Lower crossed syndrome and how sitting will ruin your hips

Lower crossed syndrome is a postural condition that develops over time in the region of the hips and lower back, and the muscular imbalance creates potential risk to other structures throughout this region.

What is lower crossed syndrome?

Lower crossed syndrome is a postural imbalance that occurs in the muscles of lower back, pelvis, and hip joints. This condition is a result of prolonged sitting and will be exacerbated by poor posture.

While sitting, some muscles are stuck in a shortened position—a position which begins to take hold. At the same time, other muscles are stuck in a lengthened position, and these muscles become weak or inhibited.

Pertinent anatomy

It’s important to know some basic anatomy of the lower back, pelvis, and hips to understand lower crossed syndrome. First, you need to understand some of the bony anatomy (which includes the joints). Then, you can learn the muscles involved and how they are affected.

Bony anatomy

To begin, the bones of the lower back are the lumbar spine, which is comprised of 5 bones.

The lowest of these 5 bones attaches to the sacrum—the last bone in the spinal column that bears the weight of your body. One more bone attaches below the sacrum, called the coccyx. The coccyx is often called the tailbone.

The sacrum sits between the left and right pelvic bones. Each half of your pelvis has three parts:

  • Ilium: the back, upper portion of your pelvis; each ilium attaches to the sacrum
  • Ischium: the lower portion of your pelvis; these are the bones you sit on
  • Pubis: the front portion of your pelvis; these bones connect to each other—a joint called the pubic symphysis

Lastly, the femur bones are the thigh bones. On each side, the femur attaches to the pelvis, and these are your hip joints.

Bony anatomy of the lumbar spine, pelvis, and thighs
Bony anatomy of the lumbar spine, pelvis, and thighs

Muscles involved in lower crossed syndrome

Muscles that are affected in lower crossed syndrome include muscles that attach from the lumbar spine to the pelvis, muscles that attach from the pelvis to the femur, and one muscle that has attachments from the lumbar spine to the femur.

  • Lumbar spine to pelvis
    • Erector spinae: a group of muscles that extend and hold your lumbar spine upright (i.e. bending backwards)
  • Pelvis to femur
    • Hip flexors: a group of muscles that pull the thighs to the front of your body (i.e. knee-to-chest)
      • Iliopsoas: a hip flexor muscle that has attachments from the inside of the pelvis to the femur
      • Rectus femoris: a hip flexor muscle that attaches from the front of the pelvis to the leg (part of the quadriceps muscle)
    • Gluteal muscles: a group of muscles that extends and abducts your hip joint (i.e. climbing stairs or side shuffling)
      • Gluteus maximus: the large muscle of your buttocks (climbing stairs)
      • Gluteus medius: the muscles on the upper/outer portion of your buttocks that pulls the thigh outward (side shuffling)
  • Lumbar spine to femur
    • Iliopsoas: a hip flexor; this muscle also attaches from the lumbar spine to the femur
The iliopsoas and rectus femoris are hip flexors affected in lower crossed syndrome
The iliopsoas and rectus femoris are hip flexors affected in lower crossed syndrome

The abdominal muscles—namely the rectus abdominis (the 6-pack muscles)—are also involved, attaching from the lower portion of the ribs and sternum to the upper portion of the pubic bone.

Pathophysiology: what causes lower cross syndrome?

Lower crossed syndrome occurs when prolonged sitting creates tightness in some muscles and inhibition of others.

Tight or hypertonic muscles

While sitting, the hip flexor muscles described above are shortened from the flexed position of the hips. Over time, the muscles begin to hold in this shortened position.

This response to shortening is described as chronic hypertonicity. A hypertonic muscle is one that has an unconscious, partial contraction. A hypertonic muscle will also have resistance to stretching due to this low-grade contraction.

The tight or hypertonic muscles in lower crossed syndrome include:

  • Hip flexors: iliopsoas and rectus femoris
  • Lumbar erector spinae

These tight muscles will pull on the bones to which they attach, even when you’re no longer sitting.

Weak or inhibited muscles

While sitting, the gluteal muscles described above are lengthened and both the gluteal muscles and the abdominal muscles inactive.

Over time, this prolonged inactivity combined with the antagonist muscle tightness (hip flexors and lumbar erector spinae) creates weakness or inhibition of these muscle groups.

Weakness occurs in the gluteal muscles as a result of prolonged sitting
Weakness occurs in the gluteal muscles as a result of prolonged sitting

Muscle imbalance

Tightness of the hip flexors and lumbar erector spinae along with weakness/inhibition of the gluteal and abdominal muscles creates a postural imbalance in the lower back and hips.

The postural imbalance noted in lower crossed syndrome is a forward rotation of the pelvis and an excessive extension in the lumbar spine, known as hyperlordosis.

This excessive backwards curve of the lumbar spine may lead to back pain, commonly known as facet syndrome, mechanical or postural back pain.

Signs & symptoms: what does lower cross syndrome look like?

As a postural imbalance, lower crossed syndrome does not necessarily present with pain or other symptoms. The signs of lower crossed syndrome are the same details as described in Pathophysiology.

