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Upper & Lower Cross Syndrome

This syndrome may sound intimidating or complicated but the truth behind that matter is that this condition is one of the most commonly presented conditions in todays society. This does not target any one specific gender, age group, or level of activity level – instead, this can be observed in nearly anybody at any time of life. In this article I will be breaking down what exactly this syndrome is, the symptoms, how to assess yourself and most importantly, how you can begin making dramatic change right away to correct this condition.

Upper and lower cross syndrome refer to a series of muscle imbalances within the body. It is possible to have one or the other (upper or lower), but it is also not uncommon that one can lead to developing the other as well. The human body is comprised of many different organs, tissues and structural components. Upper cross syndrome (UCS) or lower cross syndrome (LCS) effect the muscular and skeletal systems of the body causing muscle imbalances that result in poor posture, muscle aches and pains, reduced mobility and distorted movement mechanics.


Upper Cross Syndrome

What it is

Upper cross syndrome is often described by the presentation of rounded shoulders and a forward’s head position, or a “slouched” posture. UCS gains its name do to the cross relationship between stretched/tight suboccipitals, the upper trapezius and shortened/tight position of the pectoralis major/minor muscles with the weakness found in cervical flexors of the neck, the serratus anterior, rhomboids and lower traps between the shoulder blades.


Things that are most likely to cause UCS are extended or repetitive bouts of sitting at a desk, driving or slouching while eating, reading or being on a mobile device. Any activity that is likely to create a slouched posture where the body is leaning forwards will exacerbate this issue. For many, getting into the gym and working on strengthening the body is the go to remedy to correct UCS but without understanding what is actually going on, a uneducated approach to resistance training can also create an environment for UCS to develop. Overtraining muscles such as the chest and shoulder without adequate exercise balance to strengthen the back, spending too much time cycling or performing too much frontal flexion core exercises such as sit ups can all make the situation worse. Another area to be aware of while training is that often these imbalances within the body can cause distorted movement patterns. Muscle imbalances and improper movement can further make symptoms worse. Due to these postural distortions, it is easy to compensate using the overworked and tight muscle opposed to the target muscles intended.


There are two relatively simple ways to be able to tell if this is something you may be dealing with. One is to set up a camera or have a friend photograph you from a side profile position. Allow yourself to stand normally in a relaxed position without trying to correct your posture. In the ideal position, you should be able to draw a straight line from your earhole down and your ear, shoulder, hips, knees and ankles should be stacked. If UCS is something that is affecting you, it is common to see the head and shoulder fall slightly forwards of the lower body. In more extreme cases the head will be forwards of shoulders and the upper (thoracic spine) back will be in a flexed (rounded) position. The second way to test for UCS would be to perform a Wall Arm Slide Test. This test can also be used to help identify lower cross syndrome as well so it is always one I use with clients to identify where I need to focus attention to when doing program design, including the eligibility to perform overhead movements and barbell back squats.. For this test, you will stand with feet about shoulder width apart and about 12-18” away from a wall with back towards wall. Here you will sit back so that you can feel points of contact at your glutes, lower back, upper back, shoulders and back of head. For some people, doing this while maintaining all points of contact will not be possible and this would indicate either lower or upper cross syndrome depending what points of contact are unable to reach or stay in contact with the wall. If you are able to maintain these points of contact, you will then lift arms straight out in front of body, pull elbows back to touch the wall with elbows at 90°, then rotate arms back to bring the backs of your hands flat in contact with the wall. Take note, are you still maintaining all points of contact at your hips, lower back, upper back, shoulders, back of your head and the addition of elbows and the backs of your hands. As you are performing this, if you find your back or head is unable to maintain contact or you are unable to rotate hands flat against the wall then it is likely you have UCS. If you find that your lower back is unable to maintain contact, then lower cross syndrome may be more of the culprit (remember it is possible to have both upper and lower cross present at same time).


Understanding any muscle imbalance is essential to understanding how to solve the problem. If you continuously work a muscle that is already tight and shortened (i.e. the chest, upper traps) then issue will worsen. These areas need to be stretched out to break up the tension present from being over worked. The opposing muscle groups (i.e. the rhomboids and lower traps) needs to be strengthened to help bring additional muscle tone to these areas to offset the tension that is in front of the body. Depending on the severity of the scenario and the daily frequency of postures, positions and movements that created the condition will impact exact programming to correct it. Start each upper body workout by performing 15 minutes of stretching and mobility work to reduce tension through the chest, shoulder, and lats. This will help improve your range of motion during workout and improve your efficiency. Performing shoulder dislocates with a stretch band or dowel can target these areas. I also like to add in band pull aparts at this time to begin priming the back side of your body for workout. Target the rhomboids and lowers trap muscles by performing seated row with elbows away from your body and prone laying AWTY lifts or holds to strengthen the lower traps. A 3:1 ratio of back work to chest work is a good place to start to begin offsetting this imbalance. As you do your rowing motions, ensure you are retracting your shoulder blades back and squeezing together without allowing your shoulder to roll forwards and elbows flare up to ceiling. Keep your elbows low and encourage your pulling motions more towards your hips then mid torso or chest. In some cases, having some type of manual therapy such as massage, active release, or fascial stretch therapy can help address the overworked areas so that body can get the most response from the corrective efforts during the workout. The last piece here may not be a component of your workout routine, but on a regular basis throughout the day performing a chin tuck can help to strengthen the muscles of the rear neck. This is best performed by clasping your hands and holding behind your head as an immovable barrier. Now, while keeping chin parallel to the ground, perform a chin tuck by giving yourself a double chin and pressing back of head into your clasped hands and holding for 5 seconds, rest and repeat this 5-8 times repetitions. Several sets of this throughout the day will help reduce tension in the neck and help to support your head in a better position.

