There are many different types of spinal conditions a person can develop. Some involve an over- or under-pronounced natural curvature, while others involve an unnatural sideways spinal curve that also rotates. Keep reading to understand the difference between lordosis, kyphosis, and scoliosis.
The spine’s natural curves are important for facilitating its strength, flexibility, and ability to evenly distribute stress. While there is a normal range of natural curvatures, when curves fall beyond these normal ranges, conditions such as lordosis, kyphosis, and scoliosis can be the cause. Individuals with mild scoliosis may require only regular checkups to monitor the condition, while others could necessitate more intensive interventions like braces or surgery.
Before we get into the specifics of different spinal conditions that involve abnormal spinal curvatures, let’s first ensure the role of the spine’s healthy curves are understood.
What are Spinal Curvature Disorders?
Spinal curvature disorders refer to a group of conditions that affect the natural curvature of the spine, leading to abnormal spinal curves and a range of symptoms. The three main types of spinal curvature disorders are lordosis, kyphosis, and scoliosis. Lordosis is characterized by an excessive inward curvature of the spine, often affecting the lumbar region. Kyphosis involves an exaggerated outward curvature, typically in the thoracic spine, resulting in a rounded back appearance. Scoliosis, on the other hand, is a sideways curvature of the spine that also involves spinal rotation.
These conditions can arise from various factors, including genetics, disease, injury, and birth defects. Understanding the nature of these disorders is crucial for recognizing symptoms early and seeking appropriate treatment to prevent further complications.
Types of Spinal Curvatures of a Healthy Spine
Due to the spine’s natural and healthy curvatures, when viewed from the side, it will have a soft ‘S’ shape; when viewed from the front or back, it will appear straight.
The spine is naturally curved because it makes it stronger, more flexible, and better able to distribute mechanical stress that’s incurred during movement.
The spine has three main sections: cervical (neck), thoracic (middle and upper back), and lumbar (lower back), with each having a characteristic curvature type. The terms ‘lordosis’ and ‘kyphosis’ refer to the spine’s natural curves, and when these curves fall beyond a normal range, the conditions are also called ‘lordosis’ and ‘kyphosis’.
Normal lordotic curves are found in the neck (cervical spine) and the lower back (lumbar spine). Lordotic curves bend forwards, towards the body’s center.
Normal kyphotic curves are found in the chest (thoracic spine). Kyphotic curves bend backwards, away from the body’s center.
The spine’s healthy and natural lordosis and kyphosis work to protect the health and biomechanics of the spine by keeping it aligned. When there is a loss of one or more of these curves, it can affect the spine, and other areas of the body, in multiple ways.
In a healthy spine, the vertebrae are stacked on top of one another in a healthy alignment, separated by intervertebral discs that give the spine structure, flexibility, and act as the spine’s shock absorbers.
When the spine loses one or more of its natural curvatures, the spine is no longer optimally aligned, and this is when problems occur.
Abnormal Curvatures of the Spine
Now that we have explored why the spine is naturally curved in the first place, and the different curvature types that characterize the different spinal sections, let’s explore some abnormal curvatures of the spine that can develop: lordosis, kyphosis, and scoliosis.
A severe spinal curvature can significantly impact mobility and lead to potential health complications. Conditions such as dyspnea, ataxia, and chronic back pain can arise from severe spinal curvature, making evaluation and treatment based on the severity of the curvature crucial.
Abnormal Lordosis
Lordosis, as a spinal condition, is defined as an exaggerated inward curvature of the spine. While it most commonly affects the lumbar spine, the cervical spine can develop it as well.
A normal lordotic range is considered to be between 40 and 60 degrees, and when a person’s lordotic range falls beyond this normal range, problems can occur.
When a person develops an excessive lumbar lordosis, the changing postural effect can give a swayback appearance where the buttocks are more prominent as general postural elements tend to become more exaggerated.
Lordosis can affect people of all ages, and when it affects the lower back, it can cause varying levels of back pain and mobility issues.
Some causes of abnormal lordosis include conditions such as spondylolisthesis, osteoporosis, and obesity.
Spondylolisthesis
Spondylolisthesis is a spinal condition that develops when a vertebra slips out of place, sliding on to the one below and exposing it to adverse pressure and friction.
