Lumbar lordosis (lumbar lordosis)
Lumbar lordosis is a physiological or pathological bend in the lumbar spine characterized by a bulge. Physiological lumbar lordosis is present in every person (there is also in the cervical spine), and pathological lordosis differs from it in the degree of convexity of the bend. Most often, people are diagnosed with pathological lordosis of the lumbar spine.
Natural lordosis develops in a child during the first year, and pathological lordosis can occur at any age. Such disorders in the structure of the spine can be caused by many reasons, including congenital and acquired pathologies, as well as diseases of the musculoskeletal system, joints, muscles, etc. Pathological lordosis has a negative effect not only on a person's appearance, but also negatively affects work internal organs.
The disease manifests itself with back pain and problems with posture, it is treated both by surgery and by conservative therapy.
- Causes of lumbar lordosis
- Lumbar lordosis symptoms
- Complications of lumbar lordosis
- Diagnostics of the lumbar lordosis
- Lumbar lordosis treatment
Causes of lumbar lordosis
It is impossible to consider the causes of lumbar lordosis in the context of pathology without understanding what constitutes normal lumbar lordosis. The anatomical norm for each person is the presence of four bends: two anteriorly (lumbar lordosis and neck lordosis) and two posteriorly (sacrum and thoracic kyphosis).
You can notice the first signs of the formation of lumbar lordosis, like all other bends of the spine, immediately after the birth of the child. But in infancy, these curves are very weak. As the child grows up, begins to stand up and take the first steps, lordosis becomes more noticeable. The spine will fully complete its formation when a person reaches the age of 16-18. However, the pathology of the lumbar bend can begin to form much earlier.
Three lumbar lordosis can be distinguished, depending on its shape:
- Hyperlordosis is an excessive pathological lordosis.
- Natural or physiological lordosis.
- Hypolordosis is the straightening of the natural bend.
Depending on the degree of fixation of lordosis, one can distinguish:
Fixed bend. In this case, even by an effort of will, a person cannot return the body to its normal position. Most often, this type of lordosis is formed due to the presence of volumetric formations in the spinal column, for example, with a herniated disc. The disease usually manifests in middle age. The onset of the disease can be both acute and imperceptible to humans. The course of the pathology has an unfavorable prognosis, leading to severe pain and neurodystrophic changes in soft tissues.
- Partially fixed bend. In this case, changes in the angle of lordosis are limited. The development of this form of lordosis most often leads to radiculitis, or arachnoiditis of the spinal cord. The disease develops at a young age. The course of the disease is favorable.
- Unfixed bend. In this case, the patient can, by an effort of will, return the spine to its normal position. This form of the disease most often becomes the result of bone tuberculosis, hip contracture, hip dislocation or spondylolisthesis.
Having considered the anatomy of human lumbar lordosis, one can proceed to the causes of pathological lordosis of the lumbar spine.
All etiological factors are divided into two large groups:
Various pathological processes in the spinal column, which lead to the formation of primary lordosis. Primary lordosis can occur in humans due to congenital malformations of the spinal column. In addition, neoplasms in the area of the vertebrae and their inflammation can become the cause.
Another etiological factor in the development of the disease is spondylolisthesis. It is a displacement of the upper vertebra in relation to the lower one due to trauma, tumor, congenital pathology, etc.
Dangerous in terms of the development of primary pathological lordosis are muscle torsion spasms or torsion dystonia, which are a manifestation of disturbances in the functioning of the nervous system and are of a progressive nature. Also, inert tuberculosis can lead to pathology of the vertebral bend.
Naturally, pathological bending can occur as a result of spinal cord injuries, both open and closed.
Adaptive or compensatory reactions of the lumbar spine, which arise in response to non-physiological conditions for it and lead to the formation of secondary lordosis, among which:
- Intra-articular and extra-articular ankylosis of the hip joint.
- Congenital or acquired hip dislocation.
- Persistent restrictions on the mobility of the hip joint (contractures).
- Diseases of the muscular and skeletal system.
- Cerebral spastic paralysis of the legs.
- Poliomyelitis involving the muscles of the legs and pelvis in the pathological process.
- Carrying a baby. Most often, lordosis that occurs during pregnancy goes away on its own after the birth of a child and does not need treatment.
In addition, factors that predispose to the formation of a pathological bend of the lumbar spine can be separately identified, among them:
- Rapid growth in adolescence or childhood;
- Poor posture.
Lordosis, which forms in childhood, can be corrected if the cause that caused it is eliminated in time. As for adults, the longer they have lordosis, the more difficult it is to get rid of it, and in some cases only surgery can help.
