Swayback, lumbar hyperlordosis

• Swayback
• Lordosis
• Hollow back
• Saddle back

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

• 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

• Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders

Description

• 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

Essentials of Diagnosis

• 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)

General Considerations

• Presentation can vary significantly in presentation based upon anatomical structures
• Tight lumbar spine musculature and tight quadriceps
• Associated with thoracic kyphosis

Demographics

• Can be postural or hereditary

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• 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

Differential Diagnosis

• 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

Imaging

• 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 ...