Hyperlordosis

The most obvious sign is the posture itself: an exaggerated arch in the lower back, the buttocks held prominently, and the abdomen pushed forward. Lying flat on a firm surface, there is often a noticeable gap under the lower back. When hyperlordosis causes symptoms, the common one is lower back pain, particularly after standing for a while, because a deep curve concentrates load on the small joints at the back of the spine.

Pain that spreads into the leg, or numbness, tingling, or weakness, means a nerve is involved and should be medically assessed. Rapidly worsening weakness, or any loss of bladder or bowel control, needs urgent care.

The causes fall into two groups.

Muscle balance and posture: tight muscles at the front of the hips, together with weak abdominal and buttock muscles, tilt the pelvis forward and deepen the lower-back curve. This is the most common cause, and it is flexible and treatable with exercise.

Load on the front of the body: extra weight carried around the abdomen, or the changes of pregnancy, shifts the body’s centre forward and increases the curve. Pregnancy-related hyperlordosis usually settles after the birth, while any pain that persists well beyond that, or that spreads into the leg, is worth having assessed rather than assumed to be a leftover of pregnancy.

Spondylolisthesis: a vertebra that has slipped forward can deepen the lower-back curve, and it is one of the structural causes we assess for.

Compensation for imbalance elsewhere: the lower back can deepen its curve to keep the body upright when there is a problem higher up the spine, or a stiff hip that tilts the pelvis. Here the curve is doing a job, and treating it in isolation can make things worse.

Treatment depends on whether the curve is postural or structural, and on its cause.

Postural and flexible curves: these are managed without surgery, with physiotherapy: stretching the tight muscles at the front of the hips, strengthening the abdominal and buttock muscles, posture training, and, where weight is a factor, addressing it. This is the large majority of cases.

Structural curves: where the curve is fixed or part of a larger balance problem, treatment targets the cause. Where a slipped vertebra is driving it, the slip is treated; where the curve is compensating for imbalance elsewhere, the primary problem is addressed. Conservative care comes first, and surgery is considered only where a structural cause genuinely needs it.

Most hyperlordosis we are asked about is postural, and can be treated by seeing a physiotherapist. The cases we treat are the structural ones, and we start with a single question: is the deep curve the problem, or the spine’s way of compensating for one? Getting that right is important, because operating on a curve that was holding the body in balance can do more harm than good.

Dr. Chaidej Sasomboon is an orthopedic spine surgeon and Deputy Medical Director at Bangkok International Hospital. He completed fellowships in the United States, in minimally invasive spine surgery at UCSF and in complex and deformity spine surgery at Columbia University in New York, and his published clinical work is on the balance between the spine and the pelvis after lumbar surgery. He plans each case around the individual’s own spinal and pelvic alignment.

If your swayback posture comes with back pain, has not improved with exercise, or has been linked to a slipped vertebra or a balance problem in the spine, it is worth a proper assessment. Our specialists in Thailand and Germany can review your imaging, work out whether the curve is postural or structural and whether it is balanced, and tell you honestly whether it needs treatment at all, and if so, what kind.