Upper Cross and Lower Cross Syndromes

Upper Cross and Lower Cross Syndromes

Upper Cross and Lower Cross Syndromes

If your head is positioned forward of normal, if your backside sticks out too much, if you have a weak pendulous abdomen and are pigeon toed- chances are you are suffering from a cross syndrome.

What is it?

Due to the sedentary nature of life today, most people have some degree of contracture or tightening in the front of their hips. This continuous tight area produces a weak and elongated gluteal (backside) region. Similarly, sitting at a desk with the head forward of normal leads to a contracture of the front of the neck muscles and a reactive spasm in the upper back. A series of further contractures and inhibitions result in a cascade of reactionary muscle imbalances that lead to the posture typically described as both Lower and Upper Cross Syndrome.


Lower Cross Syndrome was first described by Czech physician Vladimir Janda. He noticed that the front of the hip (hip flexor muscles) was very tight in many of his patients, and that their antagonist muscles (the hip extensors) were elongated and weak. This was the result of a neurological phenomenon known as reciprocal inhibition (where activation of one muscle reflexly causes inhibition of its opposition muscles), and was to play a major role in his future research and therapy design. Many people suffer from the chronic effects of Lower Cross syndrome, which can be present in any age group, fitness level or occupation.



What are the characteristics?

In the diagram to the left, observe how the head is positioned way forward, with the centre of gravity line significantly behind the ear (rather than straight through it). This will cause a great deal of activity in the upper back muscles, which try to maintain neutrality of head position. Observe how the chest is sunken, which will eventually influence respiratory function. Notice further that the shoulders will have rolled forward due to tight chest muscles, exposing the lower back to increased strain. The Pelvis has rolled forward in response to tight hip flexor muscles, which results in a protruding and weak abdomen as well as a weakened  backside and hamstring region. The front of the thigh is tight, as are the calf muscles, resulting in knee joint strain; while the shin muscles are weak with the feet allowed to roll inward (pronation) resulting in flat footedness and possibly knocked-knees. The colour shaded areas in the right of the sequence represent typical weak (blue) and opposing hyperactive-contracted (red) muscle groups, and you will notice how they establish the illustrated “Cross” syndromes in both the lower and upper back regions. In fact there are several more possible “Cross” syndromes involving the lower leg, upper neck, jaw and arm regions, all related to the effects of a sedentary civilisation and the effects of reflexive inhibition of particular groups of muscles.



What are the consequences?

Below are some of the common health problems that can arise from chronic Upper and Lower Cross syndromes:

  • Trigger Points and fibromyalgia
  • Ache or burning in the shoulders
  • Pins and needles, or other referred symptoms into the arms and hands
  • Rotator cuff strains and other shoulder problems
  • Breathing disturbances including Asthma
  • Emotional and psychological conditions such as depression
  • Migraines and tension headaches
  • Digestive disturbances, bowel problems, kidney  and menstrual dysfunction due to circulation failures
  • Allergies and weak immune function, such as Candida infections etc.




It might seem peculiar to a reader how postural faults might relate to functions such as immunity and digestion. Bear in mind that the abdominal organs are not fixed in place but rather move and roll rhythmically based on the rise and descent of the diaphragm during breathing. This movement of organs promotes circulation within the body, movement of the bowel and digestive organs, as well as assisting in the secretion and distribution of hormones, enzymes, immune cells and other substances. Similarly, elimination of toxins and excess fluid can be impaired when there is stasis of organs and internal circulation. If the ribcage is put under mechanical strain from poor posture, slouching, obesity or prolonged sitting, this strain will be reflected in the function of all organ systems in the body.


What can be done about it?

As you might imagine, one of the aims of treating such conditions would be to try and balance some of the opposing muscle groups. In other words, stretch the “red” muscle groups and strengthen the “blue” muscle groups. However, as most people exhibit some degree of weakness and contracture in many muscle groups, it is important to stretch all your muscles for the purpose of stimulating good sensory and circulatory flow, which is why our exercise section has activities that will work both extremes. Nevertheless, from a clinical perspective it is most important to focus on the following activities:-


Upper Cross Syndrome

  • Stretch the pectoral muscles
  • Stretch the upper back muscles
  • Strengthen the middle back
  • Strengthen the rear shoulder muscles


Lower Cross Syndrome

  • Strengthen the gluteal muscles
  • Strengthen the abdominal muscles
  • Strengthen the hamstrings
  • Stretch the hip flexor muscles
  • Stretch the quadriceps muscles (front of the thigh
  • Stretch the calf muscles
  • Stretch the low back muscles

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