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July 27, 2021

Upper-Crossed Syndrome‍

Upper-Crossed Syndrome

Upper-Crossed Syndrome (UCS) is an extremely common occurrence in our current society, which is caused and exacerbated by poor posture. With all the sitting and desk work that most jobs require, it is very difficult to avoid experiencing this at some point throughout one's life. The COVID-19 Pandemic only made this problem worse due to so many people working from home with make-shift desks and work set ups as well as prolonged cell phone use. We have definitely seen an increase in neck, upper back, and shoulder complaints in the last year, many which can be directly linked to upper-crossed syndrome.

With UCS, forward head position and forward rounded shoulders are very commonly observed, this will also cause rounding of the upper mid back. Symptoms of UCS include but are no limited to: neck pain, head aches, jaw pain, mid or lower back pain, numbness/tingling down the arms, and decreased ROM of the shoulders, mid back, and neck. 

A Deeper Dive

Tonic (facilitated) muscles have a tendency to become too tight, phasic (inhibited) muscles have a tendency to become weakened. The reasoning for that goes back all the way to our development, tonic muscles are developed first, which is why it is hypothesized that they become more active. Phasic muscles develop later, and they have a tendency to become weak and fatigue more quickly. 

According to Dr. Vladimir Janda of the Prague School of Rehabilitation, who first described upper and lower crossed-syndromes, the muscle imbalances occur first which then lead to the functional dysfunction. This dysfunction can then cause changes in posture and our ability to perform optimally. 

When we think about tonic muscles, we tend to want to stretch/roll/massage them because they feel like they are very tight. We need to create balance between the tonic and phasic muscles in order to have proper posture and joint alignment (Joint centration). This requires specific strengthening/stabilizing exercises for the phasic musculature, simply stretching the tonic musculature will not create balance. 

The importance of the Diaphragm and breathing patterns in UCS

A proper breathing pattern is only achieved with proper positioning and use of the diaphragm. When the proper pattern is not achieved, most people will default to using accessory muscles of respiration to aid in their normal breathing pattern. The accessory muscles are only meant to be used to draw in more than normal amounts of oxygen, for example after running a sprint. 

The accessory muscles of respiration include the Scalenes, SCM, Pec Major, Upper Trap, and External Intercostals. As seen in the diagram, these are tonic muscles, which already have a tendency to become short and tight. Breathing dysfunction only feeds their ability to become chronically tight. This makes it critically important to train proper respiration and stabilization functions of the diaphragm. 

The average adult takes 12-16 breaths per minute, this equates to approximately 20,000 breaths per day! If we are not using the proper breathing patterns, then the accessory muscles mentioned above work harder than they are designed to do. This is why tightness and discomfort is experienced in the upper back and neck so often. At the office we often hear people say that they “hold their stress” in their shoulders and neck, this can be attributed to the stress breathing. With stress, our respiratory rate tends to increase without us even being aware of it, which leases to overuse of the accessory muscles causing chronic tightness in the area.


Although Upper-Crossed Syndrome has many common overlapping occurrences, an individual assessment and treatment plan still needs to be developed. 

First and foremost, a breathing assessment must take place to ensure the proper breathing pattern is being used. If this is ignored, the problem will continue to re-occur because the accessory muscles of respiration will never be able to relax. Then some type of soft tissue therapy will be performed on the short and tight (tonic) muscles observed in the UCS pattern. The best soft tissue treatment for your specific case will be determined by your provider, and here at Team Elite Chiropractic we have many tools in our tool belt to choose from. Next, the phasic muscles will be assessed and specific exercises and treatments will be applied to help activate that musculature. Again, your provider will determine the best exercises that fit your specific needs.

All 3 components need to be addressed to create the balance of the muscle system needed to completely alleviate this condition. Contact us today if you would like to book an appointment or learn more about Upper-Crossed Syndrome.

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