Lordosis of the lumbar spine

Lumbar lordosis is a special condition of the spine, which is observed both in normal and pathological conditions. It is worth noting that in vivo the spine is not completely flat. It has both bends and protrusions that form irregularities. This is of significant physiological importance, because the even spine is more prone to injury. Natural curvatures act as shock absorbers that cushion shocks and pressure on the spine.

Lumbar lordosis rates

Normally, each person has a fairly well pronounced lumbar lordosis. Represented by a bend in the opposite direction in the lumbar region. It acts as a shock absorber and protects the spinal cord from mechanical damage. But in the event that this bend is expressed excessively, it is a question of a pathological condition.

[1], [2], [3], [4]

Epidemiology

According to statistics, lumbar lordosis, as a natural physiological condition occurs in approximately 95% of cases, whereas in 5% of cases of this bend is not observed at all, which is abnormal. As for excessively pronounced lordosis, which is considered as 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 in the elderly and at a young age. In our country, there are over 25 million people who suffer from lumbar lordosis, which is accompanied by displacement of the vertebrae, pinched nerves. And in this case, the disease is accompanied by pain. Most patients are in the dispensary due to the fact that the disease takes on chronic features. Different stages and types of pathology can last for quite a long time, for years and decades. Periodically may occur aggravation. Some stages may be hidden and asymptomatic.

[5], [6], [7], [8], [9]

Causes of the lumbar lordosis

Lordosis in the lumbar spine may extend beyond the norm for various reasons. It may be a long stay in the wrong position. In general, each person was born without any bends. They are formed gradually, during the first year of life and form natural bends, which further provide the most comfortable and effective body position during walking, sitting, physical activity.

It can be said that a person being in an upright position is in itself a cause and a prerequisite for the development of lordosis. The first lordosis is formed in a child due to the ability to keep his head upright. The second bend is associated with upright walking and is formed when the child learns to walk, 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 an insufficient load on the musculoskeletal system. Previously it was thought that the cause of lordosis is an excessive load on the bones and muscles, but later it was shown that this is not the case. Only hypodynamia and a low level of motor activity leads to a low level of motor activity. It is the absence of constant, systematic loads on the spine that have a negative effect. The absence of long walking, running, frequent use of transport, insufficient level of physical culture, sports.

Indirectly, the cause of lordosis is hormonal imbalance, reduced immune processes, and other associated pathologies. Lordosis can increase with age, due to the development of degenerative and dystrophic processes in the body. A lack of vitamin can lead to a weakening of the skeletal muscles, paravertebral muscles. The bone system, the joints also weaken, become less mobile, more fragile, more prone to injury and damage.

[10], [11], [12]

Risk factors

In the group of risk factors falls in the first place, a low level of physical activity. Thus, risk factors are those factors that increase the likelihood of developing a disease. So, at risk are people who lead a sedentary lifestyle, who are prone to physical inactivity. These are people who, by virtue of their professional duties, have to spend a long time in one position: sit long, or be in a standing position. For example, people in such occupations as an accountant, economist, cashiers, operators, programmers, creative people who spend a lot of time near a computer fall into the risk group. It is also a characteristic feature that people who are not engaged in any kind of sports, do not do any gymnastics, do not spend much time outdoors, are significantly at risk. People with various injuries and injuries are also at risk because they have 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, greatly limits the mobility of a person, which can also be attributed to risk factors.

[13], [14], [15], [16], [17], [18]

Pathogenesis

The basis of pathogenesis is a 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 a high mobility of the lumbar spine. In addition, muscle tone in the muscles along the spine is impaired, which leads to displacement of the vertebrae, impaired blood circulation and innervation of the vertebrae and intervertebral discs. Especially often develops at a young age due to the fact that the body has a high mobility, plasticity. Due to the lack of stress and the forced position of the body, characteristic adjustment is noted.

[19], [20]

Cervical and lumbar lordosis

Formed as natural curves of the spine. Cervical lordosis is formed when a child learns to keep his head even. Lumbar lordosis is formed due to the ability to walk and stand smoothly. It has an important protective value, occupies the natural position of the body, and also acts as a shock absorber.

