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Posture & Pain – S-Back

In the first of our three part series Posture & Pain, Principal Physiotherapist Sylvia Ho shares why a S-back posture is common in pregnant ladies. She also shares how to prevent this posture and exercises to relieve such lower back pain.

Transcript

Today we’re going to talk about what we call the Lordotic posture or the S-shaped posture. What is S-shaped posture? If you look from the side, you can see that she has a little bit of S-shape posture. Why is this posture not good for you or gives you lower back pain? The reason for that is because in this S-shape posture, you can see that your back is being compressed?
What is a normal posture? A neutral posture is this posture. You’re comparing this posture to this posture which is the S-shape posture. We can see that the lower back gets compressed. People think this is the ideal posture. Why do they think that? They think that because the media projects it as so. The models have this posture and women tend to wear high heels to try and have this posture. But in fact, it’s actually really bad for you back as you can see.
Now, there are two set of people, people with their center of gravity forward. You can imagine the pregnant ladies. If a lady is pregnant, the center of gravity is actually forward. To counter that center of gravity, the pregnant mom has to lean backwards. When they lean backwards similarly, they increase compression and creates this hollowing of the back or the S-shape posture. Another group of people who aren’t big can also have this posture. People who are slim, people who are not fit, people who have tummy muscles that are actually weak.
When you are in the neutral posture like this, you actually require your tummy to be very strong to hold you in that position. When your tummy muscle in the front here, especially in the lower part of the tummy muscles are weak, what happens is that your pelvis tilts forward into arched position and that’s how you land in a lordotic posture or S-shape posture. What are some of the aggravating factors for these people? These people with lordotic back or very arched back will not like activities that encourages even more extension or arching.
For example, breaststroke, backstroke and butterfly all encourage even more arching of the lower back. If they do swimming with these strokes, they’re going to end up with more back pain.
Other activities that provoke this posture are anything that requires arching, like the cobra position in yoga. So you don’t want to be doing cobra. The more you do cobra, the more arching there is which leads to more compression. Standing for a long time, walking for a long time, prolonged walking, running. The first exercise for S-shape posture or lordotic posture is the Child’s Pose position. Why do we need to do a child’s pose position? If you remember the lordotic posture, the s-shape posture, the back is really hollow. What we want to do is actually stretch out that lower back. To do that, what we want her to do is sit back into a U and stretch out this way. As she does that, she opens up her back and that’s going to ease a lot of that tightness. From this position, what we can do if it’s only one side that has pain, say for example it’s only a left-side pain, then we know that the left side muscles are a lot tighter.
We can balance this exercise by getting her to walk her hands towards the right. Walk both hands to the right for me and hold that stretch. You can see from this position, not only you’re opening up the back into a more flexed position or more rounded position, you also specifically balancing it to the left side so you’re stretching the left side a lot more. You can hold it there for 10 counts and you can come back and repeat.

The second exercise is what we call the back backward pelvic rock. What’s the goal of this exercise? Two folds. The first reason why we’re doing this is to strengthen the tummy muscle, the lower abdominals. Remember, we talked about the lower abdominals, the lower part of the abdominal muscle being weak. That’s why your pelvis tilts this way. The second reason why we’re doing this is actually retrain the ability of the brain to tell the muscles to activate into this position. It also stretches out the lower back. What we’re going to do is going to get her to as she lies, think about her tailbone. What I want her to do is actually take the tailbone away from the floor and putting it back down.
When you’re doing this exercise you want to be mindful that you’re using your tummy muscle here rather than pushing through your legs. Just keep pushing your legs to create the same movement but that’s not what we want. We don’t want you to cheat by using the legs. Remember, one of the objective is actually to build your abdominal muscles in front. You’re going to try and think about a string tied to your tailbone and you’re going to draw it up, pull your pelvis up towards yourself and then putting it back down without using your hammies, keeping it soft, just really using your abdominals.
In this position, she’s strengthening her tummy and she’s stretching out her lower back as well. This is what you need.
Third exercise is the hip flexor stretch. Remember the s-shape posture, the s-shape posture has the pelvis tilting forwards this way. The reason why it’s tilting forward this way is because the hip flexors get very tight in this position. Unless you stretch it out, you’ll never get out of the S-shape posture. To stretch your hip flexors, again to this position, half-kneeling position, make sure your pelvis is leveled facing forward. You’re going to tuck your tailbone in first as a start. The reason why we’re doing that is because I don’t want her to go into an arch posture. That’s just going to compress the back and it’s going to give her back pain. From this position, you’re going to lean forward until you feel a slight stretch in the front ham. Because the hip flexors attaches to the spine while stretching the right side, we’re going to arch the arm this way and get her to side bend this way to be a bit more specific in the stretch. You should feel it through here. Hold that position. Take a deep breath in, big breath out. You’re going to lean forward slightly more and you’re going to side bend a little bit more. Big breath in and out, come forward a little bit more and slight bend a little bit more. You can feel the stretch through there.

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