In our previous article, Lower Cross Syndrome (crucialrehab.com) we talked about muscle imbalances in the lower portion of our body resulting in a pattern known as Lower Crossed Syndrome. A similar postural dysfunction also occurs in the upper portion of our torso and is known as the Upper Crossed Syndrome. The word ‘crossed’ here indicates a cross action of overactive muscles as well as underactive ones. From the side, you would notice an imaginary ‘X’ pattern formed by the activity of both groups of muscles. With the shoulder girdle connecting multiple muscles from the neck to the shoulder joints, muscles in the chest or upper back would greatly affect the posture of the neck. In other words, these two parts are closely related. For someone with this syndrome, they would appear hunched in the back with their head poking forward.
Specific postural changes that are seen here include forward head posture, increased thoracic kyphosis and elevated and protracted scapulae. It gives the illusion that someone is not standing upright and this leads many to hyperextend their back in order to keep their backs straight. However, this does not change the position of the shoulder blades, upper back or neck. If anything, it may even lead to secondary issues such as middle back pain due to the overcompensation of back extensor muscles. Upper cross syndrome can often be a cause of neck and upper back pain as well as a contributing factor to shoulder dysfunctions. This may lead to possible shoulder injuries.
Muscles that are overactive and usually tighter in this case includes the chest muscles - pectoralis major/minor as well as the muscles at the back of the neck - upper trapezius and levator scapulae. Underactive or weaker muscles include the muscles in front of the neck - neck flexors and upper back muscles such as the rhomboids, lower trapezius and serratus anterior.
How do we correct this issue? The best thing to start with is to stretch out the tight components and strengthen the weak muscles.
Stretching Exercise
Pectoralis Stretch
Levator Scapulae Stretch
Strengthening Exercise
Deep Neck Flexors Strengthening
Chin Tuck Exercise
Chin Tuck in Quadruped Position
Rhomboids Strengthening
Lower Trapezius Strengthening
References:
1. Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance: The Janda Approach 2010, Champaign, IL: Human Kinetics.
2. Bae WS, Lee HO, Shin JW, Lee KC. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J Phys Ther Sci 2016;28(5):1636–9
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