When this happens, the health of the intervertebral discs are impacted as they rest between adjacent vertebrae and are also exposed to uneven pressure and wear.
As the vertebrae shift and the discs are affected, the spine’s ability to maintain its healthy curvatures is compromised, hence the potential development of an abnormal lordotic curve.
Osteoporosis
Osteoporosis is a disease that affects bone health and develops as the body loses bone mass. This is most common in women as they age and experience hormone and bone-density changes related to menopause.
When this happens, the bones of the spine become weak and are more prone to injury. A person with osteoporosis is at risk of developing a number of spinal conditions as the overall health and strength of the spinal vertebrae are impacted.
Obesity
When obesity is the cause of lumbar lordosis, this is because carrying extra weight stresses the lumbar spine and is related to lumbar spinal disease.
Body mass index (BMI) is known to affect lumbar curvatures, so obesity can expose the spine to adverse spinal tension and added weight to support and distribute, with the potential to lead to the development of an abnormal lordotic curve.
Symptoms of Lordosis
While every case is different, there are some symptoms commonly associated with lordosis:
- A swayback appearance
- Buttocks being more pronounced
- When lying flat on the floor, there is a noticeable gap between the back and floor
- Back pain and discomfort
- Mobility issues
While lordosis involves an abnormal forward spinal curvature, kyphosis involves an abnormal backward spinal curvature.
Abnormal Kyphosis
Kyphosis, as a spinal condition, is defined as an exaggerated outward curvature of the spine and can cause a forward-rounded posture.
Kyphosis most commonly affects the thoracic or thoracolumbar sections of the spine, but it can also affect the cervical spine.
A normal range of kyphosis is considered to be between 20 and 45 degrees, but when a structural abnormality causes a kyphotic curve to develop that is beyond this normal range, this is when the curvature becomes abnormal and problematic.
People with excessive kyphosis can have posture that appears to be overly rounded forward with excessively-rounded shoulders, known to cause an overall ‘roundback’ appearance.
There are many different types of kyphosis; the three most common are postural, Scheuermann’s, and congenital.
Postural Kyphosis
Postural kyphosis is the most common type and often becomes apparent during adolescence. It presents as poor posture and noticeable slouching, and this form is the easiest to treat because it is not caused by a structural abnormality in the spine.
Postural kyphosis tends to cause a smooth and round curve that can be corrected when position is changed or when the patient makes an active effort to stand up straighter.
Postural kyphosis is also more common in girls, is rarely painful, and as it’s postural and not structural, the condition is not progressive.
Scheuermann’s Kyphosis
Named after the radiologist who first described this type of kyphosis, Scheuermann’s kyphosis is a structural condition, meaning it’s not as easily treated as postural kyphosis.
As a structural condition, Scheuermann’s kyphosis is caused by a structural abnormality within the spine. With this form, an X-ray taken from the side will reveal that multiple consecutive vertebrae are triangular in shape, rather than the normal rectangular shape of healthy vertebrae.
When vertebrae are triangular in shape, they are not able to maintain the spine’s natural curvatures and alignment as the misshapen vertebrae cause them to wedge together towards the spine’s front, which decreases the disc space and results in the characteristic forward curvature of the upper back, giving the shoulders that rounded-forward appearance.
Scheuermann’s curves tend to be sharp, angular, stiff, and rigid. It most commonly affects the thoracic spine, but can also develop along the lumbar spine.
This form is more common in boys than girls, and its progression stops once skeletal maturity has been reached.
Scheuermann’s kyphosis can be painful, especially for adults, and if pain is an issue, it’s most commonly felt around the curvature’s most-tilted vertebrae (at the apex of the curve). Pain can also be felt in the lower back if the kyphosis of the upper spine causes a counteractive curvature in the lumbar spine.
Congenital Kyphosis
With congenital kyphosis, patients are born with the condition as it develops in utero. This form develops due to a malformation in the spinal column.
Either the spinal bones don’t form as they should, or multiple vertebrae end up fused together, instead of forming into distinct spinal bones.
This form of kyphosis tends to progress with growth, and it’s not uncommon for these patients to have other medical issues related to systems or body parts not forming properly.
