Clients with Lumbar Hyperlordosis

Andrea Sobke
June 10, 2007

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 BASI Costa Mesa 2007

Abstract

Lumbar hyperlodosis is a faulty posture in which the curve of the lumbar spine is increased. This

can be caused by a variety of behavioral or congenital movement patterns or predisposed

anatomical structure; but in all cases of lordosis, the pelvis is always in an anterior tilt. The

anterior tilt of the pelvis resonates to the muscles surrounding the pelvic complex, resulting in tight

hip flexors and back extensors, and weak abdominals and hamstrings.

Tariq has an average case of lumbar hyperlordosis, and exhibits all of its characteristics. The goal

of his conditioning program is to reduce and possibly correct his lordosis of the lumbar spine. By

targeting certain muscles groups, and varying the emphasis from strengthening to stretching, the

proposed conditioning program will be of great assistance in finding better alignment and harmony

throughout the body. The Pilates program is designed to help Tariq reach his fitness goals, while

keeping his lumbar hyperlordosis the priority in the selection of exercises.

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 Contents

Anatomical Description………………………………………………..………….………….page 4

Introduction…………………………………..………………………………………………page 5

Meet Case Study: Tarik Soliman………………………………..……………………….….page 5

Conditioning Program…………………………………………………………….………....page 6

Why this Conditioning Program?.........................................................................................page 10

Closing Statement…………………………......……….……………………………………page 12

Bibliography…………………………………………………………………………………page 13

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 Anatomical Description

Lordosis of the lumbar spine is commonly known as “Sway Back”. The direct areas affected are

the lumbar spine (L 1-5), the abdominals, back extensors, hip flexors, and hamstring muscle

groups. Although lumbar hyperlordosis often affects other spinal curves and their corresponding

muscle groups, this study focuses primarily on the lumbar region of the spine and pelvic complex,

and the methods of correcting this faulty posture through the BASI Pilates Block System.

When the lumbar spine curve is increased, the placement of the pelvis is changed and therefore the

muscles which stabilize the pelvis begin to work in a way that supports the lumbar lordosis. With

the pelvis in anterior tilt tightness occurs in the back extensors and hip flexors, and weakness

occurs in the abdominals and hamstrings.

When the pelvis is in anterior tilt, the abdominals are lengthened and the hip flexors are shortened.

Meanwhile, the back extensors are shortened and the hip extensors are lengthened. This position of

the pelvis, and its affects on its surrounding muscle groups, causes the lumbar spine to curve

excessively forward. The psoas major can be a direct cause of lordosis when tight. It originates

from the anterior surfaces of the bases and lower borders of the transverse processes of the lumbar

vertebrae, and inserts into the lesser trochanter of the femur. When tight, it pulls the lumbar spine

forward toward pelvic insertion.

It is important to keep in mind that

although the contributing factors may

vary, the muscle groups surrounding

the pelvis are directly affected by any

lordosis of the lumbar spine.

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 Clients with Lumbar Hyperlordosis

Lumbar lordosis is a common flawed posture, one that can be found in all body types, even the

most fit and talented athletes. The faulty posture can be caused by many different behavioral

movement patterns or by congenital disorders. While many of the patterns or health disorders

might be involuntary and out of someone’s control, Pilates is an effective way of correcting the

negative influences lordosis can have on one’s body.

Hyperlordosis of the lumbar spine resonates throughout the body by resulting in a series of tight

and weak muscle groups surrounding the pelvic complex. The position of the pelvis in anterior tilt

can change the distribution of weight on the feet, the rotation of the femur when standing and

walking, and the overall movement pattern of the gait cycle

Meet Case Study: Tariq

The individual chosen for this case study has moderate lordosis in the lumbar spine, and all the

symptoms of lumbar hyperlordosis. Tariq is a 28 year old male, 5’11 with a medium build. He is

slim in his upper and lower extremities, with a slight splay in his ribs and abdominals, followed by

an increased curve in the lumbar spine. His weight is shifted forward on his feet, and there is a

slight increased curve in the thoracic spine with minor forward head.

Tariq has not and currently is not dealing with any injuries or medical conditions. His interest in

Pilates is solely to achieve a higher level of fitness, especially in the abdominal region, to gain

better mind-body awareness, and to increase his flexibility.

