What is upper-crossed syndrome?
Upper-Crossed Syndrome or upper-cross syndrome is the term for a particular pattern of muscular imbalance in the upper body. Upper-crossed syndrome is characterised by the tightness of the upper trapezius and levator scapula muscles of the upper back crossed with the tightness of the sternocleidomastoid muscles in the neck and pectoralis muscles of the chest. This pattern of tightness is reflected by weakness of the deep cervical flexor muscles in the front of the neck which is then crossed by the weakness of the lower trapezius and serratus anterior muscles of the mid back. This pattern of weakness to tightness from the side creates a cross hence the name upper-cross.
This pattern of imbalance creates joint dysfunction at particular points within the spine. In particular the atlanto-occipital joint at the top of the neck, the C4-C5 segment half way down the neck and the cervicothoracic joint where the neck and upper back join. The shoulder joint and T4-T5 segment in the mid back also show signs of dysfunction. Janda, who first discovered the syndrome, noted that these focal areas of stress within the spine also correspond to transitional zones in which the neighbouring vertebrae change start to change in shape.
Layer syndrome named due to the alternating layers of muscular weakness to tightness throughout the postural muscles is a combination of the upper-crossed syndrome and lower-crossed syndrome.
Why and when does upper-crossed syndrome happen?
There are several factors involved in the development of upper-crossed syndrome, one of those is thought to be a previous injury to the joints, ligaments or muscles in the neck, mid back or shoulder that doesn’t resolve completely and leaves certain muscles tight and short. This shortening and tightening of the muscles can also occur from repetitive activities or with poor posture, in particular postures that develop whilst sat at a desk or computer. Once a group of muscles have become tight and short, the relative opposite muscle groups become weakened and as a result the previous mentioned tight muscles tighten further. This starts a negative feedback cycle that if undisturbed accentuates the muscular imbalance.
What does upper-crossed syndrome feel like?
The most common result of upper-crossed syndrome is specific postural changes; however these muscular imbalances can, if left, cause the surrounding neck and mid back joints, ligaments and muscles to loose mobility becoming a contributing factor in the development and recurrence of injuries. Facet joint strains, shoulder tendonitis, TOS and headaches are all likely conditions that may develop due to the altered muscle balance. The resultant increased stress on certain joints can also cause early degenerative joint disease also known as Osteoarthritis.
The postural changes noticed include forward head posture, this when the head gets drawn much further forward than it should, increased cervical lordosis, an increase in the spinal curve of your neck and an increase in thoracic kyphosis, the spinal curve of the upper back. Shoulders will become elevated and rounded forwards and the shoulder blades in turn will become rotated or abducted allowing the tips to wing away from the low back, this is called scapula winging. All of these changes combined leads to a more hunched over posture.
How is upper-crossed syndrome diagnosed?
Your therapist will be able to diagnose you by listening to your history, looking at your posture and examining you. Your therapist will look at your posture in detail and may line you side on against a plum line to measure how altered your posture has become. The examination will consist of muscle palpation and stretching to locate the short and tight muscles and muscle testing to determine the weaker muscle groups. Your therapist will also look at the movement of all of the surrounding joints to check for underlying or causative factors. No X-rays or any further investigations are needed to confirm the diagnosis.
What treatments are available for upper-crossed syndrome?
Short term treatment will focus on restoring the mobility of your joints through joint manipulation and relaxing the overly tight muscles with massage. The best types of therapist for this condition are therapists who can treat both joints and muscles, namely Physiotherapists, Chiropractors and Osteopaths. Treatment alone will not be enough to reverse the muscular imbalance therefore your therapist will also prescribe you with exercises. Specifically mobility stretches for the tight muscles in your upper back and more specific corrective strengthening exercises for the weak muscle groups in the neck and mid back. In the long term it is important that you maintain a good working posture to avoid recurrence.
Once you have recovered it is important to prevent any muscular imbalance from developing again. If the tension has built up from poor posture or weakness then it is extremely important that you look at your office chair and desk layout as well as maintaining your prescribed exercises. Pilates or Yoga are very good at strengthening your core and improving your posture and treatments such as the Alexandra technique are very good at educating your posture. If improving your posture and maintaining the exercises hasn’t been enough to prevent muscular tension from building, then you may find it is helpful to receive regular massage treatments, in these circumstance therapists like Bowen technique, massage therapists and sports therapists are recommended.