Lordosis
| Lordosis | |
|---|---|
| Specialty | Rheumatology, medical genetics  |
Lordosis is a medical term used to describe an inward curvature of a portion of the vertebral column.[1] Two segments of the vertebral column, namely cervical and lumbar, are normally lordotic, that is, they are set in a curve that has its convexity anteriorly (the front) and concavity posteriorly (behind), in the context of human anatomy. When referring to the anatomy of other mammals, the direction of the curve is termed ventral. Curvature in the opposite direction, that is, apex posteriorly (humans) or dorsally (mammals) is termed kyphosis. Excessive or hyperlordosis is commonly referred to as swayback or saddle back; a term that originates from the fact that horses naturally high a high degree of lordosis.
Cause
A consequence of the normal lordotic curvatures of the vertebral column, (also known as secondary curvatures) is that there are differences in thickness between the anterior and posterior part of the intervertebral disc. Lordosis may also increase at puberty sometimes not becoming evident until the early or mid-20s. Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tight hip flexors (psoas).
Excessive lordotic curvature is also called hollow back, saddle back, and swayback. Common causes of excessive lordosis including tight low back muscles, excessive visceral fat, and pregnancy. Although lordosis gives an impression of a stronger back, incongruently it can lead to moderate to severe lower back pain[citation needed]. Loss of lordosis is sometimes seen with painful spinal conditions. If rigid, usually after spinal fusion surgery, it is known as flat-back.
Treatment
Lordosis of the lower back may be treated by strengthening the hip extensors on the back of the thighs, and by stretching the hip flexors on the front of the thighs. Too much importance have been attributed to the abdominal muscles in maintaining a neutral spine position. They may help by pushing the internal organs against the spine hence alleviating the lumbar curvature but they can't rotate the pelvis backward while in a standing position. Also the lumbar erector spinae is not able to rotate the pelvis forward while standing, hence its strengthening is not to be avoided during lordosis treatment. Only the muscles on the front and on the back of the thighs can rotate the pelvis forward or backward while in a standing position because they can discharge the force on the ground through the legs and feet. Abdominal muscles and erector spinae can't discharge force on an anchor point while standing, unless one is holding his hands somewhere, hence their function will be to flex or extend the torso, not the hip. Back hyper-extensions on a Roman chair or inflatable ball will strengthen all the posterior chain and will treat lordosis. So will do stiff legged deadlifts and supine hip lifts and any other similar movement strengthening the posterior chain without involving the hip flexors in the front of the thighs. Actually abdominal exercises could be avoided at all if they stimulate too much the psoas and the other hip flexors. Strengthening of the hip extensors which are on the back of the thighs and optionally stretching of the hip flexors which are on the front of the thighs will be enough to treat a lordosis in quite a shot time. Anti-inflammatory pain relievers may be taken as directed for short-term relief. Physical therapy effectively treats 70% of back pain cases due to scoliosis, kyphosis, lordosis and bad posture.[citation needed] Measurement and diagnosis of lumbar lordosis can be difficult. Obliteration of vertebral end-plate landmarks by interbody fusion may make the traditional measurement of segmental lumbar lordosis more difficult. Because the L4-L5 and L5-S1 levels are most commonly involved in fusion procedures, or arthrodesis, and contribute to normal lumbar lordosis, it is helpful to identify a reproducible and accurate means of measuring segmental lordosis at these levels.[2][3] Hypo-lordosis is more common then Hyper-lordosis. Hypo-lordosis can be corrected non-surgically through rehabilitation exercises. Many different techniques exist to accomplish this correction. These exercises, if done correctly, may reduce symptoms in those with the typical presentation in 3-6 months. The type of practitioner that usually offers this type of treatment is usually a Chiropractor, some physical therapists do this type of rehab but it is not very common.[4][5]
In non-human animals
Lordosis is seen in non-humans, particularly horses and other equines. Usually called "swayback," soft back, or low back, it is an undesirable conformation trait. Swayback is caused in part from a loss of muscle tone in both the back and abdominal muscles, plus a weakening and stretching of the ligaments. As in humans, it is sometimes seen in a broodmare that has had multiple foals. However, it is also common in older horses whose age leads to loss of muscle tone and stretched ligaments; or it occurs due to overuse or injury to the muscles and ligaments from excess work or loads; or from premature work on an immature animal. Equines with too long of a back are more prone to the condition than others, but as a longer back is also linked to smoother gaits, the trait is sometimes encouraged by selective breeding. It has been found have a hereditary basis in the American Saddlebred breed, transmitted via a recessive mode of inheritance. Research into the genetics underlying the condition has several values beyond just the Saddlebred breed as it may "serve as a model for investigating congenital skeletal deformities in horses and other species."[6]
Other
Lordosis behavior refers to the position that some mammalian females (including cats, mice, and rats) display when they are ready to mate ("in heat"). The term is also used to describe mounting behavior in mammalian males.
In radiology, a lordotic view is an X-ray taken of a patient leaning backwards.[7]
See also
Footnotes
- ^ Medical Terminology Systems: A Body Systems Approach, 2005
- ^ Thomas C. Schuler M.D., F.A.C.S 'Segmental Lumbar Lordosis: Manual Versus Computer-Assisted Measurement Using Seven Different Techniques' J Spinal Disord Tech. 2004 Oct;17(5):372-9 http://www.spinemd.com/publications/articles/segmental-lumbar-lordosis-anual-versus-computer-assisted-measurement-using-seven-different-techniques
- ^ Brian R. Subach M.D., F.A.C.S 'Segmental Lumbar Lordosis: Manual Versus Computer-Assisted Measurement Using Seven Different Techniques' J Spinal Disord Tech. 2004 Oct;17(5):372-9 http://www.spinemd.com/publications/articles/segmental-lumbar-lordosis-anual-versus-computer-assisted-measurement-using-seven-different-techniques
- ^ Harrison DD, et al. Spine 2004; 29:2485-2492. Controversy still exists regarding the degree to which manipulative therapy can help a patient. If therapeutic measures reduce symptoms, but not the measurable degree of lordotic curvature, this could be viewed as a successful outcome of treatment, though based solely on subjective data. The presence of measurable abnormality does not automatically equate with a level of reported symptoms.
- ^ Harrison DD, et al. J Manipulative Physiol Ther 1994;17(7):454-464
- ^ Oke, Stacey. "Genetics of Swayback in Saddlebred Horses Examined" The Horse online edition, December 20, 2010. Accessed December 21, 2010
- ^ http://www.wikiradiography.com/page/Lordotic+Chest+Technique
References
- Gylys, Barbara A. and Mary Ellen Wedding (2005), Medical Terminology Systems, F.A. Davis Company