What is it?
Upper Crossed Syndrome is a pattern of alternating tightness and weakness involving the neck and shoulders. Upper quadrant muscular dysfunction does not occur at random, but in a predictable pattern of altered posture for a period of time. The process usually begins when a muscle or group of muscles are overused in a certain direction and becomes shorter and tighter.
Muscles such as the upper trap, levator, SCM, and pec major can be predisposed to tightness with upper crossed syndrome. The rhomboid, serratus, scalenes, and middle or lower trap respond to dysfunction by becoming weaker.
Upper Crossed Syndrome is a direct result of an over flexed position within the head, shoulders, and arms. Research has shown that prolonged smartphone use may carry a six fold increased risk of neck pain due to the upper cross- induced posture. Forward head postures can put an increase of compressive pressure on the cervical spine and trigger improper activation of the suboccipital muscles.
Muscular balance is required for normal function, and muscular imbalance leads to dysfunctional and poor movement patterns.
Poor posture can negatively affect proprioception, balance, walk pattern, muscle activity, dysfunctional breathing, and functional performance.
Clinical Presentation
Upper crossed patients often complain of neck pain, interscapular pain, and headaches. This condition is a functional disorder that requires identification of the underlying factors that contribute to structural issues within the body.
Hypertonicity will be found in the upper traps, levator, pec major, and SCM. Palpation will reveal tenderness or trigger point activity in the previously mentioned muscles as well as weak rhomboids, serratus, middle and lower traps, scalenes, and deep neck flexor muscles.
Patients with upper crossed syndrome will often demonstrate abnormal shoulder abduction. Patients with this condition frequently demonstrate early shoulder elevation due to the upper trap and levator scapula. Upper crossed syndrome often causes patients to have weak scapular stabilizers.
Upper crossed syndrome creates a predictable pattern of joint dysfunction usually involving the atlanto-occipital joint, C4 + 5, C7- T1, T4 + 5, and the glenohumeral joint.
Diagnosis
Upper crossed syndrome is a functional diagnosis that does not generally require imaging, unless justified by suspicion of bony pathology or a structural pathology.
Management
Management of upper crossed syndrome should first attempt to eliminate abnormal proprioceptive input through joint mobilization and myofascial release. Rehab then progresses through stretching, strengthening, and functional movement patterns.
Stretching and myofascial release should be directed toward the pec muscles, SCM, upper traps, and levator. Manipulation can be necessary for restriction in the cervical, thoracic, and shoulder regions.
Corrective exercise may improve muscle activation imbalance, movement patterns, and alignment in patients with upper crossed syndrome. Therapeutic exercises have been shown to result in changes in head position and can improve neck pain. Functional rehabilitation will include proprioception and exercises to improve and retrain everyday movement patterns.