back pain

UPPER CROSS AND LOWER CROSS SYNDROME

Upper cross syndrome and lower cross syndrome are terms referring to muscle weakness and tightness in certain areas of the body that may be contributing to pain and/or reduced functional level. Each “syndrome” entails two predominant areas of muscle tightness and two predominant areas of muscle weakness. Oftentimes, these limitations occur as a result of impaired posture and can lead to pain. Once identified, both upper cross and lower cross syndromes can be effectively treated and managed with physical therapy care.

UPPER CROSS SYNDROME

The upper cross syndrome refers to the “upper half” of the body; the waist up. The two zones of muscle tightness are the pectoralis (pec) muscles and the upper trapezius/levator scapulae muscles. The pec muscles (pec major and minor) are located on the anterior (front) aspect of the chest. The upper trapezius and levator scapulae muscles are both located on the lateral (side) aspect of the neck and connect into the back. At the end of a long workday at a desk, posture can become less than ideal which includes forward head posture and slouching of the shoulders. With poor posture, these muscles become stretched and are unable to perform their jobs as effectively as needed and can lead to pain.

LOWER CROSS SYNDROME

The lower cross syndrome refers to the “lower half” of the body; the waist down. The two zones of muscle tightness are the lumbar (low back) paraspinal and the hip flexor muscles. The lumbar paraspinal is located in the lower back on either side of the spine. The hip flexor muscles are located on the front of each hip. Standing posture contributes to the prominence of the lower cross syndrome and includes increased curvature through the lower back and positioning of the abdomen in a more anterior (forward) position. Over time, standing with increased curvature through the lower back and can lead to increased tightness through the lumbar paraspinal and hip flexor muscles. These limitations form half of the “cross” of the lower cross syndrome. The second portion of the cross of lower cross syndrome involves weakness through the gluteal and abdominal muscles. With poor standing posture, these muscles become stretched and are unable to perform their jobs as effectively as needed and can lead to pain. https://www.nhs.uk/live-well/exercise/common-posture-mistakes-and-fixes/

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