Understanding posture is a bit like following along with the song "Dem Bones." The lyrics from "Dem Bones" tells us our bones are connected to one another.
Anatomically, the back of the pelvis provides the spine with a stable connection to the lower region of the body, an area responsible for supporting and moving weight. The movements of the pelvis and low back are coordinated: A neutral pelvis (the ideal position) generally supports a mild arch in the low back. This small degree of arch helps the body to balance the weight of all its parts as they connect together, support you and move you.
When you have a postural deformity, one or more bones may deviate from its ideal position. This deviation may lead to muscle strain, ligament sprain, and/or pain. It may also cause your spine to adjust its position in one more area. This is to make up for any pain or loss of balance created by the original deviation.
To define and work with postural deformities, doctors and physical therapists use exact measurements. Let's try to understand the elements of swayback from their perspective as best as we can.
The ideal tilt of the pelvic bone from the top of the sacrum in back to the pubic bone in front is 30 degrees. You might understand this as the bone in back of your pelvis being higher than the bone in the front, when your pelvis is said to be "neutral". The measurements the experts use get more complicated than this, but the meaning of "neutral pelvis" is almost that simple. Neutral pelvis is a position of balance the entire body uses to help keep you upright, moving and pain free.
In a swayback, the pelvis is tipped forward another 10 degrees or so (40 degrees total). In addition, the whole pelvis moves in a forward direction (and your hips extend). The spine bends back sharply. Both your low back curve (lordosis) and your mid-upper back curve (kyphosis) become exaggerated.
Swayback and Muscle Group Imbalance
As with any postural deviation, swayback is sometimes associated with strength imbalances between muscle groups that move the hips, spine and pelvis. In other words, weak hip flexors (located at the front of your hip) and overly strong or tense hip extensors (the hamstrings, at the back of your hip and leg) may be at the root of this problem. Tight upper abdominals, weak lower abdominals and weak mid-back muscles may also contribute to swayback. A corrective exercise program, such as one you'd likely get by seeing a physical therapist for your swayback, may help address the underlying muscle imbalances.
Who Gets Swayback?
Pregnant women and extremely obese people who carry their weight in the abdominal area are at a higher risk for swayback than many. Teenagers with "attitude" may express that attitude through a swayback posture.
Treatment For Swayback
Treatment for swayback should be based on an accurate evaluation performed by a licensed health provider trained in postural alignment. Usually this is a physical therapist. It might also be an athletic trainer, personal trainer or holistic provider with advanced education in this specialized area. Ask your doctor for a referral and for the okay to participate in a corrective exercise program for your swayback.
Your therapy may consist of posture exercises, massage therapy, biomechanics training and/or weight control. Also, maintaining a strong core is vital to a healthy upright posture. Strengthening your core posture muscles will provide a foundation for any specific exercises you do to address the swayback directly.
Swayback - One Last Word
Swayback is related to lordosis, or excessive curvature of the low back area. But the exact meaning of the word swayback may differ according to whom you ask. Some experts see swayback as excessive lordosis (hyperlordosis). Others define it as one type of lordosis. Lordosis is present in swayback, but swayback also has features that lordosis does not. For example, in swayback the hip joints extend and the kyphotic curve of the mid-upper back is excessively long going down the spine. (These two points are discussed above.)
Kendall, FP, Kendall McCreary, E, Provance, PG. Muscles: Testing and function with Posture and Pain. 4th ed. Williams & Wilkins. 1993. Baltimore.
Magee, D. Orthopedic Physical Assessment Enhanced Edition 4th ed. Saunders Elsevier. 2006. St. Louis.