If I have too much curve in my back will it cause back pain?

My name is Bryan Ausinheiler, I am a physical therapist with advanced training in orthopedics as well as a personal trainer and nutritionist. I have been publishing articles on human posture, movement and pain since 2012. A central question of my blog is the relationship between these three things: posture, movement and pain. Does the way you stand or sit affect the way you move and do either of these effect whether or not you will have pain?

A Question

In this article I will answer a question about lower back posture and pain that can be worded  several ways: Will having too much arch (lumbar hyperlordosis) in my back cause pain?  If I have too much curve in my back will it cause pain? Why do I have so much curve in my back, and is it a problem if my back is so arched? More generally, are there any deviations in posture that have been found to cause pain in high quality research studies?

Some Data

What is lumbar lordosis?

We are all born with c-shaped forward-curved (flexed) spines. Other primates maintain this flexed spinal posture their whole lives, but we humans start to develop a few curves in the other directions with upright activity. First we develop a backwards curve in the neck (cervical lordosis) as we begin to sit up, and second we develop a backward curve in the lower back when we begin to stand and walk (lumbar lordosis) [1].

At age 1, my daughter has begun to develop her lumbar lordosis… but she doesn’t seem happy about it.

Some people develop more of these curves than others. In one study of 188 individuals, females had an average of 13.2 degrees more lumbar lordosis than males [2]. Having more lumbar lordosis is often described as a postural fault (hyperlordosis) and is proposed to result from muscle imbalances. Specifically over-lengthening and under-activity of the anterior abdominal muscles and hamstrings and shortening/over-activity of the iliopsoas and lower back muscles [3,4].

Muscle imbalances proposed to cause and/or be cause by lumbar hyperlordosis [3,4]

Prospective Studies on Lumbar Lordosis and Low Back Pain

In order to find out if a posture of lumbar hyperlordosis causes back pain, you need to measure the spinal posture of a large group of people, follow them for a long time and see if the people with more arch in their back end up having more back pain.

Fortunately, this has been done by two large studies.

  1. Mikko Poussa et al measured the lumbar lordosis of the same 430 children at ages 11,12,13,14 and age 22. They recorded their reports of back pain occurring on 8 or more days in the past year and found that the children with more lumbar lordosis were not any more likely to later report back pain [6].
  2. Sanne Christensen et al reviewed 54 studies on the topic of and found no relationship between sagittal spinal posture (including lumbar lordosis) and low back pain [7].

So, the answer is no. Rest assured, your hyperlordosis does not increase your risk of getting low back pain. So don’t worry about it. 

Various methods of measuring lumbar lordosis used in the research. [5]

How can there be no association between lordosis and pain?

The thing to remember here is that having a lot of arch in your back doesn’t increase your risk of having future back pain. If you already have back pain, and it hurts more when you arch your back more, then change your posture to arch less until it feels better is a reasonable approach. Just remember that there is no biomechanical reason to fear returning to your prior spinal position.

Lumbar lordosis posture isn’t meaningless, rather it is just one part of the whole bio-psycho-social system, and probably not the most important part for most people. Pain is not a simple input to the brain caused by biomechanical “overload” or “imbalance” from too much of this or that. Pain is an output. Pain is a response your brain creates to stimuli it perceives as threatening [8]. This stimuli could include a posture of lumbar lordosis, but it would more likely include a workload you find excessive, a relationship in turmoil etc. See my article on pain and damage for more on this topic.

Should I try to change my lumbar lordosis?

At this point it should be clear that there is no biomechanical rational for reducing your lumbar lordosis to prevent back pain. However if you want to try to change your lumbar lordosis to see if this will reduce your current back pain, or because you don’t like the way the arch in your back looks or makes your pants fit, then go right ahead. There is no reason to believe that trying to change your lordosis is harmful. In fact, it is perfectly plausible that the process of working on your posture could reduce pain through improved spinal position sense and sensory processing that is independent of any biomechanical changes in posture. The way you think about the process of changing your posture is likely more important than the postural changes themselves [9]. Approach your posture change project with a focus on the sensations of the process while acknowledging and confronting any fear of movement [9].

How can I measure my lumbar lordosis?

