Saturday, March 21, 2009

The Upper Cross Syndrome

Upper Cross Syndrome is a terminology used by V.Janda that refers to a chronic postural error i.e. Upper Cross Syndrome describes a compromise in the musculoskeletal system which tightens or facilitates the anterior compartment of the “upper” torso while at the same time weakening the posterior.

While the majority of muscles involved in Upper Cross Syndrome are anterior to the shoulders there are a few posterior elements to consider as well. The chest muscles & the neck muscles (both posterior and anterior compartments) become tight and shortened (see the diagram). Consequently, you have a weakening or elongating of the scapular muscles.

The tight muscles:

Anteriorly, you have a tightening/shortening of the Pectoralis Major, Pectoralis Minor, Anterior Deltoid fibers, Sternocleidomastoids, and Scalenes. Posteriorly, you have tightening/shortening of the Levator Scapulae, Teres Major, Upper Trapezius, and Suboccipitals.

The weak muscles are:

The weakening of the Scapular muscles includes the Rhomboids, Lower Trapezius, and Serratus Anterior. There is also a weakening of the Longus Coli and Capitus muscles.

Postural effects of tightening & weakening:

The postural effects of these long, weak muscles (as well as the tight muscles) associated with Upper Cross Syndrome manifest themselves as anterior head carriage, rounded shoulders, and internally-rotated upper extremities. As a result, patients with these postural problems will have difficulty performing overhead movements, as well as pushing, pulling, and active stabilization of the cervical spine. Therefore, it is necessary to not only stretch the tight muscles, but also to strengthen the long, weak or reciprocally inhibited groups of muscles.

The altered arthrokinematics:

The altered arthrokinematics are, in large part, a result of synergistic dominance and reciprocal inhibition. Synergistic dominance is compensation in the body for the weak muscle groups that have been reciprocally inhibited.

Where do you typically see Upper Cross Syndrome?

Being that it is predominantly a postural issue, it is seen in individuals who work at a desk or are constantly leaning forward. Through postural adaptation, your body adopts the classical hunching of the upper thoracic spine, internal rotation of the shoulders, and anterior head carriage. Symptoms typically associated with Upper Cross Syndrome include headaches, upper thoracic pain (commonly from trigger points, the Upper Trapezius, and Levator Scapulae), and Thoracic Outlet Syndrome.

The self-test recommended for upper cross syndrome:

"Place two fingers at the top of your right shoulder and feel for a bony notch that protrudes from it. That's your acromion. Now grab a ruler and lie on your back on the floor, your right arm resting alongside your body. With your left hand, measure the distance from your right acromion to the floor, being careful not to raise or lower your right shoulder as you do so. If the distance is more than 1 inch, you have upper-cross syndrome."

Testing for tight & weak muscles:

It is better to carry out muscle testing separately for tonic & phasic muscles as they respond diffeently to dysfunction. Tonic muscles tighten under dysfunction where as phasic muscle weakens under dysfunction.


Pectoralis Major, Pectoralis Minor, Levator Scapulae, Teres Major, Upper Trapezius, Sternocleidomastoid, Scalenes, Rectus Capitus


Rhomboids, Lower Trapezius, Serratus Anterior, Longus Coli and Longus Capitus


1. Stretching of

Pectoralis Major – Clavicular Portion & Sternal Portion, Pectoralis Minor, Levator Scapulae, Teres Major, Upper Trapezius & Lower Trapezius, Sternocleidomastoid, Scalenes, Rhomboids, Serratus Anterior, Cervical Spine (Anterior Muscles)
Cervical Spine (Posterior Muscles)

2. Strengthening of

It is important to strengthen these weak muscle groups so that there is muscular balance throughout the body thus preventing injury upon movement. The strengthening is recommended in 3 phases.

1st Stage of Strengthening
Rhomboids, Lower Trapezius, Serratus Anterior, Longus Coli / Longus Capitus

2nd Stage of Strengthening
Rhomboids, Lower Trapezius, Serratus Anterior, Longus Coli / Longus Capitus

3rd Stage of Strengthening
Rhomboids , Lower Trapezius, Serratus Anterior, Longus Coli / Longus Capitus


1 comment:

  1. YOGA suggestion for UCS (upper cross syndrome):

    1. Gomukhasana (Cow Face)
    2. Chaturanga Dandasana (Four Limbs Staff)

    The above said Suggestion for upper cross syndrome are found in

    rita mayor


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