Hyperlordosis, also known as swayback or hollow back, is a condition involving an excessive curve of the spine in the lower back, or lumbar region. While a slight curvature is typical, an excessive curvature of the lower spine could lead to lower back pain and numbness.
Hyperlordosis creates an excessive and characteristic C-shaped curve in the lower back, or lumbar region, where the spine curves inward just above the buttocks. While lordosis refers to the natural inward curvature of the spine, hyperlordosis refers to an extreme curvature. While some curvature is typical, too much
The spine consists of three curved segments:
- the cervical spine, or neck
- the thoracic spine, or chest
- the lumbar spine, or lower back
Lumbar hyperlordosis often occurs due to slouching or a lack of exercise. Certain conditions may also cause or exacerbate the condition. In many cases, physical therapy can help improve symptoms that may occur with hyperlordosis.
This article explores hyperlordosis and explains its symptoms and treatment. It also provides a list of exercises that may help relieve symptoms.
A 2018 study investigated the effect of certain exercises on lower spine curvature, back muscle strength, and chronic lower back pain.
The study participants performed a regular 60-minute workout, consisting of eight lumbar stabilization exercises that aimed to strengthen back muscles and increase spine flexibility. They did this workout 3 days a week for 12 weeks.
After 12 weeks, there was a reduction in lower back pain and increased lumbar muscle strength and flexibility. However, there was no significant change in the curvature of the spine.
The workout included the below lumbar stabilization exercises.
- Lie on your back and bend your knees at a 90-degree angle, with the feet flat against the floor.
- Cross the arms across the chest and lift your torso to meet your thighs.
- Steadily lower your torso back down to the floor.
- Lie straight, face down, extending your arms in front of you.
- Simultaneously raise your arms, legs, and chest off the floor.
- Hold the pose for 2 seconds while exhaling.
- Slowly lower your arms, legs, and chest back down to the ground while inhaling.
Quadruped arm and leg raise
- Kneel on the floor, lean forward, and place your hands palm down.
- Keep the knees in line with the hips and the hands directly below the shoulders.
- Without moving the spine, simultaneously lift one arm and extend the opposite leg so that they are in line with the spine.
- Return to the starting position.
- Stand with your feet shoulder-width apart.
- Extend your arms out in front, clasping the hands together.
- While facing forward, lower your body as though sitting in an imaginary chair. Continue lowering until your thighs are as parallel to the floor as possible. Keep your knees and ankles in line.
- Push through your heels to return to the starting position.
Lower body or reverse plank
- Sit with your legs out in front of you and lean back. Your back should be at a 45-degree angle to the floor.
- Place your hands by your sides with the palms facing down. Your arms should be in line with your shoulders and slightly behind your hips.
- Look up at the ceiling and lift your hips while supporting your weight on your hands and heels. Tighten your core and glutes, keeping your body straight.
- Hold the position for 10–15 seconds before lowering your body.
Upper body or forearm plank
- Place your forearms and knees on the floor, shoulder-width apart. Ensure that the elbows and shoulders align and hold the forearms straight out in front.
- Lift both knees off the floor, pushing your feet back to extend your body fully. Look down to ensure that your neck is in line with the rest of your spine.
- Hold the position, keeping your hips up while tightening your core and buttocks.
- Lie on your right side with feet together. Bend your right arm at the elbow so that your forearm is in line with your shoulder.
- Contract your core muscles and raise your hips until your body forms a straight line from head to toe.
- Hold the position for as long as possible without dropping the hips.
- Repeat on the opposite side.
- Lie on your back and bend your knees, keeping the feet hip-distance apart and heels a few inches from your buttocks. Place the arms at the side, with the hands near the hips.
- Squeeze your glutes and push through your heels to lift the hips upwards. Aim to create a diagonal line across the top of your body, from shoulders to knees.
- Hold the position for 1–2 seconds before slowly lowering back down.
When working out, it is essential to spend at least 10 minutes warming up and cooling down. This can include simple movements such as walking and gentle stretching.
A person with hyperlordosis may experience the following symptoms:
- Lower back pain: People with hyperlordosis may experience mild-to-severe lower back pain, which may worsen with movement. They may also experience back spasms or tightness in the back.
- Difficulty moving: People may have movement issues due to muscle tightening and stiffness in the lower back.
- Numbness: In addition to pain, some individuals may notice a tingling sensation.
- Loss of bladder control: In some cases, a person may experience changes in bladder control.
Many factors may cause or contribute to hyperlordosis. Some reasons may include the below.
Slouching can contribute to hyperlordosis and back pain. As a result, muscles in the lumbar region can tighten too much as they try to stabilize and support the spinal column. This can pull the spine gradually out of alignment, causing an increased curving of the spine.
Obesity results in the presence of excess fat in the abdomen and buttocks. This can put extra strain on the lower back, which may cause the lumbar spine to move into hyperlordosis.
Lack of exercise
In addition to increasing the risk of obesity, a lack of exercise can weaken the core muscles that sit around the trunk and pelvis. Weakened muscles are less able to support the spinal column, allowing the spine to curve excessively.
It can be difficult to diagnose hyperlordosis, as there is a huge variation in natural lower spine curvature — which doctors call lumbar lordosis — throughout the population.
Typically, a healthcare professional will request an X-ray to measure the curvature of the spine. However, they may also recommend an MRI or CT scan if they think an abnormality in the soft tissue is responsible for the hyperlordosis.
They may also suggest a blood test and bone scans to provide more information and rule out other possible health conditions.
Treatment often involves techniques to help prevent the worsening of the curve in the lower back. A doctor may begin by prescribing pain relief and anti-inflammatory medication to relieve painful symptoms.
Where obesity may be a contributing factor, a healthcare professional is likely to devise a weight-loss plan. This may include physical therapy exercises that stretch and strengthen core muscles to improve posture. In other cases, a doctor may suggest using a hyperlordosis back brace to help keep the spine aligned.
Longer-term treatment will depend on the cause of the condition. If the hyperlordosis is due to weakness or muscle imbalances, a referral to a physical therapist or back specialist may be necessary. In more severe cases, where other treatment options do not improve symptoms, a person may require surgery to help correct the curve.
However, it is not clear from the study which condition causes the other. However, the authors speculate both hyperlordosis and hypolordosis — where the spine is straighter than it should be — place extra strain on joints, which can cause DJD.
It is best to speak with a doctor if back pain worsens. Keeping a diary to monitor the severity of the pain and how it impacts a person’s daily activities may assist the diagnosis.
People should also seek medical advice if they experience any of the below symptoms, which may indicate an alternative or additional underlying problem:
- a persistent curve in the lower back, even when bending forward
- tingling or numbness in the back, arms, or legs
- muscle spasms
- bladder or bowel issues
Hyperlordosis involves an extreme, inward curvature of the lower back. While people can be born with the condition, when it develops in adulthood, it is likely due to specific lifestyle factors. Often, maintaining a moderate weight and regular exercise can improve posture and lower back pain issues.
If exercise does not ease the symptoms of hyperlordosis, it is best to seek medical advice. A doctor will carry out a spine examination before making a diagnosis and creating a tailored treatment plan.