Upper Crossed Syndrome

What is Upper Crossed Syndrome?

Upper Crossed Syndrome is the condition build due to the stiffness of the superior trapezius and levator scapula on the dorsal side crosses with the rigidity of the major and minor pectoralis. The deep cervical flexors become weak and ventrally crosses the weak middle and lower trapezius.

This type of bony imbalance leads to joint dysfunctions, like an atlantooccipital joint, glenohumeral joint, cervicothoracic joint, C4-C5 segment, and T4-T5 segment.

These joint dysfunctional stress affects corresponding spinal areas including transitional zones and the morphological alteration occurs at the neighboring vertebrae. Alternatively, Upper-Crossed Syndrome is also known as shoulder or proximal girdle crossed syndrome^1,2.

Pathophysiology

In Upper-Crossed Syndrome, certain postural changes like heads posture forwarded, cervical lordosis and thoracic kyphosis enhancement, expanded and elevated shoulders. All these altered postures reduce glenohumeral stability due to the more vertical positioning of the glenoid fossa, which leads to abduction, rotation and wining of the scapulae. Upper trapezius and the levator scapula are more active to manage this stability reduction for maintaining glenohumeral centration^1,2.

Symptoms

In upper crossed syndrome, the mutual inhibitory process of bony structures causes one-sided muscles of a joint are relaxed for accommodating contraction on the other side of that joint. The included symptoms are:

• Posture of the head is forwarded
• Shoulders rounding of
• Upper back position has a curvature
• Headache
• Pain symptoms develop at shoulder, neck and upper back position^1,2,3.

Causes

A fierce cycle is involved in the development of upper crossed syndrome. The responsible cyclic alteration occurs due to a deskbound lifestyle in which prolonged sitting with bad posture, untrained exercise performance like rounded back position during riding a bike and/ or training imbalance because of training guidance provided by the untrained person¹.

Complications

Myofascial Adhesion’s

This condition is restricted to a point and occur due to stable stress develops on the levator scapula, upper trapezius, and pectoralis muscles place.

A migraine & Tension Headaches

Cervical nerves innervated musculoskeletal tissues have referred pain in the head. Forward carriage in the head causes stress enhancement on the upper trapezius and levator scapular muscles and increase the risk of regular headaches.

Reduced Lung Capacity

upper crossed syndrome often associated with breathing dysfunction. In upper crossed syndrome, typical head forwarded position and rounded shoulders leads to rigidity and constriction of the upper trapezius, levator scapulae, sternocleidomastoid, scalenes and pectoralis minor muscles.

The over activity of these muscles and altered positioning of the rib cage can cause respiratory functioning impairment.

Nerve Impingement & Compression

The rounded posture or kyphotic associated with upper crossed syndrome can affect the thoracic and cervical spinal nerves.

The shoulder and neck adjoining thoracic and cervical spine joints are over stressed and increased tension placed over these nerves and muscles generates because of the unnatural positioning of the shoulder and neck.

Substantial compression and compromises of the associated nerves can lead to pain and other neurological symptoms like loss of sensation, muscle weakness, pin pricking sensation and burning sensation.

Neck Pain

The cervical nerve compromised condition can be occurred due to rigid upper trapezius and levator scapula. In severe condition, the cervical nerve also compromised.

Rotator Cuff Injury

The shoulder blades tilt forwarded due to postural incorrectness and rounding of shoulder forces. This condition is termed as winning. Shoulder socket or glenoid fossa become altered because of several factors including the rounded shoulder posture, the mechanical axis of rotation is involved.

Rotator cuff muscles assist in providing additional stabilization of the humerus (arm). The resultant of these muscular additional activations and overuse lead to shoulder impingement > tendinitis > bursitis rotator cuff strain^1,2.

Treatment

Experts suggest the following intervention for correcting upper crossed syndrome:

• Chiropractic intervention
• Myofascial release
• Trigger-point therapy
• Extended series of exercises and mobility drills³

Exercise

There are several exercises available for correcting upper crossed syndrome. Here we discuss some of the posture correcting stretching exercise

Standing Theraband Row

This exercise helps to strengthen back or trapezius muscle and posterior rhomboid muscles. It is necessary to check prior to conduct exercise is the shoulder blades able to pull back and to set initial position.

Foam Roller Subscapular Activation

The correct performing of this exercise involves the subscapularis and serratus anterior muscles. The strengthen of these muscles play a vital role in providing positioning and stability of scapula and shoulders.

Prone Scapular Stabilization

During this exercise shoulder blades are squeezing and assist in resetting the shoulder blades. In this exercise, a person has to lie down by facing down the chin tucked and shoulders rolling to squeezing back the shoulder blades and hold the position for 45 seconds.

Foam Roller Thoracic Extension

Thoracic spine mobility improvement and reduction of kyphotic posture is the main goal of implementing this exercise for upper crossed syndrome. In this exercise, head weight is holding by upper extremities at the time of bent over the roller.

Deep Neck Flexor (Chin Tucks)

This cervical spine exercise neutralizes forward head position. In this exercise, stand erect against a wall. In next step, chin placed on the chest position and depict head back to the wall. The frontal neck muscle requires to active enough to hold the position for a certain duration.

Chest Stretch

Chest stretching important for improving the working ability of pectoralis muscle. In this exercise, the elbow is placed against a wall and revolve the body away from attaching point until a stretch is felt across the chest. The Same need to conduct for opposite side.

Lat Stretch

In this stretching exercise, the shoulder is rotated internally and can assist in rounding of the shoulder. Hand position needs to maintain at the line with opposite shoulder. tilt back positioning place the tension of the body weight on the lats. Hip positioning shifting needs to increase the stretch even further.

Trapezius Stretch

Trapezius Stretch – In upper cross syndrome, tightening of upper trapezius is renowned and even more. Keep the right upper limb bellow the seat and rotate the right shoulder in the backward direction.

Gently move the left ear at the lower side and bent the neck towards left until the stretching felt across the right upper trapezius. Left hand requires increasing the stretch.

Levator Stretch

This exercise is quite similar to trapezius stretch. In this exercise, look straight and head needs to rotate by 450 and then put chin to chest. The hand which is free can be placed on the back of the head to lightly pull down until stretch increases⁴.

References

1. Muscle Imbalance Syndromes. Retrieve from http://www.muscleimbalancesyndromes.com/janda-syndromes/upper-crossed-syndrome/
2. IDENTIFYING UPPER CROSS SYNDROME FOR DUMMIES (PART 1). Invictus. Retrieve from https://www.crossfitinvictus.com/blog/identifying-upper-cross-syndrome-for-dummies-part-1/
3. Upper Crossed Syndrome: The Personal Trainer’s Guide; Retrieve from https://www.theptdc.com/2014/07/upper-crossed-syndrome/
4. Posture Correction Exercises for Upper Crossed Syndrome. Retrieve from https://www.healthandexercise.com.au/exercise-physiology/exercise-physiologyposture-correction-exercises-upper-crossed-syndrome/