If you want to see if you can actually change your lumbar lordosis angle, you will need to learn to measure it. Fortunately a simple iphone app call iHandy level has been studied and found reliable at measuring lumbar lordosis [10]. All you need is the app and a friend or a mirror. The lumbar lordosis angle here is the sum of the angle between T12-L1 and horizontal and the angle between L5-S1 and horiztontal. Here is a video I shot of how to measure your lumbar lordosis.

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How can I reduce my lumbar lordosis?

I could imagine this section of the article being published in a fashion mag as “four exercises to get the sway out of your back” or on a health website as “exercises to fix lumbar lordosis” or “exercises to correct lordosis.” Such articles both make me cringe and inspire me to provide the public with higher quality content.*

Here is my own special sequence of movemnts designed to reduce lumbar lordosis. The rational behind this sequence is that you activate the long and under-activate glut max, hamstrings and anterior abdominals while simultaneously lengthening and inhibiting the short and overactive hip flexors and lumbar paraspinals. You repeat the sequence at an intensity and frequency sufficient to achieve post-tetanic potentiation with the result being that the pelvis tips back and the spine straightens slightly automatically. Take note of how this new posture feels and then practice returning to this new posture several times throughout the day to make it the new normal.

Here is a video of the sequence aimed at reducing lordosis:

And here is the sequence in photos:

1. Posterior tilt and glut squeeze (better done face down) ~60sec

2. Bretzel quad stretch on left, then right. ~30sec each

Bilateral glut bridge with posterior tilt ~60sec (do one leg at a time and bring the other thigh to your chest if you are having trouble maintaing the posterior pelvic tilt)

  • Repeat several times or until your feel consistent engagement in the gluteals, hamstrings and abdominals.

Quantified Self Experiment

I don’t have any research showing that these exercises reduce lumbar lordosis, but fortunately you can easily test them out for yourself. Measure your lordosis angle, your pain, or both if you have them, do the sequence above, remeasure and record your results. You may see immediate change in the lordosis angle, the change may take several days of repeat practice to achieve or you may not see any change at all. Whatever the case may be, report your results in the comments below for the enlightenment of all.

Thanks for reading and sharing your thoughts.

Move well, eat well, sleep well, be well,

Bryan Ausinheiler PT,DPT,OCS,CSCS,FNS

References

  1.  2002 Nigel Palastanga- Anatomy and Human Movement. pg 448
  2.  2004 Norton et al.- Differences in Measurements of Lumbar
    Curvature Related to Gender and Low Back
    Pain. JOSPT
  3. 2009 Philip Page- Assessment and Treatment of Muscle Imbalance:The Janda Approach 1st Edition.
  4. 2008 Ester Gokhale- 8 Steps to A Pain Free Back- Natural posture solutions for pain in the back, neck, shoulder, hip, knee and foot.
  5. 2013 Been et al.- Lumbar Lordosis Perspective. The Spine Journal
  6. 2005 Pussa et al.- Anthropometric measurements and growth as predictors of low-back pain: a cohort study of children followed up from the age of 11 to 22 years
  7. 2008 Christensen et al.-Spinal Curves and Health: A Systematic Critical Review of the Epidemiological Literature Dealing With Associations Between Sagittal Spinal Curves and Health
  8. 2003 David Butler & Lorimer Moseley- Explain Pain
  9. 2015 Nijs et al.- A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education With Cognition-Targeted Motor Control Training
  10. 2016 Koumantakis- Reliability and validity measurement of sagittal lumbosacral quiet standing posture with a smartphone application in a mixed population of 183 college students
  11. 2015 Cho, I., Jeon, C., Lee, S., Lee, D., & Hwangbo, GEffects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain. Journal of Physical Therapy Science, 27(6), 1983-1985
    doi.org/10.1589/jpts.27.1983
  12. Editorial questioning the validity of the biomechanical model: 2010 Lederman-  The fall of the postural–structural–biomechanical model in
    manual and physical therapies: Exemplified by lower back
    pain. https://pdfs.semanticscholar.org/5238/5e1a8cf0f8e86330fced0c60b52c85b755af.pdf

*I feel compelled to call out healthline.com for their misleading and poorly researched article titled “correcting lordosis posture.” Their article states that “lumbar lordosis causes back pain” (with no citation of course). The article then stated that the core exercises promoted have been shown to lordosis but the study they cited actually reported the opposite, that lordosis increased in the group that did core exercises [11]. Hopefully whoever wrote that article, find this and updates their article… and maybe next time they read their own references before publishing.

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