Lordosis in children and adults: Why does a morbid curvature of the back arise?

Lordosis is the name given to the natural curvature of the spine.

Conversely, hyperlordosis indicates an excessive deviation from a physiological, ie healthy state of curvature. It can be the result of a birth defect, but also as a result of a wrong posture and inactivity or a sedentary lifestyle.

Hyperlordosis = pathological lordosis.

Back pain is the most common problem that a person seeks medical attention for. It affects children, adults, and seniors.

Information is provided that ...

Up to 90% of the population has experienced back pain at least once in their lives. 

It is a problem of civilization, the cause of which we must research in the style of life, inactivity, sedentary lifestyle, and sedentary work. Subsequently, the sitting is joined by a long-term forced standing position or excessive overloading of the spine when lifting loads.

Muscle imbalance and structural errors in the spine are also at the forefront of hyperlordosis.

When looking for information about hyperlordosis, we often come across an abbreviated term - lordosis.

Let's look at the spine together

What is the spine?

In the first moment, we will imagine the vertebrae, ie small bones connected into one whole.

Right. However, that is not all.

The spine plays an important role in the movement and support of the human body, plus the spine also contains the spinal cord, in the spinal canal.

Spine = vertebral column. 
Spinal cord = medulla spinalis. 
Vertebra = vertebrae. 

The spine consists of several vertebrae. These vertebrae have a specific shape and size. Their connection ensures a certain range of motion. Of course, the spine carries the weight of the body while standing, sitting, and moving.

So the vertebrae withstand both static and dynamic loads. Intervertebral discs, ie intervertebral discs, are also helpful in this. These discs serve as shock absorbers that transfer the load to the entire surface of the vertebrae.

We have 33 to 34 vertebrae. 
Intervertebral discs 23. 

Cervical spine -  7  vertebrae = C1 to C7. 
Thoracic spine -  12  vertebrae = Th1 to Th12. Lumbar  spine -  5  vertebrae = L1 to L5. Cross- spine -  5  or  6  = S1 to S5 (S6). Skeleton  -  4  or  5  vertebrae = Co1 - Co4 (Co5). 

In Latin, they are referred to as vertebrae: 

• C - vertebrae  C ervicales 
• Th - vertebrae  Th oracicae 
• L - vertebrae  L umbales 
• S - vertebrae  S acrales 
• Co - vertebrae  Co ccygeae 

Interesting information:

The intervertebral discs are located from C2 - C3 up to the passage of vertebrae L5 and S1. 
The spinal cord is about 40 to 50 centimeters long and about 1 centimeter thick. 
It departs from the brain through the spinal canal from C1 to L2. 
Furthermore, the entanglement of nerves continues, which is referred to as the horse's tail - cauda equina.

Plus, the surrounding important structures must be added to the vertebrae and plates. And these are small intervertebral joints, ligaments, and muscles.

Together, they form a functional unit, to which we owe the locomotor and supporting components of the function of our spine, the stability and balance of the human body.

The mobility of the spine is different in each of its sections, with the highest range of motion being in the cervical spine.
The chest is reinforced with ribs, which reduce the range.
The least movable is the stem part, however, this bears the highest load.

The sacral section is immobile, as the vertebrae together form the sacrum  = the sacrum axis. The coccyx can bend only slightly in the front-rear direction.

Spinal mobility is indicated by:

1. anteflexiu - forward bend
2. retroflexia - bend
3. lateroflexiu - bow
4. rotation - rotation or even torsion
5. circular motions - which are created by a combination of the above
6. suspension - enabled by plates and is important in shock absorption

The spine is sigmoidly curved = natural, ie physiological curvature .

The axial bending of the spine is as important in supporting the body and carrying the weight as it is in damping the impacts during movement.
Plus, it plays an important role in locating the human body.

The natural curves of the spine alternate in the order: 
Cervical lordosis> thoracic kyphosis> lumbar lordosis> cruciate kyphosis.

Interestingly, lordosis is still balanced in a 6-year-old child while sleeping in a supine position. A certain degree of flexibility remains throughout life. 

The natural curvature is given in the table

Scoliosis is a pathological, ie disease,  deviation of the spine by more than 10 degrees.
You  will find interesting information in a separate article:  Scoliosis .

Hyperlordotic curvature = lordosis in brief ...

It is an excessive curvature of a part of the spine, in terms of anteroposterior deviation. Thus, the angle of curvature of the spine and pelvis increases. The cause is mainly due to the imbalance of muscles in the abdomen, back, buttocks and thighs. 

It occurs in the cervical or lumbar part of the spine.

