Upper Cross Syndrome
While I believe it is more common to treat individuals that resemble imbalances such as lower cross syndrome as discussed in the last blog. I believe upper cross syndrome also deserves a mention. I have never seen a true case of upper cross syndrome, although the imbalances noted resemble those I see frequently in the rehabilitation of injuries.
Vladamir Janda describes upper cross syndrome as tightness of the upper trapezius and levator scapula with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Specific postural changes seen in upper cross syndrome include forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapula. These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. (Frank, Lardner & Page 2010)
EriK Dalton Ph.D further explains the ramifications of this type of posture in his work, Forward Head Posture and the 42 Pound Head. For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds. Noted symptoms of this occurring include reduction in lung capacity, disc degeneration and neural complications. (Dalton2011)
In numerous physical therapy circles it is stated it is unknown as to why these imbalances occur. I agree but disagree. From a training perspective I have seen many injuries that have resulted from imbalances that resemble upper cross syndrome due to poor training habits and imbalances in lines of movement in training programs. Due to our current lifestyle choices and working habits, most are in a seated position for 40 hour plus per week. We then train the muscles that are already in a shortened state, which can then exacerbate imbalances further. Injury then results in the form of joint pain, muscular pain or damage to inert tissue.
To avoid injury and reverse these imbalances, address the length of the pertoralis major and minor and upper trapezius. It hasn’t been mentioned as of yet, but addressing the length of the latissimus dorsi and the lats little helper teres major will also assist in decreasing protraction of the shoulder. Then address the strength of the lower and middle trapezius and rhomboids via horizontal pulling movements and lower trap work.
There are many ways to skin a cat, and many way to correct length, tension and joint stability imbalances associated with upper cross syndrome. Start with the basics by addressing length and tension via stretching and massage and reassess the symptoms as you progress.
Frank, Lardner, Page, CF, RL, PP, 2010. Assessment and Treatment of Muscle Imbalance The Janda Approach . 1st ed. United States of America : Benchmark Physical Therapy Inc.
Erik Dalton. 2011. Forward Head Posture and the 42 Pound Head. [ONLINE] Available at: http://erikdalton.com/forward-heads-funky-necks/. [Accessed 10 January 16].
Written by – Dan Marshall