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PT Role of Lordosis.docx


Role of PT in Mangment of Lordosis


2016
AMR HAUSAM OUDA
ID:60111 M5
PROF. SAMIR AL-GAZZAR |

Introduction: -
Everyone’s spine curves a little in the neck, upper back, and lower back. These curves, which create the spine’s S shape, are called the lordotic (neck and lower back) and kyphotic (upper back) or curvatures. They help the body:
 absorb shock  support the weight of the head  align your head over your pelvis  stabilize and maintain its structure  move and bend flexibly
Lordotic curve refers to the natural second curvature, which is normal, but if the curve arches too far inward, it’s called lordosis, or
swayback. Lordosis can affect the lower back and neck. This can lead to excess pressure on the spine, causing pain and discomfort. It can affect the ability to move if it’s severe and left untreated.
Lower spine disorders occur when lumbar lordosis is excessive (lumbar hyperlordosis), minimal, or is reversed into lumbar kyphosis. These conditions are usually a result of poor posture and can often be reversed by learning correct posture and using appropriate exercises.
Lumbar hyperlordosis is a condition that occurs when the lumbar region (lower back) experiences stress or extra weight and is arched to point of muscle pain or spasms. Lumbar hyperlordosis is a common postural position where the natural curve of the lumbar region of the back is slightly or dramatically accentuated. Commonly known as swayback, it is common in dancers. Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tight hip flexors(psoas). A major feature of lumbar hyperlordosis is a forward pelvic tilt, resulting in the pelvis resting on top of the thighs.
Other health conditions and disorders can cause hyperlordosis. Achondroplasia (a disorder where bones grow abnormally which can result in short stature as in dwarfism), Spondylolisthesis (a condition in which vertebrae slip forward) and osteoporosis (the most common bone disease in which bone density is lost resulting in bone weakness and increased likelihood of fracture) are some of the most common causes of hyperlordosis. Other causes include obesity, hyperkyphosis (spine curvature disorder in which the thoracic curvature is abnormally rounded), discitits (an inflammation of the intervertebral disc space caused by infection) and benign juvenile lordosis.[7] Other factors may also include those with rare diseases, as is the case with Ehlers Danlos Syndrome (EDS), where hyper-extensive and usually unstable joints (e.g. joints that are problematically much more flexible, frequently to the point of partial or full dislocation) are quite common throughout the body. With such hyper-extensibility,

it is also quite common (if not the norm) to find the muscles surrounding the joints to be a major source of compensation when such instability exists. include tight low back muscles, excessive visceral fat, and pregnancy. Rickets, a vitamin D deficiency in children, can cause lumbar lordosis.
Types of lordosis:-
Lordosis in the lower back
Lordosis in the lower back, or lumbar spine, is the most common type. The easiest way to check for this condition is to lie on your back on a flat surface. You should be able to slide your hand under your lower back, with little space to spare.
Someone with lordosis will have extra space between their back and the surface. If they have an extreme curve, there’ll be a visible C-like arch when they stand. And from the side view, their abdomen and buttocks will stick out.
Cervical lordosis
In a healthy spine, your neck should look like a very wide C, with the curve pointing toward the back of your neck. Cervical lordosis is when your spine in the neck region doesn’t curve as it normally should.
This can mean: There’s too much of a curve.The curve is running in the wrong direction, also called reverse cervical lordosis. The curve has moved to the right. The curve has moved to the left.
Signs & symptoms:-
The most common symptom of lordosis is muscle pain. When your spine curves abnormally, your muscles get pulled in different directions, causing them to tighten or spasm. If you have cervical lordosis, this pain may extend to your neck, shoulders, and upper back. You may also experience limited movement in your neck or lower back.
 Lower back pain.  Numbness, Tingling.  Electric shock pains.  Weak bladder control,  Weakness of lower limb muscle.  More serious symptoms may appear that suggest a trapped nerve.

Common causes of lordosis:-
Lordosis can affect people of any age. Certain conditions and factors can increase your risk for lordosis. This includes:
 Trauma to the lower back  poor posture from sitting or lifting heavy things  obesity, as excess weight negatively affects posture  kyphosis, or humpback, which forces your body to compensate for the imbalance  discitis, or inflammation of the space between your vertebra  osteoporosis, or loss of bone density  spondylolisthesis, or when one vertebra slips forward and doesn’t align achondroplasia, a form of dwarfism
In children: -
Often, lordosis appears in childhood without any known cause. This is called benign juvenile lordosis. It happens because the muscles around your child’s hips are weak or
tightened up. Benign juvenile lordosis typically corrects itself as your children grow up.
Lordosis can also be a sign of a hip dislocation, especially if your child has been hit by a car or fallen somewhere.
Other conditions that can cause lordosis in children are normally related to the nervous system and muscle problems. These conditions are rare and include:
cerebral palsy
myelomeningocele, an inherited condition where the spinal cord sticks through a gap in the bones of the back
muscular dystrophy, a group of inherited disorders that cause muscle weakness spinal muscular atrophy, an inherited condition that causes involuntary movements arthrogryposis, a problem that occurs at birth where the joints can’t move as much as
normal
In pregnant women: -
Many pregnant women experience back pains and will show the signs of lordosis, a protruding belly and buttocks. But according to Harvard Gaze, research shows that lordosis during pregnancy is actually your spine adjusting to realign your center of gravity.
Overall back pain may be due to altered blood flow in your body, and the pain will most likely go away after birth.