Often there are pathological cases that require timely treatment and diagnosis. The basis of the diagnosis is primarily instrumental methods of research. The essence of these methods is that they allow you to identify the displacement, or excessive bending of the spinal column. The main research method is the radiological method. Functional tests are also applied. For example, the Ferguson method is used to assess lumbar lordosis, which allows you to measure the angle of deflection of the scoliotic curvature of the spine. Conducted on the basis of x-ray. Other methods are practically not used, since they are uninformative.

[21], [22], [23]

Symptoms of the lumbar lordosis

As the main symptoms of lumbar lordosis consider unnatural, overly pronounced forward bending of the spine. As a rule, in this state, neither pain nor discomfort is noted. Some patients note that they experience mild discomfort, which is manifested by pain in the lumbar region, as well as a feeling that the body is bending too far forward. The body takes on an unnatural position. If this causes the spinal curvature and displacement of the vertebra, which affects the nerves, intervertebral structures. With a strong displacement can occur clamping of intervertebral discs, damage to the spinal cord.

The first signs of lumbar lordosis are visual changes, the essence of which is reduced to the fact that the spine is excessively curved forward. It is worth noting that if such a person is put against the wall, and ask to lean against the back as much as possible. If you try to place your hand between your back and the wall, you can do it quite freely. The heavier the pathology, the more pronounced the bend, and the greater the distance between the wall and the loin. Pain is rarely felt, mainly when the pathology is neglected. Gradually, as the pathology strengthens, the belly goes forward as much as possible.

[24], [25], [26]

Lumbar lordosis in children

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

It is worth noting that due to the high mobility and flexibility of the spine, it is also easy to correct. To do this, use special exercises aimed at preventing 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 development of pathology. In addition, in the process of training, the impact is not only on the spine itself, but also on the nerve fibers, blood vessels, muscles, which creates a reliable frame and prevents deterioration in the future, 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 curving in an unnatural way, you should consult a doctor. The orthopedic surgeon will help you in the best way. If you are injured, it is worth contacting a traumatologist. Differential diagnosis is important. Most often, lumbar lordosis has to be differentiated from scoliosis, thoracic kyphosis, spinal curvature, or trauma. In addition, it is extremely important to determine whether lordosis is a natural physiological condition, or it is a pathological condition. It is also important to determine the angle of deflection.

[27], [28], [29], [30], [31]

Stages

Conditionally there are three stages of the formation of lumbar lordosis. The first stage is conventionally regarded as a variant of the norm, at which the natural physiological bend develops. During the second stage, excessive bending develops, in which the spine begins to bend forward too much and form a pathological bend. In the third stage, the abdomen moves forward strongly, a cavity is formed in the spine, the spine moves forward. It is easiest to correct the second stage, while the third requires long-term treatment, special correction.

[32], [33], [34]

Forms

There are two types of lumbar lordosis - normal and pathological. Normal is a natural physiological bend, which normally should be in every person to ensure the normal state of the body. As for the pathological condition, it implies excessive forward bending of the spine, in which the stomach also moves forward and the sacrum area goes backwards.

[35], [36], [37], [38]

Physiological lumbar lordosis

A child under one year old forms 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, relieve excessive load. Evenly distribute it to all parts of the spine.

[39], [40], [41], [42], [43], [44]

Smoothed lumbar lordosis

By smooth lordosis of the lumbar region imply a curvature of the spine in the lumbar region. Which is not clearly expressed, smoothed by other departments, 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 muscle.

[45], [46]

Flattened lumbar lordosis

Under the flattened lumbar lordosis imply that the spine in the lumbar region is smoothed and becomes flatter. Accordingly, the configuration of the entire spine changes. Otherwise, all the other spinal sections also look different. 

[47], [48], [49]

Lack of lumbar lordosis

There are cases in which the 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 borne in mind that the absence of lordosis may adversely affect the state of the spine as a whole, as well as the state of the body as a whole. A characteristic feature is that the spine has a completely flat appearance, or there is a bend only in the region of the cervical spine. In addition to increasing the load on the spine, the pressure and load on the internal organs also increase.

[50], [51], [52], [53]

Lumbar lordosis saved

Most people normally have moderate lumbar lordosis. It is a bend in the lumbar spine. At the same time, in the lordosis zone, the front part of the disks and vertebral bodies is higher than the back. The bend provides springy movements in the area of lordosis, which is very important for mitigating shocks and blows transmitted along the length of the spine when walking, running, jumping.

