Lordosis (Swayback): Causes, Treatment, and Excercise

By Author : Dr. Deepanshu Siwach
  calender 15 January,2025
Lordosis (Swayback): Causes, Treatment, and Excercise

Imagine standing tall like a proud mountain, your posture exuding confidence. Now picture your lower back taking an exaggerated dip, creating an unintentional swayback pose—welcome to the world of lordosis! While the term might sound like a spell from Harry Potter, it's a real spinal condition that affects millions globally. Studies show that about 20-40% of adults experience some form of spinal curvature abnormalities at some point in their lives, and lordosis is among the most common. But don't let this statistic make your spine shiver!

From office workers slumped over their desks to fitness enthusiasts unaware of poor form, lifestyle choices often play a leading role in lordosis. Fortunately, knowledge is your most powerful tool. So, let's dive into everything you need to know about this "swayback" condition—from understanding its causes to discovering effective treatments and exercises that could save your spine. Your journey to a healthier posture starts here!

What is Lordosis?

Lordosis is a medical term for the natural forward curvature of the spine, especially in the neck and lower back. These areas are naturally curved slightly forward, which helps you maintain good posture, absorb shock when you move, and support your body's weight. However, when the curve becomes too exaggerated, it leads to an excessive arch in the spine, causing what is known as hyperlordosis or swayback. This condition can throw off your posture, causing discomfort and sometimes pain. A normal curvature in the cervical spine is about 30 to 40 degrees, while in the lumbar spine, it is around 40 to 60 degrees. Anything beyond these ranges could be considered an abnormal lordotic curve.

In extreme cases, lordosis can cause the abdomen to protrude and the pelvis to tilt backward, affecting your overall posture. It may also lead to conditions like low back pain, muscle imbalances, and sometimes issues with internal organs like constipation or heartburn.

Various factors, including poor posture, genetics, injury, obesity, or pregnancy, can cause lordosis. In many cases, especially with children, the condition resolves on its own as they grow. Most adults with mild lordosis do not require treatment, though stretching exercises and posture correction can help relieve discomfort.

What is the Difference Between Lordosis, Kyphosis, and Scoliosis?

Lordosis, kyphosis, and scoliosis all involve abnormal curvature of the spine, but each affects different parts of the spine and causes various types of curves.

  • Lordosis is nothing but an inward curve of the spine in the cervical (neck) and lumbar (lower back) regions. It creates an exaggerated arch, which may cause the abdomen to protrude and the pelvis to tilt backward. When the curve becomes too extreme, it is often called swayback, which can lead to poor posture and back pain.
  • Kyphosis is the spine's way of giving your upper back (thoracic spine) an exaggerated backward curve—giving you that classic "hunched" appearance. Think of a turtle shell but on your back! This condition often results from age-related changes, poor posture, or osteoporosis. It might seem like a normal condition at first, but it can lead to shoulder pain, difficulty standing upright, and even breathing issues in extreme cases.
  • Scoliosis is characterized by an abnormal side-to-side curve of the spine, where the spine can bend to the left or right, often creating a "C" or "S" shape. This condition is most commonly seen in children and adolescents and may also involve some degree of rotation of the vertebrae. If not treated, scoliosis can cause uneven shoulders or hips, leading to complications.

In a nutshell, lordosis is an inward curve, kyphosis is an outward curve, and scoliosis causes a side-to-side curvature.

What are the Different Types of Lordosis?

Types of Lordosis

When we think about our spines, we usually consider them straight and sturdy—but the truth is, they have their natural curves. Lordosis is one of these curves, and while it's essential for movement and posture, sometimes it can become too pronounced. So, what are the different types of lordosis? Let's look at this swayback condition and its various forms!

  • Postural Lordosis: If you've been carrying extra weight or spending long hours with poor posture, you may be dealing with postural lordosis. This type occurs when the excess weight in your stomach area pulls your spine forward, and weak abdominal and back muscles can't provide the necessary support to maintain alignment. The result? A magnified inward curve in the lower back.
  • Post-Surgical Hyperlordosis: Did you know that surgery could be responsible for excessive curvature in your spine? Post-surgical hyperlordosis occurs when a laminectomy (an operation that removes parts of the vertebrae) creates instability in the spine, making it curve excessively. Although this isn't common, it can develop after surgery to treat conditions like chronic lower back pain.
  • Secondary Lordosis: Some types of lordosis are secondary, arising due to other conditions such as kyphosis, scoliosis, or hip joint issues. When these underlying problems disrupt the spine's alignment, they may cause an exaggerated inward curve in the lumbar or cervical spine, leading to the characteristic "lordotic curve."
  • Congenital and Traumatic Lordosis: Some individuals are born with lordosis due to spinal development issues, or they acquire it through trauma, such as fractures or sports injuries. Children are particularly prone to developing congenital lordosis, and it can be a sign of other serious conditions, such as spondylolysis. Rest and limited movement are often recommended to avoid complications like vertebrae slippage.
  • Neuromuscular Lordosis: Certain neuromuscular disorders like muscular dystrophy or cerebral palsy can lead to lordosis due to muscle imbalances and weaknesses. In these cases, treatment depends on the specific disorder affecting the muscles and nerves, and it's essential to seek medical care to manage the condition effectively.