Lower Cross Syndrome

What is it

Similarly, to UCS, lower cross syndrome (LCS) is identified by a series of muscle imbalances but in the lower body. Often visible in people who have an excessive sway in their back, their butts appear to be sticking out and the abdominal region may appear distended. Lower cross syndrome refers to the tightness and shortened position of the lumbar erectors and the iliopsoas/rectus femoris crossed with the stretch and weakened rectus abdominis and the glute maximus/glute medius muscles. This imbalance causes an anterior (forwards) pelvic tilt that can be associated with lower back and hip pain which ultimately can refer pain downstream to the knees and ankles.


Similarly to UPC, this can be caused by poor posture, improper movement mechanics, unbalanced training routines and a sedentary lifestyle (i.e. too much sitting). Extended periods of sitting is likely to be the most common offender for causing LCS, simply because when you sit the hip flexors and quads shorten and if you spend excessive periods of time in this position without moving or stretching the body begins to adapt to the familiar position. This tightness pulls the pelvis forwards when in an upright standing position which causes that rotation in the pelvis which inhibits the glutes and the abdominal regions. Based on how we all move and work in a frontwards moving fashion, the quads/hip flexors are an area that already get overworked. Now if you get into the gym and begin squatting and lunging and doing all these great lower body exercises with excessively tight quads, this can feed into this imbalance greater. Cardio exercises such as running, biking, rowing and elliptical can all further tighten the quads, and with the coupled inhibition in the glutes, this is a recipe for other issues such as sciatica, IT band syndrome, knee pains and many other less than desirable aches and pains.


Determining if you have LCS is generally done by visually assessing the posture. If you stand with your side to a mirror in a relaxed pose and you can visibly see a large sway in your lower back this is a strong indicator that you have LCS. You can also landmark the boney prominent at the front of your hip and landmark the boney prominent at the back of your hip (right near where your back dimple would be) and compare them. These two landmarks should be nearly on the same level, normally the back landmark is just slightly higher. Sometimes asking a friend or family member to help you with this makes it easier for you to relax in a standing posture and they can get on their knees to get a real good visual as to any variance. In LCS the rear landmark is often much higher than the one in the front, indicating that the pelvis it tilted forwards. Other less technical but often sure signs of LCS is generalized tightness in the hips, low back pain from sitting for extended periods of time, back pain when doing lower body exercises, a notably weak core or back pain when performing abdominal exercises and the inability to lay on your stomach and bring your heels back to within a fists width of your butt.


Taking a moment to really grasp which muscles are tight and short and which are stretched and weak is important to tackling LCS symptoms. The quadriceps and the hip flexors at the front of the hip are the pain culprits here. This means that if you are someone who spends all day sitting at a desk, regular daily maintenance will be required to start trying to offset the amount of time spent in a flexed hip position. This may require a set mobility routine that you perform in the morning before work, before your workouts, and again in the evening before bed. This routine can be short and sweet but regular frequency will help reverse this situation. Performing a sprinter’s stretch or some 90/90 hip mobility will address all the tightness and restrictions common to someone with LCS. For some people who are very restricted in their movements, beginning this process with some manual therapy to break up muscle tension and fascial adhesions will be necessary so that you can actually get down to the floor to perform the required mobility. Once you can work though these movements, you now want to work on strengthening those stretched out and weakened abdominals and glutes. There are many ways to begin building strength in but ensuring you can properly engage and connect with these muscles during simple priming exercises will result in a greater likelihood of connecting with them during larger more complex movements. Performing glute bridges, clamshells and dead bug exercises are all great ways to start correcting this imbalance. If when performing the dead bug movement, there is hip or lower back discomfort, an alternative would be a forearm front plank or even deep diaphragmatic breathing techniques. This can be done by forcefully exhaling all the air out of lungs, squeezing to create as much tension in the abdominals as possible as if trying to pull ribcage down towards the pelvis and tilting pelvis up towards ribcage from a laying on your back position. Connecting your breathing with your ability to create tension through the midsection is important to being successful with abdominal training exercises and creating maximum stability for the spine when performing exercises.


It is not uncommon that everybody has some degree of either upper, lower cross syndrome or both just based on how we as humans move, work, play, sleep etc. Our bodies are freakishly good at taking the easiest path of resistance and creating compensative patterns based around the daily stresses we put our bodies under. With that being said, ignoring the matter and just going about life is a recipe for restricted mobility, muscle tension and pains, increased stress, reduced sleep, reduced productivity and just overall decreased enjoyment of life and the things you enjoy doing. Taking action and establishing healthy habits and doing effective mobility work on a regular basis will guarantee that you feel good, move better and are able to get the most out of your daily routine. Now that you have taken the time to understand what these conditions are you have all the knowledge to address it, so get on out there, establish new habits, train smart and crush some goals.

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