Upper Cross Syndrome…Why is Everyone So Crossed?

Part 1

Upper cross syndrome is certainly an epidemic these days. Everywhere you look, you see people living their lives slouched over like they had a bag of bricks on their shoulders. Unless you are an actual bricklayer headed for a bricklaying festival (these probably don’t exist) carrying a load of bricks, you probably shouldn’t  look this way. Yes, there are circumstances where genetically or structurally a person is naturally formed this way. However, the general public should have a much more rigid posture than what we have come to see as “normal” in everyday life. Even I, a genius/ idiot in my own right, struggle with a slouched posture most of the time.

I would like to delve into this issue taking two different paths. The first being that of a structural or physical view; pinpointing the reason behind this common physical issue. Second, I would like to touch on the emotional side of this which, to some, may sound a little crazy or spiritual. I am by no means one to convince people of the energy side of therapy as I practice strictly in the form of hands-on therapy, but this topic deserves a bit of this honor. I am speaking more from the standpoint of our emotions as humans and the dramatic effect that these emotions can have on the human body. I premise this by saying I am in no way a psychologist or counselor. My opinion is only derived from experience.

First, let us delve into the physical side of this problem in order to get the anatomical viewpoint of this syndrome.

The obvious reason why upper cross syndrome occurs is that it is developed through bad habits at work, watching TV, being on the computer, and lastly, using our smartphones. We live in a world where everything takes place in front of and below our nose. This gives our bodies no choice but to adapt to a downward facing posture, thus having a slouched posture. This is already common knowledge and does not need to be beaten to death.  The key point that needs to be made here is more about the anatomical culprits which lock the body into this posture. Many may think this is also a simple answer as well. The number of times I have seen stretches for the pectorals and scalenes as the primary therapy for treating upper cross syndrome is mind-boggling. So, shouldn’t we be seeing people walking around with better posture if it is so simple to treat it?

As we know (or may not know), the spine works as a single functioning unit. Yes, there are different regions that can move independently, but as a general rule, it moves as a whole working machine. For this reason alone, one needs to realize that only treating a couple muscles in a small section of the spine in order to fix the entire dysfunction of a working spine falls a bit short.

The spine functions in balance. If one part moves or is aligned differently, the other parts have to do the opposite in order to keep balance. In other words, if one part of the spine is misaligned, another part is also going to be misaligned. This fact is demonstrated perfectly when we see a spine where the head flexes forward (just like being on a smartphone). The cervical spine straitens out of its resting lordosis as the head comes forward. As this happens, the lumbar spine follows suit and also decreases its own lordosis.  While these motions are occurring, the thoracic spine increases its kyphosis. One simple movement, three motions of the spine. (See image below)

One Motion-Three Movements of the Spine- Photo Credit Visible Body
This same principle can then be applied to a person who has a chronic upper cross syndrome. If we have an increase in thoracic kyphosis (like in upper cross syndrome) then we are going to see modifications to other parts of the spine as well. Now, we may have different presentations depending on the source of the problem, but generally, we are going to see the same patterns throughout the spine.

So, now that we have the theory down, let us use that knowledge to justify treating certain structures throughout the spine. First off, I would certainly treat the pectorals and scalenes as part of the process, however, lets add some more to the list that are just as, or even more, important. This list is simply an example of what to treat. I could probably write a post about each one and its affects on the body (and maybe I will).

Upper Body:

Serratus Anterior- Photo Credit Visible Body
  • Serratus anterior – This muscle is a main culprit due to its ability to limit retraction of the scapula. When this muscle is chronically contracted, depression and protraction of the scapula are present. This muscle alone can cause the exact posture of upper cross syndrome. It should always be assessed and treated.
  • SCM – this muscle will lock the neck and head into the classic upper cross position. It has the unique ability to flex the neck while also extending the head. Once again, the exact position of upper cross syndrome.
  • Subscapularis and teres major and Latissimus dorsi – these will release the chronic internal rotation of the humerus. They are also on this list due to their ability to also limit shoulder flexion dramatically. This causes other compensations in the body, one of which is an increase in thoracic kyphosis.

Lower Body:

Iliopsoas- Photo Credit Visible Body
  • Iliopsoas – This muscle becomes chronically shortened when the majority of our lives are spent sitting. This muscle has the ability to have two different effects on the body. It can cause a hyperlordosis or a hypolordosis of the lumbar spine. Both postures can lead to a hyperkyphosis of the thoracic spine which is an integral part of upper cross syndrome.
  • Gluteals – When the gluteals are contracted (usually very atrophied) the hips rotate externally and posteriorly which, once again, causes a hyperkyphosis of the thoracic spine and contributes to upper cross syndrome.
  • Hamstrings – Shortening of the hamstring muscles rotate the pelvis posteriorly which leads to hyperkyphosis of the thoracic spine.

This list demonstrates how complex this syndrome can actually be. Rarely have I seen a patient that only needed a couple muscles treated in order to correct their problem. Also, this list only accounts for musculature that would potentially need to be released. This doesn’t touch on the absolute need to strengthen specific muscle groups in order to correct the syndrome long term.

The moral of the story is every body is different and can present upper cross syndrome in different ways. This makes the importance of looking beyond the first couple culprits and assess the body as a whole. You may not need to treat every single structure here, but certainly adding some of these to your treatment regimen will benefit patients.

Next post I will dive into the other half of this issue. The emotional side of upper cross syndrome.