Poor Posture: It’s Called Upper Crossed Syndrome

Posture is one of the most commonly treated physical therapy issues in the United States. It’s something we can all relate to since most of us suffer from some degree of poor posture. You can probably remember being told while growing up, or even as recently as yesterday, that you should “sit up straight” or “stop slouching”.

It’s usually mothers, when you are a child, telling you to sit up straight. They seem to have some kind of instinctive training for instilling their children with proper posture. Little did we realize just how right they happened to be, or how important all of that nagging would be to us as adults. Once you have experienced some of the painful repercussions of poor posture, though, your perspective on the topic will very likely be quite different than when you were a child.

Although posture has always been an extremely important concentration of health and wellness, technological and societal changes have brought it even more into the limelight. For instance, so people use computers at work today that they are basically sitting for a living.

The problem is, excessive sitting leads to structural changes in our body which results in poor posture. Worse, those changes are related to any number of injuries which often need to be treated in professional physical therapy practices.

Poor Posture Causes Upper Crossed Syndrome

There is now an entire syndrome that has been named exclusively to describe poor posture, Upper Crossed Syndrome. It was first explained by Czech physiatrist and neurologist Dr. Vladimir Janda in The Janda Approach. The work describes patterns of muscular imbalances that are often seen in patients with poor posture and includes muscle weakness and tightness associated with this syndrome.

More precisely, upper crossed syndrome is characterized by chronic tightness in the muscles found at the back of your neck and shoulders, which are the upper trapezius, levator scapulae and sub-occipital muscles that are crossed with tightness in the pectoralis major and minor, which are the muscles in your chest.

This syndrome also includes weakness in the deep neck flexors, which are very important muscles located at the front of your neck, that is crossed with weakness in the rhomboids, middle and lower trapezius muscles that are located at your upper back and shoulder blades.

Poor Posture Causes Significant Pain and Damage

The combination of crossed weak muscles and crossed tight muscles is described as muscular imbalances in the practice of physical therapy. The structural changes and muscle imbalances caused by poor posture can accelerate joint damage in your shoulders, neck, and back. They can also lead to the development of trigger points within muscles and myofascial restrictions which cause abnormal movement patterns.

While all of those things may sound unpleasant, they feel even worse, because the end result is a great deal of pain. These structural changes in your body will cause pain to develop in your neck, back, shoulders and muscles. You will get headaches, migraines and the jaw pain associated with TMJ. Sometimes, the result is thoracic outlet syndrome which is often represented by tingling and numbness in the hands and fingers.

So it is important for the general public to realize just how many dangers are possible simply as a result of poor posture. Only then will people realize exactly why they should take care to prevent and treat it.

Signs of Upper Crossed Syndrome

Obviously, the first step of dealing with any problem is to identify it. These are the signs which will give you an idea of whether you have upper crossed syndrome.

  • Increased curve of neck
  • Forward head posture
  • Rounded forward and elevated shoulders
  • Rounded upper back or humpback
  • Winged shoulder blades

Improving Poor Posture to Prevent Upper Crossed Syndrome

If you sit for a significant amount of time during your day, chances are you will have to at least consider trying to correct or prevent upper crossed syndrome. This doesn’t only include people who work at desks all week long. People who are professional drivers, of either truck or cars, or even those who just spend a great deal of time sitting while watching movies or television are at risk.

If you identify with any of those activities, particularly if more than one applies to you, then you really should take a close look at your ergonomic setup. Your primary goal should be to align your body and posture so that any strain or stress on your bones, joints and muscles is as minimal as possible.

Professional Treatment for Upper Crossed Syndrome

If you know that you have poor posture, or if you have been working at desks for quite some time, then you have probably experienced at least some of the previously mentioned conditions. Even if you have not yet begun to experience any pain, you will likely benefit from an evaluation by a health care professional.

Physical therapists are extensively trained to diagnose and treat upper crossed syndrome, with all its attendant symptoms and pain. They develop comprehensive treatment plans that are personalized to effectively remedy the exact form of upper crossed syndrome you have, based on your specific type of poor posture.

The first thing your physical therapists will do is determine what the underlying cause is for your particular condition. Then they will actually treat your whole body as one big interconnected system, rather than a single isolated area of injury or pain. Because it has been determined that related injuries sometimes develop above or below the injured area, depending on the type of dysfunction.

In those cases, treating only the localized area of injury or pain would not always address the actual cause. The patient would then either not get better, or would possibly be predisposed to re-injure the same location in the future.

When you have a comprehensive treatment plan that is created specifically for you, it will facilitate your recovery. The treatment plan will include the stretches, exercises and manual therapy that will correct and reverse the abnormalities that have developed from your personal habits of poor posture.

Manual therapy can include spinal manipulation, myofascial release, soft tissue and joint mobilization. There will also be manually resisted exercises which can correct your muscle imbalances. That will result in improved movement patterns and restored function.

All of these things will correct the damage done by poor posture. Equally important, they will help you to create better posture habits that will prevent you from developing problems again in the future.

Self-Care for Poor Posture

While it’s true that stretching the tight muscles and strengthening the weak ones can address the issues resulting from upper crossed syndrome, the matter isn’t quite as simple as it sound. Because you must know exactly which muscles should be stretched and how, as well as what you can do in order to strengthen weakened muscles. Doing things wrong can make matters worse, instead of better.

For that reason, your best action would be to get a personal evaluation so that a healthcare professional can prescribe exercises and stretches to meet your specific needs. However, most people will find it beneficial to practice gentle stretching for at least 90 to 120 seconds, once or twice a day. These can be done with or without aids, such as a foam roller, tennis or therapy ball. Below are a few options for these.


Exercise Program

The common areas of weakness that we find opposite the areas of tightness include the deep neck flexors located in the front of the neck that function to stabilize the head and neck, and the upper back and shoulder muscles including the rhomboids,
serratus anterior, middle trapezius, and lower trapezius muscles that function to move and stabilize the shoulder blades, shoulder joint, and upper back. Physical therapy clinics commonly prescribe postural strengthening exercises elastic bands called therabands and body weight exercises. These exercises are prescribed with a focus on muscular endurance meaning the ability to perform repeated and sustained muscle activity. This involves exercising with low resistance or weight, while performing a high number of repetitions; we normally prescribe performing 2-3 sets of 20-30 repetitions, 5-7 times per week. Below are some options of the above mentioned exercises:

All of these things will correct the damage done by poor posture. Equally important, they will help you to create better posture habits that will prevent you from developing problems again in the future.

Patrick Kelly

Dr. Patrick Kelly, PT, DPT, Cert. DN is an up and coming physical therapist living and working out of the Austin, TX area. Patrick received his Bachelors of Science in Kinesiology at the University of Massachusetts Amherst in Amherst, MA. He went on to receive in Doctorate of Physical Therapy from Northeastern University in Boston, MA. Patrick is an out patient orthopedic physical therapist who specializes in manual therapy, dry needling, and exercise for the correction and management of Neuromusculoskeletal pain and dysfunction.

Patrick focuses on thorough analysis of posture and movement patterns to determine sources and contributors of his patients’ pain and functional limitations. Whether, the individual is demonstrating tightness, weakness, poor posture, or poor habits, he will find it and help you correct it.

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