What is Lordosis?

Lordosis is a spinal deformity in teenagers characterised by an exaggerated inward curve of the lower back. The cervical (neck) and lumbar (lower back) regions of the spine naturally have curves that help maintain posture and absorb shock. However, when these curves become more pronounced than necessary, it results in a condition known as Lordosis. This increased curvature can cause the spine to deviate from its natural alignment, resulting in various issues, including the tiredness of muscles.

A healthy spine in teenagers should have three natural curvatures, creating a gentle S-shape when viewed from the side and appearing straight when viewed from behind. However, various conditions can lead to abnormal curvatures that may impact posture and movement during early or late teenage years, as well as before birth.

Here is a visual representation of a person with and without Lumbar Lordosis.

What are the Types of Lordosis?

Lumbar and cervical lordosis both refer to the inward curves of the spine, but they occur in different regions. Cervical lordosis is the inward curve of the neck (cervical spine), while lumbar lordosis pertains to the inward curve of the lower back (lumbar spine).

Cervical Lordosis:

Location: The cervical spine consists of the first seven vertebrae in the neck.
Function: It supports the head, allows for a wide range of neck movements, connects the brain to the rest of the body, stabilises the head, and protects the spinal cord.
Normal Curve: A healthy cervical spine has an inward curve (lordosis) that helps align the head with the torso and distribute the weight of the head evenly.

Lumbar Lordosis:

Location: The lumbar spine consists of five vertebrae in the lower back.
Function: It supports the weight of the upper body, permits flexibility and movement in the lower back, and absorbs shock.
Normal Curve: Similarly, a healthy lumbar spine also features an inward curve (lordosis).

What Causes Lordosis?

A teenager can be born with lordosis, or they may develop it due to other health issues. Understanding these causes is essential for effective management and prevention. Here are some detailed explanations of the common causes of lordosis:

1. Posture

Maintaining proper posture is crucial for maintaining spinal health. Poor posture habits, such as rounded shoulders, a forward-leaning neck, and an uneven pelvis, can lead to spinal imbalances. Over time, these habits can exacerbate lordosis by placing undue stress on the spinal structures, resulting in pain and discomfort.

2. Improper lifting techniques

The widely known advice, "Lift with your legs, not your back," underscores the importance of safe lifting practices. When heavy objects are lifted incorrectly—by bending at the waist instead of using the legs—significant strain can be placed on the lower back muscles and spinal discs. This strain may lead to muscle tightening, decreased flexibility, poor posture, and chronic pain. Additionally, ongoing misuse can alter the mechanical alignment of the spine, worsening lordosis.

3. Obesity

Excess body weight, particularly concentrated in the abdominal region, can significantly affect spinal alignment. The additional weight shifts the body’s centre of gravity, causing individuals to lean backwards to maintain balance. This compensatory mechanism increases stress on the lumbar spine, contributing to the development or worsening of lordosis. Furthermore, obesity is often associated with inflammation and muscle weakness, which can exacerbate back problems.

4. Osteoporosis

Though very uncommon to occur in teenagers, certain types of Osteoporosis can happen in children and teenagers. Osteoporosis is a condition that leads to a decrease in bone density, resulting in fragile and brittle bones. The teenage years are crucial for bone development, as the late teens establish the majority of their bone mass. Juvenile osteoporosis can disrupt this bone-building process, potentially leading to long-term bone health issues. As the vertebrae lose strength, they may become more susceptible to fractures and instability. This weakening can also affect the intervertebral discs, which are essential for cushioning the vertebrae and maintaining proper alignment. The deterioration of these structures can lead to changes in spinal curvature, thereby increasing the risk of conditions such as lordosis.

5. Discitis

Discitis refers to the inflammation of the intervertebral discs, often caused by bacterial infection. This inflammation can result from surgery, trauma, or the spread of infection from other parts of the body. As the discs swell and become inflamed, they can disrupt normal spinal mechanics, leading to pain and potentially contributing to lordosis. Symptoms may include localised pain, fever, and neurological deficits in severe cases.

6. Kyphosis

An excessive outward curvature of the thoracic spine characterises Kyphosis. When this occurs, the lower back may be forced to compensate, working harder to maintain an upright posture. This added stress can eventually result in hyperlordosis in the lumbar region. The interplay between these two conditions underscores the importance of maintaining a balanced spinal structure and the necessity of targeted exercises to enhance overall alignment and strength.

7. Spondylolisthesis

This condition occurs when one vertebra slips forward or backwards over the adjacent vertebra due to fractures or defects. Spondylolisthesis can cause significant discomfort and alter the natural curvature of the spine. The slipping vertebra can press on spinal nerves, leading to pain, numbness, and mobility issues. The mechanical instability created by this condition may exacerbate other spinal issues, including lordosis.

By understanding these underlying causes and their implications, individuals can take proactive steps to manage their spinal health and mitigate the impact of lordosis on their quality of life. Regular exercise, maintaining a healthy weight, and practising good posture are all essential components of prevention and effective management.

What Are the Symptoms of Lordosis?

Symptoms can vary, but the main characteristic of lordosis is prominent buttocks. The symptoms may also vary depending on whether lordosis is associated with other conditions, such as spinal disorders, muscular dystrophy, developmental hip problems, or neurological disorders.

