Upper Crossed Syndrome

When muscle imbalances occur some muscles become inhibited and weak, while others become tight. Such imbalances lead to tissue changes that may result in inappropriate patterns of movement.

Symptoms

-Chronic neck pain and stiffness

-Chronic upper thoracic pain

-Constant symptoms

-Aggravated by reading, poor posture and by prolonged sitting

-Associated with micro-traumatic shoulder injuries

Signs

-Postural examination tends to reveal a marked anterior head carriage

-Upper cervical hyperextension

-Elevated and protracted shoulders (rounded)

– hyper-kyphotic thoracic spine

-Increased  lumbar lordosis

– levator scapulae, upper trapezius, subscapularis, pectoralis minor and supraspinatus muscles becomes tight.

-Postural overdevelopment of these muscles create a deltoid shear (crossing of rotator cuff under AC joint), leading to shoulder impingement, tendonitis and bursitis syndromes.

-Cervical ranges of motion restrictions with the report of pulling muscular pain elicited at the end ranges

-Positive Cervical Kemp’s test bilaterally

-Thoracic ranges of motion restrictions

-Tender myofascial trigger points in the suboccipital, SCM, levator scapulae, and upper trapezii muscle groups bilaterally

Muscles affected

Tight muscle:

-Pectoralis minor and major

-Anterior scaleni

-Upper trapezius

-Levator scapulae

-Teres major

Weak muscle:

-Serratus anterior

-Lower trapezius

-Teres minor

-Infraspinatus

-Longus colli

Treatment

SHORT TERM GOALS:

-Postural Correction

-To reduce muscle spasm

-To increase muscle flexibility

LONG TERM GOALS:

-To release taut band

-To increase joint ROM

-To increase muscle strength

Physiotherapy techniques Included for treatment

:

– Mobilisation

-Trp

-Stretching

-Myofascial Release

-Strengthening exercises

Dr Sumit Gupta

Physiotherapist

Bangalore Shoulder and Sports Medicine Institute