If it affects the section:
Neck = cervical hyperlordosis - cervical 
or 
stalk = lumbar hyperlordosis - lumbar 

At a higher rate, it is currently represented by lumbar hyperlordosis.

The lumbar part is the most congested section of the spine. With the deviation of the curvature, changes occur which are the cause of the dysfunction of the spinal segment. 

In the long run, muscle imbalance contributes to back pain, stem or lower back pain. A more serious degree is the damage to the structure of the vertebra and the intervertebral disc when there is also a risk of disc herniation.

In case of incorrect posture we can also observe:

• bent back - hyperlordosis, ie excessive bending in the lumbar (L) part of the spine
• flatback - insufficient thoracic (Th) kyphosis and lumbar (L) lordosis,
  straight - balanced lordosis of the cervical (C) or lumbar (L) spine
• round back - hyperkyphosis, and thus excessive thoracic (Th) kyphosis

Upper and lower cross syndrome

Wondering what this is all about?

In the case of muscle disbalance, we can also find two terms on the Internet, namely upper or lower cross syndrome. Upper for the upper half and lower for the lower half of the body.

Muscles have a predisposition to shorten and weaken them.

The table shows the muscles divided according to the predisposition to shortening and weakening

A. Upper cross syndrome

It is a muscle imbalance in the upper half of the body. It is manifested mainly by hyperkyphosis in the thoracic section of the spine, ie as a round back.

Subsequently, it is possible to observe:

• cervical hyperlordosis - cervical hyperlordosis
  • chin advanced
  • neck overload
• shoulders fallen forward
• protruding blades

Overloading of the cervical and thoracic spine results in shortening of the muscles in the neck and pectoral muscles. They weaken the muscles of the neck and shoulder blades.

There are difficulties due to the instability of the muscles of the neck and neck. An example is sore throat with radiation to the head, but also to the shoulders, between the shoulder blades or to the upper limbs. Plus pseudoradicular difficulties.

B. Lower cross syndrome

In this case, the muscle imbalance affects the lower half of the body. This form is represented to a greater extent.

It manifests as lumbar, or lumbar hyperlordosis. The abdominal and sciatic muscles weaken, the muscles of the back, pelvis and thighs shorten. 

The area of ​​the shaft is overloaded for a long time, which results in back pain in the shaft, lower back, as well as pain in the hips, hips and hip joints.

The causes of excessive spinal flexion can be broadly divided into a group of congenital, acquired, and postural, ie postural lordosis.

It is stated that it is the wrong posture that in most cases is the cause of hyperlordosis.

The same is true for the flat back. Then it is the opposite phenomenon when the curvature is flattened = insufficient.

Pelvic anteversion and retroversion + hyperlordosis

The pelvis plays an important role in proper posture. 

In the case of the pelvis, there are two deviations in the anteroposterior direction, and then we speak of aneversion and retroversion.  Another type is its lateral displacement, skew, or rotation. Also present in scoliosis.

The correct position of the pelvis in the anteroposterior direction is mainly influenced by the muscles of the abdomen, the pelvic floor, and also the diaphragm. Similarly, the muscles of the back, buttocks and lower limbs are important in this relationship.

A . Pelvic anteversion = tilting the pelvis forward as the lumbar symphysis moves downward.

In this context, primary pelvic anteversion with secondary hyperlordosis is mentioned. This is a condition where shortened hip flexors dominate. 

Vice versa.

If truncated lumbar straighteners with the subsequent weakening of the abdominal muscles predominate, there is primary spinal hyperlordosis and secondary anteversion.

Pelvic anteversion causes lumbar hyperlordosis and, in turn, pelvic hyperlordosis.

B . Pelvic retroversion = a condition in which the pelvis flips backward, the symphysis pointing upwards.

The cause is mainly weakened muscles in the sitting area - gluteal muscles. In this case, there is a  flat back, and thus flattening - a reduction in the curvature of the lumbar lordosis.

To a greater extent, retroversion is present in people with hypermobility of the joints. 

Poor posture + muscle disbalans + sedentary lifestyle + ...

As mentioned, hyperlordosis is increasingly due to a modern lifestyle.

This means in particular a sedentary lifestyle or excessive sitting at work.

Beware, however.

The origin of the difficulties must be traced back to childhood. Lack of movement, poor posture, incorrect movement habits, flat leg, weakened muscles, and muscle disbalance.

These are the reasons why back pain may be present in childhood.

Weakening of abdominal, sciatic muscles, back, and pelvic floor muscles. Muscle imbalance between the torso and lower limbs.

