Upper Crossed Syndrome: Postural Correction Exercises
One of the most common presentations seen by physiotherapist is Upper Crossed Syndrome. Most individuals do not have “good posture” and are likely to be in sedentary desk jobs, go to school, or spend a significant amount of time in front of a computer/TV or phone. So, it is not surprising that many show signs of muscular imbalance patterns, such as rounded shoulders, forward head posture, and excessive anterior pelvic tilt.
Performing the right type of posture correction exercise is essential when treating the muscular imbalances associated with Upper Crossed Syndrome (UCS). UCS is described as a muscular imbalance pattern that effects the position of the head, shoulder girdle and spine. UCS is usually developed due to postural repetition and is commonly found in individuals who work at a computer station for a prolonged period of time that exhibit poor posture. The muscular imbalance is the tightness and shortening of the upper trapezius, levator scapular, sternocleidomastoid and pectoralis muscles, and reciprocal weakness and lengthening of the deep cervical flexors, lower trapezius and serratus anterior.
It is also known as:
- Proximal / Shoulder girdle crossed syndrome
- Cervical crossed syndrome
- Slouched posture
- Student Syndrome
- Forward Neck posture
Signs and Symptoms of UCS
- forward head carriage/posture
- hunching of the thoracic spine (rounded upper back)
- elevated and protracted shoulder blades (winging of scapular)
- decreased mobility of thoracic spine
- reduced shoulder stability
Health Problems Associated with UCS
Myofascial Adhesion’s – or trigger points are tender spots that can develop due to constant stress being placed on the upper trapezius, levator scapula and pectoralis muscles.
Migraine & Tension Headaches – cervicogenic headaches are referred pain perceived in the head and caused by surrounding musculoskeletal tissues innervated by cervical nerves. Forward head carriage increases the stress placed on the upper trapezius and levator scapular muscles which can increase your risk of regular headaches.
Reduced Lung Capacity – breathing dysfunction is commonly associated with UCS. Individuals with rounded shoulders and forward head typically exhibit tightness and shortening of the upper trapezius, scalenes, sternocleidomastoid, levator scapulae and pectoralis minor muscles. The over activation of these muscles and position of the rib cage can cause impaired respiratory function.
Nerve Impingement & Compression – the kyphotic (rounded) posture seen associated with UCS can affect the nerves that exit the thoracic and cervical spine. The unnatural position of the shoulder and neck results in extra stress and tension placed on the nerves and muscles around these joints. Nerves can subsequently become compressed and compromised which causes pain and neurological symptoms, such as pins and needles, loss of sensation, burning and even muscular weakness.
Neck Pain – can be experienced due to tight upper trapezius and levator scapular. The nerves exiting the cervical spine can also become compromised in severe cases.
Rotator Cuff Injury – poor posture and rounding of the shoulders forces the shoulder blades to tilt forward referred to as winging. Due to the rounded shoulder posture, the mechanical axis of rotation of the glenoid fossa (shoulder socket) becomes altered. The humerus (arm) now requires additional stabilisation from the rotator cuff muscles. The additional activation and overuse of these muscles can lead to shoulder impingement, tendinopathies, bursitis and rotator cuff injuries.
Posture Correction Exercises
Standing Theraband Row – exercise is performed to strengthen the posterior rhomboid and trapezius (back) muscles. Ensure that the shoulder blades are retracted back and down to set the correct starting position prior to performing the exercise.
Push Up with a Plus – get into the top of a standard push-up with your abs drawn in. Bend your elbows to lower your chest to nearly touch the floor. As you rise back up, push your upper back up as you broaden your shoulder blades. Hold this action for a count or two to deepen the activation of the serratus anterior. This final movement is the “plus” part of the push-up and is relatively slight, but effective.
Prone Scapular Stabilisation – referred to as shoulder blade squeezes, it is an isometric exercise responsible for resetting the shoulder blades. Lying face down with chin tucked, simply roll the shoulders back squeezing shoulder blades and hold for a set duration.
Foam Roller Thoracic Extension – exercise is implemented to improve mobility in the thoracic spine and reduce the kyphotic posture associated with UCS. Weight of head is supported by hands while arching over the roller.
Deep Neck Flexor (Chin Tucks) – cervical spine exercise counteracts 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.
Chest 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.
Lat Stretch – lats are an internal rotator of the shoulder and can contribute to rounding of the shoulder. Position hand in line with opposite shoulder. Lean back using body weight to place tension on the lats. Shift hips across to increase the stretch even further.
Trapezius Stretch – upper trapezius is renowned for tightening up and even more so in UCS. Place right hand under seat and roll the right shoulder back setting good posture. 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 – setup is similar to the trapezius 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.
There are a multitude of different/variations of exercises and stretches that can be done, so please see a physiotherapist for an assessment and management. You can find me atPinnacle Health Group.