, in which an excessively large number of antibodies are produced. They ensure the elimination of pathogens, and also eliminate non-viable cells and tissues. But with excessive activity of the immune system, autoimmune aggression develops, in which the immune system attacks and destroys the cells of its own body. This form is largely determined genetically.

The third mechanism is caused by trauma, external impact on the lumbar spine.

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Lumbosacral lordosis

Damage to the lumbosacral spine, the formation of lordosis in this area is usually accompanied by severe pain, swelling. This is due to the fact that in this area there are usually quite a lot of nerve fibers, receptors. Tension often develops in this area, the nerve roots are stretched, which entails severe pain. Sensitivity also increases significantly. The process can be accompanied by swelling of the root, fibrosis, which subsequently leads to the degeneration of nerve fibers. In the event that the root stops being compressed, relief occurs (if the root is released from tension).

The displacement of the vertebrae can lead to the development of a hernia. The danger is that the hernia can often grow together with damaged nerve fibers. In this case, it seems as if the nerve is walled up in fibrous tissue. In this case, sensitivity to changes in the position of the vertebra when the body moves increases sharply. Any movement is accompanied by pain.

The main method of treatment is physical activity, performing motor exercises. Special therapeutic physical training (LFK) has proven itself well. You can use a wide range of exercises to restore and correct the spine. Rhythmic gymnastics, yoga of the spine, callanetics, aerobics, special therapeutic exercises for the spine are widely used. Breathing and relaxing practices are also used. Massage techniques and manual therapy are effective. Yoga is considered a good restorative tool, especially yoga therapy. Qigong, Chinese health practices, gymnastics for the spine (Eastern, European methods) have proven themselves well. Physiotherapy procedures, special corsets, bandages can contribute to complex treatment. Sometimes surgical treatment methods are used.

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Thoracic kyphosis and lumbar lordosis

Quite often, thoracic kyphosis and lumbar lordosis develop with spinal pathologies. The cause is often an insufficient load level or its incorrect distribution along the spine. Excessively pronounced lordosis can lead to overstretching of the posterior ligaments of the spine. In this case, severe, sharp pain develops, which is deep and constant. Usually, it is quite difficult to feel the exact source of pain, since it does not have a precise localization, is characterized as diffuse, radiating. It is accompanied by periodic improvements and deterioration of the condition.

The pathological condition requires mandatory treatment. For any pathologies of the musculoskeletal system, the main method of treatment is physical activity on the spine. A doctor or exercise therapy instructor or yoga therapist will tell you how to choose the right exercises. It is also worth noting that swimming and various hydromassage procedures are widely used for treatment. It should be taken into account that only a comprehensive approach, as well as adherence to the principle of regularity and systematic training, will effectively solve the problem.

In addition to exercise therapy, treatment with positioning, correction of the lumbar spine, treatment with the use of positions, a plaster bed are used. Surgical treatment is used in case of late diagnosis, as well as if conservative treatment is not effective.

Special exercises aimed at working the intervertebral discs, the muscles located between the vertebrae and along the spine itself also have a positive effect.

Physiotherapeutic treatment methods have found wide application. One of the most important methods of physiotherapeutic influence is ultrasound, microcurrents, waves of different lengths, electrophoresis, cryoprocedures, thermal procedures, electrical procedures.

An important role is given to segmental-reflex massage, reflexology, acupuncture, point massage (shiatsu), and vertebral impact.

The central place is given to breathing exercises: the blood is saturated with oxygen, and physical activity becomes possible. A separate place is occupied by exercises for coordination, development of strength, speed. It is necessary to include exercises for balance, since they train the vestibular apparatus, correct posture.

As an additional means for lumbar lordosis, a special corset can be recommended, aimed at maintaining the optimal condition of the spine and muscle frame. It is also important that the corset provides reliable fixation of the spine.

A bandage is also used, which is aimed at unloading the lumbar region, as a result of which lordosis is normalized. The bandage is considered exclusively as an auxiliary means, without which full treatment and maintenance of a normal condition is impossible.

Complications and consequences

Any, even minimal trauma can lead to adverse effects and complications. The most unfavorable condition is the development of edema, fibrous degeneration of the tissue of the intervertebral discs, nerve fibers. A special complication is the formation of a hernia. It is especially dangerous if this hernia subsequently grows together with the nerve fibers. In this case, the nerve fiber is walled up in scar tissue. As the pathology progresses, it can lead to the nerve dying off. Usually, the sensitivity of the nerve fiber increases sharply. Venous congestion and edema often develop. With lumbar lordosis, autoimmune processes, degenerative and dystrophic consequences appear.

