It's a common occurrence that people come into clinic telling us that they have a 'lordotic' spine or a 'kyphotic' spine, and so I thought it would be good to write a blog about it.
When it comes to medical terms, it's totally understandable that people can be worried about them, but as you'll see, the phrases lordosis (or lordotic) and kyphosis (or kyphotic) are actually totally normal findings!
A kyphosis is where the spine curves in a 'C' shape that makes us flex forwards. The concave aspect of the C (so the right side of the letter as you look at it on here, the hollow bit) will point forwards and is best used to describe the thoracic spine shape, the upper back with ribs attached to it. On the flip side, a lordosis is where the C is the opposite way around, so puts us into extension, such as in the neck and lower back. The spine is shaped as it is to be a shock absorber for the body.
The phrase 'normal' is a really broad term though! The depth of the curves of the lordosis and kyphosis in your spine is mainly genetic based, and therefore you may see similarities in your family. There is a huge variation from person to person, so as long as you are comfortable, and your back is functioning well, please don't worry! However, there are some things that can change the spinal curves, let's take a look…
Changes in your spinal curves
Sometimes, spinal curves are a result of a disease. Whilst strictly not a disease per sae, when the spine curves from side to side as you're looking at someone's back, it's called a Scoliosis. Scoliosis is a deviation from having a normal, straight spine into having lateral curves (side to side). You can hopefully now understand that this is different to the normal anterior/posterior curves of the kyphosis and lordosis that go front to back. Scoliosis can be one curve in a C shape, or multiple curves, more like an S shape.
Ankylosing Spondylitis can also cause changes to the anterior/posterior curves, and often will show itself by causing the lumbar spine to flatten and make a '?' shape when combined with the kyphosis of the upper back. If it's caught early enough, medications can help to slow or stop these changes occurring, but it can be tricky to diagnose for some people.
Scheuermann's kyphosis is a condition affecting adolescents, whereby the mid to upper back vertebrae grow in a wedge shape, rather than a box shape. This can cause a permanently increased thoracic kyphosis, a big curve through the upper back. For some cases, it may be recommended to use a back brace, and this will be prescribed by a consultant. The good news is the condition is self-limiting, so the pain often subsides by adulthood.
Posture related changes
It's no secret that we change shape and height as we age. Often, our lumbar spine flattens as we get older and we start to hunch through our upper back, but this is often a result of having arthritis in the hip that hasn't been properly addressed. It's prudent to rule out that the increase in upper back curve isn't due to fractures caused by osteoporotic changes, or brittle bone disease. Sometimes the vertebrae can start to crumble. If you suspect this, you should see your GP.
We commonly see people in acute, severe pain, and almost always they present with what we call an antalgic posture. Antalgic posture simply means your body is twisting itself away from the pain to try and make you more comfortable. It's an adopted posture and will right itself as your pain begins to settle down in time. This posture is very definitely a symptom, not a problem itself.
Sometimes, we get asked about the bump some people have at the base of the neck: Is it normal? The answer is yes, most of the time it is normal. Our vertebrae have projections of bone sticking out from the back of them which, when looking at the last neck vertebra (C7) is extremely prominent. It's referred to as the vertebra prominens in anatomy books for this reason! Sometimes it can look exaggerated if people have flattened spinal curves, or when a fatty lump forms over the top of it.
Of course, if you're worried about any of the above issues, do talk to us and we can help to ascertain if it's normal, something we can treat or something that you'll need to see your GP for.