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Posture Types in Profile

1. Balanced or Neutral Posture
2. Flat Back Posture
3. Sway Back Posture
4. Postural Bowlegs
5. Kyphotic-Lordotic Posture
6. Hyper-Kyphotic Back
7. Ways to Identify Postural Type:
8. Postural Exercises – A Recap

 

Balanced Posture 1. Balanced Posture
The stability of neutral, balanced posture begins at the feet. The weight of the body— felt as the force of gravity pulling us down to the center of the Earth—is best supported equally by both feet in front and back views, and equally between the front (ball) of the foot and the heel of the foot in side views. Thus, the "plumb line point of reference" in side views, falls midway between ball of foot and heel, which is about in front of the ankle (lateral malleolus). The plumb line also represent the line of gravity, which passes through the body's "center of gravity" and down to the support surface/ground. The "center of gravity" is an imaginary point at the center of the mass or weight (on Earth) of a body where all the downward force on a body’s mass appears to be concentrated. In Ideal/Balanced posture, the plumb line should pass through the whole body's center of gravity in the lower trunk just in front of the sacrum (vertebra that attaches lower back to pelvis/hip joint) and close to the spinal column, which stiffens the body and allows it to stand upright. If the plumb line passes in front of the spine, the spine tends to bend forward, unless the spine muscles (extensors) are strong enough to resist. (The line of gravity always passes in front of the thoracic spine. Thus the top of the thoracic spine curves forward.)

If the center of gravity of the head is very forward of the line of gravity such as in forward head posture, the inward lordotic curve of the neck may straighten over time, unless the neck extensors pulling the cervical spine backward (in a lordotic curve) are strong enough to resist.

In ideal, balanced human posture in side view, the plumb line/line of gravity, should pass through the following points: ear canal, midway through the shoulder, bodies of the lumbar vertebra, hip joint, knee joint, and just in front of ankle. (Kendall et al.)

Note in flat back posture below, the entire body leans forward, which is an unstable position and causes tightness in the back muscles trying to keep the body from falling further forward, and weakness in the front muscles that are underused.


Flat Back 2. Flat Back Posture:
— Upper Body: Forward head, Upper thoracic spine curves forward, Lower thoracic straight. Shoulders rounded forward, and shoulder blade anchoring weak. Chest sunken, muscles between the ribs (intercostals), upper abdominals and accessory muscles of respiration such as pectorals are shortened and tight; shallow breathing is the norm.
— Lower Body: Pelvis tilted backward (tucked under) causing flat lower back/lumbar spine, and no butt; pants and jeans sag in the rear. Knees may be extended but not hyper-extended as in Swayback. The Entire Body Leans Forward, only a bit, but very evident when one tries to stand straight against a wall. Body weight shifts to the forefoot causing increased strain. Calluses may form under the ball of the foot and/or the great toe, and may worsen toe conditions such as rigid great toe or hallux rigidus—degenerative arthritis of the first metatarsophalangeal joint. (I have hallux rigidus that surgery 8 years ago couldn't correct, but improving my posture has equalized body weight over the entire foot, calmed inflammation, and greatly reduced toe pain.)

To Correct:
For Upper Body: Fix the Shoulder Blade Exercise to improve forward head, pull shoulders back, strengthen shoulder blade anchoring, and free up neck motion. For tight chest muscles and upper abdominals, do Thumbs-Up and Bruegger Exercises, Wall Angels or Wall Standing Exercise, also Pectoralis Minor Stretch (note precautions), and frequently remind oneself to keep the chest lifted. Take some deep breaths during the day and notice how good it feels for the lungs to expand unimpeded when the chest is lifted.
For Lower Body: Loosen locked pelvis with hip extensor (Hamstring) stretches and practice forward pelvic tilts (in front of a mirror) or see this video Lower Back Lumbo-Pelvic Exercise. Get a sense of what it feels like to stand straight (at a 90 degree angle with the floor) by doing Wall Standing Exercises. Remind oneself often to straighten the mid-back. Strengthen lower back extensors with Multifidus and Back Extension Exercises. Remind oneself to relax the knees, and keep body weight evenly distributed between ball and heel of the feet. Strengthen hip flexors. Note: In photos of myself as a young child, I did not have flat back. But I remember being sensitive about the way I looked–I was overweight–and that led me to keep my abs tight to stop stomach bulge. Abs that are stronger than hip flexors is a factor in flat back posture. I also remember keeping my chest "caved in" to hide my chest, which is another determinant of slouched posture.  


