Spinal Curves & Back Pain (Is There A Relationship?)
The lordotic and kyphotic curvatures of the human spine has been an area of debate for decades. The ideal global and segmental degree of curvature at the spine is a primary focus in many therapeutic and movement modalities, especially the modalities that focus on posture.
Allot of what we consider to be ‘good posture’ originated from the work of Christian Wilhelm Braune (1831-1892), a german anatomist. Braune would hang frozen cadavers in the ‘normalstellung’ position where he would cut the bodies in 3 planes (frontal, sagittal and transverse). The intention of Braune’s work was to find the body’s centre of gravity. It's important to acknowledge that this was intended to be merely a reference point and not necessarily an ideal body position - ‘good posture’ (1).
Non ideal ‘alignment’ of the spinal vertebrae has been theorised to produce excessive stress on the passive and active structures of the spine, increasing the risk of injury and pain. Health practioners that take a structural approach to the body theorise or ‘know’ that certain muscles become ‘over-active’ while others become ‘under-active’ due to the non ideal alignment and ‘mechanics’ of the spine, resulting in muscle atrophy, tension and ‘dysfunction’. In theory this ‘makes sense’ and many bodywork practitioners base their practice off the concept of an ‘optimal body alignment’. As always it’s prudent to look at the research and make an informed decision in our approach to working with individuals who want to move better or get out of pain.
Neck Curvature
One study looked into the association between cervical spine curvature and neck pain (2). 107 subjects over the age of 45 years, 54 with neck pain and 53 without neck pain had their cervical spine measured from C2-C7 (segmental measurements and global measurements).
No significant differences between the two groups could be found in relation to global curvature, segmental angles or the incidence of straight spine or kyphotic deformity. What this means is that there weren’t any significant correlations amongst the pain group that differed from the pain free group.
Lower Back Curvature
A systematic and meta-analysis looked at the lumbo-pelvic kinematics in individuals with and without back pain (3). 43 studies were reviewed. None of the studies found a correlation between the angle of lordosis in the lumbar spine with those in back pain. There was also no difference in the angle of pelvic tilt. The characteristics they did find that correlated amongst those with lower back pain were:
Reduced lumbar range of motion (ROM).
Slower lumbar movement.
Reduced proprioception position-reposition accuracy.
It’s important to acknowledge these findings as correlations and not necessarily causations. Still, it is interesting that even in 43 studies the curvature of the lumbar spine didn’t present as consistent factor amongst back pain individuals.
Spinal Curvature
Another systematic critical review looked at 54 studies measuring the sagittal spinal curves and any health outcomes including back pain (4). They concluded…
‘Evidence from epidemiological studies does not support an association between sagittal spine curves and health including spinal pain. Further research or better methodological quality may affect this conclusion, and casual effects cannot be determined in a systematic review.’
The review did find some studies that showed ‘moderate’ evidence for association between sagittal curves and a few health outcomes such as temporomandibular disorder (jaw dysfunction), daily function and pelvic organ prolapse.
Although sagittal spinal curves may not be highly associated with back pain, other health outcomes may be an associated and worth considering. Daily function seemed to be impaired so potentially considering the spine curves for daily requirements such better motility may be prudent. Considering the health of the pelvic organs and jaw (temporomandibular joint) with the curvature of the spine may be worth noting too. It’s important to acknowledge that these still may just be correlations and not necessarily causations.
So what about back pain?
To conclude, it seems that sagittal spinal curvatures aren’t strongly associated with back pain and there are other factors such as the movement and proprioception of the lumbar spine (and the spine in general) that might be worth considering first before working on an individual’s posture. We shouldn’t rule the sagittal curves out as a potential contributor to pain as this may influence an individuals ability to move their spine. If a spinal curve (the cervical lordosis for example) is excessive and habitual, this may increase the sensitivity of the surrounding nerves over time which can contribute to pain symptoms. As always we shouldn’t make black and white statements as there are always exceptions to every rule and all individuals present differently.
Do you want to become a better movement practitioner and deepen your knowledge about the fascia of the lower back to help your clients move with more freedom and less discomfort?
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Tom
References
Routledge Handbook of Sports Therapy, Injury Assessment and Rehabilitation by Keith Ward 2015.
The association between cervical spine curvature and neck pain. D. Grob, H. Frauenfelder. A. F Mannion. 2006.
Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. Robert A Laird. Joyce Gilbert. Peter Kent. Jennifer L Keating. 2014.
Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spine curves and health. Sanne Toftgaard Christensen. Jan Hartvigsen. 2008.