Lumbar lordosis: treatment, straightening,exercises

Update: October 2018 Talk “I have lumbar lordosis
Department “can not: the speaker signs his own
withoutграмотности. After all, “lordosis” is a bend of the spinal column,
forward-facing and normally in the lumbar region
there is just such an arc. But the diagnoses associated with lordosis
lumbar nevertheless exist: when bending or too
large, or, conversely, has become smoothed. In these cases, the spine
needs urgent treatment.

About the spine

The spinal column is not a direct chord, as in the lower
vertebrates. A person’s ability to sit and walk on two legs
caused 4 bends to form here:

• 2 bends – cervical and lumbar – are directed by a bulge forward,
  that is, it is lordosis;
• 2 bend – thoracic and sacral – bend back. They
  called kyphosis.

Such a curved position allows the spine better
withstand loads, which, among other things, is
upright: when loading the spine is compressed like
springs, as a result, the pressure decreases.

A child is born with a direct vertebral column, and only when
he begins to learn to sit, appears at the beginning of a bend in the lumbar
department, and then, for balance, and all the other “concavity.” Here is
this lumbar flexure as long as it is within
150-170 ° (by radiograph, CT scan or MRI in lateral projection) is
physiological lumbar lordosis. As soon as this angle decreases
or increases, lordosis gets the name of the pathological.

Pathological lordosis leads to the fact that the vertical load
first to the lumbar region and then to the whole spine
is increasing. Choked vertebrae change their shape
(deformed), can easily shift relative to each other
even when doing the usual work. Change in several
vertebrae leads to the encroachment of nerves emerging from the spinal cord,
This causes pain and impaired internal function.
organs.

The sacrum is 5 intergrown large vertebrae, facing
bulge forward. From this structure can only separate
the first, upper vertebra, but they all cannot arch into another
the side. Therefore, the term “lumbosacral lordosis” is not
exists.

Types of lumbar lordosis

The fact that the lumbar lordosis is physiological (normal) and
pathological (formed as a result of the disease), we already
reviewed. The following are classifications related only to
its pathological type.

Depending on the kind of reasons, lumbar lordosis
spine can be:

1. Primary. It has two subspecies. The first is vertebrogenic,
   when bending is caused by diseases or developmental abnormalities themselves
   vertebrae, their displacement relative to each other. Second –
   паралитический, развивающийся в результате слабости  мышц,
   holding the spine. Withчинами мышечной слабости могут
   serve as inflammatory, metabolic or oncological
   processes.
2. Secondary. In this case, the bend in the lumbar spine
   may increase or decrease due to diseases of one
   or both hip joints connected to the pelvic bones, which
   connects with the sacral department.

Depending on the angle at which the spine is now curving
in the lumbar region, pathological lordosis may
be called:

1. hypolordosis, when the angle formed by the vertebral bodies in
   the place of bending is 171 ° and more. They say about this condition
   that the lumbar lordosis is smoothed;
2. hyperlordosis: the angle between the vertebrae is less than 150 °, usually
   140-150 °. The bodies of the vertebrae are no longer adjacent to each other, but
   fanlikely diverge. It is said that the lumbar lordosis
   reinforced.

When they write “lumbar lordosis saved”, this means that the angle
spinal curvature is in the range of 150-170 °, and its top
is at the level of 3-4 lumbar vertebrae (or L3-L4
medically).

There is another classification that takes into account the possibility
bring the vertebrae in the proper position. According to her and chosen
method of treatment. So, hypo or hyperlordosis can be:

• unfixed when a person can certain movements
  return the spine to its normal state;
• fixed: in the position of any
  arbitrary movements of the spine is not given;
• partially fixed: the bending angle of the back movements can be
  change only partially.

Withчины чрезмерного или сглаженного изгиба в поясничном
department

Pathological lumbar lordosis of the spine in children and
adult age is caused by different reasons.

