Condition Focus: Upper Crossed Syndrome

Complied By Binumon Joseph, Registered Physiotherapist

Upper crossed syndrome refers to a particular configuration of overlapping overactive and under-active muscle groups in the neck, chest, and shoulders. Typically, poor posture causes the syndrome, including the forward head posture, which occurs when people use electronic devices, read, and drive. Those with upper crossed syndrome usually have the same or similar set of postural irregularities that people may describe as slouching. Many different stretching and strengthening exercises exist that usually offer relief for symptoms of upper crossed syndrome.

Fast facts on upper crossed syndrome

• Common causes include a hunched over posture, often an effect of repetitive tasks, such as computer use and office work.
• Symptoms include neck and back stiffness or aches.
• Exercises are the main treatment and can help strengthen the weakened muscles of the syndrome.
• It is not usually serious, but chronic issues of pain and damage to the muscles may mean treatment is usually wise.

With upper crossed syndrome the muscles of the shoulders, neck, and chest have become deformed.
Specifically, the back muscles of the neck and shoulders (upper trapezius, and levator scapula) become extremely overactive and strained. The muscles in the front of the chest (the major and minor pectoralis muscles) become shortened and tight. As a result of these overactive muscles, the surrounding counter muscles become underused and weakened. In upper crossed syndrome, this causes weak muscles in the front of the neck (cervical flexor muscles) and in the lower shoulders (rhomboid and lower trapezius muscles). The condition gets its name from the "x" shape that develops when regions of overactive and under-active muscles overlap.

Poor posture can be a cause of upper crossed syndrome.
Different movements can cause upper crossed syndrome, but most cases develop through poor posture, specifically sitting or standing with the head forward for prolonged periods. Activities that promote this postural position include:

• computer and laptop use
• driving
• watching TV
• cellphone browsing, texting, app, or game use
• reading
• biking

In some cases, injury or congenital disabilities may also contribute to the development or creation of the condition.

Symptoms
Common characteristics of upper crossed syndrome include:

• the head is consistently or often in a forward position
• inward curvature in the portion of the spine containing the neck (increased cervical lordosis)
• outward curvature in the part of the spine that includes the upper back, shoulders, and chest (increased thoracic kyphosis)
• elevated, protracted, or rounded shoulders, where the muscles are in a continuous state of being pulled or stretched forward
• the visible portion of the shoulder blade sits out instead of laying flat (scapula winging)

The deformed muscles associated with upper cross syndrome put stress on the surrounding muscles, tendons, bones, and joints, causing most people develop symptoms that include:

• headache
• neck pain
• strain in the back of the neck and often a weakness in the front
• chest pain and tightness
• pain in the upper back, especially the shoulders
• sore shoulder blades
• pain in the jaws
• tiredness
• difficulty sitting, reading, and watching TV
• driving for more than a short period because of pain or muscle tightness or soreness
• restricted range of motion in the neck or shoulders
• numbness, tingling, and pain in the upper arms
• pain and reduced range of motion in the ribs
• lower back pain

Exercises
The best way to treat upper crossed syndrome is through exercise and postural changes. Though some people may feel a lot of discomfort when stretching, it is important that they attempt some form of gentle exercise as restricting activity can cause stiffness and soreness.
People must ensure they warm up their tissues before exercising, either with gradual, gentle motions or by having a warm bath or shower. Begin all exercises gently and build up slowly.
 
Prevention
The best way to prevent and treat upper crossed syndrome is to avoid activities that require stretching the head forward for extended periods of time.
Other tips for preventing upper crossed syndrome include:

• limiting time spent watching TV, reading, using laptops and computers, or driving
• taking breaks every 15-20 minutes while sitting or engaging in problem activities
• getting enough cardiovascular exercise, ideally 30 minutes daily from low-impact activities, such as walking or swimming
• being aware of motions, movements, or activities that worsen symptoms and avoiding them for as long as discomfort continues
• doing stretches that target sore muscles of the back neck, shoulders, and chest
• doing strengthening exercises to target weakened muscles in the upper front neck and lower shoulders
• making sure the steering wheel, book, TV, or computer screen is sitting at eye level
• using a lumbar roll in chairs
• using a headset for long telephone calls or transcribing
• using a single pillow that retains its shape

Correcting or practicing proper posture is also an important part of avoiding and treating upper crossed syndrome.

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