The spinal column displays two main types of lateral curves: lordotic curves and kyphotic curves. The cervical and lumbar regions of the vertebral column display lordotic curves, which are anteriorly convex and posteriorly concave (Spine Universe, 2015). Contrastingly, kyphotic curves are present in the thoracic and sacral regions of the vertebral column, and are anteriorly concave and posteriorly convex (Spine Universe, 2015). Together, the natural curvatures of the spine are crucial for alleviating stress on one particular part of the vertebral column, improving flexibility, and enhancing balance (Spine Universe, 2015).
Individually, each region of the vertebral column varies in the degrees of its curvature. For example, the cervical lordotic curve arcs between 20 to 40 degrees, whereas the lumbar lordotic curve arcs between 40 to 60 degrees. Lordosis, which is also referred to as swayback, is any curvature of the spine beyond the normal lordotic range (Spine Health, 2015). Furthermore, lordosis that occurs at birth, or congenitally, is the least common spinal deformity (Lonstein, 1999).
In a study conducted by Lord, Small, Dinsay, & Watkins (1997), the average curvature for segmental lordosis in children was 52 degrees (L1 to S1), despite differences in age, height and weight of children. The greatest growth in the lordotic curve occurs during the first three years of life for a child, and gradually continues to grow until puberty (Been & Kalichman, 2014). Between the sexes, females are known to have greater lordotic curves, with an increase of two to five degrees (Been, 2014). Additionally, Gava, Šćepanović, Jevtić, & Kadović, (2011) found that poor lordotic posture is more common in overweight children.
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Lordosis can be classified as congenital, idiopathic or neuromuscular. Congenital lordosis is a term for an individual who is innately born with excessive lordotic curves (Boston Children’s Hospital, 2015). However, idiopathic lordosis refers to sporadic cases of lordosis, in which the reason or mechanism for developing this abnormal spinal deformity is unknown (Boston Children’s Hospital, 2015). Lastly, neuromuscular lordosis develops as a result of poor nervous system and muscular functioning (Seattle Children’s Hospital, 2015).
Furthermore, there is also the possibility of developing total lordosis, in which lordosis affects vertebrae L1 to S1, or segmental lordosis, affecting L2 to S1, L4 to S1, L5 to S1 (Lord, 1997). Additionally, although lordotic curves are mostly know for their appearance in the thoracic and lumbar regions of the vertebral column, it is also possible for lordosis to occur in the neck (Lord, 1997).
Lordosis is mostly classified as a congenital spinal deformity (Lonstein, 1999), which means that it is present at the time of birth. Hereditary does not play a major role in acquiring this abnormal condition and in fact, according to Lonstein (1999), only 1% of individuals who have lordosis know a relative that has the same condition.
Spondylolisthesis is a possible factor for causing lordosis, and this occurs when a vertebra is displaced onto a lower bone. Spondylolisthesis too, is a congenital condition but could be the result of gymnastics, activities that put stress on the spine, or spinal arthritis (Medline Plus, 2015). Moreover, lordosis could be linked to lower back problems, weak postural muscles or hip problems such as hip dislocations (Boston Children’s Hospital, 2015).
Finally, some atypical ways of developing lordosis are through achondroplasia (dwarfism), muscular dystrophy, and/or genetic conditions (Medline Plus, 2015).
Signs and Symptoms
The signs and symptoms for lordosis vary between individuals, depending on the severity of each individual’s case. Physically, the most noticeable feature of lordosis is the buttocks. When an individual has lordosis, their spine curves inward causing their buttocks to become more prominent (Boston Children’s Hospital, 2015). Other physical symptoms are dependent on additional muscular conditions the individual may have. Physiologically, a potential sign of lordosis is the asymmetry of reflexes in the abdomen and the lack of flexibility (Lonstein, 1999).
It is important to know which symptoms are not correlated to lordosis, such as changes in the urinary system, pain in the legs, and lower back pain. According to recent research, all of these symptoms have not been linked to lordosis, therefore if an individual possesses such symptoms it is recommended they consult their doctor (Boston Children’s Hospital, 2015).
If there is concern that a child has developed idiopathic lordosis or neuromuscular lordosis, the child should be taken to visit their doctor immediately. During the visit, the doctor will review the patient’s medical history and execute a variety of tests, including a physical examination of the child to test flexibility and reflexes, x-rays of the spine, bone scans, magnetic resonance imaging, and/or computerized tomography scans (Boston Children’s Hospital, 2015). Once this procedure has been completed, the doctor will be able to make a clinical diagnosis for the child.
There are four different techniques that can help treat lordosis for children.
Lordosis is a progressive condition, which means that over time the condition of the child will become worse. Therefore, it is crucial for both the parents and child to monitor the condition, and follow up with the doctor periodically. If any changes or abnormalities arise, it is important to consult the doctor, who will then evaluate the next steps to take in order to manage the lordosis (Medline Plus, 2015).
