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Condition/Disorder Synonyms

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  • Swayback

  • Lordosis

  • Hollow back

  • Saddle back

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ICD-9-CM Codes

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  • 737.2 Lordosis (acquired)

  • 754.2 Congenital musculoskeletal deformities of spine

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ICD-10-Codes

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  • Q67.5 Congenital deformity of spine

  • Q76.3 Congenital scoliosis due to congenital bony malformation

  • Q76.425 Congenital lordosis, thoracolumbar region

  • Q76.426 Congenital lordosis, lumbar region

  • Q76.427 Congenital lordosis, lumbosacral region

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Preferred Practice Pattern1

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Key Features

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Description

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  • Excessive lumbar lordosis curvature

  • Increased extension of the lumbar spine compresses the facets

  • Anterior pelvic tilt

  • Low back pain (LBP) with primary involvement of lumbar facet joint

  • Lower-limb symptoms might be present in a non-dermatomal pattern as a result of referred pain.

  • Neurological findings minimal

  • Bilateral symptoms

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Essentials of Diagnosis

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  • Symptoms are dependent on the curve reversing when flexed

  • Diagnosis made by clinical examination

  • Use of treatment- (impairment) based classification system is useful to determine evidence-based practice (EBP) treatment plan.

  • Reproduction of symptoms when putting the joint in closed packed position (combination of extension, side-bending toward involved side, rotation away from involved site)

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General Considerations

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  • Presentation can vary significantly in presentation based upon anatomical structures

  • Tight lumbar spine musculature and tight quadriceps

  • Associated with thoracic kyphosis

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Demographics

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  • Can be postural or hereditary

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Clinical Findings

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Signs and Symptoms

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  • Pain in lumbar/sacral area that can be mechanically reproduced

  • Bilateral referred or pain in lower extremities (LEs) possible

  • ROM limited in a capsular pattern, rotation and side-bending limited in opposite direction

  • Lumbar segmental hypomobility may be present in capsular pattern.

  • Can be associated with poor core muscle strength and postural deviations

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Functional Implications

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  • Prolonged standing can cause compression pain

  • May cause decreased ability to perform ADLs/IADLs

  • May impact ability to participate in sports and other social activities

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Possible Contributing Causes

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  • Occupational factors

  • Rickets

  • Pregnancy

  • Vitamin D deficiency

  • Congenital anomalies

  • Physical condition

  • Obesity

  • Postural changes

  • Weakness of core musculature: hamstrings and abdominals

  • Tightness of hip flexors, erector spinae

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Differential Diagnosis

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  • Peripheral nerve impairment

  • Hip pathology with radiating pain pattern

  • Malignant spinal tumor or metastasis

  • Referred pain from visceral structures

  • Systematic auto-immune diseases (rheumatoid arthritis (RA), Reiter's, etc.)

  • Ankylosing spondylitis

  • Abdominal aortic aneurism

  • Radiculopathy

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Means of Confirmation or Diagnosis

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Imaging

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  • In most cases not necessary, only with persistent symptoms that do not respond to conservative management or presence of red/yellow flags

  • MRI helpful in diagnosis to visualize compressed or inflamed nerve root/disc pathology

  • X-ray/plain film radiograph helpful to ...

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