[54], [55]

Lumbar lordosis strengthened, pronounced

For many people, lumbar lordosis gains can be noticed. This is a condition in which the bend is expressed quite strongly. There are at least three main forms of occurrence of such a condition. First, there is a strong tension and compression of the membranes of the spinal cord and spinal nerve roots. This can lead to pinching of the hard shell of the spinal cord. Usually such a state is accompanied by severe pain that occurs at the moment when tension, movement occurs. The pain may stop if the pathology is properly treated. But usually in this case hypersensitivity 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, which produces an excessively large amount of antibodies. 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 organism. This form is largely genetically determined.

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

[56]

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. In this zone, tension develops quite often, nerve roots are stretched, which entails severe pain. Also significantly increased sensitivity. The process may be accompanied by swelling of the spine, fibrosis, which subsequently leads to the degeneration of nerve fibers. In the event that the root stops pinching, relief comes (if the root is relieved of 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. At the same time, it seems that the nerve is immured in fibrous tissue. At the same time, the sensitivity to changes in the position of the vertebra during body movement increases sharply. Any movement is accompanied by pain.

The main method of treatment is physical activity, the implementation of motor exercises. Well-established special therapeutic exercise (exercise therapy). You can use an extensive set of exercises to restore and repair 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. Effective massage techniques, manual therapy. A good restorative is yoga, especially yogotherapy. Qigong, Chinese wellness practitioners, and gymnastics for the spine (Eastern, European methods) have proven themselves well. A physiotherapeutic procedure, special corsets, a bandage can contribute to the complex treatment. Sometimes methods of surgical treatment are used. 

[57], [58], [59]

Thoracic kyphosis and lumbar lordosis

Quite often, with spinal pathologies, thoracic kyphosis and lumbar lordosis develop. The reason often becomes an insufficient level of load, or its incorrect distribution along the spine. Excessively manifested lordosis can lead to overstretching of the posterior ligaments of the spine. This develops a strong, sharp pain that is deep and permanent. Usually, it is rather difficult to feel the exact source of pain, because it does not have an exact localization, it is characterized as diffuse, irradiating. Accompanied by periodic improvements and deterioration.

The pathological condition requires mandatory treatment. For any pathologies of the musculoskeletal system, the main method of treatment is the physical load on the spine. How to choose the right exercise, tell the doctor or instructor of physical therapy, or yogoterapevt. It is also worth noting that swimming and various hydro-massage procedures are widely used for the treatment. It should be borne in mind that only an integrated approach, as well as adherence to the principle of regularity, systematic training, will effectively solve the problem.

In addition to exercise therapy, treatment is applied by position, correction of the lumbar spine, treatment using styling, a plaster cot. For surgical treatment resorted to late diagnosis, as well as, if conservative treatment is not effective.

The special exercises are also positively influenced, which are aimed at working out intervertebral disks, muscles located between the vertebrae and along the spine itself.

The methods of physiotherapy treatment have found wide application. One of the most important methods of physiotherapeutic influence is ultrasound, microcurrents, waves of various lengths, electrophoresis, cryoprocessing, thermal procedures, electrical procedures.

An important role is played by segmental-reflex massage, reflexology, acupuncture, acupressure (shiatsu), vertebral effect.

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

As an additional remedy for lumbar lordosis, a special corset may be recommended, aimed at maintaining an optimal state of the spine and muscular 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 normalizes. The bandage is considered solely as an adjuvant, without which, the full treatment and maintenance of a normal state is impossible.

Complications and consequences

Any, even minimal injury can lead to adverse consequences and complications. The most unfavorable condition is the development of edema, fibrous tissue degeneration of intervertebral discs, nerve fibers. A particular complication is the formation of a hernia. It is especially dangerous if this hernia subsequently coalesces with nerve fibers. In this case, the nerve fiber is immured in the scar tissue. With the progression of pathology can lead to the fact that the nerve will die. Usually sharply increases the sensitivity of the nerve fiber. Often develop venous congestion and edema. When lumbar lordosis appear autoimmune processes, degenerative and dystrophic effects.

[60], [61], [62], [63], [64], [65], [66], [67]

Diagnostics of the lumbar lordosis

The basis of the diagnosis is primarily the instrumental methods of investigation, which allow to identify the pathology of bones, displacement, or excessive bending of the spinal column. This is most often used x-ray method, at least - functional tests. The use of laboratory methods in this case is impractical.

