Lumbar Lordosis – A Guide on Treatment, Prevention & more

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I’m a runner. Can it still affect me? What’s the risk?

Introduction to L. Lordosis and LBP

Given the very physically demanding nature of running, the body is exposed to a multiplicity of external stressors which can give way to injury, especially when running outdoors because the ground is not level and any number of obstacles can be in the avid runner’s way. These stressors can become very frustrating to deal with as they might become symptomatic and painful. Then, factor in trying to maintain the often strict training regimens needed to meet the demands of planning for running events, and the result on the body is not a pretty picture.

What can best be described as a tough as nails “no-quit” culture involved with runners, having a stubborn attitude can go from what was once just a frustrating annoyance to deal with, to develop into a symptomatic issue halting running goals and progress altogether—seriously, remember to take time to adequately rest, runners.

 

Lumbar-Lordosis-Women-Runner

 

Lower back pain (LBP) can become one of these many symptomatic issues for runners, and like many of the other preventable potential issues from running, it is likely a result of overuse. So racking up the running mileage is not inherently an issue if done properly, but it should be noted that lower back pain like this can be developed from inadequate preparation, form, and rest, after the stressor of running is introduced.

A cause of LBP is called Lumbar Lordosis, and this is one issue that every runner should know how to address, treat, and prevent. So, this article will lay out in an easy, interesting way, what Lumbar Lordosis is, so that injuries can be avoided, and personal running goals can be met. 

 

What is Lumbar Lordosis?

Where some animals called invertebrates do not possess a “spine”, humans are gifted with this fantastic and complex structure which allows for an equally complex range of motions, increased bodily support—more so than invertebrates— and structural integrity during the demanding tasks of life and running.

Standing to either side looking at an individual facing forward, the healthy spine should follow a gentle curvature, where unhealthy deviance in it might even be noticed just with our eyes alone. These curves are not just for looks too, they play a key role in helping absorb stress load during movement and the constant force of gravity that our bodies bear daily; whether that is in running, other recreational activities, or day to day jobs that require heavy lifting, the spine supports it all.

 

Lumbar-Lordosis-normal-spine-curvature
Normal spine curvature

 

As a refresher in anatomy, because it has been a while since highschool, remember that the spine is a major backbone made up of many smaller bones stacked vertically called vertebrae— 33 to be exact. Each of these 33 vertebrae has a cartilaginous disc between itself and its relatively alike neighbor, stacked vertically above and below, which allows them to act cohesively by gliding and cushioning during movement articulations. Then, on a larger picture, the spine is divided into three regions: cervical, thoracic, and lumbar to further describe it.

“Lumbar” is a word derived from the latin root “lumbus” given to the lower back region, it is translated in english to mean “lion”. So, lumbar spine refers to this lower back region where the spine curves inward toward the abdomen. Basically it starts around 5 or 6 inches below the shoulder blades of the back, then connects with the thoracic spine (middle of the spine) at the top, and finally extends downward toward the sacral spine (the bottom of the spine).

So why call the lumbar region “lion”? The lumbar region is called “lion” because the lumbar is primarily built for power and flexibility, via lifting and twisting, some of which is experienced during running. And, because the lower back has such a high task to serve, it is also an area prone to failure should it be over or improperly used, like in the case of  “Lumbar Lordosis”.

 

Lumbar-Lordosis-lumbar-twist-sprint

 

In spine terminology three words are used to describe when the natural curvature is misaligned or exaggerated in areas: kyphotic, scoliotic, and lordotic. Now do not feel overwhelmed by latin terminology, it is just a fancy way to explain very basic concepts. Kyphotic spinal curvature is often referred to as “hunchback” and is what Quasimodo suffered from in the Hunchback of Notre-Dame.

The term “scoliosis” is a commonly used medical term, it is derived from the word scoliotic, where the spine is curved to the left or right of its normal midline. Last, lordotic refers to an excessive inward curve in the spine, which is where the term “Lumbar Lordosis”, or “swayback” as it is also called, comes from. Lumbar lordosis can become damaging over time if prolonged during running, where the angle that the hips and the spine hold during improper form cause a hyperextended lordosis and resultant excessive pressure and strain in areas not meant or trained to receive it.  

