Upper Crossed Syndrome

Medically reviewed by William Morrison, MD on January 8, 2018Written by Becky Young on January 8, 2018

Overview

Upper crossed syndrome (UCS) occurs when the muscles in the neck, shoulders, and chest become deformed, usually as a result of poor posture.

The muscles that are typically the most affected are the upper trapezius and the levator scapula, which are the back muscles of the shoulders and neck. First, they become extremely strained and overactive. Then, the muscles in the front of the chest, called the major and minor pectoralis, become tight and shortened.

When these muscles are overactive, the surrounding counter muscles are underused and become weak. The overactive muscles and underactive muscles can then overlap, causing an X shape to develop.

What are the causes?

Most cases of UCS arise because of continual poor posture. Specifically, standing or sitting for long periods with the head pushed forward.

People often adopt this position when they are:

  • reading
  • watching TV
  • biking
  • driving
  • using a laptop, computer, or smartphone

In a small number of cases, UCS can develop as the result of congenital defects or injuries.

What are the symptoms?

People with UCS display stooped, rounded shoulders and a bent-forward neck. The deformed muscles put strain on the surrounding joints, bones, muscles and tendons. This causes most people to experience symptoms such as:

  • neck pain
  • headache
  • weakness in the front of the neck
  • strain in the back of the neck
  • pain in the upper back and shoulders
  • tightness and pain in the chest
  • jaw pain
  • fatigue
  • lower back pain
  • trouble with sitting to read or watch TV
  • trouble driving for long periods
  • restricted movement in the neck and shoulders
  • pain and reduced movement in the ribs
  • pain, numbness, and tingling in the upper arms

Treatment options

The treatment options for UCS are chiropractic care, physical therapy and exercise. Usually a combination of all three is recommended.

Chiropractic care

The tight muscles and poor posture that produce UCS can cause your joints to become misaligned. A chiropractic adjustment from a licensed practitioner can help to realign these joints. This can increase range of motion in the affected areas. An adjustment also usually stretches and relaxes the shortened muscles.

Physical therapy

A physical therapist uses a combination of approaches. First, they offer education and advice related to your condition, such as why it’s occurred and how to prevent it in the future. They will demonstrate and practise exercises with you that you will need to continue with at home. They also use manual therapy, where they use their hands to relieve pain and stiffness and encourage better movement of the body.

Exercises

Lying down exercises

  1. Lay flat on the ground with a thick pillow placed about a third of the way up your back in alignment with your spine.
  2. Let your arms and shoulders roll out and your legs fall open in a natural position.
  3. Your head should be neutral and not feel stretched or strained. If it does, use a pillow for support.
  4. Stay in this position for 10–15 minutes and repeat this exercise several times per day.

Sitting down exercises

  1. Sit with your back straight, place your feet flat on the floor and bend your knees.
  2. Put your palms flat on the ground behind your hips and rotate your shoulders backward and down.
  3. Stay in this position for 3–5 minutes and repeat the exercise as many times as you can throughout the day.

How is it diagnosed?

UCS has a number of identifying characteristics that will be recognized by your doctor. These include:

  • the head often being in a forward position
  • the spine curving inward at the neck
  • the spine curving outward at the upper back and shoulders
  • rounded, protracted, or elevated shoulders
  • the visible area of the shoulder blade sitting out instead of laying flat

If these physical characteristics are present and you are also experiencing the symptoms of UCS, then your doctor will diagnose the condition.

Outlook

UCS is usually a preventable condition. Practising proper posture is of vital importance in both preventing and treating the condition. Be aware of your posture and correct it if you find yourself adopting the wrong position.

The symptoms of UCS can often be relieved or completely eradicated with treatment. Some people to go on to suffer with the condition repeatedly throughout their lives, but this is usually because they are not following their exercise plan or paying attention to their posture on a daily basis.

When the individualized treatment plans for UCS are followed precisely, it is an entirely manageable condition.

CMS Id: 140162