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Updated: Apr 18

What is Upper cross syndrome?

an image of a man explaining upper cross syndrome


The kinetic chain describes the interrelated groups of body segments,

connecting joints, and muscles working together to perform movements and the

portion of the spine to which they connect. The perfect example of kinetic chain

is Upper Cross Syndrome. This type of syndrome refers to tightness in one area

leading to weakness in other areas, which can affect posture and overall joint

function and mobility.

Upper cross syndrome is characterised by weakness in the deep neck muscles

and Shoulder blade muscles (lower trapezius and serratus anterior) while in the

tightness in the Upper trapezius and chest muscles (Pectorals) {1} .

What causes it?

Upper cross syndrome is most common in the people who have poor postures.

People who have prolonged sitting in front of laptop or desktop, prolonged

driving hours, watching TV, excessive cell phone browsing, or use of a texting

app, or game use, reading, biking are more prone to this syndrome.

an image explaining poor postures leading to upper cross syndrome

The muscles of the neck and shoulders (upper trapezius, and levator scapula)

become extremely over activate. The muscles in the front of the chest (the major

and minor pectoralis muscles) become shortened, tight and inhibited .As a result

of these overactive muscles, the surrounding counter muscles overact. In this

syndrome, there is weakness in the muscles in front of the neck (cervical flexor

muscles) and in the lower shoulders (rhomboid and lower trapezius muscles) {1} .

What are the symptoms in Upper Cross Syndrome?

People with this syndrome have a lot of compensations in their which may

include slouched posture, rounded shoulders and a bent-forward neck.

a man with upper cross syndrome

The inhibited muscles put strain on the surrounding joints, bones, muscles and

tendons. A person having these compensation and mechanical imbalances may

experience symptoms including:

Pain in the neck, upper back, shoulders, Jaw, lower back region along with

tightness and pain in the chest at the intercostal region.

Some people with this syndrome may experience headache, fatigue, difficulty

in maintaining sustained postures like sitting to read or prolonged driving

hours {1} .

How to treat Upper cross syndrome?

The main aim to treat upper cross syndrome is to correct the mechanical

imbalances between the muscles which may include:

Releasing the tightness in the upper trapezius muscle and front chest muscles

(Pectorals) {2} .

Techniques like Deep tissue release, foam ball rolling, self-stretching, muscle

energy techniques needs to be included in the treatment process {3} .

deep tissue release and foam ball rolling

Along with these techniques the strengthening of inhibited muscles like deep

neck flexors and working on scapular or shoulder blade muscles {3} .

Initially with the activation of these muscles and then progressing them with the

resistive bands considering their activities of daily living and the challenges

they face every day.

Include breathing exercise to improve Upper-chest expansion.

breathing exercises leading to strengthning scapular muscles

Exercises which include strengthening of scapular muscles

a woman exercising

resistance band training and T in prone

How to avoid Upper Cross Syndrome ?

The best way to avoid upper cross syndrome is to avoid prolonged postures

Break your postures every 30- 40 minutes. Avoid prolonged usage of cell

phone, limiting time spent watching TV, reading, using laptops and computers,

or driving.

Include cardiovascular exercise, ideally 30 minutes daily from low-impact

activities, such as walking or swimming.

Avoid faulty postures; do stretch the target tighter muscles of the back, neck,

shoulders, and chest. Follow proper ergonomics while doing the activities like

driving, do watch the position of the steering wheel, neck position while you

read a book, watch TV, or computer screen {4} .

an image with a woman in different postures

Make use of lumbar roll in chairs {5} , make use of the headset for long telephone

calls, and make use of a pillow which will support your neck while you sleep {6} .

While correcting the upper cross syndrome it is crucial to know the importance

of exercises, ‘Strengthen and stretch’ should be the motto while dealing with

upper cross syndrome. Avoiding faulty postures and having a habit of breaking

the sustained postures will help in prevention and faster recovery.


1] Moore MK. Upper crossed syndrome and its relationship to cervicogenic

headache. J Manipulative Physiol Ther. 2004;27(6):414‐420.


2] Bae WS, Lee HO, Shin JW, Lee KC. The effect of middle and lower

trapezius strength exercises and levator scapulae and upper trapezius stretching

exercises in upper crossed syndrome. J Phys Ther Sci. 2016;28(5):1636‐1639.


3] Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective

exercises program on electromyography activity of scapular and neck muscles

in persons with upper crossed syndrome: Randomized controlled trial. Phys

Ther Sport. 2019;37:113‐119. doi:10.1016/j.ptsp.2019.03.008.

4] Baker R, Coenen P, Howie E, Williamson A, Straker L. The Short Term

Musculoskeletal and Cognitive Effects of Prolonged Sitting During Office

Computer Work. Int J Environ Res Public Health. 2018;15(8):1678. Published

2018 Aug 7. doi:10.3390/ijerph15081678.

5] Horton SJ, Johnson GM, Skinner MA. Changes in head and neck posture

using an office chair with and without lumbar roll support. Spine (Phila Pa

1976). 2010;35(12):E542‐E548. doi:10.1097/BRS.0b013e3181cb8f82.

6] Jeon MY, Jeong H, Lee S, et al. Improving the quality of sleep with an

optimal pillow: a randomized, comparative study. Tohoku J Exp Med.

2014;233(3):183‐188. doi:10.1620/tjem.233.183

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