 

Symptoms

Being able to recognize symptoms early on is a learned practice that could prevent permanent damage during running. This requires mindfulness, time, and patience to address what might be causing the issues.


Here is a list of common symptoms related to lumbar lordosis to look out for:

  • Developing a c-shaped back which can be seen when viewed from the side profile of an individual. The buttocks will noticeably be sticking out as well.
  • When lying on the ground, look for a large gap between the lumbar lower back portion of the spine and the ground when relaxed.

 

Lumbar-Lordosis-symptoms
https://upload.wikimedia.org/wikipedia/commons/b/b5/Lordoz.jpg

 

As mentioned earlier, LBP and discomfort can result from prolonged lordosis. Sciatica is another name for this condition. Sciatica is described as being caused when a nerve root in the lower spine is compressed, in this case by lordosis, and manifests itself in a variety of ways:

 

Lumbar-Lordosis-lower-back-pain-symptoms

 

More common symptoms of sciatica:

Symptoms as they relate to running:

According to most research done on lumbar lordosis it is mainly going to cause LBP as a symptomatic issue for runners. The good news is that in most cases of lumbar lordosis during running is completely reversible with the right instructions and practice. This is why it is important to make sure proper running form and muscle memory is implemented before attempting more serious running goals and distances, leaving no room for negative feedback loops such as lumbar lordosis, which generally is a form issue, to develop.

 

Lumbar-Lordosis-proper-posture

 

As previously stated LBP issues can be a direct result of lumbar lordosis and it is going to affect overall running performance when compared to those without, especially in the long run— no pun intended. People with LBP have a reduced range of motion in all directions of movement, slower lumbar movement, and poorer proprioception—”proprioception” meaning their nervous system functioning and awareness of surroundings. Reduced postural control is also a result of LBP.

 

Causes

The common causes of lumbar lordosis are:

  • Achondroplasia: This is where a person’s bones do not grow normally throughout maturation, often resulting in a short stature. The term “dwarfism” is associated with achondroplasia.
  • Spondylolisthesis: This is a vertebral disc and bone disorder where a vertebrae slips forward onto the bone below it. Both genetic and physical factors influence this.
  • Osteoporosis: This is a condition in which vertebrae become fragile and break easily.
  • Obesity: This is a condition defined as a person’s body weight being at least 20% higher than it should be given an individual’s body metrics. If a person’s Body Mass Index (BMI) is between 25 and 29.9 they are considered overweight, if over 30 they are considered obese.
  • Kyphosis: This is a condition which causes the upper back to become haunched and abnormally rounded.
  • Discritis: This is where inflammation of the disc space between the bones and spine occurs, it is most often caused by an internal infection.

 

Lumbar-Lordosis-causes-obesity

 

Risk Factors

Lower back pain which can be onset by lumbar lordosis is a significant healthcare issue in America. According to a recent study, more than 70% of Americans have experienced at least one episode of LBP in their lifetime. In fact many people reading this article likely know a part of that 70% who are suffering from LBP, if not the reader themselves.

Lumbar lordosis if not treated and taken care of properly can lead to:

  • Lumbar disc herniation: where the soft center of a cartilaginous disc forcibly pushes its way through the harder exterior casing, leading to pain.
  • Disc degeneration: the discs between vertebrae do not have a blood supply and very few nerves, so damage to them is not recognized until significant and after being damaged because there is no blood supplied to them they do not heal.
  • Sciatica: this is characterized by pain typically felt down one leg, not past the knee. Felt as a severe burning or tingling instead of dull ache. Felt significantly after sitting for long periods of time and somewhat relieved while walking or moving.

 

Lumbar-Lordosis-leading-to-hernia
Herniation

 

Diagnosis

Lumbar lordosis can be diagnosed using a combination of previously recorded personal symptoms and measuring tools to find joint angles from three different planes of measurement. This method of calculation factors in angles from the spine, body-trunk, hips, and knees. The spine angle is calculated as the relative angle between the trunk of the body and the pelvis segments. This is then used to detect deviance from the spine’s natural placement, which should be directly midline down the back, following a gentle curvature when viewed from the side making a natural “S” shaped curve.

