Upper Crossed Syndrome Muscle Health

Can musculoskeletal therapies treat individuals with upper crossed syndrome to relieve pain, improve posture, and strengthen the muscles in the neck, shoulders and chest?

Upper Crossed Syndrome

Upper crossed syndrome is a condition in which the muscles of the shoulders, neck, and chest become weak and tight, and is usually brought on from practicing unhealthy posture. Symptoms typically include:

• Neck stiffness and pulling sensations.
• Jaw tension and/or tightness
• Upper back tension, lack of flexibility, stiffness, and aching soreness.
• Neck, shoulder, and upper back pain.
• Tension headaches
• Rounded shoulders
• Hunched spine

Upper Crossed Syndrome and Posture

• The condition affects healthy posture by creating imbalanced muscles between the upper back and chest.
• The tight short muscles in the upper chest get overly stretched and remain in a semi-contracted state pulling on the back muscles.
• This causes the muscles in the upper back, shoulders, and neck to get pulled and weaken.
• The result is a hunched back, forward shoulders, and protruded neck.
• The specific muscles affected include the trapezius and the levator scapula/side of the neck muscles. (Hospital for Special Surgery. 2023)

Individuals having back pain lasting two weeks or longer are recommended to consult a spine specialist or healthcare provider to examine and determine the cause of the pain symptoms. (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

Lingering Pain

• The imbalances in muscle activation and movement and unhealthy posture all contribute to the symptoms.
• The syndrome is characterized by chronic stiffness, tension, pain, and increasing immobility of the chest and shoulder muscles.
• Over time the tightness and pulling, combined with weakness can lead to shoulder joint damage. (Seidi F, et al., 2020)

Causes

There are certain activities and jobs that can contribute to the development and worsening of the syndrome. Factors that worsen symptoms include: (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023) – (Seidi F, et al., 2020)

• Physical trauma/injury to any of the muscle regions.
• Occupations with high amounts of physical exertion, heavy lifting, and injury risks.
• Practicing incorrect postures and positioning.
• Jobs requiring extended periods of sitting and/or standing.
• Inactivity and/or sedentary lifestyle.
• Over athletic activity.
• Smoking.

However, the syndrome is preventable and manageable.

Therapies

Working with a chiropractor and physical massage therapy team can help determine and develop a personalized treatment plan that is the most effective and suitable. A chiropractic and physical therapist will provide several options, which can include: (Cedars-Sinai. 2022) – (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023) – (Bae WS, et al., 2016)

• Bracing
• Massage therapy to increase circulation, relax, and retrain the muscles.
• Chiropractic adjustments for spinal realignment and posture retraining.
• Non-surgical mechanical traction and decompression therapy.
• Kinesiology taping – recovery and preventive.
• Posture retraining.
• Muscle movement training.
• Exercises targeting soft tissues and joints.
• Core strengthening.
• Steroid injections to a specific area.
• Prescription anti-inflammatory medication for pain symptoms – short-term.

1. Individuals may be advised by the chiropractic therapy team to avoid too much bed rest and to limit or avoid activities that can cause pain or worsen symptoms. (Cedars-Sinai. 2022)
2. Studies have shown chiropractic spinal manipulation effectively reduces neck, spine, and low back pain symptoms. (Gevers-Montoro C, et al., 2021)

Self Management

There are ways to self-manage upper-crossed syndrome and associated symptoms. Common techniques include: (National Institute of Neurological Disorders and Stroke. 2023) – (National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2023)

• Practicing correct posture.
• Increasing or decreasing physical activity as recommended by the therapy team.
• Using ice or heat packs to relieve pain and increase circulation to promote muscle rehabilitation and healing.
• Using topical pain creams or gels.
• Over-the-counter nonsteroidal – NSAIDs, like Advil or Motrin and Aleve.
• Muscle relaxants to relieve tension short-term.

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References

Hospital for Special Surgery. Move with the purpose to combat upper and lower crossed syndromes.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain.

Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L. L., & Page, P. (2020). Comprehensive corrective exercise program improves alignment, muscle activation, and movement pattern of men with upper crossed syndrome: a randomized controlled trial. Scientific reports, 10(1), 20688. https://doi.org/10.1038/s41598-020-77571-4

Bae, W. S., Lee, H. O., Shin, J. W., & Lee, K. C. (2016). The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. Journal of physical therapy science, 28(5), 1636–1639. https://doi.org/10.1589/jpts.28.1636

National Institute of Neurological Disorders and Stroke. Back pain.

Cedars-Sinai. Back and neck pain.

Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Frontiers in pain research (Lausanne, Switzerland), 2, 765921. https://doi.org/10.3389/fpain.2021.765921