A Second Opinion

Hey, ever tuned into Tim Ferriss’ podcast? ?️ If you have, you might’ve heard about his battle with lower back pain.

While he’s recently got advice from Dr. Shirley Sahrmann, I’ve got a few thoughts of my own.

Do I agree with Shirley?

Let’s dive in!

Shirley Sahrmann’s Diagnosis

Dr. Shirley pointed out that Tim has a swayback posture.

This posture consists of the following findings:

• Increased upper back curve (Kyphosis)
• Pelvis that translates forward
• Acetabulum relatively points out (retroversion)

It can look like an anterior pelvic tilt, but it’s not quite the same. That’s because the upper back posture magnifies the lower back appearance.

The movement issue with this posture is hip rotation. Swayback posture creates reduced hip internal rotation, which Tim states he has! ?

There is an association between reduced hip internal rotation and lower back pain (here & here).

Dr. Sahrmann stated that this limited motion is structural. But is it?

While retroversion is a thing, it assumes we’ve exhausted trying to gain this motion. What if we could teach Tim the opposing strategy?

By God! I’m gonna try for you, Tim. Here’s how.

Tim’s Back Pain Game Plan

If the swayback posture creates a pelvis that translates forward, then we need to bring it back. For this, we need to expand the following area: The Posterior Lower Pelvis.

To do this, there are 2 tactics we can use:

1. Shifting the hips back and down
2. Drive relative internal rotation

Here are the 3 moves I’d give Tim.

Frog Breathing

Frog breathing works by driving internal rotation from an externally rotated starting position. The internal rotation (IR) occurs from weight bearing. If we drive IR, the posterior lower pelvis will expand!

Here’s how to do it:

• Knees wider than hips.
• Make a triangle with your arms.
• Hips less than 90° flexion.
• Eyes straight down
• Contact points: Elbow, wrist base, inner knee
• Nasal breath in
• Mouth exhale, progress pressure into the above contact points
• Repeat: 5 sets of 5 breaths, twice daily for 2-4 weeks.

Retro Frog Crawl

This move biases even more posterior lower expansion by moving backwards. To move backward, you must create space back there. this move works well for that:

• Set up as above.
• Breathe in through the nose, heavy through contact points above
• Drag the opposite hand and foot back
• Exhale and limbs back down
• Alternate sides
• Repeat: 4 sets of 5 steps per side, twice daily.

Walking Wall Squat

Hinging/deadlift requires A TON of hip internal rotation. Since Tim is likely limited, we need something that’s hinge-like, but less range.

For that, this walking wall squat is a great choice it’s like a mocktail version of a deadlift, and it’s quite tasty!

• Stand an arm’s length from a wall.
• Use a box or chair behind you.
• Feet wider than hips, toes out.
• Hands on the wall, breathe in.
• Exhale & get heel heavy
• On the next inhale, suction cup hands to walk down the wall. Aim your rear for the box (hips back & knees bent)
• Hold and breathe
• Repeat: 4 sets of 5 breaths, twice daily.

Sum up

Tim, if you’re reading this, give these moves a try! They address the movement limitations associated with this presentation. I hope they make a difference.

To recap:

• Swayback posture = pelvis forward + Upper back rounded
• Associated with a hip internal rotation loss
• The key is to expand the posterior lower pelvis

If you aren’t Tim and want your posture improved, should you sit up tall? Check this post to learn about if that’s the play.