Definition of hollow cross

As a hollow cross a malposition of the lumbar spine is called.

The spine runs naturally in four vaults. It is stabilized primarily by the muscles of the back and abdomen, as well as in the area of ​​the lower spine by the gluteal muscles.

A hollow cross is caused by a muscular imbalance of these different muscle groups. The lumbar spine bulges excessively towards the abdomen and the pelvis tilts forward.

This can lead to lower back pain and serious sequelae, such as a lumbar spine herniation.

Due to sufficient exercise, a healthy posture and the strengthening of special muscle groups, a hollow cross can be well prevented and, if the hollow cross is already formed, well treated.


The cause of the hollow cross may be, among other things, a muscular imbalance.

A hollow cross may be innate or, more commonly, acquired. Most cases are due to a muscular imbalance.
The spinal column is not, as the name suggests, a straight pillar, but runs naturally in four vaults. It is stabilized by the back and abdominal muscles. In the lower back area, the gluteal muscles are also involved in the stabilization of the spine. In general, the execution of movements always requires the cooperation of opposing muscles or muscle groups. Therefore, it is important that these muscles or muscle groups should always be trained similarly well, otherwise an imbalance may arise. For example, a too pronounced hip flexor combined with poorly trained hip extensor muscles can lead to a permanent increase in the protrusion of the lower spine. This can lead to a shortening of ligaments and tendons, which is accompanied by an increasing immobility of the lower back and can eventually lead to the formation of a hollow cross.
Even a generally weak back, abdominal and gluteal muscles influence the formation of a hollow cross negatively. These muscular changes are mainly due to lack of exercise, especially due to long and / or unergonomic sitting, as well as a wrong posture.
Even heavy physical work or carrying heavy loads, obesity and incorrect muscle training can contribute to the formation of a hollow cross.
Stress also seems to favor the development of the hollow cross-promoting muscular changes through an influence on the posture.
Obesity, especially in the abdominal area, also has a strengthening effect, as the abdomen pulls the pelvis further forward.
Other rare causes of a hollow cross may be a malposition of the uppermost vertebral body ( Atlas ) or a Pomarino disease, a gait disorder in which the person is only on the toes or bales occurs.
Vertebral gliding ( spondylolisthesis ) can also be noticed via a hollow cross. It is important to know if one of these rare causes of hollow cross is present, because only then the cause can be treated accordingly.

Therapy of the hollow cross

The therapy of a hollow cross depends on the respective cause.
The most common cause is a muscular imbalance resulting from lack of exercise and improper posture.
At the beginning of the hollow cross, sufficient exercise and correct posture can already lead to sufficient improvement. The right posture is particularly important, here the so-called " dynamic sitting " is recommended. This means that the upper body is held straight and is often changed between a forward leaning, an upright and a reclined sitting position.

This stimulates the blood circulation, reduces muscle fatigue and relieves the intervertebral discs. Special ergonomic seating furniture can also be helpful. In general, care should always be taken to regularly interrupt sitting by standing and walking. Due to the close connection between stress and tight muscles, the learning of relaxation techniques can also contribute to the improvement.

You might also be interested in this topic: Exercise examples for relaxation and relaxation while sitting at a desk

It is important, as soon as the hollow cross is recognized, to counteract this. The faster a therapy, the higher the chances that no symptoms will occur, or the symptoms will improve and there will be no development of secondary diseases. The further therapy of a hollow cross should be done under professional guidance, so as not to aggravate it by the wrong execution of exercises.

In special back-school courses, which are offered for example by physiotherapists, gyms or health insurance companies, the person concerned learns exercises for strengthening and stretching of the muscles. These should also be done regularly at home.
It is important that short frequent, preferably daily, units are better than rare, but long practice sessions, 5-10 minutes per day are already sufficient. This regular training can significantly improve the symptoms and thus lead to an increased quality of life of those affected.
Since the hollow back arises as a result of a muscular imbalance, it is also important to note that the muscles are not biased on one side. This means that even when completing the exercises at home, care should always be taken to train the various muscle groups and not, for example, only the back muscles. Certain sports, such as tennis or squash, exercise the muscles rather one-sided, so that one moves, which is helpful in any case, but recommends an additional compensatory training for the back.

Can you train a hollow cross away?