Swayback 3. Sway Back Posture
— Upper Body: Forward head; Long kyphosis of the Thoracic spine extends into lumbar region; Sunken chest; Shoulders, rounded forward and shoulder blade anchoring weak. Upper trunk shifted rearward.
— Lower Body: Pelvis tilts backward, causing flattening of the lumbar spine, but it doesn't appear flattened because the upper trunk shifts or sways to the rear. There is no body-wide forward tilt as in Flat Back. The shifting backwards of the upper trunk results in elongation and weakening of the External Oblique, an abdominal muscle, while upper fibers of the Internal Oblique, another abdominal muscle, are shortened and tight, to pull the rib cage back forward. Chest muscles (pectorals and intercostals) are short and tight. Hip Flexors, especially the Iliopsoas, are weak and can't oppose the pull of the short, tight Hamstrings, which tilt the pelvis backward.
Hips and Knees bend backwards in hyper-extension.

To Correct:
— For Upper Body: Fix the Shoulder Blade Exercise to improve forward head, pull shoulders back, strengthen shoulder blade anchoring, and free up neck motion. For tight chest muscles and upper abdominals, do Thumbs-Up and Bruegger Exercises, Wall Angels or Wall Standing Exercise, also Pectoralis Minor Stretch (note precautions), and frequently remind oneself to keep the chest lifted. Take some deep breaths during the day and notice how good it feels for the lungs to expand unimpeded when the chest is lifted.

— Lower Body: Loosen locked pelvis with hip extensor (Hamstring) stretches. Do Pelvic tilts to increase pelvic flexibility. Strengthen External Oblique with Wall Standing Exercises, and Alternate Leg Raises (no double leg lifting), which also strengthens weak hip flexors. Or do other hip flexor strengthening exercises.

— The Knees: Remind oneself frequently to relax the knees and avoid hyperextension, which worsens Postural Bowlegs---›


4. Postural Bowlegs is caused by internal rotation of the femurs toward the front of the hip. Thighs, knees and feet rotate inward toward the front center of the body. The feet seem to collapse slightly inward (pronation) as body weight is borne more on the inside of the sole of the foot. From Kendall et al.— "An apparent bowing.... results from a combination of medial rotation of the hip/femur, hyper-extension of the knee joint and pronation of the foot. Medial rotation of the thigh plus pronation of the foot do not result in bowing unless accompanied by hyperextension. ... Correction depends on use of appropriate shoe corrections [e.g. New Balance has athletic shoes with slanted heels designed for pronation-prone runners], exercises to correct pronation, exercises to strengthen hip lateral rotators and cooperation by the subject in avoiding a position of knee hyperextension."
To Help Improve: Stand with feet 4 inches apart and toeing out slightly. Relax knees so not stiff or bent. Tighten buttocks to rotate legs slightly outward (until kneecaps face directly forward). Tighten muscles that lift the arches of the feet, rolling the weight slightly toward outer borders of feet.* It may not be possible to totally eliminate postural bow legs because there may be structural factors as well. This is true of those in my family with bow legs. What is obvious, though, is that when they correct their sway back posture and stop hyperextending hips and knees, the appearance of their bow legs is much improved. Sometimes postural bowlegs is compensatory for Knock-Knees, which must be fixed first.* (See a physical therapist for help correcting both postural bowlegs and knock-knees.)


