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  • Swayback
  • Lordosis
  • Hollow back
  • Saddle back

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  • 737.2 Lordosis (acquired)
  • 754.2 Congenital musculoskeletal deformities of spine

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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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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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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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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 assess alignment, fractures, and stability (flexion/extension radiograph)
  • CT scan to show herniation compressing the spinal canal/nerves and rule out abdominal pathology
  • Electrodiagnostic/nerve conduction testing can assist to determine a specific impaired nerve function
  • Doppler ultrasound to examine vascular function

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  • Physical ...

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