Upper and lower cross syndromes

Upper and lower cross syndromes

Upper and Lower cross syndromes refer to two groups of muscular imbalances first alluded to by Vladimir Janda (1996). Muscle imbalance is the presence of different and opposing groups of muscles provide directional tension in different vectors.

This inherently affects the joints of the human body and so because the human body is such an efficient machine joints will move in the path of less resistance and so will follow the tensions present.

The causes of these imbalances in the human body are said to be two fold. Firstly imbalance can be affected by biomechanics. The most popular example of this would be in a desk bound worker whose job dictates that they sit at a computer and as a result the hands are crossed across the body thus triggering increased contraction of the pectoral muscles and at the same time the head is pushed forwards to concentrate on the computer screen therefore increasing the contraction of the muscles in the back of the neck such as the trapezius.

The second reason for imbalances arising is a more natural theory centred around neuromuscular activation of muscles that is programmed from birth. Some of the muscles prone to tightness include the erector spinae muscles of the back and the suboccipital muscles of the neck.

Commonly these muscles would have been activated when learning to move around and perpetuated by normal daily movements as an adult, the suboccipitals when crawling in order to look in the direction of travel, and the erector spinae to stand up and walk without toppling over.

Upper Cross syndrome is the distinct pattern of imbalance across the neck and shoulders that creates dysfunction at transitional areas of the body, namely; the atlanto-occipital joint, C4-5, the cervicothoracic junction, the glenohumeral joint and T4-5. These problems may manifest themselves individually or may form part of a presentation as seen with cervicogenic headaches or subacromial impingement (Moore, 2004 and Page, 2011).

The pattern is tight pectoral muscles on the front and tight suboccipital muscles and trapezius muscle on the back. The muscles that are weak are the cervical flexors on the front of the neck and the rhomboids and lower trapezius fibres. These opposing lines of force form a ‘cross’ when they are drawn on an anatomical model.

Coincidentally the same naturally and neurologically stimulated tight muscles are also those that are made tight from a biomechanical perspective when sitting at a desk. In a similar fashion the weak muscles trying to resist these forces are the same weak muscles that aren’t neurologically stimulated as much when developing as a child and are resisting postural changes when working at a desk.

Lower crossed version of these described imbalances is confined to the lower back region of the body. This pattern depicts tight hip flexors and thoracolumbar extensors (such as erector spinae) and weak abdominals coupled with weak gluteus maximus. This is said to have an influence on the biggest pain causing areas in the region (L4/5, L5/S1, Sacroiliac joint and hip joint).

The crossed syndromes are only theories, however, they have arisen from observation and experience when addressing pains suffered by real people. Although not definitive they are a fantastic place to start when pelvic and lower back or upper back and neck pain is present. The theories represent a need for a full bodied, holistic approach, very much like we try to achieve here at Perfect Balance.

Kinesiology tape has also been recognised as a potential treatment technique to try and address these imbalances (Ahern, bird and Gordon, 2011) It is clear that by only treating short and tight structures we maybe able to relieve symptoms but perhaps not resolve a client’s pain. Rehabilitation is therefore of great importance to us also and allows complete counteraction of the crossed syndromes and possibly quicker resolution of pain. In other words, don’t just stretch and massage what is tight, address what is weak to!

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References:

Ahearn, I., Bird, S. and Gordon, M., 2011. Kinesio tape’s effect on musculature associated with upper cross syndrome

Janda, V., Frank, C. and Liebenson, C., 1996. Evaluation of muscular imbalance. Rehabilitation of the spine: a practitioner’s manual, 6, pp.97-112.

Moore, M.K., 2004. Upper crossed syndrome and its relationship to cervicogenic headache. Journal of manipulative and physiological therapeutics, 27(6), pp.414-420.

Page, P., 2011. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International journal of sports physical therapy, 6(1), p.51

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