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Upper and Lower Crossed Syndromes

You may have heard the terms upper and lower crossed syndrome before. Perhaps from health care professionals or fitness trainers. You may have even recognized these patterns in yourself or others, without even realizing it.

Today, I want to explain what these syndromes are, how it may relate to the development of painful conditions and how to prevent and manage these common syndromes.

These syndromes are a simplified way to describe common patterns of muscular dysfunction. With sustained or repetitive postures our bodies will inevitably develop muscular imbalances and we will develop tightness in certain muscle groups and weakness in others.

These muscle imbalances often occur because while sitting, we put a strain on certain muscles while neglecting others. Another contributing factor is not every muscle behaves the same. We can generally categorize muscles into two groups.

  • Tonic: Tonic muscles can be thought of as postural. These muscles help maintain posture by maintaining tension. If we rely on these muscles too much, they have the tendency to get tight and overactive. Think of tightness often felt in the trapezius and hamstring muscles.

  • Phasic: Phasic muscles can be thought of as muscles that initiate movement. These muscles are generally larger and dynamic and contract to initiate movement. If we do not recruit these muscles, they tend to get weak. Think of weakness often seen core and gluteal muscles.

It is important to note that these are very general categories and all muscles relate to both posture and movement in some way.

These imbalances are often seen in two major types.

Upper crossed Syndrome:

This refers to the pattern seen in the upper quarter of the body including the head, neck, shoulders, and upper back region.

With this pattern, there is an increase in tone in the upper trapezius and pectoralis and weakness of the lower trapezius and deep neck flexors.

This pattern results in an anterior head carriage, where the head translates forward and rounding of the upper back and shoulders.

Lower Crossed Syndrome:

This refers to the pattern seen in the lower torso and hip.

With this pattern, there is increase tone in the lumbar spine erectors, and hip flexors and weakness of the abdominals and gluteals.

In this pattern, individuals may develop an anterior pelvic tilt, where the lower back arch is accentuated. These individuals may also experience more difficulty extending the hip due to tight hip flexors.

What is the cause?

There is no doubt that you have seen people with these patterns or may experience this to some degree. Sitting postures are often cited as the cause for developing these conditions and this is at least partially true. When we are in static postures such as sitting, we will inevitably stress those tonic muscle groups. This is because these muscles do not fatigue as easily as the phasic muscles and end up being recruited heavily to maintain those static postures.

The other side of this coin is our lack of movement. As mentioned, previously the phasic muscle groups are emphasized during dynamic positions. If we are not moving enough throughout the day these muscles are not recruited. As a result, we will consistently neglect these muscles while overemphasizing the tonic, postural muscles.

Will this cause me pain?

These patterns are quite common and many people who develop upper and/or lower cross syndrome may not develop pain. These syndromes are “functional diagnosis” but over time these dysfunctional patterns may lead to conditions that cause neck and back pain.

This may range from a sensation of tightness in the back or neck to more significant conditions such as disc injuries or chronic neck and back pain.

How can I treat or prevent this from happening to me?

The best thing you can do to prevent or treat these syndromes is to develop muscle balance. This is done in several ways.

The first is to vary posture and avoid static postures when possible. This may include addressing workstation ergonomics or taking frequent breaks.

The next thing is to work on strengthening weaker muscles which will help lead to better balance. Strength or postural exercises have the obvious effect of leading to better muscle tone but will also help you become aware of your posture. If our brain can recognize positions that add stress this allows us to make corrections.

Stretching is also an important aspect of managing this condition. Over time, the tonic muscle groups become short. We want to gradually lengthen these tissues which help relieve tension. Stretching, like postural strengthening, will also help us become aware of our body's position and make corrections as needed.

The charts below offer some simple starting points to treating and preventing these common syndromes.

Upper crossed exercises:

Lower Crossed Exercises:

Also, check out our video library which contains a variety of strengthening and stretching exercises.


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