The lumbar lordosis of Tariq’s spine can be seen clearly from his profile, and is confirmed by the

lack of mobility in his lower back and hip flexors, and weakness in his abdominals and hamstrings.

The back extensors are extremely tight, causing him difficulty in finding posterior tilt when supine.

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When he does find his posterior tilt, his hamstrings fatigue and the position becomes strenuous for

him to maintain. The tightness resonates in exercises such as the Pelvic Curl and Roll Up. During

the Pelvic Curl, the spine immediately goes into lordosis at the top of the movement, partially due

to tight hip flexors. Although he can find his posterior tilt when lifting the pelvis, he is so fatigued

when lowering the pelvis that he cannot move through posterior tilt at all.

The lower back extensor’s agonist, the abdominals, are also afflicted with weakness due to the

lumbar lordosis. Tarik finds difficulty finding the “navel-to-spine” position, and once he has found

the position, he has trouble maintaining it due to the fatigue in his abdominals. In addition to

weakness, the over all contraction of the abdominals lacks the significant integration of the

transverse abdominus. The abdominals contract statically; they tighten in place; which is more

evident as the session progresses and he has begun to fatigue.

As expected, Tariq is very immobile in his hamstrings, illio psoas, gastrocnemius and soleus. With

his pelvis in anterior tilt, his weight tends to be forward on his feet, resulting in a “gripping” of the

plantar flexors. His hamstring immobility causes him discomfort when sitting upright with his legs

extended in parallel, and affects the execution of many of the exercises of the Fundamental level.

Increasing his mobility would greatly assist him in executing his Pilates exercises correctly and

with more efficiency.

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 Conditioning Program

Warm-Up

The exercises below will allow Tariq to focus his attention to his body and the actions necessary to

form a connection between the movement and finding the proper muscle recruitment, particularly

the Transverse Abdominus.

Exercise Focus for Lordosis

Pelvic Curl Prep
Pelvic Curl
Supine Spine Twist
Chest Lift (w/ Rotation)
Single Leg Lifts
Roll Up w/ Roll Up Bar
Finding the transverse abdominus
Focusing on drawing the navel down towards the spine
Emphasizing hamstring control and spinal articulation
Avoiding anterior tilt of pelvis, in 1st phase of exercise
Yoga ball underneath the legs for support
Maintaining “navel-to-spine”
Rib cage stabilization
Scapula Stabilization
Concentrating on pulling the navel down to the floor in order to the lift the leg
Imagery: rope attached to knee from the navel. When the navel lowers, the knee rises and
vice versa
Concentrating on scooping the belly
Feeling the lumbar spine against the mat, while rolling up and down

Footwork (on Reformer)

Tariq’s condition of lumbar hyperlordosis creates or is accompanied by slight external rotation of

the femur. His rotation is not the main concern however, it should be addressed and the adductor

group should be targeted during the footwork exercises. Emphasis is also put on the ability to

maintain a neutral pelvis and spine when extending the legs in both parallel and when in the V

stance.

Exercise Focus for Lordosis

Parallel Heels & Toes
V Toes
Open V Heel & Toes
Single Leg Heels & Toes
Calf Raises & Prances
Prehensile
Stretch
All footwork exercises emphasizing on hamstring initiation and control
Maintaining a neutral pelvis, avoiding anterior tilt
Stretch the non-working leg at 90 degrees with a theraband over the sole of the foot during
the exercise
Maintain neutral pelvis, especially with the non-working leg stretching upwards
Stretched leg should be straight at all times
Keep neutral pelvis and spine, especially with the legs extended
Stabilization of the ribs, focusing on lateral breathing and sinking the navel
Stretch the calves on the footbar, with the springs or assist by gently pulling the heels

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Abdominals (on Cadillac or Mat/Table)

The Mini Roll Ups are the perfect opportunity to find the correct flexion in the trunk, and locate the

correct position on the lumbar spine on the mat. The Double Leg Stretch, Single Leg Stretch and

Criss Cross should be done sequentially without a time to rest in order to target Tarik’s endurance.

