Chronic PIEX compensation produces which spinal change?

• A. Hypolordosis
• B. Hyperlordosis
• C. Kyphosis
• D. Neutral

Answer: (B)

In sagittal balance, the body adapts to a persistent pelvic or sacral alignment by modifying the curvature of the spine to keep the head over the pelvis. When the chronic PIEX pattern tips the pelvis and promotes a forward-oriented posture, the lumbar spine responds by increasing its extension demand. The result is an exaggerated lumbar curve, or hyperlordosis, as the spine lengthens its lordotic arc to maintain balance and keep the center of gravity over the base of support.

So, the chronic compensation tends toward a forward-leaning pelvic position that the lumbar spine must counteract by deepening its lordosis. This is why hyperlordosis is the expected change. A reduced lordosis (hypolordosis) or a thoracic kyphotic shift would reflect different patterns of compensation, and a neutral curve would indicate no such adaptation.