Lordosis: Symptoms, Types, Causes and Treatment

Lordosis is a term used to describe an excessive inward curvature of the spine, most commonly in the lower back (lumbar region) but also possible in the neck (cervical region). While a certain degree of lordotic curve is normal and essential for healthy posture and movement, too much or too little lordosis can lead to discomfort, pain, and even significant disability. Understanding the symptoms, types, causes, and treatments of lordosis is crucial for patients, caregivers, and healthcare professionals alike.

Symptoms of Lordosis

Recognizing the symptoms of lordosis is the first step towards seeking appropriate care. The symptoms can vary depending on the location and severity of the curve, underlying cause, and age of onset. Some people experience only mild discomfort, while others may face more debilitating effects.

Symptom	Description	Severity	Source(s)
Postural Change	Noticeable inward curve of spine	Mild to severe	4, 5, 6
Back Pain	Localized or radiating pain	Mild to disabling	5, 6, 10
Limited Mobility	Reduced flexibility/ROM	Moderate to severe	9, 10
Fatigue	Tiredness, muscle fatigue	Mild to moderate	4, 9
Height Loss	Apparent loss of stature	Moderate to severe	10

Table 1: Key Symptoms of Lordosis

Postural Changes

One of the most obvious signs of lordosis is a visible change in posture. People with excessive lumbar lordosis often have a pronounced arch in the lower back, causing the abdomen and buttocks to stick out. In cervical lordosis, the neck may appear overly curved or the head may jut forward 4, 6.

Back Pain and Discomfort

Pain is a common symptom, especially when lordosis is significant or associated with degenerative changes, muscle strain, or nerve compression 5, 6, 10. Pain may be localized to the lower back or neck, or radiate into the legs or arms, depending on which part of the spine is involved.

Limited Mobility and Function

As lordosis progresses, flexibility and range of motion (ROM) can be affected. People may find it difficult to bend forward or backward or to stand upright for long periods. Chronic cases can lead to muscle fatigue and a general sense of physical limitation 9, 10.

Fatigue and Height Loss

Sustaining an abnormal posture requires more muscular effort, which can lead to fatigue. In severe cases such as ankylosing spondylitis or after certain spinal surgeries, measurable loss in height is also possible due to curvature and vertebral changes 10.

Types of Lordosis

Lordosis is not a one-size-fits-all condition. It can affect different parts of the spine and arise from various underlying issues. Understanding the types helps clinicians tailor diagnosis and treatment.

Type	Location	Distinguishing Features	Source(s)
Lumbar Lordosis	Lower back	Most common, affects posture	4, 5, 7
Cervical Lordosis	Neck	Affects neck/head position	6, 9
Pathological	Any region	Due to disease/injury	5, 10
Physiological	Any region	Normal, functional curvature	4

Table 2: Types of Lordosis

Lumbar Lordosis

This is the most common and clinically significant type. The lumbar spine naturally has a lordotic curve, but when this curvature is exaggerated, it can cause structural imbalance and symptoms as described above. Lumbar lordosis is essential for upright posture but can become problematic if too pronounced 4, 5, 7.

Cervical Lordosis

The cervical (neck) region also naturally curves inward. Loss or reversal of this curve, or an exaggerated curve, can impact neck mobility, alignment, and even nerve function. Restoration of proper cervical lordosis is a focus in some rehabilitation protocols 6, 9.

Pathological vs. Physiological Lordosis

• Physiological lordosis refers to the normal, healthy curvature that supports efficient movement and weight-bearing 4.
• Pathological lordosis arises when disease, trauma, or developmental issues exaggerate or diminish the curve, leading to symptoms and functional problems. Conditions such as flat-back syndrome (loss of lumbar lordosis after spinal fusion) and lordotic deformities in ankylosing spondylitis exemplify pathological forms 5, 10.

Causes of Lordosis

The causes of lordosis are diverse, ranging from genetic and developmental factors to lifestyle, trauma, or underlying diseases. Understanding causation is key to both prevention and targeted treatment.

Cause	Mechanism/Trigger	Population Affected	Source(s)
Postural Changes	Poor posture, muscle imbalance	All ages	4, 6
Degenerative Disease	Disc/vertebral degeneration	Older adults	4, 5
Surgical Complications	Post-fusion, instrumentation issues	Spinal surgery patients	5, 7, 10
Congenital Factors	Born with abnormal curvature	Children, adolescents	4
Neuromuscular Issues	Muscle weakness, spasticity	Various	4, 10
Increased Activity	Overuse/adaptation (e.g., in fish)	Fish (model studies)	2, 3
Trauma	Injury to spine or adjacent tissues	All ages	5, 10

Table 3: Common Causes of Lordosis

Postural and Lifestyle Factors

Poor posture, habitual slouching, or muscular imbalances (such as weak abdominal muscles and tight lower back muscles) can gradually exaggerate the spine's natural curves. This is particularly relevant in sedentary lifestyles or occupations requiring prolonged sitting 4, 6.