So, excessive or, conversely, a smooth bend in the lower back
adults occur due to:

• osteochondrosis;
• перелома или вывиха vertebrae;
• osteoporosis;
• ankylosing spondylitis;
• flatfoot;
• obesity, when the lower back has a large load;
• spondylolisthesis;
• pregnancy, especially multiple or flowing with
  polyhydramnios Pathological lordosis in this case occurs to 16-20
  week and usually has a transient nature (disappears in 0.5-1 year
  after childbirth). If a woman before pregnancy already there were
  diseases of the spine (osteochondrosis, ankylosing spondylitis and
  others), then the lordosis, which arose during the carrying of the child, can
  do not go by yourself;
• herniated intervertebral disc;
• Schmorl’s hernia;
• dislocation or ankylosis (immobility) of one of the hip
  joints;
• inflammatory or degenerative diseases of the muscles that
  keep the spine;
• cicatricial changes of the muscles that fix the spine;
• ruptures of the ligamentous apparatus holding the lumbar spine
  spine;
• vertebral lesions in systemic diseases: rheumatoid
  arthritis, psoriasis, lupus erythematosus;
• achondroplasia;
• infectious lesions of the vertebrae (this is only possible with
  syphilis, tuberculosis or brucellosis);
• tumors growing from the vertebrae, or the metastases of any cancer in
  lumbar vertebrae;
• diseases that disrupt the metabolism and
  accordingly, the nutrition of the structures that fix the spine, as well as
  vertebrae themselves. It is diabetes, thyroid disease
  glands;
• oncological diseases of internal organs
  right next to the lumbar spine: the kidneys,
  uterus, prostate, ovaries, intestines.

Some of these diseases are able to “bend”
позвоночник в определенную the side. So, in a person who
received (or received) “whip” injury during a trip in the car
– when we drove first with great acceleration, and then had to
резко затормозить – возникает сглаженный лордоз lumbar.
For pregnancy, tumors and inflammations of internal organs,
lying in the retroperitoneal space, is characterized by increased bending.

When lumbar lordosis is found in children, the cause
is one of the following states:

• hereditary metabolic disease in the vertebrae or
  fixing their apparatus;
• spinal injury during childbirth;
• аномалии развития vertebrae;
• cerebral palsy;
• rickets resulting in bone softening
  fabrics;
• dysplasia of the hip joints and congenital hip dislocation,
  являющегося последher стадией дисплазии;
• violation of posture;
• dramatic growth in childhood or adolescence
  age. He is more likely to provoke hyper or hypolordosis,
  if the child has weak back muscles;
• Kashin-Beck disease.

If in childhood and adolescence hyperlordosis has not arisen
due to hereditary changes in the spine or his
ligamentous apparatus, then, if you direct all efforts to eliminate
causes, bending of the spine can be returned to normal. If the vertebrae
are long away from each other (like a fan)
adult completely eliminate this condition
Conservative methods are very hard.

How to recognize the pathological lordosis

Depending on whether the spinal curvature angle increases
or decreases, the disease manifests itself by various symptoms.
Common to both states will be such signs:

• aching pain in the back, aggravated by physical
  нагрузок, riseе тяжестей, пребывании в неудобной позе;
• in women, the pain increases with menstruation;
• men may experience erectile dysfunction;
• characteristic appearance: lowered shoulders, bulging belly
  (even in the absence of excess weight), the pelvis rejected back,
  spread legs with fully extended knees;
• change of gait: upper torso (up to the abdomen)
  deviates back and belly forward, legs divorced and man
  �“Waddling over” from one foot to the other;
• increased fatigue;
• pain in the legs, which increases after a long walk;
• problems with the digestive system: constipation, bloating
  stomach, intestinal cramps;
• sleep problems;
• deterioration of the temperature sensitivity of the pelvis and lower
  limbs.

When the lumbar lordosis is smoothed, to this is added:

• feeling not only pain, but also numbness in the lower back;
• fatigue while standing and sitting;
• appearance: shoulder blades stick out, and the lower half of the abdomen
  is bulging.

