What is Upper Cross Syndrome? Why should I care??

Today we are going to talk about a common dysfunction found in a large percentage of the population today.  Our sedentary lifystyle, coupled with working at the computer, has set the stage for a set of conditions called Upper Cross (or “upper crossed”) Syndrome.

Upper Crossed Syndrome (UCS) is described as a muscle imbalance pattern located at the head and shoulder regions. It is most often found in individuals who work at a desk or who sit for a majority of the day and continuously exhibit poor posture. As can be seen in the accompanying picture, UCS defined by a tightness of the upper trapezius and levator scapula on the dorsal side,  crossing with and associated tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. (Janda 1988)

But what the hell does all this mean? Basically, it means that when 4-5 muscle groups get too tight it can lead to a chain of events that can create shoulder instability, dysfunction and eventually pain and injury. The culprits are the trapezius and levator scapula (which help raise and lower the shoulder blades), the pectoralis major and minor (in your chest), and the sternocleidomastoid (the bulging muscles along the side of your neck).

Its been our experience both on the gym floor and in the clinic, too many clients with the trappings of UCS feel “stuck” with associated shoulder pain. The “shoulder” problems we see are mostly coming from the overuse of the traps and neck.

So, what do you look for to identify UCS? Look for these specific postural changes – which decrease stability (shoulder joint) – that are most commonly seen in UCS:

  1. Forward head posture –for every inch your head is displaced anteriorly, the neck and thorax are exposed to an additional 10lbs of force.   
  2. Increased cervical extension with thoracic kyphosis – The hunchback. Think about how your head must compensate in if your thoracic spine is in extreme hunchback…for you to see you need to extend your head up just to keep your gaze parallel to the floor causing the beginings of a terrible question mark shaped spine!!!
  3. Elevated and protracted shoulders – Also known as “douchebag shoulders” by Kelly Starrett, author of the bestseller, “Becoming a Supple Leopard”, this is when your pecs are so tight and your sub-scapular muscles (the ones between and below your shoulder blades) are too weak to hold your shoulders back so they round forward instead.
  4. Rotation or abduction and winging of the scapula – Abduction means the (scapula) bone is moving away from the body which gives it a ‘wing’ looking effect when looking at it from the side or rear views. If someone can slide their fingers under your shoulder blade and grab on to it, your scapulae are winging.

Besides looking terrible because you are walking around with “douchebag shoulders” and getting tired of having your wife or mother nag you to stand up straight or mind your posture, you should be concerned about what these postural changes can mean to your body’s short and long-term health and well-being. One or more of these symptoms can mean that your shoulders are unstable and therefore at risk for injury. As a result, other areas are overcompensating for the dysfunction, causing damage and further dysfunction because these areas are over compensating; they are turning off other areas that should be working but aren’t, which causes further instability. Or maybe your shoulder girdle is just weak. You may already be feeling the effects in the form of nerve pain in the neck and arm(s), instability while overhead, headaches, and the appearance of rotator cuff problems. In the long term, UCS can also lead to osteoarthritis and degenerative joint disease if not dealt with ASAP.

Later this week we will discuss strategies to correct upper cross syndrome. Stay tuned!