 

Lumbar-Lordosis-Diagnosis-posture

 

In some cases advanced motion-tracking computer technology is used to track specific points placed throughout the body. Researchers have used computer methods to study the effects of lordosis, kyphosis, and scoliosis on people during motion, such as running giving insights into proper form and function and long term results of improper form as detailed in this article.

A normal healthy spine should exhibit a cervical region—remember this is the upper portion of the spine connecting to the head—with a lordotic curvature; a thoracic, or middle portion, with a kyphotic curve; and a lumbar portion with a lordotic curve. This natural lordotic curve is not excessive and hyperextended as in lumbar lordosis. The spine should run perpendicular, up and down the back, right in the middle between the shoulder blades. When abnormalities occur it is due to factors and forces causing a misalignment or exaggeration of areas resulting in lordosis (excessive inward bend), kyphosis (excessive outward bend), and scoliosis (excessive side bend).

 

Lumbar-Lordosis-diagnosis

 

Treatment

Keep in mind that this is not an official diagnosis and health professionals should be seen for one, but according to recent research studies done these treatments have shown to be the most successful when treating persons with lumbar lordosis and LBP:

  • Medication or painkillers to relieve pain and swelling in the back or surrounding regions.
  • Exercise and physical therapy to increase muscle strength and flexibility.

During excessive lordosis the back is abnormally curved, some muscles are stretched and tightened abnormally which can cause or exacerbate LBP. To reduce the tightness of muscles, perform exercises that stretch the tightened areas, such as the commonly problem causing lower back muscles and hip flexors that extend from the groin area into the back. Stretching these areas through daily exercise and routine helps relieve symptoms of lordosis. The key here is to develop a consistent routine as the therapy will take time. It is also important to keep in mind when constructing a muscle strengthening routine for lordosis that the buttocks and hamstrings tend to be weakened as a result of lordosis and should be focal points of a strength routine.

When selecting muscle building exercises bear in mind that a number of factors play into postural misalignment through lordosis, such as:

  • Weak Core Muscles
  • Tight Hip Flexors
  • Poor Exercise Form
  • Weak Gluteal Muscles

It is important to select muscle building exercises that address these areas, promoting back alignment. Good muscle building exercises for lordosis often occur with the participant lying on their abdomen, this is because while lying on the stomach a person is most likely going to engage their back muscles to do more of the work.

Some recommended exercises to learn:

  • Abdominal Crunches
  • Leg Curls
  • Seated Leg Press

 

Lumbar-Lordosis-treatment-seated-leg-press

 

As mentioned previously, stretching can be one powerful tool to use in combating the symptoms and progression of lumbar lordosis. While there are many ways to go about stretching: dynamic, static, progressive-loaded, etc. Detailed below are a few great exercises to begin with and supplement a further research journey:

The Lower Back Stretch

  1. Sit in a chair and lean the body forward, placing head and arms between legs.
  2. Reach arms as far through legs as comfortably capable.
  3. Now rest and return to starting position.
  4. Perform this exercise multiple times as comfortable.

Hip Flexor stretches:

Due to the biomechanical process called “reciprocal inhibition”, which describes when muscles on one side of a joint relax to accommodate contraction on the other side, when the hip flexors are chronically tight the glutes, which is their opposing muscle group, become weak. This as a result has an adverse effect on a person’s pelvic alignment.

Here are some ways to stretch the hip flexors:

Kneeling Hip Flexor Stretch

  1. Start in a kneeling position.
  2. Place a foot on the ground directly in front as if performing a modified lunge.
  3. Now lean forward slightly until a stretch is felt in the hips— do not allow the forward leg’s knee to go over the ankle as this can overly strain the leg.
  4. Move in and out of the stretch comfortably, alternating legs.

 

Lumbar-Lordosis-hip-flexor-stretch

 

Foam Roller

Known as a “myofascial release” which is basically a relaxation of  muscle fibers through stimulation, this method provides the benefits of both massage and stretching.

