What Is Hyperlordosis: Understanding the Curvature of the Spine
Most people are familiar with scoliosis, a sideways curvature of the spine. However, another common spinal condition, often less recognized, is hyperlordosis. This condition involves an excessive inward curvature of the spine, particularly in the lumbar (lower back) region.
Understanding Normal Spinal Curvature
Our spine naturally has a gentle S-curve when viewed from the side. This natural curve helps to absorb shock and maintain balance. The cervical (neck) and lumbar (lower back) regions typically curve inward, while the thoracic (mid-back) region curves outward.
What is hyperlordosis?
Hyperlordosis, often referred to as “swayback,” occurs when the inward curve of the lower back becomes exaggerated, or an exaggerated inward curve. This can lead to various symptoms, including:
- Back pain in the lower spine: This is a common symptom, especially when standing or sitting for prolonged periods.
- Poor posture: A swayback posture can affect your overall appearance and can lead to other health problems.
- Digestive issues: In severe cases, hyperlordosis can compress internal organs, leading to digestive problems.
What are hyperlordosis symptoms?
The main characteristic of hyperlordosis is a prominent front-back curve to the spine. But because the spine already has a natural S-curve to it, the condition isn’t always as recognizable as other spinal deformities. Instead, it is usually identified by the following symptoms:
- The head being positioned farther forward than normal
- The hips tilting forward
- The buttocks sticking out farther than normal
- A sizeable gap between the lower back and the floor when lying down face up
- Lower back pain, back spasms or tightness
- Difficult moving
- Numbness or tingling
- Bladder control issues
Most cases of hyperlordosis are minor and don’t interfere with a person’s life. Therefore, a person may never even know they have it. Severe hyperlordosis, on the other hand, which is generally defined as a curvature of 70 degrees or greater, can lead to neck, back or leg pain; balance disturbances; and bladder and bowel dysfunction.
How common is hyperlordosis?
While the exact prevalence of hyperlordosis is difficult to pinpoint, studies suggest it varies significantly between genders and age groups. Research indicates that females are more likely to develop hyperlordosis, with incidence rates ranging from 1% to 39%. However, more comprehensive studies are needed to determine the true prevalence of this condition.
What are risk factors for hyperlordosis?
While we don’t know exactly what causes hyperlordosis, we do know that posture plays an important role in the development of the spinal deformity. Many kids with hyperlordosis have weaker core muscles and are prone to slouching, which then tends to lead to further weakened core muscles and poor posture. But slouching isn’t the only manifestation of poor posture. Gymnasts, for example, appear outwardly to have excellent posture, but the positions required of the sport, such as overarching the back, are actually quite unnatural. So, it’s perhaps unsurprising that gymnasts are much more likely to develop hyperlordosis than non-gymnasts. In fact, as many as 80% of female gymnasts develop hyperlordosis during their gymnastics careers.
Posture also can be affected by certain musculoskeletal disorders. It’s common for a person who has achondroplasia, a genetic disorder that causes dwarfism, to have lumbar hyperlordosis as the condition tends to cause the lumbar lordotic curve to become more pronounced. There is also a higher incidence of severe hyperlordosis among people living with cerebral palsy, particularly among children who had surgery to treat spastic cerebral palsy between ages 2 and 5.
What causes hyperlordosis?**
Hyperlordosis can arise from several factors, including:
- Poor Posture: Slouching or hunching can exacerbate the natural curve of the spine.
- Weak Core Muscles: Weak abdominal and back muscles can contribute to poor posture and an exaggerated lumbar curve.
- Medical Conditions: Certain conditions like spondylolisthesis, ankylosing spondylitis, and muscular dystrophy can lead to hyperlordosis.
- Lifestyle Factors: Factors like being overweight, wearing high heels frequently, or having a sedentary lifestyle can also contribute to the development of hyperlordosis.
While many cases of hyperlordosis have no identifiable cause, maintaining good posture, strengthening core muscles, and practicing regular physical activity can help prevent or reduce the severity of the condition.
How is hyperlordosis diagnosed?
Most patients who have hyperlordosis never know it, because the deformity causes no issues and so they never need to seek a diagnosis. If your child shows symptoms of hyperlordosis — especially symptoms of severe hyperlordosis, such as back pain, balance problems or bladder or bowel dysfunction — see your doctor.
Of course, back pain can be caused by any number of things that have nothing to do with spinal deformity. In children, back pain usually is caused by a minor injury, such as a pulled muscle or strained ligament. If back pain lingers after several days of rest, ice and over-the-counter pain relievers, make an appointment to have your child evaluated to see if anything else may be going on.
- The first step in the diagnosis of hyperlordosis is to physically examine your child. A doctor will evaluate their body alignment, spine and posture.
- If hyperlordosis is suspected, your child’s provider likely will order an X-ray of the spine and then calculate the angle of spinal curvature to determine if hyperlordosis is present.
- Angles greater than 40 degrees in the cervical spine and 60 degrees in the lumbar spine are diagnosed as hyperlordosis.
And yet, even the curvature angle may not tell the full story.
As a pediatric research center, the physicians at the Rady Children’s Spine Center are constantly working to advance our understanding of spinal deformities and developing new techniques to evaluate and treat them.
Research led by Michael P. Kelly, MD, director of scoliosis and spinal deformities in the Division of Orthopedics & Scoliosis at Rady Children’s, published in the journal Spine in 2022, shed new light on the importance of considering other factors, such as pelvic tilt, when managing and treating spinal deformities. Read the press release on Dr. Kelly’s research. Such findings are why it’s critically important to have your child evaluated by a physician who is an established expert in spinal deformity.
How is hyperlordosis treated?
The vast majority of hyperlordosis cases do not require treatment, as they don’t cause pain or interfere with activity. Most children will grow out of hyperlordosis by the time they reach adulthood, many never even knowing they have the abnormal curvature.
If hyperlordosis is causing pain, it may be manageable with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and stretching. In such cases, your child’s doctor will likely monitor the hyperlordosis with regular exams and X-rays to ensure the curvature isn’t getting worse.
If the hyperlordosis worsens or is severe — causing significant pain or dysfunction — then your child’s physician may recommend:
- Physical therapy
- Wearing a back brace
- Surgery
Hyperlordosis rarely requires surgery. It is only recommended when the lordotic curve is severe or bracing did not stop the curvature from worsening.
Hyperlordosis surgery generally involves spinal fusion, in which a surgeon removes the soft tissue between the affected vertebrae and applies bone graft to encourage the two segments to grow together over time. A system of rods and screws implanted during the surgery stabilizes the spine while the fusion occurs.
Can hyperlordosis be prevented?
Many cases of hyperlordosis, particularly those caused by cerebral palsy or muscular dystrophy, cannot be prevented. And because most cases of hyperlordosis have no known cause, it’s difficult to recommend specific prevention guidelines. But as the condition has been linked to posture and obesity, it may be beneficial to:
- Eat a balanced diet of fruits, vegetables, whole grains, lean protein and low-fat dairy
- Get regular exercise
- Strengthen the core muscles
- Develop a healthy posture when sitting and standing
Hyperlordosis care at Rady Children’s Hospital
Hyperlordosis doesn’t usually require treatment and rarely requires surgical intervention. Still, it’s important your child be evaluated by a pediatric spine specialist. As a pediatric research center, the physicians at the Rady Children’s Spine Center are committed to advancing the fundamental understanding of spinal deformities and developing new techniques to treat them. To schedule an appointment with a Rady Children’s spine specialist, call us at 858-966-6789.