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

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 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

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. Check your posture, and avoid prolonged sitting by taking breaks.

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.

Sometimes, a simple reminder can help to keep your body in a better position. However, prolonged sitting—especially in a poor position—will create the muscular imbalances described earlier.

When this happens, simply thinking about sitting more appropriately may still be ineffective. So, we developed Power-Up Posture with 21 exercise and stretches to help improve your posture!

Power-Up Posture: gamer guide to a healthy career

Power-Up Posture is an exercise and stretch program designed to counter the ill-effects of prolonged sitting. The program is effective for both prevention and rehabilitation of lower crossed syndrome.

Power-Up Posture is a comprehensive program to stretch and relax the hypertonic muscles and to stimulate activation and strengthening of the inhibited muscles affected in lower crossed syndrome.

Through participation of this program, you can effectively prevent these muscular imbalances and reduce pain associated with prolonged sitting and poor posture.

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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.