Hunchback, high rounded shoulders, a forward head posture and winging of the scapulae (shoulder blades) – these are four of the key signs you might have a common condition known as Upper Crossed Syndrome (or Upper Cross Syndrome). Often a result of excessive time spent scrolling or typing, UCS strikes when the muscles behind the neck and shoulders become overactive and strained, while the chest muscles become short and tight.
Unfortunately, we see this upper body condition all too often in the clinic. And, if left untreated, these muscle imbalances can lead to chronic neck pain, headaches, reduced range of motion and more.
However, UCS needn’t be your cross to bear. With the right treatment plan, you can improve poor posture and alleviate your symptoms. Read on for everything you need to know about tackling Upper Crossed Syndrome.
WHAT IS UPPER CROSSED SYNDROME?
Also known as proximal or shoulder girdle crossed syndrome, Upper Crossed Syndrome is a condition identified by Dr Vladamir Janda in 1979. The cross in the title refers to the “x” shape created by the overlapping of regions of underactive and overactive muscles in the neck, chest and shoulders.1
How does this happen? The muscles in our body are all interconnected and overlap, and it takes multiple muscles for our body to create movement. When one muscle is weak or underutilised, another muscle must contract to take over the work from the weak muscle. These muscles become short, tight and overactive, and our body increasingly relies on them to stabilise joints and create movements rather than expending more energy to recruit another muscle.
In Upper Crossed Syndrome, the muscles in the front of our chest, back of the neck, and tops of the shoulder blades become overactive and short. These include the pectoralis muscles, upper trapezius, levator scapulae, suboccipitals, and sternocleidomastoid. As these muscles are recruited by our body since they are already tight and active, a group of muscles in our mid-back and neck become inhibited and therefore weak. These weaker muscles include the rhomboids, lower and middle trapezius, serratus anterior, and deep neck flexors.
HOW DOES UPPER CROSS SYNDROME PRESENT?
The muscular imbalance (short, tight muscles in the chest and weak muscles in the upper back and neck) in Upper Crossed Syndrome affects the position of the head, shoulder girdle and spine, and can result in pain, headaches, and reduced range of motion.
Presentation of Upper Cross Syndrome includes:
- Forward head posture
- Increased cervical lordosis (inward curvature of the neck)
- Thoracic kyphosis (hunched / rounded top-mid back)
- Elevated and protracted (forward) shoulders or rounded shoulders
- Rotation or abduction and winging of the scapulae (shoulder blades)
- Decreased shoulder stability and range of motion
- Neck or shoulders numbness
WHAT ARE THE CAUSES OF UPPER CROSSED SYNDROME?
Activities that involve repetition of incorrect posture are largely to blame for Upper Cross Syndrome. The postural imbalance is most common in those who sit at a desk for prolonged periods, such as office workers and students.
Excessive phone, tablet and laptop usage can trigger the condition, but it can also be caused by driving, reading, or cycling. Weightlifters and swimmers can also develop this pattern of muscle imbalance due to the repetitive use of the muscles around their necks and shoulders.
The primary causes of Upper Crossed Syndrome include:
- Prolonged Poor Posture: Sitting at a desk or scrolling on a phone for long periods with your head forward and rounded shoulders can contribute to the development of Upper Crossed Syndrome.
- Sedentary Lifestyle: Lack of physical activity can lead to muscle imbalances and weakness, contributing to the development of UCS.
- Muscle Imbalances: Weakness in the deep neck flexors and lower trapezius muscles, coupled with tightness in the upper trapezius, levator scapulae, and chest muscles, creates an imbalance in muscle strength and flexibility.
- Repetitive Movements: Repetitive movements that involve the muscles in the chest and front of the shoulders, such as excessive computer work or activities that encourage a rounded shoulder posture, can contribute to muscle imbalances.