Symptoms of Kyphosis
While the signs and symptoms of kyphosis will vary depending on condition type and severity, some common signs and symptoms of kyphosis include:
- Rounded shoulders
- Pitched-forward posture
- A visible arch on the back
- Fatigue
- Spinal stiffness/rigidity
- Tight hamstrings
- Muscle pain
If a condition is left untreated, or isn’t treated appropriately, kyphotic curves that continue to progress, increasing in severity, can produce these additional symptoms:
- Weakness, numbness, and/or tingling in the legs
- Loss of feeling and sensation
- Breathing impairment
So now that we have touched on the roles of the spine’s natural curvatures and alignment, and what abnormal lordosis and kyphosis involves, let’s talk about how to respond to these conditions, in terms of treatment moving forward.
Causes and Risk Factors
Spinal curvature disorders can develop due to a combination of genetic and environmental factors. Some common causes and risk factors include:
- Genetics: Many spinal curvature disorders, such as idiopathic scoliosis, tend to run in families, indicating a genetic predisposition.
- Disease: Conditions like cerebral palsy and muscular dystrophy can increase the risk of developing spinal curvature disorders. These diseases affect muscle control and strength, which can lead to abnormal spinal curves.
- Injury: Traumatic injuries, such as those sustained in car accidents, can cause damage to the spine, leading to conditions like degenerative scoliosis.
- Birth Defects: Congenital scoliosis is a type of scoliosis present at birth, resulting from malformations in the spinal column during fetal development.
- Age: While spinal curvature disorders can occur at any age, certain types, such as degenerative scoliosis, are more common in older adults due to the wear and tear on the spine over time.
- Neuromuscular Conditions: Conditions like spina bifida and neuromuscular scoliosis can significantly increase the risk of developing abnormal spinal curvatures due to their impact on the nervous and muscular systems.
Symptoms and Diagnosis
The symptoms of spinal curvature disorders can vary widely depending on the type and severity of the condition. Common symptoms include:
- Back pain
- Difficulty standing up straight
- Difficulty breathing
- Numbness or tingling in the legs
- Weakness in the legs
Diagnosing a spinal curvature disorder typically involves a comprehensive approach. A healthcare provider will start with a physical examination and review the patient’s medical history. Imaging tests, such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans, are crucial for visualizing the spine’s structure and identifying abnormal curvatures. Additionally, a scoliosis screening may be performed to assess the patient’s posture, alignment, and spinal curves.
Treatment for Lordosis and Kyphosis
When it comes to progressive spinal conditions that are going to worsen over time, especially if left untreated, proactive treatment with the potential to reduce the abnormal curvatures and restore as much of the spine’s natural and healthy curves as possible is key.
Here at the Scoliosis Reduction Center®, I’ve treated a number of spinal conditions, and when it comes to structural conditions like lordosis and kyphosis, treatment has to, first and foremost, impact the condition on a structural level.
The goal of treatment is to control an abnormal curvature’s progression to prevent disruptions to posture and other symptoms such as pain (more common in adult patients).
There are several important patient and condition characteristics that factor into how I approach treatment, including a patient’s age and overall health, how much growth they have yet to go through, the severity of the curvature, and the condition type, particularly relevant with kyphosis.
I combine multiple treatment disciplines in order to fully craft the most effective and customized treatment plans possible: chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing.
Through a chiropractic-centered functional approach, I work closely with my lordosis and kyphosis patients to achieve a curvature reduction on a structural level by manipulating the most-tilted vertebrae of the curvatures back into a healthier alignment.
We also work to increase core strength so the spine’s surrounding muscles are better able to support and stabilize the spine.
In addition to lordosis and kyphosis, scoliosis is another highly-prevalent spinal condition that involves a loss of the spine’s healthy curves through the development of an abnormal spinal curvature.
Scoliosis
According to the National Scoliosis Foundation, there are currently close to seven million people living with scoliosis in the United States alone, and these are only ‘known’ diagnosed cases; obviously, there are also many people living with the condition unknown and undiagnosed.
Amongst school-aged children, scoliosis is the most common spinal condition, and scoliosis accounts for 20 percent of all spinal conditions in the United States.
Scoliosis is defined as an abnormal sideways curvature of the spine that rotates and has a minimum Cobb angle measurement of 10 degrees. Scoliosis is a progressive structural spinal condition.
