What is this physical medicine term Upper Cross Syndrome and Lower Cross Syndrome? This isn’t a common term used in the Chiropractic profession unless you are a clinician who practices functional rehab or physical therapy-based exercises with patients. I have been fortunate to be in an office for my first 8 years of practice that was very diverse and multidisciplinary. In this office, I was the senior clinic director for the Physical Medicine department which included: Chiropractic, Physical Therapy, Massage Therapy, Acupuncture and Personal Training. The office also had MD’s practicing Family Practice, Orthopaedic Surgery, Neurology and we even had Clinical Psychology. Like I mentioned, very diverse. It was a great environment to not only practice but to learn SO much. Between having some of my university instructors on staff and working beside them treating patients, to scrubbing in at the local hospital to observe patients getting orthopaedic surgical procedures. I was fortunate to be an on-staff member of their Allopathic Health Department. Because of this relationship with this hospital, I was able to observe hip and shoulder replacements, fracture repairs and spinal discectomy and fusions. Likely one of my highlights still, during my now almost 24 years of practicing Chiropractic.
I was able to work with some really talented Physical Therapists and Personal Trainers during my time as this office’s clinic director. It was an extraordinary Personal Trainer by the name of Tony Bruno actually, where I had the amazing opportunity of working with. Tony Bruno was like no other Personal Trainer that I have met, still to this day. His nick name was textbook Tony or Bruno, if you knew him well. He had clients from all walks of life and taught them functional exercises that would not only improve their physical fitness but improve physical and nutritional complaints they had. Bruno was one of the first people I heard of who would not do any static stretching which is the typical isolated stretches we are all used to. Bruno was from the school of thought that you could strengthen opposing tight muscle which would loosen the targeted muscle as a result. For example, with tight hamstrings, strengthening quadriceps would decrease the tightness in the hamstrings. This theory is called the antagonist/agonist rule. Think about strengthening both your bicep and your triceps at the same time. Can’t really do it right? You can only strengthen or contract one side at a time.
I had this great opportunity, with Bruno actually, where we along with another dozen healthcare professionals met at DePaul University in Chicago, in their Athletic Department’s alumni conference room. It was pretty special private invitation. We were all there to see and hear from one of the pioneers of functional medicine and probably one of the most influential in the world regarding functional rehabilitation. Vladimir Janda was a MD from Prague, Czech Republic who was an expert in chronic musculoskeletal pain and pioneered muscle imbalance evaluation and treatment. His passion may have started early cause at the age of 15 he contracted Polio. In this rare time with Dr. Janda, he introduced me to the imbalances of our own body with the flexor and extensor muscle groups that we all suffer from. Dr. Janda understood this imbalance and how it affected anyone with musculoskeletal dysfunction. He really brought Upper and Lower Cross Syndrome into the light for me.
So, how does this all apply to upper and lower cross syndrome. Well here goes… I have been describing to patients for years that we have been created with extensor and flexor muscles. Examples of extensor muscles are your triceps and quadricep, where the bicep and hamstring are flexors. A picture I describe also to patients or when doing public talks is that of a Fetus or baby compared to our geriatric or senior population. Can you visualize that? That example demonstrates how are flexor muscles are stronger than our extensor muscles. As a rule, especially with someone needing postural re-education, we need to be intentional about strengthening our extensors because the imbalance of too much flexor strength over extensor strength is what creates a lot of problems in the functional rehabilitation world.
This is how upper and lower cross syndrome is created. It is the imbalance of those opposing postural muscles that get tight on one side and stretched on the other. Another functional rehab term for tightness is hypertonic and for loose or stretched is hypotonic or inhibited. Upper cross syndrome is the tightness, strong or hypertonicity of the pectoralis group or chest muscle and its opposing functional muscle, the upper trapezius and levator scapula or upper back neck muscle. Then there is the stretched, weak or hypotonicity of the muscle of the deep neck flexor muscle in the front of the neck and its opposing functional muscle, the weak lower trapezius and serratus muscle on the mid back side. Can you picture that? If you need a visual, google image upper cross syndrome.
Lower cross syndrome is very similar in theory to upper cross but involves the lower trunk anatomy. Lower cross syndrome is the tightness, strong or hypertonicity of the erector spinae or the lower back muscle and its opposing functional muscle, the iliopsoas and hip flexor muscle or muscle in front of the hip. Then there is the stretched, weak or hypotonicity of the muscle of the abdominals or pelvic floor muscle in the front of the spine and its opposing functional muscle, the weak gluteus group, lower trapezius and serratus muscle on the mid back side. Can you picture that? If you need another visual, google image lower cross syndrome.
All my patients receive a home exercise plan when they are ready for them, whether they want them or not. If they decide to make paper airplanes out of them, I tell them they will only be able to get so much stability therefore needing more frequent Chiropractic adjusting. For those patients who need the frequent adjusting and still have functional issues due to not doing the home exercises or making the correct habitual postural changes when sitting, sleeping and standing, are then referred to one of a number of physical therapists I trust and use when needed. However, with patients who do the work and utilize the home exercises and make the necessary postural changes, can go much further between Chiropractic adjustments. I prefer to get patients to a monthly frequency if possible. Research says that if nothing is done to continue to work on these weaknesses or functional issues, muscle memory from traumatized issue, scar tissue or habits will have symptoms and dysfunction return, it’s just when.
Everyone is different in how they present and therefore treatments are individualized to some degree in order to achieve the short term and long-term goals I set for patients. Patients have all experienced different injuries, trauma and have different combinations of postural dysfunction. Therefore, I find it is important to treat them individually as they may need a combination of things to correct their upper and lower cross issues, such as an individualized plan of Chiropractic adjusting, a combination of stretching and strengthening home exercises (I prefer them to have 75% strengthening and 25% stretching). This way I can feel better about doing as much as I can for each patient. Then, I can continue to support them any way I can with Chiropractic and they can do the rest on their own, hopefully.
I hope you learned something today. Thanks for reading – and stay well. Dr SJ
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