Lordosis, I Want you back!

I’ve got a bone, or rather bones, to pick! Namely, the 7 cervical and 5 lumbar vertebral bones found in the spinal curves of you and you and you and you…. not you…. but you and you and you… and wait for it….and you! Most people are endowed with lordotic or forward swooping curves, known better as a “lordosis“ in both the neck and the lower back, with some size disparities accounted for by gender and race. The curves are important which we will get to in a bit without getting too technical. Generally speaking, the curves allow for the distribution of forces while bearing the skull weight, along with the upward translation of force when we step and jump, along with carrying loads. It is a perfect spring to distribute loads from overwhelming joints and muscles.

The problem is when well-meaning medical-minded websites, textbooks, and sites such as Wikipedia still perpetuate the notion that these curves are pathologic. To quote Bart Simpson, “Au contraire mon fre’re!” In Wiki’s defense, they offer a proper counterpoint on the matter further along in the read, and if I wasn’t lazy I would notify them to add clarity, for which I hear they are receptive.

I had to voice my concern, however, once my daughter showed me her textbook which stated, “One back problem that often occurs among teens is Lordosis, which is too much arch in the lower back.“ Wrong and wrong.

The book also went on to say that this is also called swayback, but swayback has little to do with the curve and more to do with the posterior weight-bearing of the rib cage relative to a forward pelvis. Think Deputy Droop-a-Long Coyote, or Ed Grimley pictured here:

Never minding my antiquated cartoon reference or my love of SNL, how did this happen? It happened because researchers used a short-hand term which layman picked up on in ways that were not intended. This is something the healing arts and the research community are tackling now. I bring it to light here, because you may have seen contradictory things written about the term “lordosis” to what’s being discussed here and elsewhere on this site.

Is this all just academic dirty laundry not for public consumption? …. I’ll give you a moment to answer…. times up! No, of course not, and why would anyone consume laundry?

With 80% of the population experiencing back pain at some given point in their lives, low back pain making it into the top 5 causes of disability worldwide, and with America’s youth steady along this course showing that 1/3 of them have back or neck pain, I’d have to say we need to be even more academic about our understanding of the spine. Because we are ill-equipped from early on to manage our spines, we need to educate and that starts with the anatomical premise of what the spine is, how it works, and what it looks like in practical terms. Is it too technical to teach about spinal mechanics early? Data out of Europe and Brazil for grade school through high school is suggesting otherwise.

Clinically speaking, maintaining the natural forward arch in the lumbar spine is key in maintaining the disc from excessive migration and un-seaming of some of its fibers lending to disc bulge and sciatic nerve pain. Rounding the lower back with lifts or repeat slumping while sitting and standing lends toward slow migration (or creep) of the thicker central disc material backward while bulging and, over time, it can express in pain. Picture a slow-moving air bubble in a level. Round the back when bending forward or slouching, and the disc, like an air bubble in a level, migrates backward, over time, toward the nerves that travel to the legs. We often don’t feel this process happening early on because the nerve pain fibers of the disc are located in the outer 1/3 of the rim of the disc, and only when the disc’s center material reaches that outer portion will we feel the ouch. Muscles may overwork as well, even sooner, causing pain from slumping and not maintaining one’s lordosis. This too can occur from poor posture or bad mechanics lending to their own pain scenarios.

Further fall out from lacking a normal lordosis is seen via known medical conditions such as flat back syndrome in the lower back, and military neck, or straight neck, which carries its own clinical challenges for the upper spine. Lack of curvature in the neck (or reversed curve) constitutes a postural dysfunction that lengthens healing times and decreases the predictability of healing from whiplash neck or CAD (cervical acceleration/ deceleration) injuries. Chronic pain and spasming resulting in decreased neck curvature and curve straightening, in general, and has been linked to tension headaches, and migraines, as many of the neck muscles, when irritated, refer pain to the head.

Forward head carriage - if you are not familiar with this term from its name, just look at your coworker, or better yet, hold up a mirror to view yourself from the side while working. If the ear canal is forward to the center of your shoulder, this term may be describing you. It is often called “computer worker posture”, or as we called it in college, “being a student.“ The latest is the term, “Tech neck”. Regardless of what you call it, this postural habit will result in pain and, over time, possibly curve straightening or reversal that does not allow for proper weight-bearing of the skull over the spine resulting in earlier and more prolific osteoarthritis with neck pain and headaches.

Sleeping on one’s belly increases lumbar pressures and lends toward prolonged neck torsion with pain and possible complications of curve changes and early arthritic mutation.

To be clear, when we say “keep the back straight” when lifting or doing core exercises such as the plank, In reality, we are asking to maintain the lordosis in one’s lower back. Reminders such as, “Don’t let the apple fall from your head as you lean forward” rather than slumping, is a fancy pants way of remembering to keep your lower back lordosis and “hinge at the hip when you dip.“ Conversely, when lifting above one’s head or doing sustained overhead activities, we are to temper, slightly, the lordosis from excessive pronouncement.

We need to better educate and change the vernacular to include the functional spine and how to maintain our lordoses. Just close your eyes and imagine a world where a wolf whistle and a shout of “nice lordosis!” is a welcomed catcall. Ahh, much better.

-Dr. Goodbender

PLoS One. 2015; 10(8): e0133685.

Published online 2015 Aug 24. doi: 10.1371/journal.pone.0133685

PMCID: PMC4547714

PMID: 26301782

The Lumbar Lordosis in Males and Females, Revisited

Ori Hay, 1 ,* Gali Dar, 2 Janan Abbas, 3 Dan Stein, 1 Hila May, 1 Youssef Masharawi, 4 Nathan Peled, 5 and Israel Hershkovitz 1

Spine (Phila Pa 1976)

. 2013 May 1;38(10):E602-8.

doi: 10.1097/BRS.0b013e31828b666b.

Development of the lumbar lordotic curvature in children from age 2 to 20 years

Sara Shefi 1, Michalle Soudack, Eli Konen, Ella Been