Contrary to popular belief, a healthy spine is not perfectly straight. Instead, it is designed to have three small curves. Two of these curves are in the neck and lower back, a region known as normal lordosis, while the other curve in the upper back bows slightly outward, a region known as normal kyphosis. These curves help the spine absorb shock, support the head, and keep the body stable.
But sometimes, the natural kyphosis and lordosis regions can become extreme, creating excessive spinal curves and hampering the spine’s ability to function properly. The three main spinal curvatures are scoliosis, kyphosis, and lordosis. When the spine bends due to poor posture, injury, or birth deformities, it can cause pain, a swayback appearance, and additional health issues. If symptoms of kyphosis, lordosis, and scoliosis get increasingly more pronounced or painful, it may be time to seek medical attention and formulate a treatment plan. Here are some ways to recognize the symptoms of kyphosis and lordosis.
What is Kyphosis?
While scoliosis is a sideways curve of the spine, kyphosis refers to the spinal deformity that occurs when the backbones of the upper back round forward. A normal spine should appear straight from behind, but a spine under the effect of kyphosis will curve forward. This gives the appearance of a “humpback” or rounded hump near the base of the neck.
According to Johns Hopkins Medicine, kyphosis is determined via x-ray by measuring the curvature of the spine. A healthy spine should bend from 20 to 45 degrees, while anything with a curvature of 50 degrees or more is diagnosed as kyphosis and recommended for medical treatment.
Found most often in females, kyphosis can vary from barely noticeable to severe. Patients suffering from extreme kyphosis curvature experience back pain or stiffness and a rounded spine. However, patients often suffer from mild forms of kyphosis that are only noticeably visible as a small hump or rounded upper back. Other symptoms include a forward-positioned head, rounded shoulders, fatigue, breathing difficulties, and muscle spasms.
There are three primary kyphosis types:
- Congenital kyphosis;
- Postural kyphosis;
- Scheuermann’s kyphosis.
Kyphosis can be age-related due to weakened spinal bones that may compress or crack. Compression fractures caused by broken vertebrae, osteoporosis, or specific cancer treatments also weaken the spine resulting in excessive curvature. In addition, a kyphotic curve can be diagnosed in infants and teenagers due to birth malformations or the wedging of the spinal bones over time through poor posture.
While postural kyphosis treatment includes posture improvement exercises, those with Scheuermann’s kyphosis are often treated with back bracing, physical therapy, and pain medications. Physical therapy can help strengthen the back and abdominal muscles to better support the spine.
Congenital kyphosis occurs when a child is born with a deformed, outward spinal curve. There must be an abnormal shape of one or more vertebrae to diagnose congenital kyphosis. Similar to scoliosis, the curvature may become more apparent as a child grows. Treatment may require surgery to keep the curve from worsening.
Postural kyphosis, also known as postural roundback, refers to a spine kyphosis of over 50 degrees with normal-shaped vertebrae in the thoracic region. This is the most common type of kyphosis, especially among teenagers. When you slouch or have poor posture, it stretches the ligaments and muscles which hold the vertebrae out of their natural position, resulting in a rounded spine.
Scheuermann’s kyphosis, named after the Danish radiologist who first identified it, occurs when the vertebrae have a different shape. Rather than a rectangular shape, the vertebrae take on a wedge shape that curves the bones forward. This type of kyphosis occurs most often in male teens. It can be painful and hinder the body’s flexibility.
What is Lordosis?
Lordosis refers to the abnormal inward curvature of the spine, generally affecting the lumbar spine or lower back. Typically, a healthy spine curves a little at the cerebral, thoracic, and lumbar regions. A person suffering from lumbar lordosis may appear to sway back with an exaggerated posture and stuck out buttocks due to an excessive curvature of the lumbar region. Lordosis can also occur in the neck, resulting in a “swayback” neck.
Both lordosis and kyphosis disrupt the structure and alignment of the spine and force the muscles and tendons to overwork in order to provide the necessary support. Lumbar lordosis and other spinal curvatures such as scoliosis can be painful, sometimes affecting ease of movement. While extreme lordosis can cause severe pain in the lower back, its initial symptoms are trunk weakness, short hamstrings, or weak thighs. Lordosis in the neck can be accompanied by symptoms such as neck pain, spasms, and limited mobility. Other lordosis symptoms include numbness, tingling, weakness, or bladder incontinence.
There are five lordosis types:
- Traumatic lordosis;
- Postural lordosis;
- Post-surgical laminectomy hyperlordosis;
- Neuromuscular lordosis;
- Lordosis secondary to hip flexion contracture.
Lordotic curve treatment is determined by the cause and severity of the patient’s condition. Some treatment options may include pain medications, physical therapy, weight loss, bracing, or surgery. Physical therapy helps build muscle strength, improves flexibility, and increases the range of motion in the spine and lower back.
Traumatic lordosis results from injuries that cause the connecting parts of the spine to break or fracture. Over long periods, the injury may slide the vertebrae forward, pinching the spinal nerves and causing pain, numbness, or weakness.
Excessive weight or weak back and abdominal muscles can cause this type of lordosis. The lumbar spine is dependent on these muscles for support. Thus, patients with weak muscles are more prone to developing postural lordosis.
Post-surgical Laminectomy Hyperlordosis
While post-surgical laminectomy hyperlordosis occurs in both adults and children, it is more common in children. A laminectomy, or removal of part of the vertebrae to reduce spinal cord or nerve root compression in the spine, makes the spine unstable or curved. Surgery to remove spinal cord tumors in children commonly results in lordosis.
Similar to some types of scoliosis, neuromuscular lordosis is due to conditions such as muscular dystrophy or cerebral palsy. For example, some patients with cerebral palsy undergo a minimally invasive surgery called selective dorsal rhizotomy. This surgery reduces leg spasticity but may also lead to lordosis.
Lordosis Secondary to Hip Flexion Contracture
As the hips are integral to the proper function of the spine, a weakening or contracting of the hip muscles, tendons, or ligaments rotates the pelvis forward and displaces the spine. In response to the rotation, the patient will lean forward or form a hyperlordotic spine, which can result in lordosis secondary to hip flexion contracture.
Kyphosis and Lordosis: What are the Differences between the Two?
Kyphosis and lordosis are two different types of spinal curvatures. Severe kyphosis forces the spine to curve forward, rounding the upper back. On the other hand, excessive lordosis results in an abnormal inward curvature of the spine or a swayback.
Both kyphosis and lordosis can be painful and may need medical treatment. These abnormal curvatures cause discomfort and can lead to increased health problems. Yet, they all affect the spine differently by curving it in different directions. In addition, they have different causes ranging from sports injuries to congenital disabilities. Physical therapy, posture correction, and bracing are some of the available treatment options for these varying spinal conditions.
Can You Have Both Kyphosis and Lordosis?
To get diagnosed and treated for either a kyphotic or lordotic curve, you should explore a physical exam or imaging options. The type of treatment used for kyphosis and lordosis symptoms is dependent on the cause and severity of the spinal curve. In severe cases, an individual can suffer from both kyphosis and lordosis. For example, those with scoliosis, a sideways curvature of the spine that begins before puberty, often have both kyphosis and lordosis. Suffering from all three types of spinal deformities can severely impact spinal functions and complicate treatment options.
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