Upper Cross Syndrome

Table of Contents

What is an upper cross syndrome?

Upper Cross Syndrome (UCS) is a common postural imbalance that occurs when certain muscles in the upper body become tight while others weaken. This muscular imbalance leads to a forward head posture, rounded shoulders, and a hunched upper back, often associated with prolonged sitting, poor posture, and repetitive tasks.

UCS can cause neck pain, shoulder discomfort, and headaches, affecting daily activities and overall quality of life.

The rhomboid and lower trapezius muscles in the lower shoulders, as well as the cervical flexor muscles in the front of the neck, are weak in upper crossed syndrome. The “x” shape that forms when areas of hyperactive and underactive muscles overlap gives the illness its name.

Postural abnormalities include a forward head position, lifted and prolonged shoulders, increased thoracic kyphosis and cervical lordosis, as well as scapular winging and rotation. Because of the weakened serratus anterior, the glenoid fossa becomes more vertical, causing the scapulae to rotate, abduct, and wing. To maintain glenohumeral centration in the face of this loss of stability, the activity of the levator scapulae and upper trapezius must increase.

As a side consequence, though, mobilizers become more active (hyperactive) and less flexible as a result of this compensation, which may ultimately set off a pathological series of events inside the musculoskeletal system.

Understanding the causes and addressing them through corrective exercises and ergonomic adjustments are essential steps in managing and preventing Upper Cross Syndrome.

Mechanism of Injury / Pathological Process

Muscle imbalance typically arises prior to functional dysfunction. These repetitive tasks and immobile settings can lead to pain and inflammation as well as other side effects, which are mostly responsible for the expected patterns.

Primarily affecting the anterior neck and posterior superior muscles, which are short and tonic, this disease inhibits and weakens the posterior shoulder girdle and the anterior deep muscles of the neck, which are predominantly phasic. This condition, which is frequently linked to forwarding heads, round shoulders, protracted scapulae, and thoracic kyphosis, is caused by changes in the elevation, protraction, and abduction of the shoulder as well as an increase in the angle of the forwarding head and hyperextension of the upper cervical spine. Joint degeneration may result from these muscular imbalances and movement dysfunctions because they may directly affect the surfaces of the joints.

The structural lesions’ contributing factors are examined using the functional approximation. When managing chronic “dysfunctions” with physical therapy, such as tendinitis and persistent joint pain, this approximation is most helpful.

A physiological muscle imbalance may or may not be the outcome of an initial traumatic incident, but it is usually linked to dysfunction and pain. It’s possible for the pathological imbalance to be subtle; many persons experience this muscular imbalance painlessly. It should be noted that this continuum of muscle imbalance can advance in either way: changed motion patterns might result from muscle imbalance and vice versa. Pathological imbalances can occasionally serve as functional damage compensation.

For instance, an imbalance in muscle can lead to an imbalance in the biomechanical pressures on joints, which can lead to joint damage, pain, and inflammation. As a result, a lesion may be both structural and functional; nevertheless, in order to properly diagnose and treat a patient, a clinician must determine which lesion is the real source of dysfunction.

Clinical Presentation

Postural abnormalities such as kyphosis, round shoulder, and FHP include thoracic spine flexion and excessive neck protraction, anterior tilt, and downward rotation of the scapula with an inclined tendency and internal rotation of the shoulder. Thoracic kyphosis and FHP are associated.

Weak muscles:

Reduced SA activity in the serratus anterior will result in less control over the scapula in both static and dynamic conditions.
The infraspinatus
People with FHP have weak, protracted muscles that are improperly stimulated.

Tight muscles:

Upper trapezius: An increase in UT activity causes the scapula to tilt and elevate anteriorly, which reduces subacromial space and raises the risk of shoulder disease.
An anterior tension is applied to the glenohumeral joint by the pectorals and tight pectoralis major, which reduces stability.

What is a diagnosis of upper cross syndrome?

The doctor is given a thorough grasp of the patient’s muscle function through posture and gait analysis. It is difficult for the clinician to focus only on the local level of the lesion and instead evaluate the patient’s entire motor system.
Assessment of equilibrium.
excessive movement.
It is important to exercise caution when evaluating muscle imbalance in patients with acute severe pain syndrome, as it is not a reliable method. When a patient experiences chronic pain or continues to experience pain after an acute episode has passed, it can be very helpful.

The muscles involved in a defensive flexor reaction are the most likely to become tense. This tests the upper trapezius muscle.

Upper-Quarter Muscles

Tests for the levator scapulae muscle are similar, however they include rotating the head to the opposite side.

Before the arm is positioned in abduction, the trunk needs to be secured since the trunk may rotate to resemble the usual range of motion.

Lower sternal fibers: The patient’s arm is abducted by the therapist to 150 degrees with a small external rotation.
Midsternal fibers: The patient’s arm can relax below the horizontal motion since these fibers are normal in length. Tenderness does not result from palpation.
Clavicular fibers: The patient’s arm can relax below the horizontal due to the typical length of these fibers. The fibers should not be palpably sensitive and should resist this pressure gradually.

Pectoral The patient is assessed while supine for minor muscles. The patient’s mark is seen from above by the therapist. It is possible to compare the anterior portions of the acromion process’s horizontal levels with one another. The two acromions ought to be operating at the same elevation. The lumbar spine arching upward and the arm relaxing above the horizontal are signs that this muscle is very tight.

What are the causes of upper cross syndrome?

People who suffer from upper crossing syndrome typically exhibit a similar set of postural anomalies, which might be mistaken for slouching.
While there are a variety of actions that might induce upper crossed syndrome, the majority of cases arise from weakening and poor posture, particularly while sitting or standing for extended periods of time with the head forward.

