Hyperlordosis lumbar is an increase in the lumbosacral angle (angle formed from the first

sacral bone with a normal horizontal line of 300) Where this increase in lumbar lordosis will
increase the anterior pelvis tilt and hip flexion. This increase in the lumbar curve will cause parts
the back of the lumbar functional unit will approach each other. The facet joint will be the
foundation of all body weight, even though this facet joint does not function as a weight gain.
Likewise, the inter vertebral foramen and nerves coming out of the intervertebral foramen, the
pedicles, muscles and ligaments behind the body, will be depressed. (2007, Carolyn kisner dan
Lynn Allen Colby),
increased lumbar lordosis can be caused due to excessive body weight and vertebral bone
deformity such as compensation for thoracic hyperliposis, hip flexor contractures, congenital
problems such as congenital hip dislocation (Congenital Hip Dislocation), non-formation of
segments in facet joints, and consequent modes of use high heels. Hyperlordosis can also be caused
by shortening of the muscullus iliopsoas which pulls the lumbar curve forward when standing or
walking.
Managament physicaltheraphy of low back pain e.c hyperlordosis lumbal
1. TENS
TENS is a method of electrical stimulation which primarily aims to provide
a degree of symptomatic pain relief by exciting sensory nerves and thereby
stimulating either the pain gate mechanism and/or the opioid system.
Indication of TENS is arthritis, pelvic pain caused by endometriosis, knee
pain, sports injuries, post-traumatic and post-surgical pain (acute and chronic),
phantom pain, causalgia (nerve pain), low back pain, neck pain and Post-herpetic
pain.
Contra-indications of TENS is skin irritation, unpleasant sensation,
influence on the cardiac pacemaker, stimulation of sensitive carotid sinus nerves,
altered sensation, spasm of laryngeal and pharyngeal muscles, removal of
protective influence of pain, neurotic addiction to stimulation, destruction of
operators of dangerous machines and pregnancy.
2. William Flexion Exercise
Williams flexion exercises — also called Williams lumbar flexion
exercises, are a set or system of related physical exercises intended to enhance
lumbar flexion, avoid lumbar extension, and strengthen the abdominal and gluteal
musculature in an effort to manage low back pain non-surgically. The system was
first devised in 1937 by Dr. Paul C. Williams (1900-1978), then a Dallas orthopedic
surgeon.
Indication of williams flexion exercises is spondylosis, spondyloarthrosis,
and facet joint dysfunction that causes lower back pain. And contra-indications of
williams flexion exercises is discus disorders such as discs bulging, disc herniation,
or disc protrusion.
Williams advocated seven exercises to minimize the lumbar curve.
1) Pelvic tilt exercises :
Lie on your back with knees bent, feet flat on floor. Flatten
the small of your back against the floor, without pushing down with
the legs. Hold for 5 to 10 seconds.
2) Partial sit-ups :
The athlete lies in "hooklying" position (supine with knes
bent and feet flat). With hands behind his or her head, the athlete
elevates the upper torso until the scapulae clear the resting surface
and stress is placed on the rectus abdominus. After returning to the
start position, the sit-up is repeated for a prescribed number of
repitions.
3) Knee to chest :
Single Knee to chest. Lie on your back with knees bent and
feet flat on the floor. Slowly pull your right knee toward your
shoulder and hold 5 to 10 seconds. Lower the knee and repeat with
the other knee.
 Double knee to chest. Begin as in the previous exercise.
After pulling right knee to chest, pull left knee to chest and hold both
knees for 5 to 10 seconds. Slowly lower one leg at a time.
4) Hamstring stretch :
Lying supine, the athlete places both hands around the back
of one knee. The athlete straightens his or her knee and pulls the
thigh toward his or her head so the hip goes into flexion. Williams
believed that flexible hamstrings are necessary to accomplish full
flexion of the lumbar spine. Although tight hamstrings limit lumbar
flexion in standing with knee straight, we now know that tight
hamstrings actually tilt the pelvis posteriorly and promote trunk
flexion.
