Hyperlordosis (hollow back)

treatment and prevention

Does your lower back have an exaggerated curve and does your abdomen visibly stick out? If so, you may be suffering from hyperlordosis or “hollow back” as it is commonly known. In the early stages, this deviation only causes pain now and again due to tension in the back muscles. As the condition advances, however, back pain increases and the spine is ultimately damaged. This misalignment is one of the most common conditions affecting the back. But it’s not all bad news: Hollow back can be treated with suitable therapeutic exercises and aids such as medical orthoses. And patients who are prepared to take a few extra simple steps to improve their posture can prevent hyperlordosis over the long term.

Hyperlordosis – pathological deformation of the spine

Hollow back is a highly exaggerated curvature of the lumbar spine. A striking feature of this condition is that both the abdomen and the pelvis stick out significantly. Those affected shift their rib cage to behind the axis of the body to stop themselves tipping forward. However, not every type of hollow back is pathological, with non-pathological cases known as normal lordosis. Exaggerated lordosis of the lumbar spine is known as hyperlordosis. This severe incorrect posture of the spine is pathological and can cause both physical and psychological problems (due to appearance).

Causes of hyperlordosis

Hollow back can have all kinds of different causes. It is often the result of a lack of exercise. This can lead to lordosis turning into hyperlordosis, even during childhood. Hollow back in children and adolescents is not usually a cause for concern since they are still growing, but the hips and pelvis should be kept stable from the age of ten. A permanently incorrect posture of the spine can also lead to hollow back. This particularly affects people who spend most of their time sitting or standing. Postural changes due to being very overweight are another factor involved. Weak abdominal and back muscles also increase the risk of developing hyperlordosis, while people who constantly strain their lumbar muscles and demand too much or too little of their hip flexors run the risk of developing the condition too. Hollow back may also develop as a result of external factors, e.g. following an accident.

Problems caused by hyperlordosis

In the early stages, people with hyperlordosis are only aware of occasional tension in the back muscles. It is only as the condition advances that hollow back makes its presence felt through increasing pain and damage to the spine. Slipped disks in the lower back are the most common problem caused by hyperlordosis. The reason for this is that excessive strain is placed on the intervertebral disks due to the misalignment. The sciatic nerve is sometimes affected too, resulting in low back pain and pain that radiates into the legs. A tingling sensation or numbness in the legs can also be signs that the sciatic nerve is affected.

Treating hollow back

It is particularly important to make improvements to posture and become more active on an everyday basis, since these factors affect the way the condition progresses. Patients can primarily make these changes through physiotherapy and by attending special back courses.

Dynamic sitting is the first therapeutic measure recommended to people who are particularly sedentary. With dynamic sitting, patients switch regularly between an upright and a reclined sitting position. These changes provide effective relief for the muscles and intervertebral disks. Patients who want to go a step further to improve their posture when seated can also opt to use an ergonomic chair or an inflatable cushion.

Progression of the condition

The main problem associated with lordosis is the lack of balance between the muscles. The back extensor and hip flexor muscles are taut, while the abdominal and buttock muscles are only used to a small extent. Rectifying this imbalance is a long process, since incorrect posture is generally acquired over the course of years and feels “normal”. Patients therefore need to practice the correct posture by means of a back therapy training course or under the guidance of a physiotherapist. However, the body tends to fall back into its old patterns after every exercise, so patients who want to correct their hollow back need to constantly check their back posture, especially at the start of the therapy, and be prepared for a lengthy treatment process. At the outset, the treatment measures require a lot of perseverance and can be very demanding on an everyday basis. Over time, however, adopting the correct posture becomes so natural that people no longer have to think about it or pay particular attention to it.

Preventing hyperlordosis

Preventing hollow back is not difficult. It is simply a case of changing your posture regularly and standing up at intervals when you are doing a seated activity. And if you are busy with a standing activity, you just need to take a few steps every now and then. These simple measures can be very effective. It is also important to ensure that you have a good, upright posture virtually all the time: your shoulders should be down and back in a relaxed position (away from your ears), while your abdominal and buttock muscles and pelvic floor should be taut in order to stabilize the spine. Anyone who is unsure about whether or not they are adopting a healthy posture can attend a special back course to learn more. These courses are designed to improve posture and relieve pain.

If the trunk muscles are not particularly strong, specific training of the abdominal, back, and buttock muscles can also help to prevent hyperlordosis. After all, only well-trained muscles can stabilize the spine. Fitness training, swimming, and Nordic walking are all ideal for this.

Orthoses as part of the treatment for hyperlordosis

Medical aids are also used to support therapy and to correct the lumbar spine in patients with hollow back. The Spinova Unload Plus is an orthosis designed to reduce lordosis – i.e. to correct hyperlordosis. Its support surrounds the torso, compresses the abdomen, and provides extensive stabilization for the lumbar spine. Special functional elements at the front and back (abdominal pad and bridging frame) also help to correct posture. These can be removed step-by-step, thereby allowing for multi-stage treatment and  gradually helping the spine to go back to a natural shape. And that’s not all: the orthosis also prevents incorrect posture and helps to relieve pain.