Types of lordosis based on the part of the spine involved:

  • Cervical lordosis involves the neck, creating an inward curve in the cervical spine. Too much of this curve could lead to neck pain and a limited range of motion.
  • Lumbar lordosis is the classic swayback affecting the lower back. It leads to a noticeable curve in the lumbar spine, making your abdomen and buttocks protrude.

Lordosis in Special Cases:

  • Pregnancy: Pregnant women often experience a temporary form of lordosis as the body adjusts its center of gravity. This is normal and should resolve post-birth.
  • Children: Benign juvenile lordosis occurs in children due to weak or tightened muscles around the hips. It often corrects itself with growth, but in some cases, it may be a sign of more serious issues like hip dislocation or neuromuscular disorders.

What are the symptoms of Lordosis (Swayback)?

While many people with lordosis don't experience symptoms, more severe cases can cause discomfort and affect daily activities. Let's explore the range of symptoms associated with this condition.

  • Visible Postural Changes: One of the primary signs of lordosis is a visible change in posture, where the body appears overly arched, with the stomach and buttocks protruding. The head and neck may lean forward, shifting the alignment of the upper body. These postural changes often prompt individuals to seek medical advice, especially if the shift becomes more noticeable.
  • Pain and Discomfort: In addition to visible changes, lordosis can lead to pain and discomfort. Lower back pain is commonly associated with lumbar lordosis, where the exaggerated curve strains the muscles and joints. Neck pain can result from cervical lordosis, particularly if the curve causes additional stress on the neck muscles. Due to the spine misalignment, individuals with lordosis may also experience mid to upper back pain and muscle tightness. These symptoms worsen with activities like prolonged standing or walking, leading to reduced mobility and flexibility.
  • Nerve-Related Symptoms: As the curvature of the spine becomes more severe, nerve compression can occur, causing additional symptoms. Sciatica, where pain radiates down the legs, is often a result of pinched nerves in the lower back. Numbness, tingling, and a pinning sensation in the legs or back can also develop, signaling nerve involvement. In more advanced cases, leg weakness and difficulty moving may occur. These nerve-related symptoms indicate a more progressed condition and require immediate medical attention.
  • Advanced Symptoms: In the rarest and most severe cases, lordosis can cause complications such as bladder or bowel control issues, which signal significant nerve compression and require urgent intervention. Due to nerve involvement in the lower spine, men may also experience erectile dysfunction. Such advanced symptoms are red flags and necessitate prompt evaluation to prevent further damage to the spine.
  • Symptoms in Children: Children with lordosis may show a more exaggerated swayback posture. In some cases, they may experience pain, tingling, or weakness in their legs, and in rare instances, they could lose control of their bladder. While lordosis in children often resolves on its own over time, it's essential to monitor for signs of more severe nerve involvement and seek medical attention if any concerning symptoms arise.

What are the Causes and Risk Factors for Lordosis (Swayback)?

Lordosis can result from various factors, including postural habits, medical conditions, and biomechanical imbalances. Some of the key risk factors and causes of lordosis are:

  • Poor Posture: Consistently sitting or standing with improper alignment can strain the spine, leading to an exaggerated inward curve. Prolonged periods of poor posture weaken stabilizing muscles and contribute to the development of swayback.
  • Muscle Imbalances: Lordosis often stems from muscular imbalances, such as tight hamstrings, weak abdominal muscles, and overstretched gluteal muscles. These imbalances can misalign the pelvis and spine, resulting in excessive curvature.
  • Obesity: Excess body weight, particularly in the abdominal region, shifts the body's center of gravity forward. This added strain can increase the curvature of the lumbar spine, exacerbating lordosis.
  • Trauma: Accidents, sports injuries, or falls that damage the vertebrae or surrounding structures can alter spinal alignment. Conditions such as spondylolysis (spinal fractures) or other traumatic injuries may result in lordosis.
  • Medical Conditions: Certain medical conditions can predispose individuals to lordosis:
    • Spondylolisthesis: A spinal disorder where one vertebra slips forward over another.
    • Osteoporosis: Weak and brittle bones that may collapse, altering spinal curvature.
    • Muscular Dystrophy: Muscle degeneration affects spinal support and posture.
    • Cerebral Palsy: Neuromuscular impairments often result in abnormal spinal curvature.
  • Neurological or Developmental Issues: Conditions like developmental hip dysplasia or static encephalopathy can lead to abnormal spinal alignment and swayback posture.
  • Pregnancy: The weight and shifting center of gravity during pregnancy often lead to a temporary increase in lumbar lordosis. While this typically resolves post-pregnancy, persistent swayback can occur in some cases.
  • Surgery: Certain spinal surgeries, such as selective dorsal rhizotomy or treatments for scoliosis, may inadvertently alter spinal alignment, contributing to lordosis.

How is Lordosis Diagnosed?

The diagnosis of lordosis typically involves a comprehensive evaluation by a healthcare provider. This process includes a combination of medical history review, physical examination, and diagnostic imaging to confirm the presence and severity of the spinal curve.

  • Medical History and Symptom Assessment: The healthcare provider begins by taking a detailed medical history to identify potential risk factors or underlying conditions. Questions may include: 
    • When did you first notice the curve in your back?
    • Has the curve changed over time or become more pronounced?
    • Do you experience any pain, discomfort, or limited mobility?
    • Are there family members with similar spinal issues or other conditions?
  • Physical Examination: During the physical examination, the spine doctor observes the individual's posture and spinal alignment. They may ask you to perform specific spine movements, such as bending forward or to the side, to assess:
    • The flexibility of the curve (whether it changes with movement).
    • The range of motion in the spine.
    • Any abnormalities, such as misalignment or muscle imbalances.
    • Signs of associated conditions like scoliosis or kyphosis.
  • Diagnostic Imaging: Imaging tests are commonly used to confirm a lordosis diagnosis and evaluate the severity of the curvature. These include:
    • X-rays: The primary imaging method to measure the angle of the spinal curve and determine if it exceeds the normal range.
    • MRI (Magnetic Resonance Imaging): Offers detailed images of soft tissues, including spinal discs, nerves, and muscles, to detect potential complications or underlying causes.
    • CT Scan (Computed Tomography): Shows cross-sectional spine views, providing detailed information about bones and surrounding structures.
    • Bone Scans: Occasionally used to identify inflammation, fractures, or bone-related conditions contributing to lordosis.
  • Additional Tests: In some cases, additional tests may be necessary:
    • Blood Tests: These may help rule out metabolic or systemic conditions that could contribute to lordosis.
    • Neurological Assessments: If nerve-related symptoms (e.g., tingling or weakness) are present, a neurological evaluation helps determine the extent of nerve involvement.

Diagnosis for Children

For children, the diagnostic process is similar but often includes close monitoring over time. Many cases of pediatric lordosis are idiopathic (without a known cause) and may resolve as the child grows.

Determining the Need for Treatment

After analyzing the findings from physical exams and imaging, the healthcare provider evaluates whether the curvature is within normal limits based on your age, height, and overall health. Flexible curves that cause no symptoms often require no treatment, while fixed or symptomatic curves may need targeted interventions.

Accurate diagnosis allows healthcare providers to determine the severity of lordosis and develop an appropriate treatment plan tailored to the individual's needs.

How is Lordosis Treated?

Treatment for Lordosis

Treatment for lordosis depends on the location of the curve, its severity, and whether it is causing symptoms such as pain, stiffness, or mobility issues. In most cases, lordosis does not require significant medical intervention. However, when treatment is necessary, the focus is on alleviating discomfort, improving posture, and preventing further curvature progression.

Conservative Treatments

  • Physical Therapy and Exercise: Physical therapy is a cornerstone of lordosis treatment. Specific exercises and stretches are designed to:
    • Strengthen core muscles, including the abdomen, back, glutes, and hamstrings.
    • Improve flexibility and spinal alignment.
    • Alleviate pain and discomfort.
    • Common exercises include pelvic tilts, cat-cow stretches, hamstring stretches, and wall angels.
  • Pain Management: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) can help reduce lordosis pain and inflammation. These medications are typically used in combination with other treatments.
  • Weight Management: Maintaining a healthy weight lessens stress on the spine, which can help improve posture and alleviate symptoms of lordosis.
  • Lifestyle Modifications:
    • Practicing proper posture.
    • Using ergonomic furniture to support spinal alignment.
    • Avoid extensive sitting or standing in one position.