  1. To begin, lie prone, aligning the hip flexors with the center of a foam roller.
  2. Allow the body weight to push into the roller, do not be afraid to dig into it.
  3. Wait approximately 30 seconds in this position and alternate.

 

Standing Hip Flexor Stretch

The hip flexors can also be manually stretched while standing, this stretch also works the buttock and deep abdominals, the muscular core of the body.

  1. Lung forward on one leg.
  2. With one leg extended behind try to straighten it and feel stretch in hips.
  3. Now hold this position for 30 seconds.
  4. Alternate legs.

 

Lumbar-Lordosis-standing-hip-flexor-stretch

 

Exercises to avoid:

Performing exercises with proper form is important in order to prevent further injury. Those with lumbar lordosis should avoid certain exercises because they may be difficult to perform without the proper practice and form.

Until the condition is corrected, try to avoid these movements:

  • Squat
  • Hack Squat
  • Military Press
  • Roman Chair Sit-Up

 

Wearing a Back Brace can help

Motion of the lumbar spine can delay healing in spinal fractures or postoperative fusions. With lumbar lordosis a back brace may aid in restricting movement and has been found to decrease LBP and discomfort for a time. There are currently two popular back braces to choose from, each with their own advantages and disadvantages:

  • Rigid Braces

These are braces that are made from form fitting rigid plastic materials, such as the Boston Overlap braces or the Thoracolumbar Sacral Orthosis (TLSO). If the brace is fitted properly it has been found to restrict at least 50% of all lower back movement. Patients that wear these braces do complain of overheating in them and because of the rigidity, it may become uncomfortable to wear. This kind of brace is only meant to be worn while standing, and should be taken off at night or while lying down.

 

Lumbar-Lordosis-TLSO-brace

See them here: (TLSO)

 

  • Corset Braces

Sometimes these braces are recommended to limit the motion of the lumbar. This kind of brace does not allow a person to bend forward. People with jobs involving routine heavy lifting sometimes wear corset braces to prevent lower back injury, or help a previous injury heal. These act by limiting motion and serve as a reminder to keep proper posture during work, requiring a person to properly engage their leg muscles instead when lifting.

 

Lumbar-Lordosis-Corset-Brace

See them here: (Corset Brace)

 

Weight Loss

People that are overweight or obese may experience LBP, sciatica, and more which can be onset from lordosis. Losing weight can reduce stress on the lower back over time and strengthen the lower back and surrounding core muscles, depending on the exercises used to lose excess weight. Healthy eating can also improve the body’s ability to heal as well as lose weight.

 

Surgery

If lumbar lordosis persists over time it may lead to permanent damage in the lower back such as disc degeneration or slipping. When this happen surgery becomes a viable option to fix LBP. Instruments are installed on the spine such as hooks, rods, wires, attaching to the spine to realign the bones of the spine and keep them secure following injury. Surgery should always be considered as a last resort as it can lead to permanent restriction in movement, and there is a risk of rejection or infection following the implants.

Here are some common lower back surgeries:

Spinal Fusion

This is a major surgery lasting for a few hours in the operation room. It is meant to join or fuse two or more vertebrae in the back. In order to fuse the bones a bone graft can be taken from the pelvis bone or a bone bank, and is grafted onto the vertebrae in order to make a bridge between them. Metal implants are often used in conjunction with the grafts to hold the vertebrae in place until the graft is finished fusing and healing. Some risks of this surgery are: pain at the bone graft site; failure of the fusion, breakage of the metal implants, or both; blood clots which may lead to a pulmonary embolism—which is a very serious instance where an artery in the lung is clogged; nerve injury; graft rejection; or infection.

 

Lumbar-Lordosis-spinal-fusion-treatment-surgery

 

Artificial Disc Replacement

This surgery is often needed when disc degeneration occurs.

Disc degeneration is when the cartilaginous discs between vertebrae become damaged by natural causes or a twisting injury where the inner and outer portions of a disc may tear or break, irritating the nerves on the outer edge of the annulus—which is just a fancy term for vertebral disc.