Kyphotic-Lordotic Posture 5. Kyphotic-Lordotic Posture
— Upper Body: Forward head, Increased cervical spine lordosis ("C" curve) with Back neck extensors tight and short; front neck flexors are elongated and weak.
Hyper-kyphotic thoracic spine with upper back extensors elongated and weak. Shoulders rounded forward. Shoulder blades held farther apart in back and anchoring muscles are weak. Chest muscles tight and short, and rectus abdominis bulges out and pulls down on rib cage causing "sunken chest."
— Lower Body: Pelvis tilts forward pulling the lumbar spine into hyper-lordosis. Forward tilting pelvis is often caused by short, tight hip flexors (quadriceps) pulling the pelvis down in front, with the abdominals too weak to oppose. If the lower back extensors are short/tight, they pull up on the pelvis in the rear tilting the pelvis forward also, and are unopposed by weak hip extensors (hamstrings). However, the low back may not be tight; if lumbar lordosis straightens while sitting, then the main cause of forward tilting pelvis is tight hip flexors, not tight back extensors. (Kendal et al.)

To Correct:

— For Upper Body:
Fix the Shoulder Blade Exercise
to improve forward head, pull shoulders back, strengthen shoulder blade anchoring, and free up neck motion. For tight chest muscles and upper abdominals, do Thumbs-Up and Bruegger Exercises, Wall Angels or Wall Standing Exercise, also Pectoralis Minor Stretch (note precautions), and frequently remind oneself to keep the chest lifted, by lengthening spine from top of pelvis to ribcage. Take some deep breaths during the day and notice how good it feels for the lungs to expand unimpeded when the chest is lifted.

— For Lower Body:
First – correct anterior pelvic tilt: A) Stretch front hip flexors/quadriceps to allow pelvis to tilt back more easily, and then B) do Posterior Pelvic tilts to flatten the lumbar curve by tightening front abdominals to pull up on the pelvis, which tilts it backwards.
Second – strengthen weak, elongated external obliques see below for abdominal exercises: A) Wall Standing,  B) Isometric "Abdominal Bracing Exercises"  C) abdominal anti-rotation exercises. Avoid crunches, which strengthen rectus abdominis (6-pack abs), which acts to pull down the rib cage and depresses the chest. Crunches also do not strengthen the external obliques.
Third – strengthen gluts and hamstrings. Squats are great for improving strength of the posterior chain of muscles, especially hip extensors and gluts. However, make sure to correct hyper-lordotic lower back first.

*Kendall et al.Muscles: Testing and Function with Posture and Pain, 5th edition, 2005


6. Hyper-kyphotic back is usually a posture seen in older people. As back extensor muscles weaken from lack of physical activity and loss of muscle from age related sarcopenia, the trunk bends forward and hunches. Posterior spinal ligaments stretch, and back extensor muscles elongate and weaken, yet must work harder to keep the upper body from falling further forward. The front chest and abdominal muscles shorten and tighten. Balance is compromised because the center of gravity of the head and upper body is forward of the line of gravity/plumb line of reference at the middle of the feet. Once the center of gravity shifts beyond the feet, another base of support is needed such as a cane or walker.

With age, hunched back posture can become permanent as ligaments calcify and the spinal bone, weakened by low bone density (osteopenia and osteoporosis) wedges in the front or flattens and destabilizes from compression fractures. Back pain is common. Causes include spasms from stretched, overworked back muscles, or compression fractures. Neck pain is common because the neck curve must be maximal to see ahead instead of looking down at the ground. For those with a straightened cervical curve, even looking straight ahead is difficult.

The hyper-kyphosis may be limited to the upper thoracic spine and not include the lower back, which may be straight or lordotic***. There is still the problem of lifting the head enough to see straight ahead. This is done by hyper-extending the neck, but the hunched upper back may get in the way of tilting the head back. The need to hyper-extend the neck can be a painful neck.

