Upper Crossed Syndrome

What is Upper Crossed Syndrome (UCS)?
Upper crossed syndrome is identified as an imbalance between the anterior (front) and posterior (back) muscles of the upper body causing a postural misalignment. The syndrome presents in a forward head carriage, rounded shoulders and a hunching of the upper back.

If we were to put this into a diagram, it becomes easy to see why this presentation is called “upper crossed” as the muscles affected are opposite each other in a cross pattern.

​Specifically we’re talking about a tightness through the:

• Suboccipitals, upper trapezius and levator scapulae muscles (neck region)
• Pectoralis minor muscle (pecs) in the chest

 
The overuse of these muscles causes an inhibition in the muscles opposite - these are supposed to be supporting the body into an upright position. They become long and weak.
These include:

• Rhomboids and lower trapezius muscles (between the shoulder blades)
• Deep cervical neck flexors (front of the neck).

Who does UCS affect?
UCS presents most commonly in desk workers because they are in a constant “crossed” posture at the computer all day.
Couriers and truck drivers are also common patients for the same reason.
Cyclists are at an obvious disadvantage also, being in an aggressive hunched position when riding.

Associated issues:
Trigger Points:
Or “knots” in the shoulders and chest due to constant stress being put on the muscles.
 
Tension headaches:
Referral pain from these trigger points in the shoulders and neck can present as a tension headache.
 
Reduced lung capacity:
Rounding of the shoulders and a hunching of the back means that the diaphragm and lungs are unable to expand to their full capacity, making it hard to take a deep breath and get enough oxygen to muscles during exercise.
 
Nerve and vascular impingement and compression: 
Rounding of the shoulders and tension through the neck compresses nerves and blood vessels in the area, causing numbness and tingling in the arms, wrist and fingers and restricting blood flow.
 
 How to fix it:
The aim of treatment is treat the tight muscles through soft tissue therapy and strengthen the inactive muscles to improve posture and regain range of motion.
​
Chin Tucks:
These counteract a forward head position.
Stand upright with back to wall. Slightly tuck chin to chest and draw head back to wall. The muscles in the front of the neck should be active while holding this position for a set duration.

​Scapular Setting:
Relaxing the shoulders so they are not hiked up, squeeze the shoulder blades in a "back and down" motion, like a diamond pattern to activate the rhomboids and lower trapezius.

​Foam Roller Thoracic Extension:
This improves extension and rotation in the thoracic spine, counteracting the hunched position. Weight of head is supported by hands while arching over the roller.
 

​Pec Stretch:
Works on improving the range of motion through the pectoralis (chest) muscles. Place inside of elbow against a wall and rotate body away from anchor point until a stretch is felt across chest. Repeat on opposing side.

​Trapezius Stretch: 
Gently lower the left ear to left shoulder until a stretch is felt across the right upper trapezius. Use left hand (as shown in the image) to increase stretch further.

Levator Stretch
Looking straight ahead, rotate the head by 45° and then tuck chin to chest. The free hand can be placed on the back of head to gently pull down, increasing the stretch further.