- Incorrect Ergonomics: Poor ergonomics at workstations, including improperly adjusted chairs, desks, or computer monitors, can encourage poor posture and contribute to muscle imbalances.
- Unaddressed Injuries: Past injuries in the neck, shoulders, or upper back may contribute to muscle imbalances and the development of Upper Crossed Syndrome.
- Lack of Exercise and Stretching: Failing to engage in regular exercises that target postural muscles and neglecting stretching routines can contribute to muscle tightness and weakness.
- Genetic or Neurological Factors: Some individuals may be predisposed to musculoskeletal imbalances due to genetic factors. Certain neurological conditions may also affect muscle function.
WHAT ARE THE SYMPTOMS?
Those with Upper Crossed Syndrome may experience the following:
- Neck pain/tightness
- Back pain/tightness
- Chest pain/tightness
- Arm pain
- Jaw pain
- Neck or shoulder numbness
- Pins and needles in the neck/shoulders/arms/forearms/ hands or fingers
- Reduced range of motion of the neck, back and/or shoulders
ARE THERE LONG-TERM RISKS ASSOCIATED WITH UCS?
If left untreated, the above symptoms can become chronic which may lead to long-term pain, discomfort and movement dysfunctions.
Our muscles are responsible for moving our joints, and allowing this imbalance to continue can create stress on the joints and even inflammation of the joints. This cycle can cause our body to adapt to a new motor pattern which can lead to even more muscular imbalance. In some cases, people may develop joint degeneration.
Additionally, in active and athletic individuals, upper crossed syndrome can affect mobility and performance. Not only may this increase the pain and discomfort already experienced with UCS, but the associated movement dysfunctions can lead to poor lifting and sport-related biomechanics and increase the risk of sustaining other injuries.
Potential issues associated with untreated Upper Crossed Syndrome include:
- Chronic Neck Pain: This is very common due to the strain on the neck muscles caused by the forward head position.
- Shoulder Pain and Impingement: Imbalances in the muscles around the shoulder girdle can contribute to shoulder pain and impingement syndromes.
- Headaches: The tension in the upper shoulder and neck muscles can lead to tension headaches.
- Jaw Pain (Temporomandibular Joint Dysfunction – TMJ): Poor posture and muscle imbalances can contribute to jaw pain and TMJ dysfunction.
- Reduced Range of Motion: Imbalances can limit the range of motion in the neck and shoulders, affecting daily activities.
- Muscle Weakness: Chronic muscle imbalances can lead to weakness in specific muscles, affecting overall strength and stability.
- Impaired Breathing: A head-forward position and tight chest muscles can restrict the expansion of the ribcage, potentially affecting breathing.
- Nerve Compression: Prolonged muscle imbalances may contribute to nerve compression, causing numbness or tingling in the arms and hands.
- Postural Changes: Untreated Upper Crossed Syndrome can result in long-term postural changes, making it more challenging to correct as time goes on.
- Degenerative Changes: Over time, chronic muscle imbalances and poor posture may contribute to degenerative changes in the spine.
HOW CAN YOU PREVENT UPPER CROSSED SYNDROME?
Since many of us don’t have a choice when it comes to the hours spent desk-bound, there are several things you can do to help prevent tight muscles.
An ergonomic workstation is incredibly important to prevent Upper Cross Syndrome. This type of setup is designed to enhance comfort and productivity while minimising strain and injury. It includes adjustable furniture, proper monitor height, ergonomic keyboard and mouse, wrist supports, and good lighting.
Good ergonomics promotes proper posture and reduces the risk of musculoskeletal issues associated with long-term desk work. (Ask about our workplace ergonomic assessments in Melbourne today).
MOVE AND STRETCH
Even with a perfect workstation, you should schedule regular breaks into your day. Set an alarm to remind you to move around or stretch every half hour or so..
Exercise to improve strength, flexibility and range of motion. Pilates is an excellent practice to help prevent Upper Cross Syndrome (and Clinical Pilates with a physio can be particularly beneficial).
