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Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human vertebral column.Medical Systems: A Body Systems Approach, 2005 Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacrum regions is also termed kyphosis or kyphotic. The term comes .
Lordosis in the human spine makes it easier for humans to bring the bulk of their mass over the pelvis. This allows for a much more efficient walking gait than that of other primates, whose inflexible spines cause them to resort to an inefficient forward-leaning "bent-knee, bent-waist" gait. As such, lordosis in the human spine is considered one of the primary physiological adaptations of the human skeleton that allows for human gait to be as energetically efficient as it is.
Lumbar hyperlordosis is excessive extension of the lumbar region, and is commonly called hollow back or saddle back (after a similar condition that affects some horses). Sway back is a different condition with a different cause, that at a glance can mimic the outward appearance of lumbar hyperlordosis. Lumbar kyphosis is an abnormally straight (or in severe cases flexed) lumbar region.
In radiology, a lordotic view is an X-ray taken of a patient leaning backward.
Other health conditions and disorders can cause hyperlordosis. Achondroplasia (a disorder where bones grow abnormally, which can result in short stature as in dwarfism), spondylolisthesis (a condition in which vertebrae slip forward), and osteoporosis (the most common bone disease in which bone density is lost resulting in bone weakness and increased likelihood of fracture) are some of the most common causes of hyperlordosis. Other causes include obesity, hyperkyphosis (spine curvature disorder in which the thoracic curvature is abnormally rounded), discitis (inflammation of the intervertebral disc space caused by infection), and benign juvenile lordosis. Other factors may also include rare diseases, including Ehlers–Danlos syndrome (EDS), where some joints throughout the body are so hyper-extensible that they can become unstable (i.e. problematically much more flexible than normal, frequently to the point of partial or full dislocation). With such hyper-extensibility, it is also quite common (if not the norm) for some of the muscles surrounding an unstable joint to compensate for that instability by contracting.
Excessive lordotic curvature – lumbar hyperlordosis, is also called "hollow back", and "saddle back" (after a similar condition that affects some horses); swayback usually refers to a nearly opposite postural misalignment that can initially look quite similar. Common causes of lumbar hyperlordosis include tight Human back muscles, excessive visceral fat, and pregnancy. Rickets, a vitamin D deficiency in children, can cause lumbar hyperlordosis.
For example, the height loss was measured by measuring the patient's height while standing straight (with exaggerated curves in the upper and lower back) and again after the patient fixed this issue (with no exaggerated curves), both of these measurements were taken in the morning with a gap of 6 months and the growth plates of the patient were checked to make sure that they were closed to rule out natural growth. The height loss occurs in the torso region and once the person fixes their back, the person's Body Mass Index will reduce since the person is taller and the stomach will also appear to be slimmer.
A similar impact has also been noticed in trans women who have weaker muscles in the lower back due to increased estrogen intake and other such treatments.
However, the cause of height loss in both situations is a little different even though the impact is similar. In the first scenario, it can be due to a genetic condition, trauma to the spine, pregnancy in women, increased abdominal fat, or a sedentary lifestyle (sitting too much causes muscle imbalances and is the most common reason for this issue) and in the second scenario, the estrogen weakens the muscles in the area.
Merely slouching doesn't cause height loss, even though it may make a person look shorter, slouching may lead to perceived height loss, whereas lumbar hyperlordosis leads to actual and measured height loss. To make it easier to understand the difference, people losing a vertebra (which is around 2 inches or 5 centimeters in height) in the spine will be shorter regardless of posture. Lumbar hyperlordosis, of course, doesn't make you lose a vertebra but it bends them in such a way that your spine's vertical height is reduced.
Although lumbar hyperlordosis gives an impression of a stronger back, it can lead to moderate to severe lower back pain. The most problematic symptom is that of a herniated disc where the individual has put so much strain on the back that the discs between the vertebrae have been damaged or have ruptured. Technical problems with dancing such as difficulty in the positions of attitude and arabesque can be a sign of weak iliopsoas. Tightness of the iliopsoas results in a dancer having difficulty lifting their leg into high positions. Abdominal muscles being weak and the rectus femoris of the quadriceps being tight are signs that improper muscles are being worked while dancing which leads to lumbar hyperlordosis. The most obvious signs of lumbar hyperlordosis are lower back pain in dancing and pedestrian activities as well as having the appearance of a swayed back. p. 122
Technical factors
Since lumbar hyperlordosis is usually caused by habitual poor posture, rather than by an inherent physical defect like scoliosis or hyperkyphosis, it can be reversed. This can be accomplished by stretching the lower back, hip-flexors, quads and strengthening the abdominal muscles, hamstrings, and glutes. Strengthening the gluteal complex is a commonly accepted practice to reverse excessive lumbar lordosis, as an increase in gluteal muscle tone assists in the reduction of excessive anterior pelvic tilt and lumbar hyperlordosis. Local intra-articular hip pain has been shown to inhibit gluteal contraction potential, meaning that hip pain could be a main contributing factor to gluteal inhibition. Dancers should ensure that they don't strain themselves during dance rehearsals and performances. To help with lifts, the concept of isometric contraction, during which the length of the muscle remains the same during contraction, is important for stability and posture. p. 36
Lumbar hyperlordosis 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.
Only the muscles on the front and 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 the inflatable ball will strengthen all the posterior chain and will treat hyperlordosis. So too will stiff-legged deadlifts and supine hip lifts and any other similar movement strengthen the posterior chain without involving the hip flexors in the front of the thighs. Abdominal exercises could be avoided altogether if they stimulate too much the psoas and the other hip flexors.
Controversy regarding the degree to which manipulative therapy can help a patient still exists. 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.
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