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Diagnostics lumbar lordosis

Diagnostics are based primarily on instrumental research methods that allow us to identify bone pathology, displacement, or excessive curvature of the spinal column. For this purpose, the X-ray method is most often used, and functional tests are less common. The use of laboratory methods in this case is inappropriate.

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Ferguson's method for assessing lumbar lordosis

This method allows you to measure the angle of deviation of the scoliotic curvature of the spine. This will require an X-ray image. On the image, select the vertebra that protrudes to the side the most. In the center of the body of this vertebra, put a point. Then select two vertebrae (one on top, the other on the bottom). These vertebrae should deviate from the norm the least, the least protrude. After this, draw two lines through the center of the first and second points, as well as two lines between the second and third lines. Lines are also drawn between these lines, after which the angle between these lines is measured. The resulting angle is the Ferguson angle we are looking for.

Instrumental diagnostics

The main method of instrumental diagnostics is the X-ray examination method, which allows determining the presence or absence of changes in the spine, allows calculating the magnitude of deviation in the spine. The main images are taken in two projections - in a standing position and in a lying position. Other methods are practically not used, since they are uninformative.

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Differential diagnosis

The essence of differential diagnostics is to differentiate the signs of one disease from the signs of another disease if the symptoms are similar and have common features. Most often, it is necessary to differentiate lumbar lordosis from scoliosis and traumatic curvatures of the spine, and also to determine whether lordosis is a natural physiological condition, or whether it goes beyond the norm and should already be considered a pathology. It is also important to determine the angle of deviation.

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Treatment lumbar lordosis

The main method of treating this pathology is physical activity, performing motor exercises. This is the main means that is truly effective in restoring the spine. No other means can compare with physical exercises. Special therapeutic physical training (LFK), represented by an extensive set of exercises for restoring and correcting the spine, has proven itself well. Massage and manual therapy techniques are no less effective, but without adequate motor activity, these methods are ineffective.

Yoga, especially yoga therapy, is considered a good restorative tool. There is a special section – yoga of the spine, since yoga believes that a healthy spine is the key to our health. It contains the main vital force, energy, and activity of a person. This section of yoga contains a set of exercises designed to specifically affect the spine.

Qigong, Chinese health practices, gymnastics for the spine (Eastern, European methods) have proven themselves well. Various methods of treating lordosis according to Bubnovsky, the author's rehabilitation methods of Sergey Valentinovich Ovcharenko (especially methods created on the basis of I Jin Jing, qigong), yoga and yoga therapy complexes by Andrey Sidersky have also found wide practical application. It is almost impossible to restore the spine without proper breathing. The yoga complex "pranayama" has proven itself well, as well as various kriyas (exercises for cleaning and complex development of the spine, paravertebral muscles located along the spinal column and intervertebral discs).

Physiotherapeutic procedures, special corsets, and bandages can contribute to the complex treatment of lumbar lordosis. Sometimes surgical treatment methods and hyperextension are used.

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Prevention

Prevention is based on hygiene rules, correct posture (you need to monitor the correct body position when walking, sitting, lying down). If possible, you need to change your position and type of activity as often as possible, it is not recommended to sit in one position for a long time. You also need to sleep in the correct position, if necessary, use special orthopedic mattresses, pillows. One of the main measures is regular exercise, an active lifestyle, proper nutrition, consumption of the required amount of vitamins and minerals. It is important to undergo regular preventive examinations, if necessary - timely treatment.

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Forecast

The course and prognosis of the disease depend on the severity of the disease, its expression, and the treatment or lack thereof. If the cause is identified in a timely manner and the necessary treatment is administered, the prognosis will be favorable. Usually, lumbar lordosis is fairly easy to treat. However, if diagnosis and treatment are delayed, the prognosis may be unpredictable, even leading to disability.

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Permanent disability group

The concept of permanent disability in relation to children is established in three cases. In the first case, this category applies to a person who has not reached the age of majority, if he or she has the category of "disabled child". This category can be established no later than 2 years after the initial diagnosis.

In the second case, permanent disability may be granted if no positive dynamics have been observed within 4 years after the initial diagnosis, even despite the fact that intensive rehabilitation measures have been carried out. Moreover, the unconditional basis for permanent disability is the deterioration of the condition against the background of rehabilitation therapy.

The third case also applies to children and occurs if the primary diagnosis was made no later than a 6-year period after the diagnosis was made and is noted if the child is diagnosed with a complicated malignant tumor.

As for adults, permanent disability is given to women after 55 years and men after 60 years. Cases in which a person has had a disability for 15 years and, despite treatment and rehabilitation, no improvement is observed are considered as special circumstances. Also included in this category are WWII veterans, defenders of the Motherland, and all persons who became disabled in the course of performing official duties, during service.

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