Posture & Pain – Sway Back

15 November 2019

In the second installation of our three part series Posture & Pain, Principal Physiotherapist Sylvia Ho shares why a Sway back posture, casually known as the ‘lazy posture’ is usually seen in people with weak muscles. She also shares how to prevent this posture and exercises to relieve such lower back pain.

Posture & Pain - Swayback Posture


This next posture is what we call the Lazy Posture or the proper name for it is the cerebral posture. In this posture you can see that the pelvis is really forward relative to the ankle. If this is forward, the body has to create normalization of the center of gravity and this is done through the thorax hanging backwards. The thorax hanging backwards, your upper back hangs backwards and the head has to stick forwards.

You can also see from this posture that the knees are hyper-extended, completely locked in that position and turning. This posture is called the lazy posture because people who adopt this posture don’t want to use their muscles. Buttock muscles are switched off, abdominal muscles are switched, the leg muscles are switched off.

Now, why do they have lower back pain? They have lower back pain because the spine is hinging off several structures. Because she stands like that, all her forces are hinging off the lower back through here. That’s why they lead to lower back pain. This is slightly different from the S-shape posture because the S-shape posture doesn’t have such strong forward hip posture. It doesn’t have the hip that sticks out so much. With this posture, not only do you have lower back pain, you will also have neck pain because the head sticks forward just to counter the center of gravity.

Who are these people who have this posture? People who have this posture are people who don’t have a very strong muscles. Because they don’t have very strong muscles, they can’t depend on their muscle so they try and lean off things – lean off the spine, lean off the structures. These are the people who hang on the wall, lean against the wall, sit on the table or in their chair looking for support all the time.

What are some of the aggravating activities that encourage lower back pain for this sort of people? If you have this posture activities that you have to avoid are similar to the one with the S-shape posture.

You want to reduce compression through here. You don’t want to be doing activities that compresses further. So, no cobra position, no swimming breaststroke, running, standing for too long, walking for too long, doing your Superman exercises. Those are the activities that’s going to increase compression and pain through the back.

One more thing that actually aggravates this posture is the hip position. If you have anything that requires looking down, that requires even more forward head bang, it’s going to give you lower back pain. Say for example looking at the iPad or iPhone down below, reading with the head hanging down this way. You’re going to end up with neck pain as well.

How are we going to solve this problem and reduce the pain? First and foremost, we need to stop hinging for our back. We need to stop hinging through the lower back. To do that, the most important thing for this posture is to actually take them out of this posture. How do we take them out of this posture? We’re going to get them to bring their pelvis now which is in front of the ankle, now over the ankle. From this position, they feel they’re going to fall backwards because the thorax is too round and the center of gravity is too far backwards. What you want her to do is actually get the thorax extended this way.

Pelvis over the ankle, thorax up right and you can see that change in posture. To stay in this position, you require muscle activation. It requires bringing more effort as opposed to sway back posture. We’re going to do this exercise to build her buttock muscles. So you remember the lazy posture, buttock muscles are really quite weak. We’re going to start building the buttock muscle.

We’re going to do the step up now. The common way people do a step up is push through the balls of their feet. If you come up normally like that, this is normally just squat activation. We don’t want to do that. We want you to focus on buttocks. So, step back down again. This time as you step up, I want you to put your forces through the heel. As you step up through the heel, put the force through the heel, it will be all completely gluteal. Let’s just do five more. You can hang on to the wall if you want. That’s fine. That’s it. Can you feel that in your buttock? Four and last one, five and step down. Excellent.

The second muscle that we’re going to work on is the quads muscle but not the full range of the quads muscle, just a small angle from zero to 15 degrees. Why do we have to do that? We have to do that because the way she stands with the sway back posture, the knees are locked and turned in. The reason why she’s doing that is because they control the knees very poor. So we’re going to start strengthening that control in the knee. Step up both legs for me. Hang on to the wall for me. She’s going to step forward with her right leg and she’s going to pretend to step down. That’s it. Super slow. From zero to about 30 degrees, that’s enough. And straighten the leg, that’s it. Three, four and five. Good job. With this sway back posture, what they tend to want to do is as you extend the upper back, the pelvis will want to move forward. That’s not a good way to do it. That’s wrong. We want the thorax to come forward without the pelvis moving. That’s why we put the chair here. We don’t want the pelvis to be touching the chair. Keeping that pelvis relatively stable, what we want Jess to do now from a fairly slump position is to come forwards and back and again. Excellent. Two, three, without moving the pelvis too much, four and five.

Experiencing neck pain? Click here to find out more about physiotherapy for neck pain relief and how Core Concepts can help