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Lordosis, kyphosis and scoliosis

Hadyn Luke posted this on Monday 11th of November 2013 Hadyn Luke 11/11/2013

Tags: Anatomy and physiology , Special populations

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Today’s blog focuses on three types of spine curvature. It’s important for personal trainers to recognise these issues, as it will affect the choice of training programme they set for clients presenting with any of these three disorders.

We all have a slight kyphotic curve in the upper back and a slight lordotic curve in the lower back, and this “neutral” spine relieves stress on the vertebrae and ligaments. However, some people develop more prominent curvature.

What are lordosis, kyphosis and scoliosis?

Lordosis is when the spine curves in excessively at the lower part of the back; also known as swayback. It can be caused by a variety of conditions, including:

  • Osteoporosis
  • Obesity
  • Kyphosis
  • Achondroplasia
  • Pregnancy

Kyphosis is when the mid to upper back becomes rounded to a significant degree and is often accompanied by an anterior pelvic tilt. It can be caused by:

  • Poor posture
  • Arthritis
  • Osteoporosis
  • Spine infections or tumours

Scoliosis is when the spine develops an S-shaped or C-shaped sideways curve – or lateral deviation. Most commonly found in adolescents, it can be hereditary or cause by a birth defect, an injury or disease. It can also develop from regularly carrying something heavy on one side of the body – for example a mother carrying a child on her hip.

All three conditions will hamper movement and create additional stress on the spine and the tissues that surround it.

Symptoms of spine curvature

The symptoms of these conditions can vary from mild to severe but may include:

Lordosis – back pain, reduced mobility, pronounced buttocks, a gap between the floor and the lower back when lying down.

Kyphosis – back and leg fatigue, curved upper back, head tilting forwards.

Scoliosis – leaning to one side, uneven hips, uneven shoulder blades.

Fitness training and back problems

When exercising in a gym environment or during everyday activities such as lifting and bending, it’s important for individuals to keep a neutral spine to avoid developing lower back pain (see our blog on Lower back pain) or any of these more severe back conditions.

Personal trainers may find that clients who overtrain the anterior part of their body during resistance training, for example by doing a lot of chest presses without working the opposite muscles, can develop kyphosis (see our blog on Resistance exercise: How to avoid overtraining).

Equally, those who spend long hours seated for work may develop tight hamstrings, which bring the hip down into anterior pelvic tilt, which over-arches the back.

Treatment for spine curvature disorders

Mild cases of lordosis and kyphosis can be treated with strengthening and corrective exercises and physical therapy, while more severe cases may need medication, a back brace or surgery. Obese people can help relieve symptoms by losing weight. Anti-inflammatories can help, but personal trainers should be careful when training clients taking medication as they may not feel pain when carrying out an exercise incorrectly and could cause additional damage to the back. 

For scoliosis, a back brace can benefit growing children to prevent the conditioning worsening, although in some cases surgery may be needed.

Corrective exercises

A fitness trainer can work with clients to address lordosis and kyphosis, whether using corrective exercises or PNF stretching (see our blog on PNF stretching) to stimulate the muscles in the back and retract the shoulders.

Lordosis – generally a client’s abdominal, hamstring and gluteus maximum muscles are likely to be weak, which will affect their ability to carry out exercises such as the squat, the Roman chair sit up and the standing military press. To counteract this, a personal trainer can set the following as corrective exercises:

  • Crunches
  • Seated leg press
  • Leg curl
  • Kneeling hip flexor stretches and lower back stretches

Kyphosis – a client with kyphosis may struggle with overhead exercises, in particular the shoulder press, seated triceps extension and overhead squat. The client may benefit from carrying out the following:

  • Low rows
  • Lateral pull downs
  • Hamstring and hip flexor stretches

Scoleosis – although there are fewer exercise solutions for this particular condition, a personal trainer could work with a client on stretching the concave side of the curve and strengthening the muscles in the convex side of the curve.

Conclusion

When a personal trainer is working with a new client they should always carry out a fitness and lifestyle assessment, which should point towards any of these spine curvature disorders, even mild cases such as minor pelvic tilt. It is of great help if the PT understands what they are looking for in a basic postural assessment and if there are any severe issues, they should refer the client to a doctor or physiotherapist.

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