To find help, the first step should probably be to see an orthopedist, who should evaluate for osteoporosis, nerve compression, arthritic changes, etc. If the problem is postural, request physical therapy for evaluation and therapy to correct the hyper-kyphosis. In some cases it can't be fixed because tissues calcify, discs dry out and loose height, and the changes are too great. But if the back is still flexible, strengthening back extensors and stretching anterior chest and abdominal muscles should help improve the posture.
***Those with lordotic backs when younger, retain lumbar lordosis more readily than those who tend to flat or sway back. The difference is due to anatomical shape of the pelvis. Those with greater lumbar lordosis have a wider front to back pelvis, which allows a greater pelvic range of motion.

see: "The Loss of Skeletal Muscle Strength, Mass, and Quality in Older Adults: The Health, Aging and Body Composition Study," Goodpaster et al. (2006) and,
"Age-Related Hyperkyphosis: Its Causes, Consequences, and Management," Katzman et al. (2011)

7. Ways to Identify Postural Type:

— Using an adjustable, swivel-type mirror in front and a full-length mirror in back, observe yourself in profile. Such a mirror set-up also serves as a visual reminder, and a way to practice good posture while your sense of the body (proprioception) is still adjusting to what good posture feels like. The mirrors are also used to monitor shoulder blade stabilization during arm lifts, and to correct activation of back muscles during the Fix the Shoulder Blades exercises.

— Have someone take a photograph of your whole body, both a front and a profile view. A background with vertical lines, such as wallpaper or a fence, helps to show forward or side leaning tendencies. But a photograph is only helpful if it's an everyday posture, not an artificial pose. (I took posture photos of people in my exercise class. I told them to relax and assume their usual posture. Most of their postures looked great as they "posed" for me. But watching them during class exercises told a different story. As the instructor said, "At least that they know how to stand straight") Even better is a video taken during everyday activities because static posture in front of a camera may not accurately reflect a person's predominant posture during everyday movements. Watch for the tendency to look down at the ground while walking, tilting the head down while texting. and slouching while eating, working at the computer or watching TV. (It is useful to see photos of both very relaxed posture and posture as good as the person can do. The very relaxed posture shows the inherent tendencies/imbalances of the postural muscles, and what the subject is up against trying to maintain improved posture.)

— Observe postures of other family members. Postural tendencies seem to run in families. I tend to Flat Back, as my mother and her sisters did. My husband tends to Swayback as do his sisters. Of my children, two tend to Flat Back and one to Swayback. In particular, Swayback may by influenced by habitual leg/knee posture, especially bowed legs, which also runs in my husband's family.

— Posture changes from moment to moment often with mood and energy level, but tends to stay in a range. Look for one's predominant posture. Flat Back and Sway Back are similar. Some people with predominant flat back tend to switch to Sway Back when they are tired; they let their abdominals pouch out, and hyperextend their knees and hips, which throws their hips forward. (I find myself doing this, though I tend to flat back posture.) Those with Kyphotic posture usually don't assume the other postures.

— Still undecided? Try exploring what your body can do. Imitate the various faulty postures and observe the results in the two mirror set-up:

For sway back, hyper-extend the knees, throw the hips forward and feel the mid to upper body shift backwards to balance, while the chest caves in and the very top of the back and head curve forward. Feel the slackening of the abdominal area. Note the long kyphotic curve (the sway) from top of lumbar spine through mid to upper back.

For flat back, tilt your pelvis backward and note the flattening of the lordotic curve at the lower back. Flatten the rest of the back but not at the very top. Crane head forward. Do not throw hips forward. Stiffen the knees slightly but don't hyperextend.

For kyphotic-lordotic: Accentuate all the natural spine curves. Tilt pelvis forward and note increased lordotic curve in the lower back and pouching out of the entire abdominal area. Hunch mid to upper back to accentuate thoracic curve; the lordotic curve of the neck automatically increases to compensate (except in anatomical flattening of the cervical spine).