Bracing

Bracing may be recommended for children and adolescents if the curvature is significant or worsening. A custom-made brace supports the spine and prevents further progression of the curve. Based on the healthcare provider's recommendations, the brace is typically worn for at least 20 hours daily.

Surgical Intervention

Surgery is rarely required and is typically reserved for severe cases where:

  • The curvature is rigid or worsens over time.
  • Neurological symptoms, such as numbness or weakness, are present.
  • Other treatments have failed to alleviate symptoms.

The most common surgical procedure for lordosis is spinal fusion, which stabilizes the spine and reduces the abnormal curve. Surgeons may use bone grafts or implants to promote healing and alignment.

Monitoring and Follow-Up

Patients with mild lordosis or no symptoms should visit their healthcare provider regularly to monitor the curve and ensure it does not worsen.

Treatment for Underlying Causes

If lordosis is associated with an underlying condition such as muscular dystrophy, spondylolysis, or achondroplasia, treatment will also address the primary condition alongside managing lordosis symptoms.

Which are the Best Exercises for Lordosis (Swayback)?

Exercises designed to improve lordosis focus on strengthening the core, glutes, and back muscles while enhancing flexibility and spinal alignment. Here are some of the most effective exercises for managing swayback posture:

  • The Plank: Planks help strengthen the core, including abdominal muscles, glutes, and shoulders, which are crucial for spinal stability.
    • Lie face down on the floor or a mat.
    • Place your forearms on the ground with elbows under your shoulders.
    • Tighten your abdominal and glute muscles.
    • Lift your body off the ground and create a straight line from head to heels.
    • Hold the position as long as possible without shaking or arching your back.
    • Lower back down smoothly.
    • Repeat 2–3 times, increasing the duration as your strength improves.
  • Glute Bridge: This exercise strengthens the glutes, hamstrings, and core to balance the pelvis and support the spine.
    • Lie on your back with knees bent and feet flat on the floor, hip-width apart.
    • Tighten your glutes, lifting your hips until there's a straight line from your shoulders to your knees.
    • Hold the position for 10–20 seconds.
    • Lower your hips back to the ground slowly.
    • Repeat 2–3 times, gradually increasing hold duration and reps.
  • Cat-Cow Pose: Improves spinal mobility and flexibility, reduces stiffness, and realigns the spine.
    • Begin on all fours, placing hands under shoulders and knees under hips.
    • Exhale and arch your spine upwards, tucking your chin to your chest (Cat Pose).
    • Inhale and drop your belly while lifting your head and tailbone (Cow Pose).
    • Move slowly between these positions for 10–15 seconds each.
    • Repeat for 5–10 cycles.
  • Hip Flexor Stretch: Stretches tight hip flexors that can contribute to an exaggerated curve.
    • Kneel on one knee on a soft surface.
    • Place the opposite foot in front so the knee forms a 90-degree angle.
    • Keep your pelvis neutral and shoulders down.
    • Lean slightly forward into the hip while keeping your torso upright.
    • Hold for 30–45 seconds.
    • Switch sides and repeat 2–5 times.
  • Supine Hollowing: Engages deep core muscles and strengthens the pelvic floor.
    • Lie on your back with your knees bent and feet flat on the floor.
    • Relax your shoulders and arms to the side.
    • Draw your belly button/navel towards your spine while contracting the pelvic floor.
    • Hold the contraction for a few breaths without moving the hips or ribcage.
    • Release and repeat for 8–10 repetitions.
  • Seated Leg Lift: Strengthens the lower abdominals, pelvis, and hip muscles.
    • Sit upright in a straight-backed chair with feet flat on the ground.
    • Lift one leg, keeping it straight and flexed at a 90-degree angle.
    • Hold for 2–3 seconds, then lower it back down.
    • Switch legs and repeat ten times on each side.
    • Gradually increase sets as you build strength.
  • Resistance Band Pull Apart: Strengthens the upper back and shoulder muscles, improving posture.
    • Hold a resistance band at shoulder width in front of you.
    • Pull the band wide apart while squeezing your shoulder blades together.
    • Pause briefly, then return to the starting position.
    • Perform 1–2 sets of 15 reps, increasing to 3 sets as you gain strength.

Tips for Effective Exercise

  • Try focusing on proper form to avoid injury and strain.
  • Increase repetitions and sets gradually as you build strength.
  • Stop any exercise that causes pain or worsens symptoms.
  • Combine these exercises with professional guidance for optimal results.

These exercises can help manage lordosis by improving muscle balance, spinal alignment, and overall posture when practiced regularly.