Exercise Focus for Lordosis

Hundred Prep Legs at table-top
Keeping the lumbar spine on the carriage during flexion of the trunk
Mini Rolls Ups Focusing on trunk flexion, while maintaining neutral pelvis
Emphasis on contacting the lumbar spine with the mat
Mini Roll Ups Oblique Maintaining neutral pelvis, while identifying a clear flexion and rotation of the trunk
Re-educating the body from doing “crunches”

ON MAT OR TABLE OR CARRIAGE OF REFORMER

Double Leg Stretch This exercise will test Tarik’s endurance
Keeping the lumbar on the mat when the arms and legs are extended
Single Leg Stretch Coordination of the hands on the knee and ankle
Criss Cross This exercise will test Tarik’s endurance

Hip Work (on Reformer or Cadillac)

It is imperative that he remain out of lordosis when extending the legs. When the legs are extended

in a supine position, Tarik loses the abdominal support due to fatigue, and his hip flexors become

the sole muscle group supporting his legs.

Exercise Focus for Lordosis

Frog
Circles (down & up)
Openings (only on Reformer)
Hamstring control and initiation
Hamstring and adductor control
Abdominal stabilization
Hamstring and adductor control
Abdominal stabilization

Spinal Articulation (on Reformer)

Because of the difficulty Tariq has with the Pelvic Curl, it depends on the session and his

advancement with the exercises as to whether the Bottom Lift should be included in the session.

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Exercise Focus for Lordosis
Bottom Lift Hamstring strength and control
Finding the articulation of the lumbar spine
Short Spine Hamstring stretch and extension strength
Articulation and extension of the spine

Stretches (on Reformer)

The focus should be on the psoas muscle lengthening into the stretch, rather than contracting

against it. The session will also close with a series of stretches designed to increase mobility in

Tariq’s hip flexors, back extensors, and hamstrings.

Exercise Focus for Lordosis

Standing Lunge Posterior tilt during hip flexor stretch
Anterior tilt in hamstring stretch

Full Body Integration 1 (on Reformer and Cadillac)

The Up Stretch exercises are difficult for Tariq to maintain a neutral spine due to the lack of

flexibility in his hamstrings. It is likely that these exercises may not be included until Tariq has

increased his flexibility and is able to sit upright without his lower back extensors fatiguing into

flexion or lordosis.

The thigh stretch is an important exercise for Tariq to focus on his posterior tilt, while challenging

the quadriceps during the intense stretch accompanied by the movement.

Exercise Focus for Lordosis

Scooter Keep slight lumbar flexion
Isolation of the leg action from the trunk, avoiding slipping into lordosis when the working
leg pushes back
Up Stretch 1 Working the thoracic spine extensors
Hamstring stretch
Targeting the abdominals to draw the carriage in
Up Stretch 2 Keep an extended spine
Abdominals engaged, keeping from slipping into lordosis
Reverse Knee Stretch Maintain correct trunk flexion
Focusing on abdominals to bring the knees forward
Down Stretch Hip flexors extended
While keeping an extended back, avoid sinking into the lumbar spine
ON CADILLAC

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Sitting Forward Finding correct flexion of the lumbar spine
Using the back extensors (thoracic spine especially)
Hamstring stretch
Side Reach Abdominals engaged, supporting a contracted lumbar spine
Thigh Stretch Hip flexor stretch
Focusing on posterior tilt

Arm Work (on Reformer)

Straps will be added to the Rowing Series exercises once Tariq has found the needed contraction of

the abdominals to correctly and safely execute these exercises on a mat or table.

Exercise Focus for Lordosis

Sitting Series Keep back extended (not hyper extended) while sitting
This sitting position will probably be a stretch for the hamstrings
Shoulders adducted for biceps and rhomboids
Tarik is capable of the knee and kneeling series, but the sitting series should be
accomplished first to achieve hamstring mobility and back extensor strength
Rowing Back 1 Abdominal strength
Imagery: Shoulders away from the ears
Rowing Back 2 Flexion on the lumbar spine while rolling down
Sequentially engaging the back extensors to return to starting

Additional Leg Work (on Wunda Chair)

Exercise Focus for Lordosis

Hamstring Curl Focusing on pelvic lumbar stabilization

Lateral Flexion and Rotation (on Wunda Chair and Step Barrel)

The Side Stretch and Side Lift are both challenges for Tariq to do without slipping into his lumbar

lordosis.

