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[Purpose] To demonstrate the reduction of lumbar hyperlordosis, sacral base angle and anterior thoracic translation posture in an 11-year-old female. [Participant and Methods] A pediatric patient presented with lumbar hyperlordosis and underwent Chiropractic BioPhysics® treatment protocols to reduce her spinal deformity and correlated symptoms. Symptoms included thoracolumbar, hip, knee and ankle pains and lower extremity weakness. Radiographs confirmed lumbar hyperlordosis, increased sacral base angle and a forward translated thoracic posture. Spinal traction as well as corrective exercises and spinal manipulative therapy was performed over an 11-month period. [Results] After 57 treatments, there was a 13.4° reduction in L1-L5 lordosis, an 11.8° reduction in sacral base angle and a 13.8 mm reduction in anterior thoracic translation. The improved structural changes correlated with improved symptoms. [Conclusion] Lumbar hyperlordosis can be reduced in pediatric patients presenting with hyperlordosis and associated symptomatology. Routine radiography may be warranted in the diagnosis of lumbar spine deformities in pediatrics. Further research into the non-surgical reduction of lumbar spine hyperlordosis is needed.

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Background and objectives One of the most frequent conditions for which people seek physiotherapy treatment is low back pain (LBP). When the aetiology of low back pain is whittled down to mechanical factors, pelvic tilting becomes apparent. The iliopsoas muscle is the key to relieving LBP in such circumstances, and since it is tightened, we concentrated on stretching it adequately in this study. Proprioceptive neuromuscular facilitation (PNF) and muscle energy technique (MET) are two stretching techniques that we have compared for this purpose. There are many other stretching techniques available, but the evidence has proven these two to be the most effective. Methods The participants in the study were those between the ages of 18 and 60 who had exaggerated lumbar lordosis, or LBP, and met the inclusion criteria. There were two groups created: A and B. PNF and traditional physiotherapy was used to manage the participants in group A, and MET and traditional physiotherapy were used to manage the participants in group B. Each group underwent the same pre-and post-tests, which included the Numerical Pain Rating Scale (NPRS) to assess pain intensity; a universal goniometer to measure hip joint extension range of motion (ROM) to assess iliopsoas flexibility; and a side-lying X-ray to measure the lumbosacral angle (LSA) to determine the angle of lumbar lordosis. Result In both the stretching interventions, i.e., PNF and MET, there were statistically significant differences in pain, hip extension range of motion, and lumbar lordosis angle (P > 0.0001). However, for the PNF group, the difference between the pre-and post-test was greater than that for the MET group. Conclusion The current study, which included 100 participants, demonstrated that both PNF and MET are remarkably effective for loosening the tight iliopsoas. A comparison of both techniques showed that the PNF group had benefited significantly more than the MET group.

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BACKGROUND AND IMPORTANCE: Lumbar hyperlordosis in ambulatory children is an uncommon but potentially problematic spinal deformity, and the operative management has not been comprehensively described. CLINICAL PRESENTATION: We report the case of a 14-yr-old girl presenting with severe progressive lumbar hyperlordosis (-122°) and sagittal imbalance (-6 cm). She had multiple prior surgeries, including myelomeningocele repair at 10 d old, midlumbar meningioma resection at 8 mo old, and posterior lumbar instrumented spinal fusion at 5 yr old. She presented with progressive lumbosacral back pain and intermittent numbness in her left lower extremity, and severe skin contractures over her prior posterior incisions. From an all posterior approach, prior implants and dural scar were removed and then an L5 vertebral column resection (VCR) was performed to disarticulate her lumbar spine from her anteverted pelvis, allowing for slow distraction forces to correct her lumbar hyperlordosis. This was followed by a T7-sacrum fusion using pedicle screws and iliac screws, with autologous bone graft and plastic surgery wound closure. Postoperatively, lumbar lordosis was corrected to -55° and sagittal balance reduced to -0.5 cm. At 10-wk and 14-mo follow-ups, the patient reported resolution of her back pain with no limitations in physical activities. Dramatic improvement was seen in both her preoperative to 14-mo postoperative Oswestry Disability Index (ODI) (54 to 12) and Scoliosis Research Society Scoliosis Research Society (SRS)-22r (54 to 93) scores. CONCLUSION: This case highlights a rare presentation of severe progressive lumbar hyperlordosis in an ambulatory adolescent after myelomeningocele repair, meningioma resection, and posterior lumbar instrumented spinal fusion with subsequent surgical treatment incorporating important components of both spinal and plastic surgery involvement.

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[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.

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An 11-year-old girl with early-onset facioscapulohumeral muscular dystrophy (FSHD) presented with progressive gait disturbance and lumbar hyperlordosis. The motor power of her pelvic extensor muscles was grade 3. Pelvic tilt and hip flexion were markedly increased as determined by gait analysis. This FSHD case is an impressive example of a patient demonstrating the concept that weak pelvic extensor muscles cannot keep the spine upright and balanced. The most important factor in the development of hyperlordosis is the weakness of the pelvic extensor muscles, and the results of gait analysis exquisitely explain the pathophysiology. The patient stands with her spine hyperextended to maintain upright posture by a compensatory mechanism of relatively strong back extensor muscles. Corrective surgery for lumbar hyperlordosis was not considered as it could eliminate the compensatory lumbar hyperextension, thus making the spine of the patient stoop forward through the hip joint during walking, being caused by the weakness of her pelvic extensor muscles.

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