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Hyperlordosis

  • Cause
    • poor posture : slouched posture
    • prolonged standing
    • other postural condition : bilateral iliotibial band contracture, pes planus, hyperkyphosis
    • weak abdominal muscles
    • pregnancy
    • obestiy
  • Symptoms
    • increase lumbar lordotic curve with bilateral anterior pelvic tilt and hip flexion
    • pes planus, knee hyperextension , bilateral iliotibial band contracture
    • muscle imbalance
      2. Short and tight : Lumbar extensors(Erector spinae, Quadratus lumborum), Hip flexors(iliopsosas, rectus femoris, tensor fascia lata), adductors
      3. Weak or stretched : Abdominals(rectus abdominals, External oblique, internal oblique), Gluteus maximus, Hamstrings
    • Pain from tight ischemic tissue, overstretched tissue, trigger points, Stretched anterior longitudinal ligament, Facet joint approximation(Facet joint surfaces approximate when the spine extends)
    • Decreased ROM of hip extension
  • SOAP
    • Subject information : health history
    • Objective information
      1. Observation
        1. Postural Assessment
          1. Slight knee hyperextension
          2. Bilateral anterior pelvic tilt
          3. Lumbar lordotic curve increased
          4. Compensatory hyperkyphosis and head forwarded posture
          5. bilateral pes planus
    • Treatment Plan
      1. For shortend and tight muscles : Erector Spinae, QL, Iliopsoas, recturs femoris, TFL, Adductors
        1. Heat hydrotherapy
        2. Deep techniques
          1. Deep fascial work ( to reduce fascial restrictions)
          2. Deep petrissage
          3. Trigger points release
        3. Passive stretch
        4. PNF
      2. For loosen and weak muscles : Abdominals, Gluteus maximus, hamstrings
        1. Cold hydrotherapy
        2. Stimulating massage techniques
          1. Tapotement
        3. Strength exercise
      3. Joint mobilization for the hypomobile joints
      4. Home care
        1. Avoid maintaining one position for prolonged periods
        2. Chair and seats should have adaquate lumbar support
        3. When sitting, client’s femurs should be horizontal to the ground to maintains normarl lordosis.
        4. client make an effort to maintain an increased posterior pelvic tilt
        5. Avoid sleeping with the hips in flexion
        6. Self stretch shortened muscles
        7. Strengthen weak muslces
          • Long sit exercise to strengthen the rectus abdomins

  • Practice for the OSCE
    1. Trigger point release : QL, erctor spinae, rectus femoris, TFL, adductor longus, adductor magnus
    2. fascial work : IT band, lower back area
    3. Passive stretch : QL, erector spinae, iliopsoas, rectus femoris, TFL, adductors
    4. Pincement and hacking : gluteus maximus, hamstings

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