Upper crossed syndrome is a postural condition that develops over time in the region of the shoulders and upper back, and the muscular imbalance creates potential risk to other structures throughout this region.
Upper crossed syndrome is a postural imbalance that occurs in the muscles of the upper back, scapular, and shoulder 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.
It’s important to know some basic anatomy of the upper back and shoulders to understand upper 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.
To begin, the bones of the middle and upper back are called the thoracic spine, which is comprised of 12 bones. The bones of the neck, called the cervical spine, are also involved. The cervical spine has 7 bones.
The scapulae are your shoulder blades. The attachment of your arms to the shoulder blades are your shoulder joints, and the shoulder blades are held onto your body by groups of muscles (read below).
Lastly, your ribs, clavicles (collar bones), and sternum (breast bone) are attachment sites for a few muscles involved.
Muscles that are affected in upper crossed syndrome include back muscles, neck muscles, and shoulder muscles.
Upper crossed syndrome occurs when prolonged poor posture (most often sitting) creates tightness in some muscles and inhibition of others.
Many people have a tendency to sit or stand with their shoulders rounded forward and their head and neck looking downward.
In this position, the pectoralis major and sternocleidomastoid muscles described above are shortened from the forward rounding position.
At the same time, the shoulder blades tend to be shrugged, creating shortness in the upper trapezius and levator scapula muscles. 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 upper crossed syndrome include:
These tight muscles will pull on the bones to which they attach, even when you’re not sitting or standing with poor posture.
While in this rounded position, the lower trapezius, deep neck flexors, and serratus anterior muscles described above are 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:
Tightness of the pectoralis major, sternocleidomastoid, upper trapezius, and levator scapula along with weakness/inhibition of the lower trapezius, deep neck flexors, and serratus anterior creates a postural imbalance in the upper back, neck, and shoulders.
The postural imbalance noted in upper crossed syndrome is a forward rotation and shrugging of the shoulders with an forward leaning position of the head and neck.
This imbalance may lead to mechanical or postural neck pain.
As a postural imbalance, upper crossed syndrome does not necessarily present with pain or other symptoms. The signs of upper crossed syndrome are the same details as described in Pathophysiology.
Other symptoms may include:
The mechanism for the onset of upper crossed syndrome is simple and straight forward. Prolonged poor posture, most often from sitting, will lead to the muscular imbalance.
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 upper 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 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 upper 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 upper 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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