Lumbar lordosis symptoms
The symptoms of lumbar lordosis will be examined in terms of the presence of a pathological bend.
Among the main signs of the disease are:
- Patient posture disorders. They are associated with the fact that the spine is a single whole and if any violations occur in one of its departments, this will certainly affect the state of the support column as a whole.
Fatigue in humans increases and occurs earlier than in healthy people.
- Pain in the lumbar region. They become stronger after physical exertion, or after a person has been in an uncomfortable position for a long time.
- Limitations of mobility of the spine during exercise or simply while moving.
- If the pathology exists for a long time and has a high degree of severity, then this will negatively affect the work of internal organs. First of all, problems will begin in the work of the heart, intestines, kidneys, lungs, stomach. Violations are associated with the fact that their normal location relative to each other changes, since the spine cannot cope with its main function.
The appearance of a person with pathological lumbar lordosis changes.
There are several options for how the patient's posture will be disturbed:
The back becomes round. In this case, the thoracic kyphosis increases, and the lumbar bend decreases. While walking, such people constantly bend their legs, tilt their head forward to maintain balance, since the center of body mass shifts backward. A typical image of the patient: arms lowered along the torso, belly protruding forward, sunken chest. Doctors call this posture kyphotic.
- The back is flat-concave. The cervical bend gradually smoothes out, the thoracic kyphosis becomes smaller, and the lumbar lordosis increases, the pelvis is displaced posteriorly. A typical image of the patient: sunken chest, protruding shoulder blades, bent knees, drooping head and chin.
- The back is rounded. All physiological curves of the spine are enhanced. The characteristic appearance of the patient: the legs are slightly bent at the knees, protruding shoulder blades, adducted shoulders, raised shoulder girdles, a stomach sticking out forward, a head pushed forward. This posture is called kypholordotic in orthopedics. According to statistics, it is this type of posture that most often develops in people with pathological lumbar lordosis.
The back is flat. All physiological curves of the spine are reduced, and most of all lumbar lordosis. The characteristic appearance of the patient: protruding shoulder blades, chest displaced anteriorly, coming out forward of the lower abdomen.
Complications of lumbar lordosis
Complications of lumbar lordosis lead to problems in the functioning of many vital organs. The fact is that the load on the muscles, on the ligaments and on the bones with a spinal disease is redistributed incorrectly. In this case, the ligaments are stretched too much, and the muscles are constantly tense. From this, a person experiences severe fatigue, gets tired even after little physical exertion, and constant pain will lead to nervous disorders and sleep disturbances.
If you do not get rid of the pathological lordosis of the lumbar spine in a timely manner, the following complications are likely to develop:
- Formation of a hernia of the spinal column, with multiple hernias most often appearing.
- Vertebral disc prolapse (prolapse).
- Inflammation of the iliopsoas muscle. This pathological process is called "psoit".
- Instability of the vertebrae with their excessive mobility.
- Dystrophic changes in the joints of the spine with the subsequent development of deforming arthrosis.
Diagnostics of the lumbar lordosis
Diagnosis of lumbar lordosis is the responsibility of an orthopedist. After listening to the patient's complaints and examining him, the doctor will refer the patient to an X-ray. Also in the arsenal of a specialist there are techniques that, already during the initial examination, will make it possible to determine the degree of lordosis mobility, as well as the presence of neurological disorders. The compulsory examination program includes palpation of the muscles of the back and the spine itself. The doctor also assesses the condition of the organs of the chest cavity using special tests.
Radiography is performed in two projections (frontal and lateral). To establish the degree of pathology during the execution of the pictures, the patient can be forced to unbend as much as possible and bend as much as possible. The images obtained can also be used to judge the presence of violations in the form and structure of the vertebrae, as well as the correctness of their relative position.
Lumbar lordosis treatment
Treatment of lumbar lordosis is the responsibility of an orthopedist or vertebrologist. First of all, it is necessary to eliminate the cause that led to the formation of the pathological bend.
The patient undergoes orthopedic procedures, he is obligatorily shown kinesitherapeutic rehabilitation. Therapeutic massage is useful, manual therapy gives a good effect. A complex of physiotherapy exercises is compiled on an individual basis. Swimming and water aerobics are very useful, but the back should not be too overworked.
Sometimes doctors prescribe multivitamins to help maintain bone health. They should contain phosphorus, magnesium, calcium, B vitamins, vitamin D and vitamin A.
As for drug therapy, it is usually symptomatic. It is possible to take painkillers that, if necessary, relieve inflammation - these are Ibuprofen, Diclofenac, Movalis.
Also, to reduce pain, wearing a corset or bandage is indicated. Surgical intervention is carried out in case of detection of primary lordosis.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".