Managing Lumbar Lordosis/Retrolisthesis With Seated Postural Support

Almost certainly the most common complaint presenting within chiropractic offices is lower back pain often associated with radiating leg pain. Commonly associated structural imbalances include Lumbar hypolordosis and/or L5-S1 retrolisthesis. I recently reviewed a new paper which looked at the effects of “slump sitting” postures on both lower lumbar retrolisthesis and loss of the lumbar lordosis and I wanted to take this opportunity to share some thoughts on low tech management of seated postures to help reduce posterior translations of the lower segments and support a more healthy lordotic curve.

First, the findings of the paper (1). The authors sought to better understand lower lumbar hypolordosis and retrolisthesis by comparing standing radiographs with those taken in “slump sitting” postures. When compared to standing postures, slumped sitting postures were associated with flattening of the sacral slope (reduced Ferguson’s Angle), loss of L5-S1 lordosis, lower lumbar retrolisthesis and loss of disc height. The authors concluded the associated postural imbalances were the “likely result from long-standing lower lumbar spine bending forces against the posterior ligamentous complex which occur during slump sitting postures predisposed by a negatively sloped sacrum and increased lumbar flexibility.” (emphasis ours)

Practitioners with a genuine interest in actually changing this patient’s spinal mechanics will quickly run up against the limits of our rapid loading adjustments to make meaningful corrections when the patient sits in poor posture for hours every day. On my experience, habitual postures like this can be really tough to break unless the patient can be supported into a healthier position. In these “slumped” cases we are hoping to accomplish several things at once: 1) increase the sacral base angle, 2) Increase the lumbar lordosis, and 3) reduce postural loading forces against the posterior ligamentous complex to (hopefully) minimize retrolisthesis of the lower lumbar segments.

**Forward Tilting Seat Wedge** https://www.matlinmfg.com/products-overview/seatwedge

One easy, low tech approach is to simply place the patient on a forward tilting seat wedge when in a seated position for any extended time. The picture here demonstrates how the wedge increases the sacral base angle to help reduce posterior slippage of the lower segments and reinforces the lumbar lordosis. Encourage patients to use for short periods of time until they build up enough strength to spend most of their day working hours sitting upright on the wedge. Now their seated posture becomes a force for correction instead of creating long term imbalance.

This is just one suggestion for a simple method of providing postural support. Other possible approaches might include lumbar extension traction, extension exercise and/or spinal remodeling.

Hope you find this helpful. Feel free to contact me if I can be of help.

Best regards,

Mark R. Payne DC

Reference: 1. Hwee Weng Dennis Hey, Justin Chia Loong Lim, Gin Way Law , Gabriel Ka-Po Liu , Hee-Kit Wong. Understanding the Pathophysiology of L5-S1 Loss of Lordosis and Retrolisthesis: An EOS Study of Lumbopelvic Movement Between Standing and Slump Sitting Postures. World Neurosurg. 2021 Nov 14;S1878-8750(21)01735-6. doi: 10.1016/j.wneu.2021.11.034. Online ahead of print.

Link To Abstract: https://pubmed.ncbi.nlm.nih.gov/34785359/

Postural Rehab- Managing Lumbar Lordosis/Retrolisthesis