How Can You Prevent Lordosis?

While it may not always be possible to prevent lordosis, especially if it is idiopathic or caused by underlying health conditions, adopting healthy habits and practices can minimize the risk of developing or worsening abnormal spinal curvatures. Here are some strategies:

  • Maintain Good Posture: Always be mindful of your posture during daily activities, whether sitting, standing, or lifting. Keep your shoulders back, your chest open, and your spine in a neutral position. Avoid slouching or excessively arching your lower back.
  • Strengthen Core Muscles: Regularly perform exercises that target your core, glutes, and lower back to support spinal alignment. Effective exercises include planks, glute bridges, and pelvic tilts. Activities like yoga and Pilates are also beneficial as they emphasize core strength and proper posture.
  • Practice Proper Lifting Techniques: When lifting hefty objects, bend at your knees rather than your waist. Keep the object close to your body, and avoid twisting your spine while lifting.
  • Maintain a Healthy Weight: Excess body weight can strain your spine, worsening the curvature. Regularly engaging in physical activities and having a balanced meal can help you achieve and maintain a healthy body weight.
  • Avoid Prolonged Sitting or Standing: Alternate between standing and sitting to prevent stress on your spine. Use ergonomic chairs with lumbar support if you must sit for long periods. For prolonged standing, consider using a footrest to shift your weight periodically.
  • Make Ergonomic Adjustments: Optimize your workspace to encourage good posture. Adjusting the height of your chair will help support your spine. Consider using standing desks and taking frequent breaks to stretch and move around during sedentary tasks.
  • Stay Flexible and Active: Incorporate stretching exercises into your routine to keep muscles flexible, particularly your hip flexors and hamstrings. Exercises like the Cat-Cow pose, pelvic tilts, and leg raises can improve spinal mobility and prevent stiffness.
  • Seek Timely Medical Attention: Address any back pain or discomfort as soon as possible with the help of a healthcare provider. Regular check-ups are essential to monitor spinal health, particularly during growth spurts in children, when spinal changes may occur.

By maintaining good posture, strengthening your core, and adopting healthy lifestyle habits, you can support spinal health and lessen the risk of complications associated with lordosis.

Final Thoughts

As we've uncovered, lordosis isn't a life sentence; it's a wake-up call to pay attention to your posture, lifestyle, and overall spine health. With nearly 80% of people worldwide experiencing back pain at some point in their lives, adopting proactive habits like core-strengthening exercises, ergonomic adjustments, and regular movement isn't just about treating lordosis—it's about preventing a host of back-related woes.

Remember, your spine is your body's superhighway, supporting every move you make. Treat it like the VIP it is, and it will reward you with strength, flexibility, and freedom. Whether addressing mild swayback at home or consulting a spine specialist for more advanced issues, staying informed and taking action is crucial. So, straighten up, embrace your spine's natural curves, and let's move forward—free from lordosis!

Author

Doctor of Pharmacy

Dr. Deepanshu Siwach is a skilled clinical pharmacist with a Doctor of Pharmacy degree. He has 4+ years of experience and has worked with thousands of patients. He has been associated with some of the top hospitals, such as Artemis Gurgaon.

Reviewer

Head of Department (HOD)
Spine Surgeon

Artemis Hospital, Gurgaon

A renowned Neuro-spine Surgeon, Dr. S K Rajan, has successfully performed over 3000 surgeries, including intricate spine cases. With over 25 years of experience, his expertise lies in minimally invasive (keyhole) spine surgery, Craniovertebral junction (...

Frequently Asked Questions

If your lower back appears excessively arched and your buttocks protrude more than usual, you may have lordosis. Common symptoms of lordosis include back pain, stiffness, and difficulty standing straight for long periods. A spine doctor can diagnose the condition through a physical exam and imaging investigations such as X-rays.

Lordosis is when the spine curves excessively inward at the lower back or neck. This abnormal curvature can cause uneven weight distribution, leading to muscle imbalances, back pain, and, in severe cases, nerve compression or mobility issues.

Lordosis can be managed or improved with appropriate treatments, such as physical therapy, bracing, or lifestyle adjustments. In children, mild lordosis may correct itself as they grow. Severe cases may require long-term management or surgery.

Natural methods, such as exercise, proper posture, and weight management, can often improve mild lordosis. While these measures can reduce symptoms and prevent worsening, they may not completely "cure" the curvature. For severe cases, medical and/or surgical intervention may be necessary.

The best treatment depends on the severity of the condition and its underlying cause. Common treatments include physical therapy, bracing, medication, and surgery.

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