Which posture is hardest to duplicate? Which the easiest? (For me, kyphotic-lordotic was most difficult, which was understandable. Decades of flat back had limited my pelvic flexibility. Flat back was easiest for me, but sway back was easy too. In family photos, I'd seen myself with sway back —especially when I held my grandson. Flat back and sway back have an important similarity; they share a flattened lumbar curve—the result of a backward tilting pelvis (often from tight, short hamstrings). If a person with flat back hyper-extends his or her knees, and relaxes the external abdominal obliques, the rest of sway back posture is a natural consequence. There is another difference between kyphotic-lordotic posture on one hand, and flat and sway back on the other. The pelvises of those with deep lordotic lumbar curves are wider front to back and have a steeper angle of incidence than those with flattened lumbar curves. Angle of incidence depends on anatomy of the pelvis, is unique to each individual, and determines how lordotic the lumbar curve can be. So those with a pelvis having a high angle of incidence, will increase their lordosis with lots of sitting and with "lazy" posture. While those with a low angle of incidence pelvis, will tend to flatten or even round their lower backs with frequent sitting and "lazy" posture.

8. Postural Exercises – A Recap

Neck:

Strengthen Neck Flexors: Correct forward head/kyphotic posture with Fix the Shoulder Blade exercise. With this exercise the strengthening and rebalancing of neck flexors and neck extensors occurs naturally. Later when the neck is no longer painful, deep neck flexor exercises may be done. See A byproduct of improving "Forward Head".... Also see the YouTube Video, Deep Neck Flexor Training, and also Professor Jull's Handbook, Whiplash Injury Recovery.

Thoracic Spine:

Strengthen Thoracic Spine Extensors and Reduce Kyphosis with Fix the Shoulder Blades exercise and Upper Back Extension exercises. Includes the prone "Y", "T", "W" and "L" positions for posture improvement. Also Bruegger Exercises.

Also Stretch Chest Muscles, Intercostals (Between the ribs), Abdominals and Accessory Muscles of Respiration such as Scalenes and Pectorals with a few deep diaphragmatic breaths, several times a day. Keep chest high by elongating the trunk instead of arching the back, as part of improving posture in standing and sitting. Do Thumbs-Up and Bruegger Exercises.

Upper and Lower Trapezius:

Upper Trap Dominant: Stretch upper trapezius and strengthen lower trapezius with Pull Down part of Fix the Shoulder Blade exercise.

Lower Trap Dominant/Depressed Shoulders: Hold a high shoulder shrug to stretch tight lower trapezius and shorten upper trapezius. Use weights to strengthen weak upper trapezius. Don't shrug all the way down to prevent over-stretching of upper trap. For a single depressed shoulder do shrugs only on the affected side, until shoulders are evened out.

Low Back:

Strengthen Low Back Extensors (Flat Back and Sway Back): see Back Extension, Multifidus and Transversus Abdominis exercises.

Stretch Low Back Extensors with Posterior Pelvic tilts (Kyphotic-Lordotic only) On a firm padded floor surface, lie on the back with bent knees and have feet flat on the floor. Keep hands alongside head, to avoid helping with arms. Tilt the pelvis backwards to flatten low back on the surface by tightening abdominals† (a pulling up towards the upper body, and in with lower abdominals). While keeping low back flat, slide heels down to straighten knees as much as possible with back held flat against the floor. Slide one leg back at a time to return to knees–bent position. (Do not use buttock muscles to tilt pelvis and do not lift feet from surface). (ref. Kendal et al.)
†Technically an ab exercise as well.

Abdominals

Strengthen Abdominals especially External Oblique (needed for Kyphotic-Lordotic and Sway Back postures):
A.) Wall–Standing Exercises (Can be done seated on a stool): Stand with back against a wall, with heels about 3 inches away. Place hands up beside head with elbows touching the wall. Tilt pelvis back to flatten low back against the wall by pulling up and inward with the lower abdominal muscles. Firmly tighten the abdominals especially the lateral obliques to shift the upper body forward and the pelvis back." Keep arms in contact with wall and move slowly to a diagonally overhead position (like a wall angel exercise).

