Designing a Program for Swayback Posture

Many fitness professionals confuse faulty lordotic posture with swayback posture (Kendall 2005).

The scientific definition of swayback refers to posture in which the hips are swayed forward and the rib cage is swayed backward in the sagittal plane (Kendall 2005). Commonly, people picture the swayback of an older horse—which actually more resembles lordotic posture. Upon closer look at joint positions and at muscle length and strength, it is obvious that these postures are different.

Fitness professionals must understand the differences, because these two faulty postures lead to different injury risks and require different types of corrective exercise.

Those who can correctly identify swayback posture can address clients’ muscle imbalances prior to the onset of pain or dysfunction and can then effectively create exercise programs to combat muscle atrophy and overuse injuries or trauma during exercise.

Research

According to Sherrington (1931), “Posture follows movement like a shadow.” After extensive study of the ideal posture and its relationship to muscle balance, pain and good body mechanics, it has become increasingly apparent that how we hold our bodies statically (when unmoving or stationary) affects our movement patterns and is also a true reflection of our daily activities. Think of people who swim, run or have a sedentary job. We can imagine their posture by the activities they do, then view their posture and make an educated prediction about the types of overuse injuries they might sustain in their future.

There is extensive research describing ideal posture and its role in health and wellness. Most physical therapists, sports conditioning specialists and personal trainers have adopted postural evaluations as a tool for exercise program design, whether the goal is pain reduction, improvement of sport performance or overall fitness and wellness.

Swayback Versus Lordotic Analysis

Upon quick comparison, swayback and lordotic postures appear similar, owing to the concave curve in the back. However, upon closer observation it is apparent that in lordotic posture the lumbar spine is concave, while in swayback posture the low lumbar area is actually flattened. In swayback posture the concave curve of the spine is much higher, in the lower thoracic spine.

There are two excellent ways to differentiate between the two (Kendall 2005). The first is to identify the position of the pelvis. In lordotic posture the pelvis is tilted anteriorly, while in swayback posture it is tilted posteriorly. Second, in both lordotic and ideal postures the greater trochanter is over the lateral malleolus. In swayback posture the greater trochanter is considerably anterior to the lateral malleolus, revealing the forward sway of the pelvis in the sagittal plane (Kendall 2005; Sahrmann 2002).

Swayback posture is common in runners, ballerinas and sedentary individuals. It is also common in older adults because of the characteristic weakening of the aging gluteals. In addition, those with chronic pain frequently present with swayback posture (Sahrmann 2002).

In my practice I am seeing an increase among 14- to 25-year-olds with swayback. I have two theories for why this is occurring: (1) young adults seem to have become more sedentary with the increased use of technology; and (2) fashion! I’ve noticed that youth in low-rise pants stop flexing at the hips, because their clothing is restrictive.

Lordotic posture is common in athletes with iliopsoas tightness; for example, gymnasts and football offensive linemen. It is also seen in majorettes, aerobics participants and pregnant women (Kendall 2005). Interestingly, it is the first posture acquired by children learning to walk and is generally present until the abdominal muscles mature around the age of 12 (Kendall 2005).

Swayback Posture in Detail

Kendall (2005) provides a detailed description of the faulty swayback posture. The posterior tilt and anterior deviation of the pelvis and thighs create a neutral ankle joint with hyperextended knees and hips. The lower lumbar spine is flattened, and there is a long kyphosis (backward curve of the thoracic spine, known also as “hunchback” or rounded upper back) in the posteriorly displaced upper trunk. The muscle imbalances related to this scenario include short and strong hamstrings and internal oblique muscles with lengthened psoas and external oblique muscles.

Sahrmann describes the dominance of the rectus abdominis over the external obliques, for the posterior tilt, as a significant cause of the caving of the chest in swayback posture. Because of the shift of the upper torso backward and the pelvis forward, the swayback curve might be incorrectly described as a lordosis (Kendall 2005). This posture reveals a caved chest, rounded shoulders and flattened buttocks, with atrophy of the gluteals.

One of the dangerous movement patterns in swayback posture is use of the hamstrings to extend the hip. Because the hip is in full extension in this posture, the gluteals are inhibited and the hamstrings take over as the prime movers for hip extension. Unfortunately, because of the origin and insertion of the hamstrings, the extension they create at the hip puts a torque on the femur, causing the head of the femur to move forward in the hip socket (Sahrmann 2002). This can produce significant wear and tear on the anterior area of the hip joint and undue strain on the hamstring tendon.

Common overuse injuries related to faulty swayback posture include labral tears at the hip, low-back pain, plantar fasciitis, iliopsoas bursitis and tendinopathy, recurrent hamstring strain and shoulder impingement (Sahrmann 2002).

Retraining for Activities of Daily Living

When working with swayback clients, it is important to emphasize corrective exercise and focus on retraining for activities of daily living. Swayback clients often “cheat” during traditional exercise, so knowing the issues surrounding this faulty posture will help you cue for proper alignment in order to make each exercise more challenging and effective.

The first and most important lesson is correcting the standing swayback posture. For those in pain this will calm the muscles and remove the effects of the spine’s poor position (McGill 2007). For those with no pain, correcting the standing alignment will prevent flawed movement patterns.

To correct swayback posture, begin by teaching clients the bony landmarks of the lateral malleolus and greater trochanter. Next, teach them how to flex slightly at the hip joint to move the greater trochanter back over the lateral malleolus. They will feel their weight transfer to the heels and notice their pelvic floor and gluteals engage. Next, ask clients to draw up and in at the “lower abdomen,” while pulling down with the ischial tuberosities (sit bones). Be sure they lengthen the torso out through the top of the head and elongate the spine. This will begin to reset the relationship between the external obliques and the dominant hamstrings. A good tip is to remind clients that people with swayback posture tend to stand with feet far apart and arms crossed over the chest, and they should try to catch themselves doing this.

Also review daily activities, such as moving from sitting to standing. Clients with typical swayback posture will get in and out of a chair using the hamstring muscles rather than the gluteals. As these clients sit down, they will tuck the pelvis into a posterior tilt and avoid the natural forward lean of the torso. As they stand up, they will shift their pelvis forward and hyperextend their knees to “put on the brakes” at the top of the motion.

Review the sit-to-stand motion with them, encouraging “nose over toes” and “sit bones pointing at the chair.” Avoid internal rotation of the hips or medial collapse at the knees. There should also be deliberate hip flexion during the movements of sit-to-stand and stand-to-sit.

Swayback posture is a common faulty posture that can inhibit normal exercise function and lead to pain and dysfunction. Identifying this posture is critical in the design and success of an exercise program. Trainers and instructors who can correctly identify this posture will be able to teach new functional movements and provide exercises to effectively resolve the postural faults before any damage occurs.