Upper cross syndrome and lower cross syndrome are terms heard within the world of medicine that, on the surface, sound a little intimidating. However, each term simply refers 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. Often times, 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 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 work day at a desk, posture can become less than ideal which includes forward head posture and slouching of the shoulders. Over time, forward head posture and shoulder slouching can lead to increased tightness through the pecs, upper trapezius and levator scapulae muscles. These limitations form half of the “cross” of upper cross syndrome. The second portion of the cross of upper cross syndrome involves weakness through the deep cervical neck flexors as well as the lower trapezius/serratus anterior muscles. The deep cervical flexors are located deep inside of the neck with the lower trapezius and serratus anterior located in the back. 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 refers to the “lower half” of the body; the waist down. The two zones of muscle tightness are the lumbar (low back) paraspinals and the hip flexor muscles. The lumbar paraspinals are 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 prominence of 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, can lead to increased tightness through the lumbar paraspinals and hip flexor muscles. These limitations form half of the “cross” of lower cross syndrome. The second portion of the cross of lower cross syndrome involves weakness through the gluteal and abdominal muscles. The gluteal muscles are located on the posterior (back) and lateral (side) portions of the hips and the abdominals on the front portion of the abdomen. With poor standing posture, these muscles become stretched and are unable to perform their jobs as effectively as needed and can lead to pain.
Physical therapy intervention works to identify these deficits and then to address them by mobilizing muscles and joints that are tight and by strengthening muscles that are weak. A focused physical therapy plan of care can effectively manage both upper and lower cross syndrome to reduce pain, improve quality of life and improve function.
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