B.) Isometric Abdominal Bracing Exercises: In a neutral spine position, stiffen the abdominal wall by tightening abs, gluts, back etc. as if preparing for a punch in the gut, and hold for several seconds (goal is 30 seconds to a minute). Do not allow spine or pelvis to move, and the abdomen should not suck in or push out. Dr. Stuart McGill, well-known professor of spine mechanics and stabilization, calls this "full abdominal co-contraction." Its difficulty can be increased by simultaneously bracing the abdomen and doing exercises such as prone planks, side planks and the bird–dog. See videos of these exercises here: Stuart McGill's Big 3 Core Exercises. A type of crunch called a Curl-up is included but "there is very little curl and the upper body and neck stay elongated." Neck and back remain in–line.
 Which approach is more effective for spine stabilization, abdominal bracing or abdominal hollowing? (ab hollowing activates the transversus abdominis) McGill reports** that the abdominal bracing technique improved spine stability by 32%, while transversus abdominis contraction contributed less than 1%. And since the transversus adds nothing to spine stability, he concludes that spine stability will lessen due to inadequate activation of the important muscles, such as rectus abdominis and obliques. "If you hollow in, you bring the muscles closer to the spine [also elongate them] and you reduce the stability of the back," McGill says. "Try rising from a chair with a hollowed-out stomach. Not only are you weak, it is very difficult." "Professor Shirley Sahrmann, a physical therapist at the Washington University School of Medicine found that, no matter how many times the movement is repeated, it does not become second nature and therefore will not provide constant back support." ref Also see Comparison of the Effects of Hollowing and Bracing Exercises on Cross-sectional Areas of Abdominal Muscles in Middle-aged Women, Koh et al, 2014) "...performing bracing exercises, which can contract both deep and superficial muscles entirely, rather than performing hollowing exercises, which only contract deep muscles independently, is more effective for activating the abdominal muscles."
 Maybe something in between is preferable. I've been taught by my exercise instructors to breath out and tighten the gut when doing the lifting part or strenuous/concentric contraction part of an exercise. This is easy to remember because I count my reps when I breath out. There's some "sucking in" because I've pushed air out of my lungs with the breath out, and some abdominal bracing because I consciously tighten/brace my gut as well as the back and gluts.

**Quantification of lumbar stability by using 2 different abdominal activation strategies. Grenier and McGill (2007)

C.) (and my favorite!) Anti-rotation exercise for abdominal strengthening (Pallof Press), which has no spine bending or twisting, and strengthens the entire core!
   1.) Attach a resistance band to a door frame at chest height. Hold the end of the resistance band in both hands against your upper chest, and have you body sideways toward the door. (or use a cable pulley machine)
   2.) Move away from the door (or pulley machine) until you feel a strong pull, then
   3.) Straighten your arms, extending your hands forward, and resist the turning force (torque) trying to twist you around toward the door (or the cable pulley machine) for 1 - 2 seconds. The Pallof press forces you to tighten the entire core, including the abs, shoulder and back muscles.
   4.) To increase difficulty hold for longer or extend your hands higher until you feel the need to turn and hold 10 seconds. Repeat on the other side. (see this webpage for further anti-rotation exercises)
       Note: Do the exercise with feet at least shoulder length apart, knees bent, and butt back in a slight squat for stability. See tonygentilcore.com for more instructions and videos.

