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Posture & Pain – Sway Back

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.

Transcript

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.

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I had an excellent sports massage by Wan Ling, which was very different from the usual massage I've tried elsewhere. Wan Ling skillfully and systematically loosened every muscle in my upper back and neck over the course of an hour. If anyone is seeking relief from tense muscles, I would highly recommend making an appointment with Wan Ling.
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Varun Sharma
Really good sports massage! Booking process was efficient too :)
Charmaine Miranda
Charmaine Miranda
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Benedict Koh
Benedict Koh
My mum received her first Apos treatment. We intend to continue until her hip muscles become strong. We believe in the treatment as we saw how amazing it was. The idea was simple. Really love that she can be herself again, for long term. The hip and knee cap operations offers 15yrs. Hence we reject the cost and short-life. My wish is that the treatment cost can be lowered and more are aware of this treatment. God bless and thank you team.
Victoria Soh
Victoria Soh
Look for Soo, he is a great physiotherapist . Always communicating and always asking for my feedback. I’m on the right path to recovery all thanks to Soo. Two thumbs up.
Daniel Wang
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Xue Ting has been working on my troublesome QL, hip girdle - basically the whole left lower kinetic chain! She has been patient, strong and cerebral in her approach to my 48 year old compensatory mechanisms. Her strong massage will finish with an assessment of muscle imbalance and poor activation with finally a retraining back to healthy movement.I’m impressed! Thanks Core Concepts!
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Ken is really amazing!
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The physiotherapist here explained the problem very well and provided me with exercises that helped improved my condition.
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I have been experiencing great pain on my shoulder coupled with occasional numbness on my arm. Thanks to Ken Liew, I felt so much relieved after my first session. He was very patient and knowledgeable and had definitely made my 1st visit to a physiotherapy clinic a very memorable one. Thank you so much Ken
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Hi I am Sally and I am in my late sixties. I have endured a year of thigh(joint) pains and thought that it must be due to old age. Visited Core Concepts at Novena and after only 2 sessions, my condition improved so much that I was able to climb stairs easily again. THANKS to my Physiotherapist Samuel Ong who is extremely polite, professional and knowledgeable.
Shino Tutu
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I have had several sports related injuries and Core Concepts has saved me and put me "back to new" each times! The therapists are excellent - knowledgeable and professional, and the receptionists (Carol, Adiqah and Rin) are always friendly and helpful. They even give me oreo cookies for my children! :)
Paola Venturini Hubert
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Highly recommended for sports massage
Simon Ray
Simon Ray
Extremely friendly staff and therapists! Folks Novena Square are just simply smiley and happy. Coming here towards the end of the work day always brings up my mood. Therapist and coach are fabulous. My condition improve so much that I can even start to train up some of my predominately unrealized problems. Highly recommended!
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I go to Novena and Cheryl is my therapist. She was upfront from the get go about my neck condition. I liked her honesty and said we'll give it a try. I was better after 4 weekly sessions and continued to go to her every 2 weeks. With her help I am in a better condition, had to put in effort on the exercises she taught me as well.
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Claire Chia
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Jaz
Knowledgeable and brilliant!
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Brenda Chong
-emails with advertisement and birthday wishes came, but they didn't think that their customer (with 4/10 sessions remaining in his package) would have expected a reminder of ANY kind if his package was already expiring. I asked the clerk from my last visit how many sessions I had remaining, and she told me 4, with no update on the expiry at all. -assumed I wanted a physiotherapy (PT) appointment when my past SMS have always been for sports massage (SM); whenever I asked for "available slots", they would give me the slots for SM. yet they suddenly gave me the list of available slots for PT ytd. I'm also to blame for not verifying and reading their long SMS carefully.-their masseuse is very good though, skilful and respectful. They ask important questions to understand their client before starting on the SM. I'd still return even though the administrative process is lacking.
Beale Liu JieXiong
Beale Liu JieXiong
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