Basically, a hollow back can be healed by certain exercises or other orthopedic therapies.
The appropriate treatment plan depends on the severity of the hollow cross and the age of the patient and should be prepared in advance by an orthopedist.
In the early stages, it is often sufficient to move more, to consciously pay attention to a healthy posture while sitting, and to stretch the shortened muscles through stretching exercises. For this purpose, other muscle groups, which counteract the hollow cross formation, should be strengthened. These muscles include the lower abdominals, glutes, and hamstrings.
However, appointments to a physiotherapist or a back school should be done to learn how to properly perform stretching exercises, as it can aggravate the discomfort caused by incorrect exercises / incorrect execution of the correct exercises.
In more severe cases (such as the hollow spine as a sign of chronic spondylolisthesis), the original shape of the spinal S-shape can be made by surgery or orthopedic corset.

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Exercises against a hollow cross

Simple, uncomplicated hyperlordosis can be perfectly corrected by exercises and training. It is important to know that you do not practice the hollow back or the spine, but you may always neglected muscles and this posture changes the posture. This attitude change in turn leads to the disappearance of the hollow cross.

To correct a hollow back, extensive training of the abdominal and back muscles is just as indispensable as the strain on the gluteal muscles. Decisive are especially the lower abdominal muscles.

  • Reverse Chrunches: The legs are fixed at a 90 degree angle from the ground upwards and back again when the upper body is fixed.
    How to do a reverse chrunch is explained on our page: Reverse crunch
  • The pair of scissors: To do this, you cross the stretched-off legs alternately on your back. Even the purely static holding the stretched legs just above the floor from the supine position requires the lower abdominal muscles maximum.
  • The most recommendable exercise, however, is the simple forearm support, the Plank: When properly performed, this exercise trains the entire trunk and improves overall body tension.

Also the back should be strengthened with some exercises. For example, it makes sense to lift off the upper body and the arms in prone position as one would "fly".

But even standing down the straight back to lower ground and to hold this position only from the power of the lower back, demands the back of the body.
Trained know this exercise in combination with additional weights as "dead lift" or "deadlift". In the beginning, however, all exercises should always be carried out without additional weight or with little weight.
The number of repetitions may also be slightly lower at the beginning. It is important that the affected person's body first learns and correctly executes the new movement sequences. Decisive is the perfect technique!

In addition, it is recommended to stretch the hip flexor (iliopsoas muscle) thoroughly. Often it is due to tension or shortening the cause of pain in the back. Especially people who sit at the desk all day often neglect these muscles and risk their stunting.

To correct a hollow cross, an individual training plan should be prepared by an experienced trainer or physiotherapist. The latter should also take the time to guide all exercises and correct the exerciser.
Of course, despite optimal guidance, one can not expect that a hollow cross, which may have existed for years, will disappear immediately and definitively within one hour of training. Correcting a hollow cross with targeted exercises is a long process that requires great patience and regular training.

Many more exercises against the hollow cross can be found on our partner page : MedOn - exercises against a hollow cross


In certain, very special cases, an operative correction of a hollow cross is possible and advisable. These are primarily postural defects attributable to other pre-existing diseases of the spine.
For example, surgery may be useful in patients with very severe scoliosis or less common changes in Bechterew's disease.
However, affected patients usually know about their illness and are already receiving medical treatment.

Even for extreme forms of "normal" hyperlordosis, some surgical techniques are in circulation, but they have in common that they are rarely used and can not show absolute success rates. Unfortunately, few patients benefit from these procedures.

In patients with uncomplicated hollow back, which are otherwise healthy, an operative correction of the hollow back is not a solution.

Hollow back and lower back pain

Due to the tension associated with a malposition of the spine, it often comes to sufferers to lower back pain.
These tensions develop due to the over- or Fehlbelastung of the torso and pelvic muscles and tend to increase in the course of the disease.
Here, painkillers such as Voltaren or Ibuprofen can provide relief.
Apart from that, the hollow cross also increases the risk of herniated discs and spinal stenosis.
In the herniated disc, one or more of the cartilage discs located between the vertebral bodies "fall" and cause painful nerve entrapment with radiations down to the legs. In spinal canal stenosis, nerves are narrowed by the narrowing of the spinal canal (which often causes sclerosis), which can lead to unilateral pain radiating to the legs.

This topic might also interest you: Pain in the lower back

Diagnosis of a hollow cross

The diagnosis of a hollow cross can usually already be made by the so-called inspection, the viewing of the undressed patient as part of a physical examination.

The typical posture of the person concerned, the pre-tilted pelvis and the buckling of the spine in the abdominal direction, are usually clear.