  • Muscular imbalance
    • Tight or hypertonic: hip flexors and lumbar erector spinae
    • Weak or inhibited: gluteal and abdominal muscles
  • Postural imbalance
    • Anterior pelvic tilt: forward rotation of the pelvis
    • Hyperlordosis: excessive backwards curve of the lumbar spine
    • External rotation of the hip: although not the hallmark presentation of lower crossed syndrome, thighs may be rotated outward due to weakness in the gluteus medius

Other symptoms may include:

  • Lower back pain
  • Hip pain
  • Decreased range of motion of the hips and lower back
  • Feeling tightness or discomfort with hip movements

Common mechanism of injury

The mechanism for the onset of lower crossed syndrome is simple and straight forward. Prolonged sitting will lead to the muscular imbalance, and this imbalance is exacerbated by poor posture.

Lower crossed syndrome in gamers
Prolonged sitting is the most common cause of lower crossed syndrome

Prevention & rehabilitation: how do you fix lower crossed syndrome?

Likewise to the mechanism, prevention is simple and straight forward. Avoid prolonged sitting by taking breaks, and check your posture!

However, there are other preventative measures to reduce your risk of developing lower crossed syndrome if you are stuck in a seated position for many hours per day.

As it turns out, these exercises and stretches are also effective for rehabilitation of lower crossed syndrome.

Stretches

To aid in preventing your muscles from becoming tight or hypertonic, there are a few stretches you can do:

Hip flexor stretch – lunge position

This stretch is a lunge position stretch primarily for the iliopsoas muscle

Hip flexor stretch - lunge position
  1. Begin in a lunge position with the both knees bent at 90 degrees
  2. Internally rotate the trail leg (turn your thigh so your foot is further out than your knee)
  3. Perform a posterior pelvic tilt (flatten your back)
  4. Lunge forward keeping your back flat
  5. Hold this stretch for 20-30 seconds to a point of mild discomfort
  6. Repeat on the other leg

Seated rotation stretch

This stretch is a simple, yet effective stretch for the lumbar erector spinae

Seated rotation stretch
  1. Sit with your legs crossed in front of you
  2. Rotate your shoulders to the left; with your right hand, grab outside of your left thigh or knee to increase the pressure
  3. Hold this stretch for 20-30 seconds to a point of mild discomfort
  4. Repeat on the other side

Child’s pose

Perhaps the simplest stretch of them all, this stretch is a passive position to effectively stretch the lumbar erector spinae

Child's pose
  1. Begin by kneeling down and sitting back on your feet
  2. Lower your upper body down towards the floor
  3. You can extend your hands overhead or leave them at your sides
  4. Gently rest your forehead on the floor in front of you and allow your back to relax
  5. Hold this position for 20-30 seconds

Activation exercises

Since half of lower crossed syndrome includes weak/inhibited muscles, another preventative measure includes simple activation exercises of those muscles.

These exercises do not need to be performed with the goal of increasing muscle mass, power, or significant strength. Instead, the goal is to activate these muscles to counter the hypertonicity of their antagonist groups.

Clam shells

An activation exercise for the gluteus medius

Clam shells
  1. Lie on your side with your knees bent and stacked on each other
  2. Keep your shoulders square, and separate your top knee by opening your hip
  3. Be sure not to rotate your trunk or lean backwards
  4. To increase activation, wrap a resistance band around your knees
  5. Perform this exercise on both sides, 10 repetitions on each side

Lunges

This exercise is primarily for the gluteus maximus and can be performed basically anywhere

Lunges
  1. Stand upright
  2. Take a moderate sized step forwards or backwards with either leg
  3. With your weight on your front leg, lower bend your knee and hip to lower your body towards the ground
  4. Your trailing knee should bend and drop straight towards the floor
  5. Press back upward and return to a neutral starting position
  6. Repeat with the other leg, and perform 10 repetitions with each leg

Basic abdominal crunch

It’s probably the most basic abdominal exercise, but it’s effective for the activation of the rectus abdominis

Basic abdominal crunch
  1. Lie flat on your back with your knees bend and feet flat on the floor
  2. Cross your arms across your chest
  3. Squeeze from your belly and try to pull your shoulder blades an inch or two off the floor
  4. Slowly return your shoulder blades back to the floor
  5. It is NOT necessary to sit all the way up!
  6. Perform 3 sets of 10 repetitions

Bicycle crunch

A slightly more advanced version of the abdominal crunch, this exercise creates greater activation of the rectus abdominis

Bicycle crunch
  1. Lie flat on your back with your knees bend and feet flat on the floor
  2. Place your hands to the side of your head with your elbows pointed slightly in front of you
  3. Raise your right shoulder blade and left foot off the floor, bringing your elbow and knee towards each other
  4. Return to the starting position, and repeat with the left elbow and right knee
  5. Perform 20 times total, or 10 for each side

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Disclaimer

This information is for educational purposes only and is not intended to replace the advice of your doctor. Esports Healthcare disclaims any liability for the decisions you make based on this information.

The information contained on this website does not establish, nor does it imply, doctor-patient relationship. Esports Healthcare does not offer this information for diagnostic purposes. A diagnosis must not be assumed based on the information provided.

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