These are mainly muscles:

• musculus transversus abdominis - transverse abdominal muscle
• musculus gluteus maximus - the largest sciatic muscle
• musculus iliopsoas , lumbar muscle, composed of
  • musculus psoas major clings to the spine and femur
  • iliacus muscle, which attaches to the lumbar and femur
• musculus erector trunci - a system of muscles clamping to the spine,
  torso straighteners and spine - erector spinae
• musculus quadratus lumborum - square lumbar muscle 
• hamstrings - they are made up of 3 muscles of the back of the thigh
  • biceps thigh muscle - biceps femoris
  • semimembranous muscle - semimembranosus
  • semitendinosus
• pelvic floor muscles, a set of multiple muscles
  • from the group musculus levator ani, musculus coccygenus, m. transversus perinei superficialis, m. ischiocavernosus and others
  • muscles important for breathing, posture, movement, excretion and also for sexual function and others

Mechanism of the problem of the  muscle imbalance in simplicity:

For long-term overloading of the back muscles, it shortens them. Reduced blood flow and nourishment contribute to this, which results in the onset of deformity of the lumbar spine and its flexion. On the contrary, the abdominal muscles are weakened and stretched.

Weakening of abdominal muscles + sciatic muscles>
shortening of  torso benders + spine straighteners>
influence of thigh muscles + functional pelvic floor. 

Summary of main causes and risk factors in brief:

1. congenital malformations - abnormalities occur during intrauterine development 
2. acquired - in case of damage during childbirth, injury during childhood, spinal surgery, other diseases as well as tumor
3. overweight and obesity, especially in childhood 
4. vitamin deficiencies, especially vitamin D, which is important in bone formation and minerals such as calcium
5. pregnancy
6. incorrect posture
7. long-term sitting, inactivity, sedentary lifestyle, and sedentary work
8. muscle disbalance
9. flat feet
10. incorrect breathing
11. excessive overloading - lifting loads
12. unilateral overloading of the spine

Read also articles: 
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Long-term difficulties are behind the problem. These can manifest themselves in childhood or adolescence.

Pain in the back, stem or lower back and neck may be the first to occur. The pain can have the character of cutting, burning, in the form of lumbago, it is long-lasting, it is repeated. 

The complication is a change in the structure of the vertebra and one-sided overloading of the intervertebral disc. This condition can lead to damage to the disc and herniation, ie to the arching part of the plate.

Another risk of a hernia disc is the compression of the spinal cord or spinal nerve. Compression of nerve structures causes root irritation - radiculopathy. These are pain and other nervous symptoms (tingling, difficulty insensitivity, or movement) that spread in the area of ​​the innervation of the nerve in question.

Pain is not the only problem with hyperlordosis. 

An example is the increased muscle tension in the lumbar region. Stiffening of the back muscles spreads on the sides. One perceives it as discomfort.

Associates are visibly incorrect posture. This is related to locomotor mechanisms. Attitude changes, gait. 

The pelvis is extended forward, the stem is more bent, the back is sunken.
in cervical lordosis, of course, the neck.
The protraction of the arms is present - the shoulders fall forward. 

During the diagnosis, anamnesis and examination are applied, which are divided into static or dynamic. In addition to the examination of posture, movement, and the spine itself, the examination is also performed using a plumb line, according to Mathias, Jaroš and Lomíček, the Adams test,  and others.

It is important to evaluate the neck, chest, pelvis, lower limbs, flat leg, posture symmetry, the height of the shoulder blades and hips, upper and lower limbs, muscle tone is also evaluated. And from every side insight, but also in touch.

Imaging methods, such as X-rays, CT, or MRI, are also important. 

The degree of curvature is evaluated on the side view of the X-ray image. When CT and MRI may reveal damage to the vertebrae that may have cone shape and condition of the plate.

Differential diagnosis is also important in back pain, which aims to reveal the exact cause of the problem. 

Information on hyperlordosis cites poor posture and muscle imbalance as the main causes. This problem begins in childhood and in the preference for a sedentary lifestyle. 

Excessive lordosis that has not yet left damage to vertebrates can be corrected. 

Pain is a symptom of long-term overload of the spine, vertebrae, platelets, but also stiffness of the back muscles. The pain can spread to all parts of the back, up under the shoulder blades, or to the buttocks.

After an injury and a fall to the buttocks, it is necessary to think about the coccygeal syndrome - coccygodynia. However, the pain of this type can occur over a long period of time when a person has forgotten about the fall.

Intense pain and the spread of other difficulties, such as tingling, impaired sensitivity, as well as severe muscle weakness in the limb, leading to radiculopathy. The radicular syndrome occurs, for example, in a herniated disc.

Pain is accompanied by a change in posture, in movement habits. When viewed from the side, we find a noticeable bent back, shoulder shoulders.