If hyperlordosis has developed, it is noted:

• strong tension of the lumbar muscles;
• lying on the stomach is impossible because of severe pain;
• when lying on your back you can see a large distance between your back in
  lumbar region and horizontal surface;
• tilting can only be done by bending the legs
  hip joints;
• when standing, one can see that the legs are either bent at the knees, or
  slightly bent in them;
• the head drops a little and moves forward.

In addition to these manifestations, there are symptoms that indicate
possible cause of hypo or hyperlordosis. It:

• Increased temperature, decreased appetite, weakness – with
  infectious processes;
• The gradual development of symptoms of lordosis plus a sliding gait.
  This combination suggests that the cause of the change in bending angle in
  поясничном department позвоночника являются опухоли или воспалительные
  processes in the field of spinal nerve roots. It may be
  radiculitis, spinal cord arachnoiditis or other pathologies due to
  which causes contracture in the gluteal or lumbar muscles,
  which is trying to compensate for lordosis;
• The appearance of symptoms of lordosis in middle age suggests
  the presence of osteochondrosis lumbar. It may be
  gradual and even sharp (if the gelatinous nucleus burst sharply).
  Osteochondrosis is indicated by soreness of the hip joints,
  which occurs when trying to set the back and buttocks in
  normal position.

Lordosis complications

If lumbar lordosis is not treated, whatever
was – hyperlordosis or hypolordosis – this leads to a strong
load on individual vertebrae and discs between them. When is
state exists for a long time, it leads to such
complications like:

• intervertebral hernia;
• pathological (excessive) mobility of individual
  vertebrae;
• reduced disc stability between several vertebrae
  (multiple ladder pseudospondylolisthesis);
• loss of disks;
• inflammation of the iliopsoas muscle;
• arthrosis deformans between the articular processes
  поясничных vertebrae;
• squeezing of the spinal cord
  self urination and defecation, infertility,
  immobilization (partial or complete) of the lower extremities.

How is the diagnosis made?

At home, the diagnosis is not made. Even a traumatologist
on the basis of inspection alone, it is not entitled to:
requires radiography, CT or MRI tomography to see
pathological lordosis and estimate the bend angle. And if radiography
helps only establish the diagnosis and determine the type of lordosis, then
tomographic techniques can help find the cause of such
states.

The doctor may only suspect this disease. For that he
asks the patient to stand with his back to the wall, leaning against her buttocks and
shoulder blades. If a lot remains in the lumbar region (more than 5 cm in
the deepest point of the bend) of free space, it speaks of
pathological lordosis.

In addition to determining the lordosis itself and its type are held
studies (analyzes and instrumental diagnostics), purpose
которых является определение причины данного states.

Treatment

Treatment of lumbar lordosis begins with conservative
events that are held in the complex. If this does not lead to
the desired effect and, moreover, there are signs of compression of the spinal cord.
brain surgery is performed.

Conservative therapy

It consists in a complex consisting of:

• measures to eliminate the cause of the disease;
• medication correction;
• Exercise therapy;
• physiotherapy;
• diets;
• additional methods.

Consider in order.

Elimination of the cause of the disease

This is possible only when the identified cause hyper- or
hypolordosis:

• if it is an osteochondrosis, deforming spondilarthrosis or
  deforming disease of the hip joints, appointed
  drugs chondroprotectors (“Don”, “Artra” or others);
• when the cause of pathological lordosis is infectious
  processes, treatment prescribed by an infectious diseases doctor. Usually this
  antibiotics that take into account the sensitivity of the microorganism. In course
  may include immunomodulators and vitamins;
• if it is determined that the cause is a systemic disease,
  A rheumatologist is involved in the treatment. She prescribes drugs
  that affect the immune system and stop its attack on
  own cells;
• with spondylolisthesis, intervertebral hernia and Schmorl’s hernia
  treatment with medicines and manual therapy;
• in case of obesity, an endocrinologist is connected to therapy, who
  helps to find the cause of this condition, and a nutritionist who picks up
  effective diet.