Degenerative Changes

As people age, the intervertebral discs and spinal joints can degenerate, leading to alterations in spinal curvature. Loss of lumbar lordosis is a hallmark of aging and is often accompanied by increased kyphosis (outward curvature) in the thoracic spine 4, 5.

Surgical Complications

Spinal surgeries, especially those involving fusion or instrumentation, can disrupt normal spinal alignment. Flat-back syndrome, a disabling loss of lumbar lordosis, is a well-known complication after extensive scoliosis surgery—especially when instrumentation extends into the lower lumbar spine or sacrum 5. Conversely, reconstructive surgeries may aim to restore proper lordosis using specialized implants 7, 8, 10.

Congenital and Neuromuscular Causes

Some people are born with abnormal spinal curvatures, or develop them in childhood due to conditions like cerebral palsy, muscular dystrophy, or congenital vertebral malformations 4, 10. These may be accompanied by other physical or neurological signs.

Animal Models and Activity-Related Lordosis

Research in fish has shown that excessive swimming activity or muscle strain can induce lordotic deformity, suggesting that mechanical overload can trigger adaptive but abnormal changes in vertebral structure 2, 3. While this is primarily an animal model, it highlights the impact of unusual mechanical forces on spinal development.

Trauma

Injuries to the spine or surrounding tissues can result in abnormal curvature, either through direct vertebral damage or compensatory changes in posture and muscle tension 5, 10.

Treatment of Lordosis

Treatment strategies for lordosis depend on the severity, underlying cause, and patient goals. Approaches range from conservative management to complex surgical interventions, and ongoing research continues to refine these options.

Treatment	Approach/Technique	Indication/Goal	Source(s)
Physical Therapy	Exercises, stretching, posture	Mild to moderate cases	6, 9
Bracing	External support	Children, flexible curves	4
Medication	Pain relief, inflammation control	Symptomatic management	4, 5
Chiropractic Care	Manipulation, traction	Cervical/lumbar alignment	6, 9
Surgical Correction	Osteotomy, cage placement, fusion	Severe, fixed deformities	5, 7, 8, 10
Prevention	Early detection, tailored surgery	At-risk populations	5, 4

Table 4: Lordosis Treatment Approaches

Conservative Management

Most cases of mild to moderate lordosis are managed conservatively:

• Physical Therapy: Targeted exercises to strengthen core muscles, improve flexibility, and correct postural habits can reduce symptoms and prevent progression 6, 9.
• Bracing: In children and adolescents, external bracing may be used to guide spinal growth and prevent worsening curvature 4.
• Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers are used for symptomatic relief 4, 5.

Chiropractic and Rehabilitation Techniques

Chiropractic care—including spinal manipulation and specialized traction methods—has shown promise in restoring cervical lordosis and reducing neck pain, as well as improving spinal alignment and function 6, 9. Studies report measurable improvements in pain and posture after structured interventions.

Surgical Options

Surgery is reserved for severe, fixed, or progressive cases where conservative measures fail:

• Osteotomies: These procedures involve cutting and realigning spinal bones to restore proper curvature. Polysegmental lumbar osteotomies have shown good results in correcting long, curved deformities in ankylosing spondylitis 10.
• Interbody Cages and Ligament Release: Modern minimally invasive techniques use specialized implants (lordotic cages) and targeted ligament release to increase lumbar lordosis and restore sagittal balance, often with fewer complications than traditional osteotomies 7, 8.
• Fusion and Instrumentation: Spinal fusion may sometimes be required but carries risk of losing natural lordosis if not performed carefully. Prevention of flat-back syndrome involves preserving lumbar curvature during fusion 5.

Prevention and Early Detection

A key aspect of modern care is prevention—screening at-risk individuals, optimizing surgical techniques, and maintaining long-term surveillance to catch early postural deformities before they become symptomatic or disabling 5, 4.

Conclusion

Lordosis, while a normal feature of spinal anatomy, can become problematic when its curvature is exaggerated or diminished. Recognizing the symptoms, understanding the types and causes, and applying evidence-based treatment strategies are essential steps in maintaining spinal health and quality of life.

Key takeaways from this article:

• Symptoms commonly include postural changes, pain, reduced mobility, fatigue, and sometimes height loss.
• Types of lordosis include lumbar, cervical, pathological, and physiological forms, each with distinct features.
• Causes are diverse—ranging from poor posture and degenerative changes to surgical complications, congenital factors, and even activity-induced adaptations.
• Treatment spans conservative management, chiropractic care, and surgical correction, with prevention and early detection as critical components.
• Ongoing research continues to refine our understanding of lordosis and improve outcomes for affected individuals.

By staying informed and proactive, both patients and clinicians can help ensure healthier spines and better overall well-being.