Upper Crossed Syndrome

If you happen to have read my article a few months ago about Lower Crossed Syndrome, this may be a bit familiar to you! The Upper Crossed Syndrome (UCS) is very much the same concept, but in the upper body.

This is a common muscle imbalance pattern we see in the neck, shoulder and chest area. The pattern is characterized by a forward head posture and rounding of the shoulders. Common symptoms may be stiffness and pain in the neck, headaches, tension along the shoulders, sore upper back, and reduced shoulder range of motion. It may also present with neurological symptoms such as tingling or pins and needles to the arms, hands and fingers.

There are some common issues that can arise from chronic Upper Crossed Syndrome. These may be decreased lung capacity, muscular trigger points, rotator cuff strains, migraine or tension headaches, and referred symptoms to arms and hands from nerve compression or impingement.

Upper Crossed Syndrome is most commonly found in individuals who work at a desk or who sit for prolonged periods of time and continually exhibit poor postural habits. In this postural position, the muscles at the back of the neck and the front of the chest get tight, as we sit with our shoulders rounded forward. The tight muscles at the back of our neck and upper shoulders are the upper trapezius and levator scapulae. Along our chest area, the pectoral muscles are tight and shortened from rounding the shoulders forward. This leaves our anterior neck muscles (the deep neck flexors) and the upper back muscles (lower trapezius, serratus anterior) to become lengthened and weak. This pattern of imbalance can create joint dysfunctions in our neck and thoracic joints. There are some key areas of our body that are most affected. These may be C1-2, C4-C5, the cervicothoracic joint (C7-T1), the glenohumeral joint (the shoulder) and the T4-T5 segment.

Ergonomics in your home or office is integral to alleviating some of these issues. A great place to start is setting up your office area properly. Here are some tips on proper ergonomics when using a computer:

1. The top of the monitor should be positioned at or just below eye level. Your eyes should look directly forward, often 2-3” below the top of the monitor. It should be positioned roughly an arms length away.

2. Increase the font, adjust the lighting and sit squarely in front of the screen.

3. The keyboard should be at a level such that your elbows are bent at 90 degrees, shoulders are slightly back and wrists remain in neutral.

4. The feet should be planted on the ground, hips (90-120 degrees)and knees at 90 degrees and the back erect and supported.

5. Move around frequently – aim for every 30 minutes.

Treatment for UCS is generally to stretch whatistightandstrengthenwhatisweak! However, if this pattern of imbalance has been chronic, there will undoubtedly be trigger points in muscles that may need deep tissue massage, acupuncture / IMS or active release techniques. If there are joint dysfunctions (stiff, “stuck” joints) manual therapy, joint mobilizations and myofascial release can be beneficial. Other modalities such as acupuncture, TENS, and ultrasound may help to diminish painful symptoms, speed healing and decrease radiating pain symptoms.

Here are a few exercises that can help get you started:

1. Doorway Stretch – stand in the middle of a doorframe with one arm on each side of the frame. Stagger your feet to protect your lower back, slightly tuck your chin down and lean through the doorway feeling a nice stretch across your chest.

2. Neck Stretches – for the upper trapezius muscle, drop your chin slightly and let your ear side bend towards your shoulder. For the levator scapula muscle, look down towards your armpit area.

3. Wall stand – stand with your back up against the wall. Try to rest your lower back, shoulder blades and back of your head against the wall. Slightly tuck your chin, which will help to strengthen your deep neck flexor muscles. How long can you hold this position?

4. Seated row – tie an elastic theraband onto a doorknob and hold an end in each hand. Sitting up tall in a chair, shoulders down, arms outstretched in front of you. Like a row motion, pull your arms back (as if trying to touch your elbows behind your back) and feel your shoulder blades squeeze together. Repeat 10x. Keep your shoulders away from your ears!

5. Roller – have you ever rolled on a foam roller? It’s medicine for your neck and lower back! Place a roller on the floor, perpendicular to you. Lay onto the roller at your mid back, support your head in your hands and lift your hips up off the floor (knees are bent). Slowly roll along the roller from the top of your shoulders to the mid back (avoid rolling onto your lower back)

All of these exercises are best taught with some guidance and technique. If you think you may have UCS or suffer from any of the symptoms above, it is best to be properly assessed by a physiotherapist who can help you identify the cause and teach you the best techniques for your body. If any of these exercise tips worsen your symptoms, please stop and book yourself an appointment! We would love to help. 

Jennifer Gordon (BScPT, AFCI, GIMS, BKin)