IMPROVE YOUR SPORTING TECHNIQUE
If your condition is sports-related, work on improving your technique. A sports physiotherapist or exercise physiologist will be able to help you here, and also help to reduce your risk of injury.
THE IMPORTANCE OF PROPER POSTURE
Correcting Upper Crossed Syndrome is impossible without addressing your posture. To maintain good posture:
Keep the head and neck in a neutral position, aligning your ears over the shoulders, and avoiding prolonged looking down. Keep the shoulders relaxed, avoid rounding forward, and imagine sliding your shoulder blades down the back. Ensure a neutral spine with a slight lower back curve, especially during extended periods sitting. Keep your elbows and arms close to the body, maintaining a 90-degree angle when using a desk.
When standing, distribute weight evenly on both feet and when sitting, sit back in the chair with your hips against the backrest. Position your computer monitor at eye level and maintain an arm’s length distance to prevent looking down or up.
A supportive pillow that maintains the natural curve of your neck when sleeping is also important.
HOW IS UPPER CROSSED SYNDROME TREATED?
Treating Upper Crossed Syndrome usually involves a mix of physical therapy, education, stretches, ergonomic adjustments, lifestyle modifications and exercise. Expect:
- Hands-on treatment including soft tissue massage and joint mobilisation
- Education and addressing the causes of UCS, including chronic poor posture
- Education on how to address it with stretches and lifestyle adjustments
- Exercises to strengthen weakened muscles and improve stability, endurance and flexibility
EASY STRETCHING EXERCISES TO PREVENT UPPER CROSSED SYNDROME
Upper trapezius stretching exercises – and other simple stretches – are your secret weapon to help prevent neck pain, muscle tightness and Upper Cross Syndrome. Here are some stretches your physiotherapist may suggest, depending on your condition. (Please note, this is not a prescription and independent physiotherapy advice should be sought before embarking on a stretching program.)
Upper Trapezius Stretch
Sitting on your right hand, roll your right shoulder back. Place your left hand on top of your head and gently pull your left ear to your left shoulder until you feel a stretch. Hold for 30 seconds. Swap sides and repeat.
Levator Scapulae Stretch
Sitting on your right hand, roll your right shoulder back. Look down 45 degrees bringing your chin towards your left underarm. Place your left hand on top of your head and gently add light pressure to the stretch. Hold this position for 30 seconds. Release and swap sides.
Sit or stand up straight with your shoulders relaxed and your spine in a neutral position. Keep your head in a neutral position, with your eyes looking straight ahead. Gently draw your chin in towards your neck without tilting your head up or down. Imagine making a double chin. Hold this position for 5-10 seconds. Release the chin tuck and return to the neutral position.
Chest Opener Stretch
Stand in a doorway with your arms at a 90-degree angle on each side. Step forward, allowing your chest to open up. You should feel a stretch in your chest and underarms.
General Sitting Stretch 1
Start with your hands behind your head. Bring your elbows as far back as you can until you feel a stretch in your pectoral muscles and chest. At the same time, arch over the back of your chair.
General Sitting Stretch 2
Interlace your fingers and bring your palms towards the ceiling. Stretch your arms up as far as you can, then slowly bring your arms backwards until you feel a stretch down the sides of your arms and trunk.
HOW WE CAN HELP YOU TACKLE UPPER CROSS SYNDROME
From physical therapy to corrective exercises and education, we will address the cause of your UCS so you can enjoy life – pain-free.
With a Doctor of Physiotherapy degree from the University of Melbourne and a Bachelor of Science and Human Movement from Penn State, Michelle Labonia is a skilled physiotherapist with a passion for holistic patient care. Particularly interested in back and neck pain and hip and knee injury, she combines her extensive knowledge of the body and expertise in manual therapy, Clinical Pilates and dry needling to relieve pain, rehabilitate and prevent future injuries.