Lumbar Lordosis Angle - What is Normal?

Measuring the Low Back Curve

Lumbar curve - how much should you have?
Lumbar curve - how much should you have?. katrinaelena

Lumbar lordosis - the forward curve in the low back - is a key element of posture, good or bad. Along with the cervical and thoracic curves, it's a normal feature of the human spine.

But when it comes to definitively measuring lumbar lordosis, spine physicians do not agree on exactly what "normal" is, report Chernukha and associates in their 1998 study (published in Spine) entitled "Lumbar Lordosis Measurement."

Lumbar Lordosis Angles for the Rest of Us - Confused Yet?

Not only that, but there's no one way to measure nor interpret a lumbar lordosis. Been and associates, in their 2014 research entitled "Lumbar Lordosis," and published in Spine, reviewed 120 studies that looked at factors associated with measuring the angle of a lumbar lordosis, and how to determine normal values. They found that positioning during testing, as well as the number of spinal bones included in the measurement, can cause variations in results.

And as if this weren't confusing enough, they say that lots of things - from age, gender, ethnicity, engagement in sports and physical activity, and how much strength and flexibility you have and your body mass index (a height to weight ratio that's used to determine your relative degree of underweight, normal weight overweight, obesity, etc.) - can affect the results of a lordosis test.

So there are many reasons why no one can really tell you what normal lordosis is in terms of numbers and angles. But for those of us who wish to be pro-active about addressing our posture issues, this can be frustrating: How bad is it really? What angle should we go for when working to reduce our excessive lordosis?

Would our time and efforts be better spent addressing one of our other spinal alignment issues?

Related:  About your spinal curves...

One bit of definitive information about measuring lordosis Been and associates did find is that most accurate position for taking the x-ray is in standing with the shoulders flexed at a 30 angle, and arms supported.

Lordosis Measurement for Math Geeks

If you are a math geek, you may be wondering what system of interpretation is used to translate the x-ray film into an angle measurement that expresses how much lordosis a person has. It turns out that a number of tools are used - from determining Cobb angle (from a side view x-ray) to using centroid, tangential radiologic assessment of lumbar lordosis (TRALL) and/or Harrison posterior tangent line-drawing methods. But not all are suitable; one must fit the tool to the task. Studies conducted by Harrison et. al in 2001 show that for a lumbar lordosis determining the Cobb angle is the most accurate. (The researchers asked the same question regarding thoracic and cervical curves, and found in those cases, the Cobb angle, while a strong contender, was not the best measurement tool.)

Related:  What is the Cobb Angle?

The Value of Coming Up with a Normal Lordosis Value

If coming up with normal values for a very normal phenomenon such as the lumbar curve is so hard, why do it at all? Well, it's good information to have for one thing. Spine surgeons use this measurement when making decisions. Been and associates found an association between the lumbar lordosis angle and conditions such as spondylolysis and isthmic spondylolisthesis, which could inform treatment choices.

Plus, you don't want to worry for nothing, do you? Been and her team also found inconclusive evidence for an association between excessive lordosis and lower back pain. Although they call for more research on this question, the idea that your back pain may be caused by too much lumbar curve may possibly be overrated.

Sources:

Been, E., & Kalichman, L. (2014). Lumbar lordosis. Spine Journal, 14(1), 87–97. http://doi.org/10.1016/j.spinee.2013.07.464

Chernukha, K. V., Daffner, R. H., & Reigel, D. H. (1998). Lumbar Lordosis Measurement. Spine. http://doi.org/10.1097/00007632-199801010-00016

Harrison, D. E., Harrison, D. D., Cailliet, R., Janik, T. J., & Holland, B. (2001). Radiographic Analysis of Lumbar Lordosis. Spine. http://doi.org/10.1097/00007632-200106010-00003

Harrison, D. E., Cailliet, R., Harrison, D. D., Janik, T. J., & Holland, B. (2001). Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine, 26(11), E227–E234.

Harrison, D. E., Harrison, D. D., Cailliet, R., Troyanovich, S. J., Janik, T. J., & Holland, B. (2000). Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine, 25(16), 2072–2078.

Youdas, J. W., Garrett, T. R., Harmsen, S., Suman, V. J., & Carey, J. R. (1996). Lumbar lordosis and pelvic inclination of asymptomatic adults. Physical Therapy, 76(10), 1066–1081.

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