Lordosis Treatment: Physical Therapy, Bracing, and Surgical Options

Lordosis (excessive inward lumbar curvature) treatment depends on severity, age, flexibility, and underlying cause (postural, congenital, neuromuscular, post-surgical, spondylolisthesis).

Conservative Management (First-Line)

• Physical therapy: Core stabilization (transverse abdominis, multifidus), gluteal strengthening, hip flexor/hamstring stretching, postural re-education, lumbar flexion exercises (Williams flexion), breathing retraining.
• Bracing: For adolescents with flexible curves >45° or adults with pain; Boston brace or TLSO. Limited evidence in adults; mainly for pain relief and posture cueing.
• Pain management: NSAIDs, acetaminophen; short-course muscle relaxants; topical agents. Avoid chronic opioids.
• Activity modification: Avoid hyperextension sports (gymnastics, diving) if symptomatic.
• Weight loss: Reduces mechanical load on lumbar spine.

Surgical Indications

Reserved for severe, progressive, or neurologically symptomatic cases failing 6+ months of conservative care:

• Curve >60–70° with pain/disability
• Neurologic deficit (radiculopathy, myelopathy)
• Fixed deformity with sagittal imbalance
• Spondylolisthesis with instability

Surgical Techniques

• Posterior spinal fusion with instrumentation (rods, screws)
• Osteotomies (Smith-Petersen, pedicle subtraction) for rigid deformity
• Anterior lumbar interbody fusion (ALIF) for disc height restoration

Multidisciplinary Follow-Up

Long-term PT, bone health optimization, and monitoring for adjacent segment disease. Patient education on spine-sparing mechanics is crucial.