The symptoms of lordosis can resemble other back problems or may arise from an injury or infection. Your teenagers need to see their doctors and physiotherapists for an accurate diagnosis and treatment. The following are some conditions that can cause spinal deformities in children:

1. Congenital Spine Deformities

These deformities are present at birth due to improper development of the bones or vertebrae during pregnancy, often resulting from conditions such as spina bifida.

2. Neuromuscular Disorders

Neuromuscular disorders affect the nerves and muscles, impairing muscle control and strength, which can lead to spinal deformities. Conditions such as cerebral palsy and Duchenne muscular dystrophy are examples of this category.

3. Diseases

Certain diseases, including osteoporosis and both cancerous and non-cancerous spinal tumours, can increase the risk of spinal deformities in children.

4. Weak Abdominal Muscles

Weak abdominal muscles may increase a child's likelihood of developing spinal deformities, as they struggle to support the weight of the spinal cord.

5. Poor Body Posture

Habits like slouching can weaken spinal muscles and contribute to abnormal curvature. This issue is more prevalent in children who spend excessive time sitting or using electronic devices.

6. Overweight

Being overweight can place additional strain on the lower back, pulling it forward and increasing the risk of lordosis, a condition characterised by an excessive inward curvature of the lower spine.

7. Genetics

A family history of spinal issues can elevate the risk of spinal abnormalities, particularly idiopathic scoliosis.

8. Injuries or Infections

Spinal injuries, such as fractures, can disrupt the spine’s alignment. Similarly, infections such as osteomyelitis (a bone infection) can damage the vertebral structures, leading to abnormal spinal curves.

9. Idiopathic Spinal Deformities

These deformities occur without a known cause and are not linked to any underlying disease.

10. Other Factors

Nutritional deficiencies, such as insufficient calcium and vitamin D, can weaken bones and contribute to spinal alignment issues.

How Is Lordosis Diagnosed?

A doctor can diagnose lordosis through a comprehensive health history, a physical examination, and specific tests. They will also inquire about any family history of lordosis.

Your teenager may require the following tests:

X-rays: This imaging test reveals internal tissues, bones, and organs and can measure the angle of the spinal curve. Treatment often depends on this measurement.
Bone scans: This test can help rule out infections or broken bones in your teenager's back.
MRI: This test employs large magnets and a computer to produce detailed images of the organs and structures within the body, helping to rule out any other spinal cord or nerve issues.
CT scan: This test combines X-rays and a computer to create detailed images of the body.
Blood tests: Blood is drawn and analysed in a laboratory to provide additional information.

Detecting lordosis early is crucial for effective treatment.

Treatment Options for Spinal Deformities

The treatment for spinal deformities in teenagers varies based on the severity of the curvature, its location in the spine, the teenager's age, and the progression of the condition.

Treatment approaches are categorised into two main types: nonsurgical and surgical treatments.

Nonsurgical Treatment

1. Observation

For mild spinal deformities (less than 20°), particularly in younger teenagers, doctors may recommend regular monitoring to assess whether the curvature worsens over time.

2. Bracing

To prevent moderate curvature (20–40°) from worsening as the teenager grows, bracing is often used. This treatment is effective when the teenager is still growing and the curvature is progressing. Braces are typically worn for 18–20 hours each day, but can be removed during sports or other activities.

3. Physical Therapy

Physical therapy can strengthen the muscles surrounding the spine, improve posture, and increase flexibility. It is often recommended as a complementary treatment, particularly for teenagers with mild deformities or those using a brace.

Surgical Treatment

Surgical correction may be necessary if the spinal curvature exceeds 50°, compresses other organs, or if persistent pain persists despite nonsurgical treatments.

The goal of surgery is to straighten the spine, stabilise it in the new position, and prevent further progression of the curvature. Two standard surgical procedures include:

1. Spinal Fusion: This is the most common spinal surgery, where the spine is permanently stabilised and straightened using rods, screws, or bone grafts.

2. Growing Rods: This procedure may be used in younger teenagers to allow for continued growth while correcting the spinal curvature. The implant can be adjusted and lengthened as needed every few months.

How can parents help teenagers with spinal curvature?

Parents can play a crucial role in managing and supporting their teenager's spinal condition by:

1. Teaching good posture habits, such as sitting up straight, avoiding slouching, and using backpacks correctly.

2. Encouraging regular physical activity, including swimming, yoga, or sports, to strengthen back muscles and improve flexibility.

3. Helping maintain a balanced diet to avoid excessive weight gain, which can reduce strain on the spine.

Can a Teenager With Spinal Curvature Participate in Sports?

Yes, most teenagers with mild to moderate spinal curvature can participate in sports and physical activities safely. Low-impact exercises such as swimming, cycling, or walking are particularly beneficial for strengthening back muscles and improving posture.

However, for severe cases or after surgery, it is essential to consult a doctor for guidance on activity levels and to avoid high-impact or strenuous sports as recommended.

Conclusion

Most people don’t think about their bones until there is a problem. Lordosis is no exception; often, you might not experience any symptoms or even notice that your spine is curving more than it should. Although it can be unsettling to consider that changes might be occurring in your spine without your awareness, lordosis typically does not have a significant impact on your life or your ability to engage in the activities you love.

If you notice any signs of lordosis, don't hesitate to seek professional help. Orthopaedic surgeons can conduct thorough evaluations, including X-rays or MRIs, to diagnose spinal issues and recommend appropriate treatments.

Lordosis Symptoms in Teenagers: Early Warning Signs Parents Should Know

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