The hollow back is classified according to cause and severity:

1. Functional hyperlordosis:
   • Temporary poor posture caused by muscular imbalances or misalignments.
2. Structural hyperlordosis:
   • Permanent misalignment, often caused by changes in the vertebrae or intervertebral discs.
3. Compensatory hyperlordosis:
   • Adjustment of the spine to compensate for other misalignments, e.g., in cases of leg length discrepancies.

The causes of a hollow back are diverse and include:

• Lack of exercise and poor posture:
  • Prolonged sitting in non-ergonomic positions or standing activities without compensatory movement can negatively affect posture.
• Muscular imbalances:
  • An imbalance between weakened abdominal muscles and shortened hip flexor muscles leads to poor posture.
• Overweight:
  • A large abdominal circumference increases pressure on the lumbar spine and promotes a hollow back.
• Pregnancy:
  • The shift in the body's center of gravity due to the growing child often leads to temporary hyperlordosis.
• Spinal diseases:
  • Congenital or acquired changes such as scoliosis or Scheuermann's disease can cause a hollow back.
• Psychological factors:
  • Stress and psychological burdens can affect body posture and exacerbate a hollow back.

The symptoms vary depending on the severity and duration of the poor posture:

• Back pain:
  • Pain often occurs in the lower back, especially after prolonged standing or sitting.
• Movement restrictions:
  • The mobility of the spine is often restricted, especially in forward or backward movements.
• Posture problems:
  • Visible poor posture with a protruding abdomen and a backward-leaning upper body.
• Muscular tension:
  • Chronic tension in the back muscles can cause additional discomfort.
• Stress pain:
  • Pain during physical activity or stress due to increased strain on the lumbar spine.

The diagnosis of a hollow back is made through a combination of medical history, physical examination, and imaging techniques:

- Medical history:

- The doctor inquires about the duration of symptoms, possible triggers, and previous treatments.

- Clinical examination:

- Visual inspection of posture and tests for spinal mobility and muscle strength.

- Imaging techniques:

- X-ray: Visualization of the curvature of the spine and possible structural changes.

- MRI: Examination of discs and soft tissues to assess damage or inflammation.

Conservative Therapy

In most cases, a hollow back can be treated without surgery:

• Physiotherapy:
  • Targeted exercises to strengthen the abdominal and back muscles and to stretch shortened muscles.
• Ergonomic Adjustments:
  • Optimization of sitting and standing posture, e.g., through height-adjustable workstations.
• Weight Reduction:
  • Reduction of abdominal circumference to relieve the lumbar spine.
• Manual Therapy:
  • Treatment by physiotherapists to correct misalignments and relieve tension.
• Pain Therapy:
  • Use of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.

Surgical Therapy

In severe cases or with structural changes in the spine, surgery may be necessary:

• Spinal Stabilization:
  • Surgical correction of the curvature and stabilization of the affected areas.
• Disc Surgery:
  • Treatment of herniated discs or other degenerative changes causing the hollow back.

To prevent a hollow back, the following measures are recommended:

1. Regular exercise: Promoting back health through sports such as swimming or yoga.
2. Back school: Exercises to improve posture and stabilize the spine.
3. Ergonomic workplace design: Use of height-adjustable desks and chairs.
4. Strengthening exercises: Strengthening the abdominal and back muscles to support the spine.
5. Correct posture: Avoiding poor posture during everyday activities such as sitting, standing, or lifting.