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Lower Cross Syndrome

What is it?

Lower Crossed Syndrome is described as a predictable pattern of alternating tightness and weakness involving muscles within the core and pelvis. This condition frequently contributes to back pain and is associated with some diagnoses throughout the lower body.

Lower quadrant muscular dysfunction does not occur at random, but in a particular pattern of altered posture as the body attempts to compensate. The process typically begins when a muscle or muscle group is overused in a certain direction and becomes shorter and tighter.

The lower extremity postural muscles (iliopsoas, rectus femoris, and lumbar extensors) are predisposed to tightness while the phasic muscles (abdomen muscle group and glutes) respond to dysfunction by becoming weaker.

Muscular balance is required for normal function and muscular imbalance leads to dysfunctional movement patterns. Long Standing postural dysfunction may cause joint degeneration and changes to motor control. Poor posture can negatively affect proprioception, balance, gait, and functional performance.

Lower crossed patients often complain of pain in the low back, hips, and pelvis. The postural deficits associated with lower crossed syndrome can contribute to a few lower extremity diagnoses including greater trochanteric pain syndrome, ITband syndrome, patellofemoral pain syndrome, and plantar fasciitis.

Clinical Presentation

Assessment of lower crossed syndrome begins with a visual inspection. Postural evaluation of patients with lower crossed syndrome will often reveal an anterior pelvic tilt, lumbar hyperlordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension.

Lower crossed syndrome may be based on whether a patient’s postural imbalance is hypertonicity or weakness. Patients with hypertonicity demonstrate predominately tight, short hip flexors, resulting in excessive hip and knee flexion accompanied with hyperlordosis in the lumbar spine. Patients with weakness exhibit weak abdominal and gluteal muscles, which lack adequate force to counteract the relatively strong hip flexors and spinal erectors.

Joint dysfunction may arise secondary to muscular imbalance. Lower crossed syndrome creates a pattern of joint dysfunction involving L4, L5, S1, sacroiliac, and hip joints.


Lower crossed syndrome is a functional diagnosis that does not generally require imaging, unless justified by suspicion of concurrent structural deficits or bony pathology.


Management of lower crossed syndrome should first attempt to target abnormal proprioceptive input through joint mobilization and myofascial release. Rehab should progress sequentially through stretching, strengthening, to initiate normal movement patterns. Core stability and hip flexibility exercises have been shown to improve function in low back pain patients.

Stretching and myofascial release should be directed at the thoracolumbar extensors, iliopsoas, rectus femoris, quadratus lumborum, TFL, hamstrings, glutes and piriformis. Home self-massage of trigger points in the thigh and pelvis may be facilitated with a foam roller. Manipulation may be necessary for restrictions in the lumbopelvic joints.

Strengthening exercises should focus on the abdominal and gluteal muscles. Functional rehabilitation must include proprioception and exercises to reeducate new movement patterns.

Patients should be counseled to reduce repetitive stress - including ergonomic workstation modifications.


Dead Bug

Hamstring Doorway Stretch

Psoas Stretch - Kneeling

Standing ITB Stretch

Bird Dog

Side Bridge

Semi-Stiff Deadlift

Posterior Lunge

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