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Updated: May 31, 2023

What is 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 characterized 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.

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.

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}.

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.

Exercises which include strengthening of scapular muscles

W in prone

Y in prone

Resistance band exercise

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}.

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. doi:10.1016/j.jmpt.2004.05.007.

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. doi:10.1589/jpts.28.1636.

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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