In order to assess the manifestation of the hollow cross and to assess more accurately already occurred consequential damage, an X-ray examination can be carried out.

Since the treatment may vary depending on the cause, a detailed orthopedic examination is carried out with the aim of identifying the cause of the hollow cross formation.

In addition to the muscular imbalance also a malalignment of the uppermost vertebral body ( Atlas ), a Pomarino disease (forefoot / Spitzfußgang in children) and spondylolisthesis ( spondylolisthesis ) can cause a hollow back.

How can you recognize a hollow cross yourself?

Just a quick glance is enough to get an overview of his back: You stand in front of a sufficiently large mirror and look at your own posture in as natural a position as possible. This means that you should neither exert much effort nor pay attention to a straight posture.
If you have the feeling that you are always in a particularly straight position under observation, it can help to ask a friend or acquaintance to take a picture in profile while you are busy with something else. The image then spontaneously and unobtrusively, while you no longer think about it and is therefore much more meaningful.

In particular, one should pay attention to the shape of the back when looking at it: Is the body axis straight? Is the head in a line above the pelvis? Where is the center of gravity of the standing body?
The hollow cross is characterized by a strongly arched lower back and a tilted forward and down pelvis. Are there clear dents in the spine?
Of course, this is only a first overview. The fact that you do not see any particularities in the mirror or in pictures does not necessarily mean they can not be there.
Especially lighter forms of the hollow cross often need an experienced look of a doctor to be recognized. So it is quite advisable to consult a doctor for back pain or the suspicion of a hollow back.

frequency distribution

Due to the influencing factors, more and more people are affected by a hollow cross. Lack of exercise and poor posture, especially sedentary activities, as well as stress lead to the fact that even with 60% of new schoolchildren posture damage. In addition to the hollow back, these include the rounded back ( hyperkyphosis ), the flat back and the hollow circular ridges, which can also be caused by unnatural stress on the back muscles and the spine.

Symptoms of the hollow cross

Initially, a hollow back, apart from tensions, usually does not cause discomfort. Over time, then the weakened back and abdominal muscles increasingly express themselves in back pain. The shortened ligaments and tendons also lead to a stronger immobility. As a general rule, the fewer movements that are "cushioned" by the back muscles, the more strain is put on other surrounding structures. In the case of the hollow cross, the load is distributed unevenly over the vertebrae, which can lead to increased wear, especially of the intervertebral discs of the lumbar spine. Therefore, people with a hollow back have an increased risk of further spinal disorders such as vertebral damage and herniated discs in the lumbar spine. This risk depends on the extent and duration of the hollow cross.
A hollow back can also lead to narrowing of the spinal canal. In this channel are important nerve pathways, for protection it is covered by bones and ligaments of the spine. If it comes through a hollow back to the narrowing of this channel, the victim has pain, which radiate mostly from lower back to the legs.


The prevention of a hollow cross is relatively easy and is based on two large columns. On the one hand, enough exercise is of utmost importance: Everyday movements such as riding a bicycle instead of a car and climbing stairs instead of driving are already helpful. For this regular exercise should be done, such as swimming, walking or fitness training. In order to prevent the best possible, it should already be emphasized in childhood and adolescence.
The second major pillar in the prevention of a hollow cross is a healthy posture, which is also promoted by sufficient movement. It is important to always pay attention to your own body position and to correct bad posture. This can be exhausting at first, but getting used to it is usually fast. Especially when sitting, care should be taken to sit " dynamically ", so do not sit too long in a sitting position and interrupt sitting by regularly walking and standing. This can be supported by ergonomic seating, as you often do not even notice that you take an increasingly poorer attitude. In addition, the optimal posture can be promoted by special training. This training corresponds to what is also recommended for therapy with Hohlkreuz, so that here too, that a professional instruction is required. The specific exercises for the back, abdominal and gluteal muscles should be performed regularly to strengthen the muscles permanently. Should a hollow cross be suspected, an orthopedic surgeon should be consulted as soon as possible to establish the exact cause of the hollow cross. In addition, therapies should be initiated as soon as possible to avoid worsening of symptoms and the onset of complications.

Forecast of the Holhkreuz

The prognosis of a hollow cross depends on whether and how rapidly counteracting measures take place. The sooner and more consistently the appropriate muscle groups are trained, the higher the likelihood that no discomfort and sequelae will develop. With early detection and well-performed therapy, the prognosis of a hollow cross is very good.

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