[68], [69], [70], [71]

Ferguson's method for evaluating 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. In the picture there is a vertebra, which is the maximum in the side. In the center of the body of this vertebra put a point. Then choose two vertebrae (one on top, the other on the bottom). These vertebrae should be the least deviate from the norm, the least stand out. After that, two lines are drawn 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 that we are looking for.

Instrumental diagnostics

The main method of instrumental diagnostics is the method of X-ray examination, which allows you to determine the presence or absence of changes in the spine, allows you to calculate the amount of deviation in the spine. Conduct main pictures in two projections - in a standing position and in a prone position. Other methods are practically not used, since they are uninformative.

[72], [73], [74]

Differential diagnosis

The essence of the differential diagnosis is to differentiate between 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 spinal curvatures, and also to determine whether lordosis is a natural physiological state, or is beyond the normal range and should already be considered as a pathology. It is also important to determine the angle of deflection.

[75], [76], [77], [78], [79], [80]

Treatment of the lumbar lordosis

The main method of treatment of this pathology is physical activity, the implementation of motor exercises. This is the main tool that is really effective in restoring the spine. No other means can be compared with exercise. Well-established special physical therapy (physical therapy), represented by an extensive set of exercises to restore and correct the spine. Not less effective are the methods of massage, manual therapy, but without adequate physical activity, these methods are ineffective.

A good restorative is yoga, especially yogotherapy. There is a special section - spine yoga, because in yoga it is believed that a healthy spine is the key to our health. It contains the main vitality, energy, activity of a person. This section of yoga contains a set of exercises designed to target the spine.

Qigong, Chinese wellness practitioners, and gymnastics for the spine (Eastern, European methods) have proven themselves well. Also, various methods of treating lordosis according to Bubnovsky, author’s methods of rehabilitation of Ovcharenko Sergey Valentinovich (especially methods created on the basis of Yi Jin Ching, qigong), yoga and yogotherapy complexes of Sidersky Andrew have found wide practical application. It is almost impossible to restore the spine without proper breathing. The yoga complex “Pranayama”, as well as various Kriyas (exercises for cleansing and complex study of the spine, paravertebral muscles along the spinal column and intervertebral discs) worked well.

Physiotherapeutic procedures, special corsets, and bandages can make a contribution to the complex treatment of the lumbar lordosis. Sometimes applied methods of surgical treatment, hyperextension.

[81], [82], [83]

Prevention

The basis of prevention is the observance of the rules of hygiene, the correct position (you need to monitor the correct position of the body while walking, sitting, lying). If possible, you need to change the position and type of activity as often as possible; it is not recommended to sit in one position for a long time. You should also sleep in the correct position, if necessary, use special orthopedic mattresses and pillows. One of the main measures is the regular exercise, agile lifestyle, proper nutrition, the consumption of the necessary amount of vitamin and minerals. It is important to regularly undergo prophylactic examinations, if necessary - be treated promptly.

[84], [85]

Forecast

The course and prognosis of the disease depends on the severity of the disease, its severity, or the lack of therapy. If it is timely to determine the cause and carry out the necessary treatment, the prognosis will be favorable. Usually,  lumbar lordosis is  fairly easy to treat. If, however, the diagnosis and treatment is delayed, the prognosis can be unpredictable, even disability.

[86], [87], [88], [89], [90]

Disability group indefinite

The concept of permanent disability in relation to children is established in three cases. In the first case, a person under the age of majority falls into this category if he has a category “disabled child”. It is possible to establish this category no later than 2 years of age after the initial diagnosis.

In the second case, permanent disability can be given if during 4 years after the initial diagnosis no positive dynamics was observed, even though intensive rehabilitation measures were taken. Moreover, the unqualified basis for permanent disability is the deterioration of the condition on the background of rehabilitation therapy.

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

As for adults, women are over 55 years old and 55 years old after men. Cases in which a person has a disability for 15 years are considered as a special circumstance, and, despite treatment and rehabilitation, no improvement is observed. Also, this category includes participants of the Second World War, defenders of the Motherland, and all persons who have acquired a disability during the performance of official duties during service.

[91], [92], [93]