Not advised are sit-ups, and modified sit-ups such as Crunches. Reasons include:
   1.) Trunk–forward bending (flexion) exercises shorten and strengthen the rectus abdominis, but inhibit the external obliques at the sides of the trunk (Kendall et al). Strengthening and shortening of the external obliques is needed to keep the upper body from shifting back of the hips as in sway back; and to help in pulling up on the front of the pelvis to reduce lordotic lumbar curve in kyphotic-lordotic posture.
   2.) A short, strong rectus abdominis pulls down on the ribcage more strongly, which further depresses the chest and increases hunched back, and
   3.) Any kind of forward bending (flexion) of the back under loading places high stresses on the anterior (forward) half of vertebral discs in the lower back, and increasing risk of herniation into the spinal canal.
   4.) Those with low bone density (osteoporosis) are at particular risk of wedging and spine compression fractures due to high anterior stresses on weakened bone of vertebral bodies (bone between the discs of vertebra) during crunches.
   5.) Crunches that include a trunk rotation for the oblique abdominals, like all trunk-twisting exercises, increase risk of disc herniation and osteoporosis–associated spine compression fractures. The spine is weakest under twisting forces (torque), but more resilient under forward and backward bending forces...up to a point. Any twisting should be controlled and strong trunk/core muscles stabilize the spine and prevent quick, uncontrolled movements that might damage discs and vertebra.

Back Hip Extensors:

Stretch Back Hip Extensors—Hamstrings (Flat Back and Sway Back): For a specific easy exercise: Hamstring Stretching from Duke Sports Medicine. But no extra exercise time is needed if a Deadlift Hamstring Stretch is used in the middle of chores that require bending down such as loading/unloading the dishwasher (the way I got my lumbar curve back!); and also provides practice for keeping the back straight rather than in a rounded "scared cat" posture that unbalances the back stabilizer muscles and stresses the intervertebral discs (causes posterior bulging of the disc).

Strengthen Back Hip Extensors—Gluts and Hamstrings (Kyphotic–Lordotic Posture): Lie on the back with knees up. Keep the back in neutral position. Squeeze the Gluteus maximus (the butt cheeks) together. Then relax. Do 10 times, a couple times a day. A variation is to lie on the back, knees up and lift the butt off the floor keeping the back straight, as if making a bridge. See exactly how to perform this exercise in the video: Bridges for Glutes.
Squats are excellent for strengthening the entire posterior chain of muscles. They made a big difference in my life!

Front Hip Flexors:

Stretch Front Hip Flexors (for Kyphotic–Lordotic Posture; Tight Hip Flexors are often the Predominant Factor in Lumbar Hyper-Lordosis): Side Lying Quadriceps Stretch. Lie on your right side with right elbow bent to support the side of your head. Bend the left knee and grab the left ankle with left hand. Mainly use the glut and hamstring muscles to pull the left thigh behind the body, but gently pull up left ankle toward butt to help. Very importantly, keep the lower back curve neutral. Do not arch the lower back. Hold gentle, but firm stretch for 1 minute. Repeat a few times per day as long as no soreness. See video of Side Lying Quad Stretch. Also see this video of a Kneeling Hip Flexor Stretch. The same hip flexor stretch can be found on the ABC of Fitness site. (Make sure you are actually stretching the quads. My friend with hyperlordotic lower back thought she was doing side lying quad stretches but her body was fooling her; her lower back was arching even more to make up for tightness of her quads.)

Strengthen Hip Flexor Muscles at front of hip and thigh (for Flat Back and Sway Back): DO NOT DO THIS WHEN THERE'S BACK PAIN BECAUSE THIS EXERCISE WILL WORSEN IT AND CAN STRAIN THE LOW BACK. Walk in place or hold onto a support of some kind, and alternate raising each knee high enough so the thigh is horizontal to ground. Or while sitting in a chair with back supported, lift one knee with the hands as high as comfortable, let go and hold up for 10 seconds, then lower and lift the other knee, repeat 10 times. If no pain at all, try Seated Straight Leg Raises: Start seated on mat with back straight, knees bent, feet flat on the mat. Lean back keeping back straight, arms/hands behind in support, and extend one leg forward (knee may be slightly bent) and toes pointed (the other leg still bent with foot flat on mat). Tighten thigh muscle and lift the straight leg a few inches above the mat, hold a few seconds then lower. Repeat 5 times, then repeat with the other leg. With time increase reps until 20 have been reached. For extra strengthening light weight can be added to the ankle of the leg being lifted.

† warm up with a 5 to 10 minute walk or take a warm shower/bath.

 

 

© 2017 Rochelle Cocco