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Introduction

Sciatica refers to pain and numbness that radiates from the lower back through the buttocks and down the leg, caused by compression or tension on the sciatic nerve.

In recent years, a condition known as flat back—the loss of the spine’s natural S-curve—has been increasingly recognized as a contributing factor.

This change in posture can alter tension on the spinal dura mater and nerve roots, potentially worsening sciatic symptoms.

In this article, we’ll define what flat back is, explore the common causes, and present evidence-informed strategies to address it—especially focusing on dural tension mechanisms reported in medical literature such as PubMed.

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1. What is Flat Back?

Flat back refers to a loss of lumbar lordosis, the natural inward curve of the lower spine, typically between 30–50°.

When this curve disappears, it creates increased tension in the dural sac at the lumbar level, pulling it backward, while the thoracic region may experience relative shortening and slack.

This uneven dural tension can place excessive traction on the nerve roots, contributing to sciatic pain.

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2. What Causes Flat Back?

Flat back posture can result from various structural, functional, and lifestyle-related factors:

▷ Muscle weakness and poor posture

Weakness in deep core stabilizers like the transverse abdominis and multifidus can lead to posterior pelvic tilt, reducing the ability to maintain lumbar curvature.

▷ Sedentary lifestyle and prolonged sitting

Long hours in a seated position cause habitual posterior pelvic tilt, reducing flexibility of spinal joints and ligaments.

▷ Developmental or genetic predisposition

Some individuals naturally have a low pelvic incidence (PI) or structural spinal variations that make it harder to maintain lordosis.

▷ Trauma or postoperative changes

Flat back can occur after spinal surgeries such as lumbar fusion, which may restrict the spine’s natural curves.

These factors may act independently or in combination, leading to the collapse of the spine’s normal S-shaped alignment.

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3. How to Improve Flat Back Posture

Addressing flat back requires both structural mobilization and functional retraining. Here are key strategies:

✅ Dural-tension-conscious mobilization

• Gentle mobilization of each lumbar segment to restore lordosis while minimizing strain on the dura mater.
• Thoracic-level breathing-assisted mobilization helps regain slack in shortened areas, restoring balanced tension.

✅ Deep core strengthening

• Exercises like planks and draw-in maneuvers improve coordination of the deep stabilizers, supporting lumbar curvature dynamically.

✅ Stretching with breath coordination

• Diaphragmatic and thoracic expansion stretches help release tension in the thoracic spine and reduce compensatory stress on the lower back.

✅ Postural retraining and daily habits

• Re-educate the body to maintain neutral pelvic alignment in standing and sitting.
• Use footwear or insoles to subtly encourage anterior pelvic tilt while walking, promoting a functional S-curve.

✅ Supportive equipment

• When appropriate, a lumbar-supporting brace can reduce muscle fatigue and assist in regaining range of motion.

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In Conclusion

Excess tension on the dura mater and nerve roots caused by flat back posture can significantly worsen sciatica.

However, even in cases with congenital or structural predispositions, targeted movement therapy and posture re-education can help recover a functional spinal curve and reduce neural stress.

At Kyoto Osteopathy Center, we combine anatomical assessments with manual therapy and exercise-based interventions to help restore optimal dural tension and relieve sciatic pain at its source.

If you’re struggling with posture issues or persistent sciatica, we invite you to reach out and experience a tailored approach to healing.

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#Kyoto #KyotoOsteopathyCenter #Osteopathy #Chiropractic

#Pain #Numbness #Paralysis #Posture #Walking #DuralTension #SpinalCurve

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Sota Omura,
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