Diagnosis: -
Measurement and diagnosis of lumbar hyperlordosis can be difficult. Obliteration of vertebral end-plate landmarks by interbody fusion may make the traditional measurement of segmental lumbar lordosis more difficult. Because the L4-L5 and L5-S1 levels are most commonly involved in fusion procedures, or arthrodesis, and contribute to normal lumbar lordosis, it is helpful to identify a reproducible and accurate means of measuring segmental lordosis at these levels.
A visible sign of hyperlordosis is an abnormally large arch of the lower back and the person appears to be puffing out his or her stomach and buttocks.
 Precise diagnosis is done by looking at a complete medical history, physical
examination and other tests of the patient.  X-rays are used to measure the lumbar curvature, bone scans are conducted in order to rule out possible fractures and infections,  magnetic resonance imaging (MRI) is used to eliminate the possibility of spinal cord or nerve abnormalities  computed tomography scans (CT scans) are used to get a more detailed image of the bones, muscles and organs of the lumbar region.
Treatment: -
Most people with lordosis don’t require medical treatment unless it’s a severe case.
Treatment for lordosis will depend on how severe your curve is and the presence of other symptoms.
Treatment options include:
 Complete rest.  Correct poor posture and maintain healthy lifestyle.  Medication, to reduce pain and swelling.  Daily physical therapy, to strengthen muscles and range of motion. This can be accomplished by stretching the lower back, hip-flexors, hamstring muscles, and
strengthening abdominal muscles. Weight loss, to help posture.  Braces, in children and teens.  Nutritional supplements such as vitamin D.  Surgery, in severe cases with neurological concerns.
Stretches: -
 Hamstring Stretch to stretch your hamstring muscle group and the upper attachment of the
calf muscle.

 Stork Stretch to stretch the quadriceps muscle group, especially the rectus femoris muscle, also stretches the iliopsoas muscle, and hip flexor. Especially helps with lumbar lordosis  Spine Flattener to stretch the long extensors of the spine and to assist in the remediation of an abnormal lordotic curve of the neck and lower back.  Mad Cat to strengthen abdominal, shoulder, and back muscles and to assist in the remediation of lumbar lordosis and inflexible lower back.  Chair Hip Flexor Stretch to stretch the hip flexors and to assist in the remediation of forward pelvic tilt and lumbar lordosis.  Facedown Thigh and Hip Flexor Stretch to stretch the quadriceps muscle group, specifically the rectus femoris muscle and the iliopsoas hip flexor muscle; may also assist in remediation of lumbar lordosis.

Braces: -
The Boston brace is a plastic exterior that can be made with a small amount of lordosis to minimize stresses on discs that have experienced herniated discs. In the case where Ehlers Danlos Syndrome (EDS) is responsible, being properly fitted with a customized brace may be a solution to avoid strain and limit the frequency of instability.
Lordosis exercises:-
There are many postural and muscle related factors that contribute to lordosis. These are weak core muscles, tight hip flexors, poor exercise techniques and weak gluteal muscles. Some of these problems may be corrected with lordosis exercises. These include:
Pelvic tilt
Pelvic tilt position is the position exactly opposite of the “arched back position”. It can
help to correct lordotic posture if applied daily. The patient must lie on his/ her back with his/her knees bent and feet flat on the floor. Then he/she should inhale properly. After that, he/she should exhale and tilt the lower part of pelvis simultaneously. Twenty repetitions of this exercise must be performed daily.




Stability Ball Bridge
This exercise strengthens the gluteal muscles. Lie on your back with your calves draped over the ball. Start with a pelvic tilt and the squeeze your butt until a bridge position is obtained. When you roll down, try to feel that each vertebra is touching the floor. Your lower back should touch the floor before your pelvis. Make 12 repetitions daily.


Knees to Chest Stretch and Heel Slide
Lie on your back with your knees bent and then lift both legs from the floor and draw the knees to your chest. After that, lower one heel to the floor. Keep the opposite knee close to your chest. Rotate the other heel along the floor until the leg is straight. Make 8 repetitions daily.



Article reference:-
 Been, E., & Kalichaman, L. (2014, January). Lumbar lordosis [Abstract]. Official Journal
of the North American Spine Society, 14(1), 87-89. Retrieved from http://www.thespinejournalonline.com...385-5/abstract
 Cho, I. Y., Park, S. Y., Park, J. H., Kim, T. K., Jung, T. W., & Lee, H. M. (2015,
October). The effect of standing and different sitting positions on the lumbar lordosis: Radiographic study of 20 healthy volunteers. Asian Spine Journal, 9(5), 762-769. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591449/
 Kerkar, P. (2015, September 15). Cervical lordosis: Causes, Treatment, Exercise.
Retrieved from http://www.epainassist.com/back-pain...vical-lordosis
 Lavoie, A. (2007, December 12). Female lower back has evolved to accommodate strain
of pregnancy. Retrieved from Female lower back has evolved to accommodate strain of pregnancy | Harvard Gazette
 Lockstadt, H. (2015, November 10). Back pain during pregnancy. Retrieved
from http://www.spineuniverse.com/conditi...ring-pregnancy
 Lordosis. (n.d.). Retrieved from Lordosis :: Nationwide Children's Hospital  Lordosis: Causes, symptoms, diagnosis, treatment and exercises. (2013, August 20).
Retrieved from Lordosis: Causes, Symptoms, Diagnosis, Treatment & Exercises | Spina Bifida Resource Center
 Lordosis definition. (n.d.). Retrieved from Lordosis Definition | Back Pain and Neck Pain Medical Glossary  Lordosis – swayback. (n.d.). Retrieved from http://www.cedars-sinai.edu/Patients/Health-
Conditions/Swayback-Lordosis.aspx
 Regan, J. J. (2015, September 8). A closer look at lordosis. Retrieved
from http://www.spineuniverse.com/conditi...-look-lordosis
 What is lordosis? (n.d.). Retrieved from http://www.seattlechildrens.org/medical-
conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/lordosis/