Cervical lordosis

Cervical lordosis is the natural curve of the neck. Seen from the side, the seven neck vertebrae form a gentle arc that curves the opposite way to the upper back: the lower back has a similar curve, called the lumbar lordosis, while the upper back has a thoracic kyphosis (Lam & Mukhdomi, 2023).

What does cervical lordosis mean in practice?

The curve is built into the cervical spine: together, the neck vertebrae create the lordotic curve (Waxenbaum et al., 2026). Most people only hear the word when it turns up on an X-ray report, usually as “loss of cervical lordosis” or “straightening of the cervical spine”. That means the curve looks flatter than expected on that image. A “reversed” or kyphotic curve means the neck, or part of it, bends the other way.

Doctors measure the curve by drawing lines along the vertebrae on a side-on X-ray, for example between C2 and C7 (Grob et al., 2007), and there is more than one way of doing it (Singh et al., 2025). Values differ between people. In 255 adults with neck pain, the average curve measured with the Cobb method was about 27 degrees (Singh et al., 2025).

Does a straight neck cause neck pain?

This is the question most people have, and most of the studies point in one direction:

• No difference between people with and without pain. In 107 people over 45, X-rays showed no difference between those with and without neck pain in the overall curve, the angle at each level, or how often the neck was straight or slightly reversed. A slight reversal at one level was found in 23% of people with neck pain and 17% without. The authors concluded such findings should be considered coincidental (Grob et al., 2007).
• No link with the type of pain. In the 255 adults above, the curve was not linked with whether neck pain stayed in the neck, spread to the arm, or came with nerve compression (Singh et al., 2025).
• No strong evidence overall. A review of 54 studies found no strong evidence that the curves of the spine seen from the side are linked with spinal pain, and noted that most studies were of low quality (Christensen & Hartvigsen, 2008).

Not every study agrees. Researchers working in chiropractic reviewed 277 neck X-rays and found that people with a curve of 20 degrees or less were more likely to have neck complaints (McAviney et al., 2005). The authors suggested a curve of 31 to 40 degrees as a goal for chiropractic treatment. On balance, though, a flatter curve is a common finding that does not, by itself, explain pain.

Common misunderstandings

“My X-ray shows the problem”

Changes on neck imaging are common in people with no symptoms at all. Disc bulging was found on MRI in 87.6% of 1,211 people without symptoms (Nakashima et al., 2015), and the authors of the curvature study above noted that a loss of the curve often comes with wear-related changes that may “remain clinically silent” (Grob et al., 2007).

“The curve has to be restored”

Some chiropractic methods aim to restore the neck curve. A review of their published results was built on case reports: 60 patients in 41 papers (Oakley et al., 2022). Case reports can’t show that a treatment works, and since a flatter curve hasn’t been shown to cause pain, there is little reason to make restoring it the aim.

“A straight neck is the same as forward head posture”

They are different things. Cervical lordosis describes the curve within the neck; forward head posture describes where the head sits relative to the shoulders. Looking down at a phone is a third thing again, covered in text neck.

When should you see a doctor?

An X-ray finding on its own is rarely the reason to see a doctor. Your symptoms are. See a GP if neck pain doesn’t go away after a few weeks, if painkillers haven’t helped, or if you have pins and needles or a cold arm (NHS). More on the common causes is in neck pain from desk work, and the NHS also lists sleeping position among them, which the guide to sleeping position and pillow covers.