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Lower Crossed Syndrome

If you’re up to date with our blog postings, then the title of this post may sound vaguely familiar to you. If not, check out our previous blog on Upper Crossed Syndrome! Lower Crossed Syndrome (LCS) aka Distal or Pelvic Crossed Syndrome is like the not so fun cousin of Upper Crossed. LCS is categorized by its predictable pattern of alternating tightness and weakness involving core and pelvic musculature. (1) This condition is often the cause of back pain and is associated with many other diagnoses throughout the lower body.

...if you haven't met us yet- we are all about sarcasm and memes

Since we know the ultimate goal of the body is to reach and maintain homeostasis (aka-healthy balance), LCS becomes predictable. When a muscle or muscle group is overused in a certain direction, it adapts and becomes shorter and tighter. The muscles opposite of this action, then lengthen and tend to become longer and weaker. (3)

Much like Upper Crossed Syndrome, Lower Crossed Syndrome got its name due to the crossed structure that can be drawn linking tight muscles to each other that then crosses the line that can be drawn between the weak muscles. (4)

Patients displaying LCS will typically complain of pain in the low back, hips, and pelvis. (5)

Want to know if you could potentially be suffering from Lower Crossed Syndrome? Come on in! Assessment will begin with a visual inspection by yours truly. First, we’ll check out your posture. Ideally, when viewed from the side, your posture should look like the skeleton man on the left above. Whereas patients with LCS typically look like the skeleton man on the right- with an anterior (forward facing) pelvic tilt, lumbar hyper-lordosis (think sway back), lateral (to the outside) leg rotation, and/or knee hyper-extension (over-straightening). Furthermore, it is typical for LCS patients to display gluteal muscle weakness, which can be confirmed through testing pelvic drop or knee valgus when performing single leg exercises such as single leg stand, single leg squat or single leg step down. Essentially, we are looking for your knee to cave in because your glutes don't have the strength to keep your knee tracking correctly.

LCS is a functional diagnosis that does not require imaging.

Finding a solution to a problem (especially a patient’s) is my favorite part of my job! Management will focus on eliminating abnormal joint movement through joint mobilization and myofascial release (torture tools!!!). (6) The patient’s rehab program will then progress through stretching, strengthening, and the facilitation of normal movement patterns. (2)

Stay tuned- we’ll be posting some of these stretches/exercises throughout the month of September on our Facebook and Instagram pages! Until next time friends-

Dr. Amy


1. Frank C, Page P, Larnder R. Assessment and treatment of muscle imbalance: the Janda approach. Human Kinetics; 2009.

2. Janda, V., 1987. Muscles and motor control in low back pain: assessment and management. In: Twomey, L.T. (Ed.), Physical Therapy of the Low Back. Churchill Livingstone, New York, pp. 253-278.

3. Kendall FP, McCreary EK, Provance PG. Muscles: testing and function with posture and pain. Lippincott Williams & Wilkins; 2005.

4. Janda compendium. Vol II. Minneapolis: O.P.T.P., p. 7-13

5. Liebenson C. Rehabilitation of the Spine: A Practitioner’s Manual. Baltimore: Williams and Wilkins, 1996; 97-112, 196.

6. Jull G. Janda V: Muscles and Motor Control in the low back pain: Assessment and management. Edited by IN Twomey LT, Taylor JR: Physical Therapy of the low back, Churchill Livingston, New York, 1987.

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