Drug treatment

It includes prescription drugs that should relax
tense lumbar muscles and allow using
exercise, physiotherapy and additional spinal techniques
take the desired position. These are drugs such as:

• anti-inflammatory drugs. With strong or permanent
  back pains are taken in pills or injections (“Diclofenac”,
  �”Celebrex”). If the pain is tolerable, it is better to use local
  agents: Olfen plaster, Diclofenac ointment, Voltaren gels,
  �”Fastum” and others;
• muscle relaxants (directly relaxing muscles):
  �Mydocalm, Sirdalud;
• Group B vitamins: Milgamma, Neurorubin.

Exercise therapy

Exercises for the lumbar lordosis should be prescribed by a doctor who
taking into account the type and degree of pathological bending, state
Your spine. We give common exercises that are used
In most cases:

When performing exercises follow these rules:

1. Exercise regularly.
2. Before performing a set of exercises, warm up,
   Massage your spine and joints.
3. Start with a minimum load, gradually increasing it.
4. Back pain, as well as other discomfort, with
   performance should not be. If dizziness, pain or
   heartbeat stop exercise.
5. The emotional mood should be positive.
6. After class, there should be a slight fatigue, not a feeling.
   exhaustion.
7. Wear loose clothing and orthopedic shoes. Loin
   must be covered and warmed.

Physiotherapy

It includes therapeutic massage, which should improve
blood circulation in the affected lower back and improve blood flow from it,
loosen the “sandwiched” and tone overly relaxed
muscle. In addition to massage, one or more of these are performed.
procedures:

• underwater (in the bath) traction;
• electrophoresis on the lumbar region, with novocaine and
  hydrocortisone;
• ultrasound on the spine;
• magnetic therapy on the buttocks and lower back area;
• mud applications on the lumbar region.

After such procedures it is necessary to put on orthopedic lower back
bandage to fix the spine and prevent it from “dropping” those
the changes that were achieved by treatment. In the bandage you need to walk
all the time, taking it off only for the time of local treatment and before
a dream. You need to sleep on an orthopedic mattress. While it is not, temporarily
sleep on your stomach, under which place the roller.

Additional methods of conservative treatment

These are methods that not all doctors include in the course of treatment. With
By this, the methods themselves demonstrate high efficiency. They
include:

• acupuncture – needles action on bioactive points,
  which helps direct the body’s desired energy to a certain
  place – in this case, to the lumbar spine;
• hirudotherapy is a method when on biologically active points
  leeches are planted. They и стимулируют сами точки, направляя энергию к
  lumbar, and inject substances into the blood, diluting it.
  As a result of the latter effect, blood circulates better.
  body, without forming stagnation;
• manual therapy – the impact of hands on the area
  pathological bending, the purpose of which is to bring it to
  normal angle.

Diet

Compliance with the nutrition rules below will not cure.
pathological lordosis, but will help food to pass
скомпрометированному желудочно-кишечному тракту, усваиваясь и without
stagnation. This will help prevent constipation and, therefore,
intoxication:

1. drink at least 30 ml / kg of fluid weight, and more can be, if not
   heart or kidney failure;
2. eat fresh vegetables, which are many
   fiber;
3. eat less sweet and flour;
4. completely eliminate fatty, fried and spicy foods, alcohol,
   smoked meat

Surgical treatment

It is used mainly in severe congenital conditions,
and also when due to lordosis occurs
squeezing the spinal cord. Traumatic operations are carried out under
general anesthesia. After them you need a long and competent
rehabilitation. There are 2 types of them:

1. fixation of the vertebrae in the area of ​​pathological lordosis using
   пластин, стержher или других металлоконструкций;
2. replacement of the affected vertebrae with titanium implants, of which
   You can fold the structure with a normal bend angle.

Unfortunately, the second type of operation in the CIS countries is practically not
performed.

Prevention

You can only prevent acquired lordosis, and do it
best from childhood. For this you need:

• to live an active lifestyle;
• perform daily exercises similar to those described above;
• enough to rest;
• sleep on a hard mattress;
• eliminate bad habits.

Автор: Кривега Мария Салаватовна врач-реаниматолог