Cobb Angle Measurement
A patient’s Cobb angle measurement tells me how far out of alignment their spine is and places the condition on its severity scale of mild, moderate, severe, or very severe:
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
While some patients may only require monitoring, others may need to consider scoliosis surgery as a viable treatment to correct or manage the condition.
So while lordosis and kyphosis involve abnormal spinal curvatures that bend backwards or forwards, scoliosis involves an abnormal spinal curvature that bends to the side.
The most common form of scoliosis is idiopathic, meaning it has no single-known cause, and idiopathic scoliosis accounts for 80 percent of known diagnosed cases. The most common form of idiopathic scoliosis is adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18. The remaining 20 percent are associated with known causes such as neuromuscular, congenital, degenerative, and traumatic.
When an abnormal scoliotic curve develops, it can range greatly in severity and produce a wide range of symptoms based on a number of patient and condition characteristics such as patient age, severity level, condition type, and curvature location.
While every case is different, common signs and symptoms of scoliosis include:
- Uneven shoulders/shoulder blades
- Uneven hips
- Rib arch
- Arms and legs that appear to hang at different lengths
- A visibly-curved spine
- Changes to gait and balance
- Clothing that doesn’t hang evenly
- Back, neck, head, or leg pain (more common in adults)
As scoliosis is progressive, it’s particularly beneficial to detect and diagnose the condition early on so proactive treatment can be started early in the condition’s progressive line.
One of the most common questions I’m asked is how painful scoliosis is, and the answer will largely depend on whether or not the patient has reached skeletal maturity.
In adult patients, the condition can cause varying levels of pain that can range from intermittent and mild to chronic and debilitating. In older patients who have reached skeletal maturity, meaning they have stopped growing, their spines have settled due to gravity and maturity, so they are vulnerable to the compressive force of the scoliotic curve that can be felt not only by the spine, but also in its surrounding vessels, muscles, and nerves.
In children and adolescents, scoliosis is not known to be painful because as they have not yet reached skeletal maturity, their spines are experiencing a constant lengthening motion, and this counteracts the compressive force of the curvature, known to be the source of most scoliosis-related pain.
So after a scoliosis diagnosis is given, what’s the best way to control its progression and restore the spine’s natural curves and alignment?
Treatment for Scoliosis
As a scoliosis chiropractor, I know scoliosis, and I know the spine. Here at the Center, patients have access to multiple scoliosis-specific treatment disciplines for the most specific and customized treatment plans.
Important patient and condition characteristics that help shape a treatment plan include patient age and overall health, condition severity, condition type, and curvature location.
With these characteristics in mind, I design treatment plans that are based on how best to impact the condition structurally by reducing the abnormal curvature, and increasing core strength so the spine is better supported and stabilized.
This is achieved through a chiropractic-centered functional approach that prioritizes the overall health and function of the spine.
Through combining scoliosis-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing, I can fully customize each patient’s treatment plan to address the specifics of their condition.
Conclusion
The spine is an important part of human anatomy. It allows us to stand upright, practice good posture, and engage in flexible movement.
In addition, as the spine works in tandem with the brain to form the body’s central nervous system (CNS), spinal conditions have the potential to cause numerous effects felt throughout the body.
Just as there are different types of healthy curvatures a spine relies on for its strength, flexibility, and ability to distribute stress, there are different unhealthy curves and spinal conditions an unhealthy spine can develop.
Different types of spinal curvature disorders include lordosis, kyphosis, and scoliosis.
Lordosis involves an abnormal backward curvature that most commonly affects the lumbar spine and gives the posture a swayback appearance.
Kyphosis involves an abnormal forward curvature that most commonly affects the thoracic spine and gives the posture a roundback appearance.
Scoliosis involves an abnormal sideways curvature that can develop anywhere along the spine and gives the posture an overall asymmetrical appearance.
When the spine develops an abnormal scoliotic curve, this means there is a loss of the spine’s natural curves and alignment. As the spine’s ability to function optimally is dependent on its health curves and alignment, the development of an unhealthy curvature negatively impacts the spine’s overall health and biomechanics.
Here at the Scoliosis Reduction Center®, I work closely with every patient to design a fully customized treatment plan with the potential to reduce the abnormal spinal curvature and realign the spine, while preserving the spine’s strength and function.