The following activities support this posture:

using a laptop or computer while driving
using a phone to watch TV surf, message, use apps or games, read, or biking

What are the symptoms of upper-crossed syndrome?

The following are typical signs of upper crossed syndrome:

The head is constantly or frequently facing forward. shoulders that are rounded, elevated, or prolonged, with muscles that are continuously drawn or pushed forward. Because the twisted muscles strain the surrounding tendons, bones, and joints, the majority of people with upper cross syndrome experience symptoms like these:

headache
tightness and chest pain
pain in the upper back, particularly in the shoulder blades or shoulder joint
fatigue; jaw pain; trouble sitting, reading, or watching TV; tightness or pain in the neck or shoulders that prevents you from driving for long periods of time; rib pain and restricted range of motion; upper arm numbness, tingling, and pain
lower back pain.

Differential Diagnosis

Scheuermann’s Kyphosis
Stress and anxiety
Pseudoradicular syndrome
Scalene syndrome

Management

In the past few decades, therapists have primarily used structural and functional methods to create exercises that are appropriate for correcting musculoskeletal malalignments. According to the conventional structural approach, biomechanics is responsible for the alterations in malalignments like UCS, which are thought to result in modifications to the strength and length of nearby muscles. This could explain why, during the correction phase, short muscles are stretched and weak muscles are strengthened at the issue spot while other related malalignments are ignored. Moreover, the usefulness of stretching and strengthening exercises for the treatment of postural abnormalities has been called into question by several review studies.

The interaction of the central and peripheral nerve systems, as well as the role of the skeletal and muscular structures in producing and regulating motion, are the foundations of the functional (neurological) approach to musculoskeletal issues.

Physical therapy treatment

Pain management:

For the treatment of pain, electrotherapy can be useful.

How does electrotherapy work?
All of these treatments typically involve applying a low-voltage electrical current to the pain locations using an electrode-equipped device.

Pain management is electrotherapy’s primary objective.

Pain management with electrotherapy frequently involves the use of TENS (Transcutaneous Electrical Nerve Stimulation). Electrodes are positioned over or close to the painful area using small, sticky pads. a sequence of low-voltage electrical currents delivered to the region by the battery-powered device.
Interferential Current Therapy
Therapy with ultrasound:
It works well for people with neck pain who have myofascial pain syndrome or trigger points over the trapezius muscle.
Cervical traction: This technique aids in pain relief.

Exercises of the upper cross syndrome

UCS isometric exercises: You can sit, stand, or lie on your back to complete these exercises.

Cervical flexion: Put your palm on your forehead and flex your neck slightly forward.
Cervical extension.
Cervical side flexion: Press on the left side with your left hand, then repeat the side flexion on the other side.
Cervical rotation.
Your physical therapist will give you specific instructions on how long and how often to perform these exercises depending on your unique set of symptoms.

Strengthening Exercises of the Upper Cross Syndrome

The four-step corrective exercise process for UCS begins with lengthening and inhibiting any potentially overactive muscles (usually through foam rolling). Next, the corresponding underactive muscles are strengthened, and lastly, the involved muscles are integrated to restore functional, synergistic movement patterns.

Usually, the goals of this corrective technique are to extend the client’s range of motion, strengthen their local muscles, and help them learn how to better control their newly acquired range of motion. Additional advantages include the potential for less pain and discomfort, upper torso stability, and enhanced athletic performance during play and training.

Step 1:
Apply pressure to sore regions for 30 seconds using the upper trapezius, levator scapulae, and sternocleidomastoid muscles.
Step 2: Static Stretching and Lengthening
Levator Scapulae: The movement of the chin downward until the right side feels a typical stretch.
SCM: Same as above, but with the chin turned upward.
Execute the exercise on both sides, spending 30 seconds in each stretch position.
STEP 3: Activate/strengthen
Floor Cobra: For two seconds, hold.
Step 4:
After holding at each spot, bring the arms back to their stretched frontal positions.

Postural exercise of UCS

An additional upper cross syndrome exercise

The best course of action for treating upper-crossed syndrome involves core stability exercises and body posture adjustments. Even though some people may find stretching exercises quite uncomfortable, it’s still necessary for them to try some kind of moderate stretching and movement to prevent deformity because restricting activity can lead to soreness and stiffness. Before working out, people should make sure their tissues are warmed up, either by taking a warm bath or shower or by moving slowly and gently. Build up to each workout gradually and start out softly.

Exercise while lying down
Place a thick pillow or towel approximately a third of the way up your back while lying down, keeping your spine straight. Ensure that your head is in a neutral, relaxed position and that it is not tense or stretched out against the muscle. For ten to fifteen minutes, hold this posture, and then practice the exercise multiple times over the day.

Exercise while sitting
The stiff muscles in your shoulders, chest, and side neck should start to extend and relax. Press your palms into the floor without really moving them for a more intense chest stretch. Then, move softly and relax. For five minutes, or for as long as it is comfortable, maintain this posture.

Exercise standing up
Remain calm while placing your feet three to four feet apart. Turn your right foot out ninety degrees and pivot your left foot inward to around a thirty-degree angle while maintaining your current torso position. Bend your right knee to a maximum of 90 degrees while maintaining a straight left leg and body.

Stretching in upper cross syndrome.

Forward and Backward Tilt

You can perform this either sitting or standing. Continue moving slowly and smoothly.

For 20 to 30 seconds, bring your chin up to your chest and hold there. Return to the starting posture and raise your head slowly once more.
Do this as many times as possible. Include it in your everyday routine.

Side Tilt