Exercise Focus for Lordosis

Side Stretch Keeping the pelvis still
Focusing on the obliques, but also trying to stay out of lordosis
ON STEP BARREL
Side Lift Oblique strength, but keeping a straight movement pattern
Not arching into lordosis at the top of the lift

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Back Extension (on Step Barrel, Reformer or Cadillac)

Each of the selected exercises below should be done with caution of Tariq’s tendency to be in

lordosis and use his back extensors without the support of the abdominal wall. The back extension

exercises are also selected to work on the extension of the thoracic spine, which tends to curve

excessively forward. The pectoralis major should be stretched and lengthened.

Exercise Focus for Lordosis

Swan Prep Stay out of lordosis
Lift with the back extensors, not allowing the abdominals to sink forward
ON REFORMER
Breaststroke Prep Keeping abdominals engaged so as not to sink into lumbar spine
Imagery: shoulder away from the ears
ON CADILLAC
Prone 1 Abdominals engaged and integral to the extension of the back

Why this Conditioning Program?

The goals set for Tariq to meet through his Pilates program were to strengthen the hamstrings and

abdominals, stretch the hip flexors and back extensors, and re-educate the back extensors and

abdominals to correctly engage to flex/extend the trunk. At the beginning of the program, Tariq’s

abdominals and back extensors were contracting incorrectly. His abdominals contracted statically,

and his back extensors contracted without the support of his abdominal wall. To effectively

address Tariq’s goals, a Pilates program was designed for his needs, while still meeting his fitness

goals, utilizing the BASI Block System.

All of the exercises listed in the conditioning program are not to be addressed in a single session.

The exercises listed in the conditioning program are a combination of Fundamental and

Intermediate exercises, each chosen specifically for Tariq’s needs and abilities, weaknesses and

strengths.

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The exercises were chosen for Tariq as a way to correct or reduce the increased curve in his lumbar

spine. They can be done for a variety of individuals facing any faulty posture or sports injury. The

focus intended for Tariq per exercise is what personalizes the conditioning program for his needs

for a healthier musculature and spine.

Closing Statement

Lordosis is a painful posture which can be incapacitating for many individuals. Through the

exercises and observations used through this Pilates conditioning program, Lumbar Hyperlordosis

can be severely corrected or at least reduced by creating a mind-body connection with the muscles

integral in attempting to achieve ideal posture. By locating and understanding the role of the

transverse abdominus and the hamstrings, anyone with lordosis of the lumbar spine will be able to

exercise in correct pelvic and spinal posture. In addition to the strengthening of the abdominals

and hip extensors, the stretching of the back extensors and hip flexors plays a similar vital role in

eliminating or reducing lordosis. By stretching the two muscle groups, the muscles surrounding

the pelvic complex can begin to work symbiotically to improve and work towards neutral pelvis,

spine, and eventually work towards the ideal posture.

The condition program proposed for Tariq is a series of exercises chosen specifically for his needs,

both to create a trimmer waistline and to achieve healthier alignment.

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 Bibliography

Eva Hellsing, Thomas Reigo, John McWilliam and Erik Spangfort. Cervical and lumbar

lordosis and thoracic kyphosis in 8, 11 and 15-year-old children. European Journal of Orthodics.

http://ejo.oxfordjournals.org/cgi/content/abstract/9/1/129. May 24, 2007

Kemp, Simon. Lower back pain Injury Clinic - diagnosis and effective treatments. http://

www.sportsinjurybulletin.com/archive/lower-back-pain.html. May 24, 2007.

Randal P. Morris, Kim J. Garges, Milan Mody, Anthony J. Muffoletto, Rita M. Patterson,

Jinping Yang, James W. Simmons. The Affect of Lumbar Spine Lordosis on Stability and Injury.

http://www.ruf.rice.edu/~preors/Morris.pdf. May 24, 2007.

Regan, John MD. What is Lordosis? SpineUniverse. http://www.spineuniverse.com/

displayarticle.php/article1438.html. May 24, 2007.

Images

Kasper Dl, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ: Harrison’s

Principles of Internal Medicine, 16th Edition: http://www.accessmedicine.com

Psoas Major Muscle. 30 May 2007. Wikipedia, the Free Encyclopedia. http://en.wikipedia.org/

wiki/Psoas_major_muscle.

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