Sunday, March 22, 2009

Lower-Crossed Syndrome (LCS)

Change in movement pattern:

The muscles can often serve as “windows” to the function of the CNS. The CNS regulates 2 muscle groups: The tonic muscle group and the phasic muscle group. These muscle groups oppose each other in function. The tonic muscle group functions as a facilitator, the phasic muscle groups inhibition. Pain, pathology or adaptive changes in the system result in compensations or adaptations that lead to systemic and predictable patterns of muscle imbalance. “Altered movement pattern” is a movement pattern in which a change occurs in the coordination of the muscle firing sequences for a specific group of muscles, facilitating a specific joint movement. The primary muscle responsible for specific joint movement may become weak and inhibited, causing a synergistic muscle/muscles to become hyperactive. As a result, a different sequence of muscular contractions occurs. This is a sign of muscle imbalance in the body because of muscular dysfunction.
When any component of the kinetic chain is not working properly (tight or long muscles, reciprocally-inhibited muscles, adhesions, joint dysfunction), neuromuscular control is altered. This results in chronic pain and disability.

What is LCS?
The lower kinetic chain is one of two basic parts of the musculoskeletal system that are controlled and innervated through the CNS.
Lower-crossed syndrome is a postural distortion syndrome affecting the lower kinetic chain (lumbopelvic hip complex, knee, and ankle). Because the structural integrity of the lower kinetic chain is compromised in lower cross syndrome, abnormal distorting forces result on all structures within the kinetic chain. In lower-Crossed syndrome the pattern of muscle imbalances often leads to changes in movement patterns with hip extension, hip abduction and trunk flexion. This alteration may be observed with the patient sitting, standing, or walking. In lower-crossed syndrome the patient usually presents with anterior pelvic tilt, increased lumbar lordosis (swayback), and weak abdominals muscles. These patients usually experience chronic low back pain, piriformis syndrome and anterior knee pain.
The predictable pattern of muscle imbalances most often include the following:
Tight/Faciliated: Iliopsoas, Rectus Femoris, TFL, Adductor Group, Errector Spinae, Gastrocnemius, Soleus
Weak/Inhibited: Rectus Abdominis, Oblique, Gluteus maximus, Gluteus medius, Hamstrings
Because of above said Tight/Faciliated & Weak/Inhibited muscles following things results in: Anterior rotation of pelvis, Increased lumbar lordosis, Hips in flexion, Knees may be hyperextended
Common Injuries that occurs because of changed kinetics: Low back pain, Knee pain, Hamstring strains etc.
Other consequences of this syndrome are seen in anterior tilt of the pelvis and flexion of the hip that exaggerates the lumbar curve. L5-S1 may have soft-tissue and joint stress with pain and discomfort. This progresses to instability of the sacroiliac joints and piriformis, and knee involvement.
What causes LCS?
Lower-cross syndrome may develop from a number of scenarios such as chronic, repetitive actions such as running. Inaction may also have a negative impact on the body’s mechanics, such as immobilization, disuse, or chronic postural stress such as sitting for long periods of time or poor workstation posture. Sports injuries or injuries that never healed properly can lead to pathology. Pain, pathology, or adaptive changes can lead to patterns of muscle imbalance that can lead to a situation of lower-cross syndrome.
Focus points of physical assessment in LCS:

1. Postural assessment
2. Global Assessment
3. Normal Firing Pattern of the Pelvis
4. Thomas Test
5. Forward Bending Test
6. Gluteus Maximus Strength Test
7. Psoas Major Strength Test
8. Erector Spinae
9. Transverse Abdominal Muscle
10. Rectus Femoris
Focus points of treatment in LCS:
A. Stretch

1. Hamstrings
2. Hip Flexors
3. Erector Spinae
4. Gluteus Maximus
B. Strengthen

1. Hamstrings
2. Transverse Abdominals
3. Gluteus Maximus
4. Hip Flexors
5. Erector Spinae

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