Lumbar Hyperlordosis
Lumbar lordosis refers to the inward curvature of the lumbar spine that is created by wedging of both the lumbar intervertebral discs and the vertebral bodies.
Deviations of the lumbar spine such as an increased lumbar lordosis have an impact on overall postural stability particularly in maintaining sagittal balance due to a degeneration of the sagittal spine curvature.
A greater lordosis angle is a risk factor for developing spondylolysis and ventral bulging of the affected vertebra, with researchers having proved a positive association between lumbar hyperlordosis angle and spondylolysis and isthmic spondylolisthesis.
Been and Kalichman gave a detailed description of the anatomy of lumbar lordosis stating that dorsal wedging of the vertebral bodies and discs increases the lordosis angle, whereas more ventral wedging of these structures reduces the lordosis angle.
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The authors explained that a high correlation exists between the lumbar lordosis angle and pelvic and thoracic orientation in space, with hyperlordotic angles correlating with a greater sacral base angle and increased anterior pelvic tilt.
While discussing the aetiology of lumbar hyperlordosis and its pathophysiology, Sparrey et al. established that spinal extensor muscle hypertonicity shows a strong correlation with lumbar hyperlordosis, providing an opportunity for formulating preventative strategies to improve postural deformities.
The prevalence of underlying biomechanical disturbances such as a hyperpronated foot can increase the predisposition of an individual to increased lumbar lordosis.
This is because a hyperpronated foot induces excessive medial femoral rotation leading to changes in the pelvis, spine and sacroiliac joints.
As a consequence of this, the iliopsoas shortens and the spinal column rotates contralaterally, increasing the sacral base angle and lumbar lordosis. These contribute to subluxations of the joints.
With studies having proven that hyperpronation can lead to an immediate lumbo-pelvic deviation which changes the pelvic position, asymmetrical changes in foot alignment need to be considered to address pelvic and lower back dysfunction.
An orthotic intervention in the form of MASS4D® customised foot orthotics provides structural support to the feet to enforce optimal postural alignment that reduces the stress placed on the entire spine allowing for maximum functionality of all joints in the lower extremity.
This will help in protecting the individual from degeneration of joints that occurs as a result of structural changes induced by lumbar lordosis.
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References:
- Sparrey, C. J., Bailey, J. F., Safaee, M., Clark, A. J., Lafage, V., Schwab, F., Smith, J. S., Ames, C. P. (2014) Etiology of Lumbar Lordosis and its Pathophysiology: A Review of The Evolution of Lumbar Lordosis, And The Mechanics And Biology of Lumbar Degeneration. Neurosurgical Focus: May 2014, Vol. 36, No. 5. DOI: 10.3171/2014.1.FOCUS13551
- Been, E., Kalichman, L. (2013) Lumbar Lordosis. The Spine Journal: October 2013, Vol. 14, No. 1. DOI: 10.1016/j.spinee.2013.07.464
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