A micromotion instability can be caused from disc degeneration because the discs can no longer hold the vertebral column together as well as it used to. Keep in mind that the discs themselves already have no blood circulation and very little nerve endings. Without a blood supply they are not able to heal themselves like other portions of the body can.

 

Lumbar-Lordosis-disc-degeration

 

Pain from damaged discs can last for years if not treated, felt as either chronic pain or flaring up occasionally. Disc degeneration and the symptoms resulting are commonly felt from ages 30 to 60 years old, but can be onset by injuries during lumbar lordosis. Lumbar artificial disc replacement “total disc replacement”  is used to treat lumbar lordosis. This surgery is used to treat painful, injured lumbar discs. It does not restore complete spine range of motion, but will maintain some form of motion and reduce pain which is important in keeping the rest of the spine healthy. Keep in mind that disc implants may wear out after 10-20 years following surgery, and infection at the area of operation can occur, but is rare.

 

Prevention

Prevention of lumbar lordosis is possible if the signs and symptoms are recognized before permanent injury can occur. At the first sign of symptoms pay careful attention and rest from suspected activity, which may be causing them, to avoid overuse and permanent injury.

The following are ways to prevent lordosis and resultant LBP from happening during running:

  • Back muscle strengthening exercises
  • exertive exercises
  • Do not sit hunched, slouched, or remain in improper posture for long periods of time, the spine is created to flex and move in a variety of ways. Some jobs require remaining stationary, get creative in implementing ways to move: medicine ball chair, standing desk, even a treadmill desk can help.
  • Lower back braces, especially corset braces, have been found to teach by reminding to keep proper posture. And if injury has already occurred they can reduce chance of further injuries to the lower back area by restricting movement and allowing to heal.

 

Lumbar-Lordosis-back-strengthening-exercise

 

False Positives

False diagnoses of lumbar lordosis is not generally something to be worried about as it is fairly simple to diagnose using calculations of angles as they relate to the pelvis, spine, and knees and the common corresponding symptoms laid out in this article.

When trying to treat their own symptoms an individual may confuse the lordotic excessive inward bending of the lower back with either kyphosis or scoliosis and should be careful to understand the differences between them in order to address a change in running. Progressive injuries to the lumbar region of the back can also be confused with lumbar lordosis, such as disc degeneration or disc slipping caused by another force, perhaps by over twisting, called torsion, during exercise.

 

To Sum It Up

Lumbar Lordosis is the excessive inward bending of the lumbar region of the back, the region which in latin means “lion” because it is built for the power and flexibility required during lifting, twisting, and bending which happens in everyday lives.

Lumbar Lordosis can become an issue during running if not corrected as it puts strain and pressures in areas of the lower back by misaligning the natural “S” curve which is by nature designed to absorb impact forces most effectively. As a runner it is important to be aware of any painful symptoms and not stubbornly push through them, as this can result in permanent damage to either the vertebrae or discs lying between them.

 

Lumbar-Lordosis-runner-stretching



This is a treatable issue if caught soon enough and is most likely caused by poor running form. In this case the runner should research and learn from experts about proper running form and alignment to avoid further irritation to the lower back. If pain already exists it is recommended to rest from running or wear a corset brace until the pain has subsided and then try to address the running form in practice. Other causes of lumbar lordosis include being overweight or obese, and weak core-muscles which may need to be strengthened through training, something that runners may neglect while exercising primarily the cardiovascular system when running.

If the advice suggested in this article to address lumbar lordosis does not bring relief from lordosis pain, see a licensed physician for spinal examination. This is especially important if the back is becoming progressively difficult to stretch or is more inflexible after the exercises detailed. It should also be noted that in some studies the use of abdominal muscle strengthening exercises and stretching exercises of the back and one-joint hip flexor muscle to correct faulty posture is questioned for its efficacy in treating lumbar lordosis.

 

Sources Used While Conducting Research

Reading this article is not a substitution to seeing a licensed physician for medical diagnoses, especially in trauma situations. Research for this article has been done with reputable sources that have been linked below for the convenience, trust, and cross evaluation of readers. The majority of sources were written by medical professionals or consist of published studies in medical journals, and peer reviewed studies.

Sources