Lordosis: What Is an Excess Lower-Back Curve and How Do You Know You Have One?
Lordosis is the natural inward curve of your lower back. When that curve becomes exaggerated, often called hyperlordosis, your pelvis tips forward and your lower back bears extra load. Standing whole-body imaging can measure the curve under real weight-bearing conditions, revealing alignment problems that lying-down scans can miss.
Key takeaways
- Some lordosis is normal. It only becomes a problem when the curve is excessive and causes pain or stiffness.
- Hyperlordosis often starts with a pelvic tilt, tight hip flexors or weak core muscles.
- Lying-down imaging relaxes the spine and can hide the true size of the curve.
- A standing EOS scan captures your full alignment from head to feet under gravity.
- ScanAlign provides the imaging. Treatment decisions are made with your clinician.
Your lower back is supposed to curve inward a little. That curve helps absorb shock when you walk and keeps your weight balanced over your hips. The trouble starts when that curve deepens beyond what is healthy. Your belly pushes forward, your buttocks stick out, and your lower back muscles tighten to compensate. Over time this can lead to persistent pain, stiffness and problems elsewhere in the body.
What are the symptoms of lordosis?
The most common symptom of excessive lordosis is a tight, aching lower back that worsens after standing or walking for a long time. But the effects often spread well beyond the lower back itself.
A deep ache across the base of the spine, worse after prolonged standing or walking.
Your belly appears to push forward and your buttocks stick out noticeably behind you.
Difficulty bending forward or straightening up fully, especially first thing in the morning.
Hip pain, knee discomfort or upper-back tension that seems unrelated but stems from the same misalignment.
Because the body is a connected chain from feet to head, an exaggerated lower-back curve can force your mid-back, hips and knees to compensate. That is why pain often shows up away from the actual problem.
When to seek urgent help. If you notice numbness or weakness in your legs, or any loss of bladder or bowel control, contact your GP, call 111 or go to A&E straight away. These are signs that need immediate medical attention, not a routine scan.
What causes lordosis to become excessive?
Hyperlordosis develops when the muscles and structures around the pelvis and lower spine fall out of balance. Several factors can tip that balance.
Hours in a chair shorten the hip flexors and weaken the glutes, pulling the pelvis forward.
When the abdominal wall cannot support the spine, the lower back over-arches to compensate.
Carrying extra weight around the abdomen shifts your centre of gravity and increases the curve.
Spondylolisthesis (a vertebra slipping forward), disc problems or previous spinal surgery can alter the curve.
Lordosis is not the same as kyphosis. Kyphosis is an excessive outward rounding of the upper back. The two conditions can exist together, with the lower back over-arching to counterbalance a rounded upper back.
Why does lordosis need to be assessed standing up?
Your spinal curves change shape depending on whether you are standing or lying down. When you lie on a scanner bed for a standard X-ray, CT or MRI, gravity is removed, your muscles relax, and the curve can flatten or shift. The image may look normal even when your lordosis is excessive under everyday conditions.
An EOS scan takes a full-length image of your skeleton while you stand naturally, bearing your own weight. It captures your spine, pelvis, hips and legs in one single exposure, using about 90% less radiation than a standard X-ray, around ten times less. This means your clinician can see exactly how your lower-back curve behaves in real life, and how it relates to the position of your pelvis, hips and legs.
Want to understand your lower-back curve in full standing alignment? A free video consultation can tell you whether an EOS scan is the right next step.
Book a free video consultationWhen MRI is the better choice. EOS shows bones, joints and alignment clearly. If your clinician suspects disc problems, nerve compression or other soft-tissue issues, MRI is usually the better tool. The two scans complement each other well.
How is lordosis managed?
Management depends on what is causing the excessive curve and how much it affects your daily life. The first step is always an accurate assessment so that any treatment plan is based on real findings, not guesswork.
Common approaches include physiotherapy to strengthen weak muscles and stretch tight ones, postural re-education, and in some cases orthotics or manual therapy. If a structural problem such as spondylolisthesis is involved, a surgeon may need to assess you further.
ScanAlign does not provide treatment. It provides the detailed standing imaging that helps your treating clinician understand your alignment from head to feet and plan accordingly. You can bring your scan results to any specialist you choose.
To learn more about how alignment imaging works for the full spine, visit the spine imaging page.
Frequently asked questions about lordosis
Yes. A gentle inward curve in the lower back is completely normal and helps your spine absorb shock. It only becomes a concern when the curve is significantly exaggerated and causes pain or affects how you move.
Lordosis is an inward curve of the lower back. Kyphosis is an outward curve of the upper back. Both are normal in moderation. When either becomes excessive, it can cause pain and postural problems. The two can occur together.
Many cases of hyperlordosis improve with targeted physiotherapy, stretching and postural changes. Whether this is enough depends on the cause. Accurate imaging helps your clinician decide the best approach for your situation.
When you lie flat, gravity no longer acts on your spine and your muscles relax. This can reduce the curve and make it appear less significant than it actually is when you are standing and bearing weight.
An EOS scan is a low-dose, standing X-ray that captures your entire skeleton from head to feet in one image. It uses about 90% less radiation than a standard X-ray, around ten times less. For lordosis, it shows the true curve under weight-bearing conditions and how it relates to your pelvis, hips and legs.
No. ScanAlign is a private, self-pay clinic. You can refer yourself. The process starts with a free video consultation to check whether an EOS scan is the right step for you.
Yes. The EOS system uses about 90% less radiation than a standard X-ray, around ten times less. You can find more detail on safety on the FAQs page.
Pricing details are available on the FAQs and cost page.
Yes. Tight hip flexors pull the front of the pelvis downward, tilting it forward and increasing the lower-back curve. This is one of the most common contributors to hyperlordosis, especially in people who sit for long periods.
You speak briefly with a member of the ScanAlign team about your symptoms and history. They explain whether an EOS scan is appropriate for your situation. There is no obligation and no charge.
Understand your lower-back curve, standing up
A free video consultation is the first step. No referral needed, no obligation.
Book a free video consultationSources
- NHS, "Back pain," nhs.uk, 2023.
- Been, E. and Kalichman, L., "Lumbar lordosis," The Spine Journal, 14(1), 87-97, 2014.
- Illés, T. et al., "The EOS imaging system and its uses in daily orthopaedic practice," International Orthopaedics, 36(7), 1325-1331, 2012.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.