(Swayback; Saddle Back)
Lordosis is a normal inward curve in the lower back and neck. Hyperlordosis, or swayback, occurs when the angle of the inward curve is exaggerated. The sooner hyperlordosis is treated, the better the outcome.
The exact cause of hyperlordosis is often unknown.
Factors that may increase your chance of hyperlordosis include:
- Achondroplasia —a genetic disorder that results in abnormal cartilage growth and dwarfism
- Spondylolisthesis —displaced vertebrae of back
- Neuromuscular disorders such as muscular dystrophy or cerebral palsy
- Congenital abnormalities of the spine
- Back surgery
- Hip disorders
- Poor posture
- Abnormal vertebral bodies—more commonly found in children with hyperlordosis
- Hyperkyphosis —an exaggerated outward curve of the thoracic spine
- Disc problems
Often times there are no symptoms with hyperlordosis. Depending on the degree of abnormal curving, you may experience back pain.
Your doctor will ask about your symptoms and medical history. A physical exam will be done. During the physical, your doctor may ask you to bend and move your back. Hyperlordosis can be seen during the exam. Some tests may be done to rule out or confirm other conditions that may be causing hyperlordosis.
Your doctor may recommend imaging tests to see the spinal curve and the structures around it. These may include:
For mild cases of hyperlordosis, treatment is often not necessary. You may need additional treatment to resolve any underlying conditions that contribute to your hyperkyphosis. Your doctor may refer to you a specialist who treats spinal disorders.
Options include the following:
Your doctor may refer you to a therapist to learn specific exercises. Exercises may be used to strengthen muscles and increase range of motion. You may also be taught how to maintain a correct posture.
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be given for discomfort or to decrease swelling.
Braces are sometimes used with children. The brace can make sure the curve doesn’t worsen as they grow.
Surgery may be used when the curve is severe, progresses, or when other treatment methods fail. The goal of surgery is to correct the exaggeration of the curve. The spine is corrected with a metal rod, hooks, or screws in the back bones. Surgeons also use a bone graft to promote new growth and stability.
There are no current guidelines to prevent hyperlordosis.
North American Spine Society
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed February 7, 2014.
Lordosis. Seattle Children’s Hospital website. Available at: http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/lordosis. Accessed February 7, 2014.
Lordosis in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/az/Site1095/mainpageS1095P0.html. Accessed February 7, 2014.
Spine basics. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00575. Updated December 2013. Accessed February 7, 2014.
Swayback (Lordosis). Cedars Sinai Health System website. Available at: http://www.cedars-sinai.edu/Patients/Health-Conditions/Swayback-Lordosis.aspx. Accessed February 7, 2014.
Vialle R, Khouri N, et al. Lumbar hyperlordosis of neuromuscular origin: pathophysiology and surgical strategy for correction. Int Orthop. 2007;31(4):513-523.
Last reviewed December 2014 by Teresa Briedwell, PT, DPT, OCS, CSCS
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.