Lordosis: Normal Curves, Symptoms and Treatment

Normal spinal curves

MedlinePlus defines lordosis as the inward curve of the lumbar spine, just above the buttocks, and states that a small degree of lordosis is normal. Newcastle Hospitals explains that the spine has a natural curvature, and describes lordosis as a significant inward curve at the lower back or neck, mostly in the lumbar region.

In other words, having a lordotic curve is not a disease. What matters is whether the curve is excessive, whether it is flexible or fixed, and whether it causes symptoms.

Lordosis versus hyperlordosis

MedlinePlus says that too much curving is called swayback, and that lordosis tends to make the buttocks appear more prominent. Other names include arched back. Hyperlordosis refers to this exaggerated curve.

Newcastle Hospitals describes significant lordosis as giving a backward-leaning appearance and forcing muscles and tendons to work harder to support the spine. It places lordosis among the types of adult spinal deformity, alongside degenerative scoliosis, idiopathic scoliosis, kyphosis (an increased rounding of the upper back) and flatback syndrome, where the spine loses its natural curves.

Symptoms and harmless variation

Many people with a visible curve have no symptoms. MedlinePlus says that, most of the time, lordosis is not treated if the back is flexible, because it is not likely to progress or cause problems.

When lordosis is significant, Newcastle Hospitals says the extra muscle work can lead to pain in the lower back or neck. It also lists numbness, tingling, weakness and bladder incontinence. Such nerve-related symptoms can have several causes and need prompt medical assessment rather than being put down to the shape of the back.

Associated causes and conditions

MedlinePlus lists conditions that can cause an increased lumbar curve:

benign juvenile lordosis, a marked curve in some children that usually corrects itself with growth
spondylolisthesis, where a vertebra slips forward onto the one below; it can be present from birth, develop after sports such as gymnastics, or develop with arthritis of the spine
much less commonly in children, achondroplasia (a bone growth disorder), muscular dystrophy and other genetic conditions

Newcastle Hospitals adds that adult spinal deformity in general can result from a birth defect, growth in childhood, aging, injury or previous spine surgery. The sources do not name a single main cause of lordosis.

Flexible versus fixed curves

MedlinePlus explains the key distinction. During an examination, the person bends forward, to the side and lies flat on a table. If the lordotic curve is flexible, meaning it reverses when bending forward, it is generally not a concern. If the curve does not move, medical evaluation and treatment are needed.

MedlinePlus notes that children with hyperlordosis have a large space under the lower back when lying face up on a hard surface. This is something a clinician observes as part of the exam; it is not a reliable way to diagnose yourself at home.

Assessment and imaging when needed

Assessment starts with a physical exam. MedlinePlus says further tests may be needed, particularly if the curve seems fixed, including:

an x-ray of the lower spine
an MRI of the spine
laboratory tests and other tests for conditions that could be causing the curve

In adults being considered for surgery for spinal deformity, Newcastle Hospitals describes further x-rays, MRI or CT as part of pre-assessment. Imaging is chosen to answer a specific question, not routinely for every curve.

Lordosis in children

MedlinePlus advises contacting a child’s health care provider if you notice an exaggerated posture or curve in the back, so the provider can check for a medical problem. Many children with marked lordosis have benign juvenile lordosis, which usually corrects itself as they grow.

In children, the main question is whether the curve is flexible and whether an underlying condition such as spondylolisthesis is present. Treatment decisions are made by the child’s doctor.

Adults: function, exercise and treatment

For adults with spinal deformity, Newcastle Hospitals says conservative treatments come first: medication, physiotherapy, lifestyle changes and possibly nerve root injections. It notes that staying active and exercising regularly can help reduce pain, and mentions low-impact options such as swimming, cycling, Pilates or yoga, along with a healthy weight and not smoking. Our guide on posture exercises covers general exercises for the back.

Major surgery to correct the deformity and relieve symptoms is considered only when all conservative treatments have been tried. It involves fusing vertebrae with implants, carries significant risks, and not all patients get pain relief. The aim of treatment is usually to relieve symptoms and improve function, not to reach a particular curve measurement.

Where the sources differ

Focus. MedlinePlus focuses on lumbar lordosis in children and says flexible curves usually need no treatment. Newcastle Hospitals discusses lordosis as one type of adult spinal deformity, where pain and nerve symptoms may lead to treatment.

Symptoms. MedlinePlus does not list pain or nerve symptoms for flexible lordosis. Newcastle Hospitals lists back or neck pain, numbness, tingling, weakness and bladder incontinence in significant adult lordosis.

Location. MedlinePlus defines lordosis in the lower back; Newcastle Hospitals includes the neck.

In summary

Lordosis is the normal inward curve of the lower back; when exaggerated it is called swayback or hyperlordosis. A flexible curve that reverses when bending forward is generally not a concern, while a fixed curve needs medical evaluation. Causes include benign juvenile lordosis and spondylolisthesis, and in adults lordosis can be part of spinal deformity.

Treatment focuses on symptoms and function, with exercise and physiotherapy first and surgery only in selected adults. New nerve or bladder symptoms need urgent assessment. After a medical assessment, our physiotherapy practice in Bilbao can help adults with back pain and function (consultations are in Spanish).

Frequently asked questions about lordosis

These answers are general information and do not replace an examination or individual medical advice.

Can lordosis be corrected?

Often it does not need correcting: flexible curves are usually left untreated, and benign juvenile lordosis tends to correct itself. In adults, treatment aims to relieve symptoms and improve function; surgery is reserved for selected cases.

What can cause an increased lordotic curve?

Causes include benign juvenile lordosis, spondylolisthesis and, less commonly, conditions such as achondroplasia or muscular dystrophy. In adults it can be part of spinal deformity from aging, injury or previous surgery.

What is lordosis of the spine?

It is the inward curve of the spine in the lower back, and to a lesser extent the neck. A small degree is normal; too much is called swayback.

How serious is lordosis?

A flexible curve is usually not a concern. A fixed curve needs evaluation, and significant adult lordosis can cause pain. New nerve or bladder symptoms need urgent assessment.

Does a normal curve need treatment?

No. MedlinePlus says lordosis is usually not treated if the back is flexible, because it is not likely to progress or cause problems.

How are treatment goals different in children and adults?

In children the focus is whether the curve is flexible and whether there is an underlying condition. In adults it is relieving pain and maintaining function, with conservative care first.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.