Lordosis

Quick answer: Lordosis is the natural inward curve of the spine in the neck and lower back. When people say someone “has lordosis,” they usually mean that curve has become excessive, which is more precisely called hyperlordosis.

Also called: lordotic curve; used loosely for hyperlordosis.

Is lordosis normal?

Yes. A healthy spine has two inward curves, in the neck (cervical lordosis) and lower back (lumbar lordosis), and one outward curve in the upper back (kyphosis). Together they help absorb load. The question isn’t whether you have lordosis, but whether the curve is balanced.

What’s the difference between lordosis, hyperlordosis and hypolordosis?

• Lordosis: the normal inward curve.
• Hyperlordosis: too much curve, often seen as an exaggerated arch in the lower back.
• Hypolordosis: too little curve, as in flat back or, in the neck, military neck.

Is lordosis the same as sway back?

No. Sway back describes where the hips sit relative to the trunk. It can come with an exaggerated lower-back curve, but the two terms aren’t interchangeable.

How much lordosis is normal?

A very wide span, which is the single most useful thing to know. A review of 26 normative studies reported average lumbar lordosis of about 44 degrees measured L1 to L5 and 58 degrees measured L1 to S1 — and ranges described as normal across the literature running from roughly 31 to 88 degrees. The reviewers found “no concordance” between radiography and photogrammetry.

So a single number cannot tell you much, and neither can a photograph. Lumbar lordosis has the measurements in full.

Is lordosis the opposite of kyphosis?

Yes, in direction — and a healthy spine needs both. Lordosis curves inward, kyphosis curves outward, and they alternate down the spine so your head stays balanced over your hips. Your neck and lower back are lordotic; your upper back and sacrum are kyphotic.

That alternation is why the regions are worth assessing together rather than separately: an exaggerated curve in one often arrives with a compensating change in another. The kyphosis page carries a full side-by-side comparison of the two, including what each looks like when excessive and when flattened.

One trap worth knowing: the same word means opposite things depending on the region. “Thoracic kyphosis” on a report usually just describes normal anatomy, while “cervical kyphosis” means the neck has lost or reversed the curve it should have.

Does having more lordosis mean you will get back pain?

The evidence points the other way, which surprises most people. A systematic review and meta-analysis in The Spine Journal pooled 13 studies, 796 people with low back pain against 927 controls, and found the back-pain group had smaller lumbar curves on average, not larger (SMD −0.33 in age-matched studies).

The effect is small, and the studies are cross-sectional, so they cannot show which came first — a painful back is often held flatter. But it does mean the familiar advice to flatten an “excessive” curve runs against the best available comparison. Worth knowing before you set out to change yours.

Which lordosis page do you need?

“Lordosis” gets used for the normal curve and for several different problems. The useful page depends on your question:

• What the normal curve is and how it is measured → lumbar lordosis
• An exaggerated lower-back arch → hyperlordosis
• A flattened lower back → flat back
• Hips pushed forward of the trunk → sway back
• The pelvis tipping forward underneath it → anterior pelvic tilt
• The pelvis tipping backward → posterior pelvic tilt
• The neck having lost its curve → cervical kyphosis or military neck

What Does Change, and by How Much

Those findings are all about the shape of a curve. The more useful question is what changes when someone actually does something, and there the evidence is both larger and more encouraging.

The evidence base for exercise and movement in persistent low back pain is far larger than the evidence base for any postural measurement, and it is worth putting the two side by side. A Cochrane review pooled 249 trials and 24,486 participants. Against no treatment, usual care or placebo, exercise reduced pain by 15.2 points on a 100-point scale (95% CI −18.3 to −12.2), with moderate-certainty evidence, and that difference is large enough to matter to the person feeling it.

What was measured	Change with exercise	Evidence behind it
Pain (0–100 scale)	−15.2 points, clinically important	249 trials, 24,486 participants
Day-to-day function	6.8 points, a real improvement	Same review
The lumbar curve angle	Not the number that tracks progress (no significant change, p = 0.401), which is why progress is measured in pain and function	4 trials

Read that table as an instruction about what to measure. The angle is the outcome that does not reliably move. Pain is the outcome that does. A program judged on a photograph is being judged on the one thing least likely to change; a program judged on what hurts and what you can do is being judged on what the research says actually shifts.

Two honest qualifications, because the headline figure is specifically about exercise versus doing nothing. Compared with other active treatments the differences were smaller and did not reach the clinically important threshold, and exercise showed no advantage over manual therapy. It did beat education alone and electrotherapy. So the strong claim is that moving deliberately beats not moving — which is the comparison most people are actually choosing between.

On what kind of movement, a network meta-analysis of 217 trials and 20,969 participants found Pilates, McKenzie-style work and functional restoration produced the largest improvements, with Pilates reducing pain by 18.7 points (95% CI −24.4 to −13.1) against minimal treatment. But the authors’ closing advice is the part worth taking to heart: people with chronic low back pain “should be encouraged to perform the exercise that they enjoy to promote adherence.”

Which is why the useful targets are not shapes. What responds to this kind of work, and what is worth assessing and re-assessing, is: how much range of motion you have and whether it is comfortable through the whole of it; how much strength you have and where it runs out; how well the right muscles coordinate and fire when you load a position; how readily you learn a new movement pattern and hold onto it; and how much you can do before something complains. Those change, they are measurable, and they are what a person actually notices.

Sources

• Porto AB, Okazaki VHA. Thoracic Kyphosis and Lumbar Lordosis Assessment by Radiography and Photogrammetry: A Review of Normative Values and Reliability. Journal of Manipulative and Physiological Therapeutics, 2018.
• Chun SW, et al. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. The Spine Journal, 2017.

Related terms

• Lumbar lordosis
• Hyperlordosis
• Kyphosis
• Sway back
• Flat back
• Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021. 249 trials, 24,486 participants.
• Hayden JA, Ellis J, Ogilvie R, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. Journal of Physiotherapy 2021;67(4):252–262. 217 trials, 20,969 participants.

Learn more and take the next step

If your lower back arches more than you’d like, our hyperlordosis guide covers causes, self-checks and exercises.

If you’d like someone to look at what’s driving your posture, a free 30-minute consultation starts with a postural assessment, in one of our clinics or through virtual posture therapy.

This entry is general education, not medical advice. If you have pain, numbness, weakness, or a change in your posture that appeared quickly, see a physician first.