It’s normal to have an S-curve in your back — in fact, it helps keep your body weight balanced and absorbs shock when you move. It can keep you strong, aligned and flexible. It can even help you breathe properly. But sometimes, you can develop problems with the curve of your spine that can cause stiffness, pain or discomfort.
One of those problems is swayback posture, also called hyperlordosis. It’s when your lower back curves too much. It can feel like your belly is too far forward and can affect how your spine and pelvis align.
Another is called anterior pelvic tilt (APT). It’s when the front of the pelvis tilts forward and downward, so the lower back arches too much. It creates a curve in the lower spine, similar to swayback. It can push the belly forward and make the buttocks more prominent.
These conditions are similar, but swayback posture mainly affects the lower back while APT affects the pelvis, too. You could have one or both of them.
Jonathan Landsman, MD, a spine surgeon with Banner Brain & Spine, explained more about these orthopedic conditions.
What to know about swayback posture
The curve in your lower back that you have with swayback posture can change your center of gravity and lead to muscle imbalances and pressure on your spine. It can cause discomfort or pain in your lower back, hips and knees.
“There is a whole slew of reasons why these conditions develop,” Dr. Landsman said. You could develop a swayback posture from:
- Sitting for too long without support or breaks
- Weak abdominal muscles and tight lower back muscles
- Not getting enough physical activity
- Lifting improperly
- Hormonal changes during pregnancy
- Obesity, since extra weight increases pressure on the spine
- Genetics
- The structure of your bones
- How flexible your joints are
What to know about anterior pelvic tilt
When your pelvis is rotated forward, it can stress your lower back and the muscles around it. You could have tight hip flexors that pull your pelvis downward and weak abs and glutes that make the tilt worse. You may also have rounded shoulders and a forward head posture.
APT is usually caused by sitting for long periods and not getting enough physical activity. It can lead to muscle strain and lower back pain and it can affect your movement during daily activities.
How these conditions can affect your life
With both swayback posture and APT, you can:
- Feel uncomfortable when you’re sitting. You might fidget or change your position often.
- Be less flexible and find it harder to move around, due to tight muscles.
- Get tired after standing or walking for a long time.
- Find that clothes don’t fit properly.
Diagnosing swayback posture and anterior pelvic tilt (APT)
If you have lower back, hip or knee pain or you think you might have one or both of these conditions, you’ll want to see a health care provider. They may:
- Look at the curves in your spine, your pelvic angle and the alignment of your shoulders and hips.
- Feel for tension or abnormalities in the spine or pelvis.
- Check the strength of your abs, lower back and hip flexors.
- Examine the range of motion in your spine and hips.
- Analyze your posture with tools like plumb line assessments or posture analysis software.
- In some cases, recommend imaging studies such as X-rays or MRI to check the spine and pelvis for structural problems, disc degeneration or other conditions.
Treating swayback posture and anterior pelvic tilt (APT)
“We used to treat the spine and the hips separately,” Dr. Landsman said. “But we’ve learned that the two are very interconnected. The posture in your hips will affect the curve of your spine and vice versa. For this reason, treatment should take both areas into account.”
If you’re diagnosed with either or both of these conditions, your provider may recommend:
- Physical therapy to help with core strengthening, stretching tight muscles and improving your posture. “Physical therapy is important. It can help keep you in balance, control pain and improve your ability to exercise,” Dr. Landsman said.
- Joint mobilization, where a physical therapist gently moves your spine and pelvis to improve mobility and reduce stiffness.
- Massage or myofascial release to help relieve muscle tightness and improve range of motion.
- Adjusting your desk height and monitor position and using lumbar supports and footrests.
- Using a supportive chair and keeping your spine neutral when sitting at home.
- Learning how to lift things and move your body so you don’t strain your spine and pelvis.
- Taking regular breaks to stretch and move.
Following these treatment strategies can help you manage these conditions and stay comfortable and healthy.
In rare cases, you could need surgery to correct these conditions, but usually physical therapy and self-care steps are all you need. “Most spine surgeons won’t even see people until after they’ve tried conservative care, including physical therapy,” Dr. Landsman said.
Preventing swayback posture and anterior pelvic tilt (APT)
Good habits that keep your muscles and bones strong and healthy can help prevent these conditions:
- Take regular breaks from sitting or standing to stretch and change positions.
- Move throughout the day to reduce muscle stiffness and fatigue.
- Maintain a healthy body weight, since excess weight can strain the spine.
- Get regular physical activity. Options like walking, swimming or yoga can help you improve muscle tone and posture.
- Adjust your desk height, chair support and monitor position to reduce strain on the spine and pelvis.
Exercises that can help
Cat/cow
Moving slowly back and forth between these two poses will engage your core and build flexibility in your lower back and hips
Downward dog
Lengthen your back by straightening your spine through your arms and into the ground through your palms. You should feel this stretch in your back, core and hamstrings.
Table pose with leg lift
With anterior pelvic tilt, you may need to strengthen your glutes, hip flexors and hamstrings. On all fours and with a straight back, extend one leg at a time behind you.
Glute bridge
With your shoulders and feet on the ground, gently lift your hips and bring them back down. You should feel your core and glutes engage, plus a stretch in your hip flexors.
Chair pose
Squat as if you’re going to sit in a chair, with your arms stretched out in front of you. This exercise will strengthen your hips and abdominals.
When to see a health care provider
You should get medical care for:
- Persistent pain, discomfort or stiffness in your back, hips or pelvis despite self-care.
- Pain that interferes with your daily activities or gets worse over time.
- Difficulty walking, lifting or bending.
- Changes in your mobility or range of motion that impact your quality of life.
- Noticeable changes in the curve of your spine or pelvic tilt.
- Symptoms that are getting worse.
Get medical care right away for:
- Pain that radiates down the legs or into other areas of the body.
- Numbness, tingling or weakness in the legs or feet.
- Sudden loss of bowel or bladder control.
- Unexplained weight loss along with posture-related symptoms.
The bottom line
Understanding swayback posture and anterior pelvic tilt is important for your overall health. Both conditions can cause pain or discomfort and affect your daily activities.
Strengthening your core muscles, improving your flexibility and making ergonomic adjustments at home and work can support healthy posture. If you have discomfort, pain or changes in your posture, talk to your health care provider or reach out to an expert at Banner Health.