In this type of treatment, a physiotherapist will create various exercise programs for the child to help build stronger spinal muscles and reduce pain (Boston Children’s Hospital, 2015). Alleviating muscular weakness and working towards achieving a healthy lordotic curve will increase biomechanical stability and overall strength for the child (Morningstar, 2003).
Bracing is only implements for those patients who are progressing at a rapid rate, such as if their lordotic curve has arched more than 30 degrees (Boston Children’s Hospital, 2015). Depending on the child’s condition, the doctor will determine a specialized bracing program for the individual case (Boston Children’s Hospital, 2015).
The vertebral column is very rigid and resistant to correction (Lonstein, 1999), therefore surgery is the most invasive treatment option for a child and is not recommended, but should only be used for the most crucial cases. The operation consists of straightening the vertebral column, by having the doctor attach a rod to the vertebrae, using hooks and screws. A bone graft may also be placed parallel to the vertebral column to prevent the vertebrae from shifting and to correct any displacement that has occurred (Seattle Children’s Hospital, 2015).
According to Lord (1997), the surgical route for treatment has a 60% complication rate, implying that preventative measures and alternative treatment methods are the best ways to reduce lordosis.
For the Practitioner
Health care professionals should work collaboratively to manage a case of lordosis. Doctors should do a full assessment of a child with lordosis, including all the clinical exams previously mentioned in the “Diagnosis” section, as well as postural corrective exercises (Gava, 2011). In addition, it is important for the doctors to test the child’s reflexes (Lonstein, 1999), as any abnormalities in reflexes can be a strong indicator of muscular dysfunction. Nutritionists should educate the child’s parents so that they can implement a healthy food program at home and monitor the child’s food intake, ensuring they are receiving the nutrients they need (Gava, 2011).
For the Coach
Engaging in physical activity is critical in order for a child’s condition of lordosis to improve. Building muscular strength, gaining flexibility and being able to socialize with their peers, is vital for a child’s physical and emotional development (Gava, 2011). However, a coach should be aware of the child’s capabilities and ensure that all exercise practices are not harmful or pose a threat to the child. For example, research has shown that running is linked to greater lumbar lordosis angles and anterior pelvic tilt, therefore this type of activity should be avoided for children who have lordosis (Been, 2014).
For the Parents
Parents play a major role in managing lordosis in children. Maintaining a healthy relationship in the home environment provides the child with a strong foundation of support, building their confidence and self-efficacy. In addition, socioeconomic status of the family influences the resources available to the child. For example, if a family is financially struggling, medical expenses will be difficult to pay for and as a result, the child will not receive the appropriate care they need to get better (Gava, 2011).
Overall, helping a child to improve their condition of lordosis can be very challenging. However, with appropriate education, accessible resources, suitable treatment plans and a strong social support system, the lordosis can be reduced. In addition, future recommendations suggest that preventative measures remain the primary focus for the public, in terms of reducing the number of cases of Lordosis (Seattle Children’s Hospital, 2015).
Been, E., & Kalichman, L. (2014). Lumbar Lordosis. The Spine Journal, 14(1), 87-97. doi:10.1016/j.spinee.2013.07.464
Boston Children’s Hospital. (2015). Lordosis in Children. Retrieved from http://www.childrenshospital.org/conditions-and-treatments/conditions/l/lordosis/overview
Gava, B., Šćepanović, T., Jevtić, N., & Kadović, V. (2011). Frequency of Postural Disorders in Sagital Plane of Younger-aged School Children. Activities In Physical Education & Sport, 1(2), 151-156.
Lonstein, J. (1999). Congenital Spine Deformities - Scoliosis, Kyphosis, and Lordosis. Orthopedic Clinics of North America, 30(3), 387-405. doi:10.1016/S0030-5898(05)70094-8
Lord, M., Small, J., Dinsay, J., & Watkins, R. (1997). Lumbar Lordosis - Effects of Sitting and Standing. Spine, 22(21), 2571-2574. doi:10.1097/00007632-199711010-00020
Medline Plus. (2015). Lordosis. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003278.htm
Morningstar, M. W. (2003). Strength Gains through Lumbar Lordosis Restoration. Journal of Chiropractic Medicine, 2(4), 137-141. doi:10.1016/S0899-3467(07)60077-9
Seattle Children’s Hospital. (2015). Bone, Joint and Muscle Conditions: Hyper Lordosis. Retrieved from http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/lordosis/
Spine Health. (2015). Lordosis Definition. Retrieved from http://www.spine-health.com/glossary/lordosis
Spine Universe. (2015). Spinal Curves. Retrieved from http://www.spineuniverse.com/anatomy/spinal-curves