5) Standing lunges :
This exercise actually results in some extension of the
lumbar spine when performed properly. Nonetheless, it is a good
stretching exercise for the entire lower extremity, especially the
iliopsoas, which may be a perpetrator of low back pain if it is
abnormally tight or in spasm.
The athlete begins the forward lunge in a standing position
with the feet shoulder width apart. He or she then takes a big step
forward with the right leg and plants the foot out front, keeping the
body relatively straight. The knee should stay over your ankle and
not extend out over the toes to minimize stress on the knee joint.
6) Seated trunk flexion :
This exercise is performed by sitting in a chair and flexing
forward in a slumped position. Maximum trunk flexion is obtained
and direct stretching of the lumbosacral soft tissue structures occurs.
7) Full squat :
William's squat position is with the feet placed shoulder
width apart, the hip and knees are flexed to the maximum available
range of motion, and the lumbar spine is rounded into flexion. Upon
reaching maximum depth, the athlete "bounces the buttocks up and
down" 15 to 20 times, with 2 to 3 inches of excursion on each
bounce, then repeats 3 to 4 times.
3. Stretching
Stretching is a form of physical exercise in which a specific muscle or
tendon (or muscle group) is deliberately flexed or stretched in order to improve the
muscle's felt elasticity and achieve comfortable muscle tone.
Indications for use of Stretching :
1) ROM is limited because soft tissues have lost their extensibility as
the result of adhesions, contractures, and scar tissue formation,
causing functional limitations or disabilities.
 2) Restricted motion may lead to structural deformities that are
otherwise preventable.
3) There is muscle weakness and shortening of opposing tissue. • May
be used as part of a total fitness program designed to prevent
musculoskeletal injuries.
4) May be used prior to and after vigorous exercise potentially to
minimize post exercise muscle soreness.
Contraindications to Stretching :
1) A bony block limits joint motion.
2) There was a recent fracture, and bony union is incomplete.
3) There is evidence of an acute inflammatory or infectious process
(heat and swelling) or soft tissue healing could be disrupted in the
tight tissues and surrounding region.
4) There is sharp, acute pain with joint movement or muscle
elongation.
5) A hematoma or other indication of tissue trauma is observed.
6) Hypermobility already exists.
7) Shortened soft tissues provide necessary joint stability in lieu of
normal structural stability or neuromuscular control.
8) Shortened soft tissues enable a patient with paralysis or severe
muscle weakness to perform specific functional skills otherwise not
possible.
4. Range of Motion
Range of Motion is a basic technique used for examination of movement
and for initiating movement into a program of therapeutic intervention. Movement
that is necessary to accomplish functional activities can be viewed as muscles or
external forces moving bones in various patterns or ranges of motions. Bones move
at the connecting joints. The structure of the joints, as well the integrity and
flexibility of the soft tissues that pass over the joints affects the amount of motion
that can occur between any two bones. The full motion possible is called the Range
of Motion (ROM). When moving a segment through its ROM, all structures in the
region are affected: muscle, joint surfaces, capsules, ligaments, fasciae, vessels and
nerves. Therapeutically, ROM activities are administered to maintain joint and soft
tissue mobility, in order to minimize loss tissue flexibility and contracture
formation. ROM exercises do not encompass stretching techniques that intended to
increase range.
Types of Range of Motion (ROM) Exercises :
1) Passive ROM (PROM). PROM movement is within the unrestricted
ROM for a segment that is produced entirely by an external force.
There is little or no voluntary muscle contraction. The external force
may be from gravity, a machine, another individual, or another part
of individuals own body.
 2) Active ROM (AROM). AROM is movement within the unrestricted
ROM for a segment that is produce by an active contraction of the
muscles crossing joints.
3) Active-Assistive ROM (A-AROM). A-AROM is a type of AROM
in which assistance is provided by an outside force, either manually
or mechanically, because the prime mover muscles need assistance
to complete the motion.
5. Core Stabilization Exercise
Core stabilization or motor control exercise is a common type of therapeutic
exercises prescribed for LBP patients. Core stabilization exercise is designed to re-
educate the coactivation pattern of abdominals, paraspinals, gluteals, pelvic floor
muscles, and diaphragm (2016, Pourahmadi M, Taghipour M, Ebrahimi TI).