Swayback vs Lordosis Charlotte NC | Posture, Hyperlordosis, and Imaging | Clear Life Scoliosis

By Dr. Justin M. Dick, DC · Clear Life Scoliosis and Chiropractic Center, Charlotte, NC · Published November 05, 2026

Swayback is a posture in which the pelvis shifts forward of the ankles and the upper body leans back to balance it. Hyperlordosis is an increased inward curve of the low back. They are often confused because both make the low back look hollow. In a study of 30 young adults using motion sensors, the overall lumbar curve was the same in people with and without sway-back posture; the difference was regional, with a flatter upper lumbar spine and a sharper lower lumbar curve in the sway-back group.

I am Dr. Justin M. Dick, DC, at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. I am Chiropractic BioPhysics certified and hold CNMT and ARRT(N)(CT) imaging credentials. Sorting a posture from a structural curve takes a standing film, and this post explains why.

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Swayback Posture

Swayback describes the whole-body arrangement: hips forward, upper trunk back. As a posture, it can change with position and effort. Shin and colleagues measured 30 asymptomatic young adults with sensors at T1, T7, T12, L3, and S2. Global lumbar angle did not differ between sway-back and normal groups, but the sway-back group had a flatter upper lumbar arc and a steeper lower lumbar arc. A single lordosis number on a report can miss that pattern.

Hyperlordosis

Hyperlordosis is a structural or habitual increase in the lumbar curve. Been and Kalichman's review found lordosis varies with age, sex, body mass, ethnicity, and sport, and that greater lordosis is associated with spondylolysis and isthmic spondylolisthesis. Roussouly and colleagues showed that lordosis shape follows the tilt of the sacrum, which is set by pelvic anatomy, so a deep curve can be normal for a person with a high pelvic incidence.

Telling Them Apart

A standing lateral radiograph shows where the pelvis sits relative to the feet and trunk, the regional shape of the lordosis, and the pelvic parameters. Swayback shows a forward pelvis with a relatively normal or flattened upper lumbar curve. Hyperlordosis shows an increased lumbar curve, often with an anterior pelvic tilt. This distinction is clinical radiographic reasoning applied to the studies above.

What Can Change

Posture can change with training and awareness, but I found no randomized trial specifically treating sway-back posture with a measured outcome, so I cannot give an effect size. For reduced lordosis, Diab and Moustafa's trial showed extension traction changed the radiographic curve, though pain differences were not statistically significant; my post on adult sagittal balance and my lordosis treatment post cover that evidence.

How Dr. Justin M. Dick, DC Evaluates Posture at Clear Life

At our Charlotte office, posture complaints start with standing observation and, when clinically indicated, standing radiographs measured for regional lordosis, pelvic parameters, and global balance. Care then targets what the measurement shows. Our Chiropractic BioPhysics page explains the approach.

Comparison

Research and Evidence

Evidence tiering: Shin is a small cross-sectional sensor study, Roussouly a radiographic study of volunteers, Been a narrative review, Diab a randomized trial of traction in reduced lordosis. No trial measures treatment of sway-back posture directly.

My own published work includes sagittal alignment in older adults. The geriatric sagittal alignment case series, Radiographic Sagittal Alignment and Kinetic Chain Alterations in Geriatric Patients With Scoliosis: A Case Series(Cureus, 2026, PMID 42037873), describes two patients and is case-level evidence.

References

1. Shin SS, An DH, Yoo WG. Assessing the effects of sway-back posture on global and regional spinal sagittal angles using inertial measurement units. J Back Musculoskelet Rehabil. 2023;36(3):661-667. doi:10.3233/BMR-220072
2. Been E, Kalichman L. Lumbar lordosis. Spine J. 2014;14(1):87-97. doi:10.1016/j.spinee.2013.07.464
3. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine. 2005;30(3):346-53. doi:10.1097/01.brs.0000152379.54463.65
4. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J Manipulative Physiol Ther. 2012;35(4):246-53. doi:10.1016/j.jmpt.2012.04.021
5. Whelan JP, Dick JM. Radiographic sagittal alignment and kinetic chain alterations in geriatric patients with scoliosis: a case series. Cureus. 2026;18(3):e105827. doi:10.7759/cureus.105827

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Service Area

Clear Life Scoliosis and Chiropractic Center sees patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, Fort Mill SC. Families from across the Charlotte region and the South Carolina border communities come to the Rachel Freeman Way office for radiographic scoliosis evaluation with Dr. Justin M. Dick, DC.

Related Pages

• Sagittal Alignment
• Adult Sagittal Balance
• Can Poor Posture Cause Scoliosis
• Postural vs Structural Scoliosis
• Chiropractic BioPhysics in Charlotte
• Tech Neck
• Can Scoliosis Cause Pelvic Tilt
• Radiographic Imaging Credentials
• Scoliosis Care Program
• Dr. Justin M. Dick, DC Research

Schedule an Evaluation in Charlotte

If your low back looks hollow and you want to know whether it is posture or structure, a standing film answers it. Dr. Justin M. Dick, DC provides that at our Charlotte office.

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