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Upper what??

We are going to start a 3-part series about those pesky shoulder complaints! To start, we are going to talk about “Upper Crossed Syndrome” aka “Cervical Crossed Syndrome” aka crappy posture that we are (almost) all guilty of. Upper Crossed Syndrome is described as a predictable pattern of alternating tightness and weakness involving the neck and shoulders. (1) This condition frequently results in that nagging neck and mid-back back pain that usually knocks on our door after we’ve put in long hours behind a desk at a computer or on our phones.

Me talking to Liv about UCS and her being very interested- pic used because anytime I can tie in a cute picture of my dog or kid I'm going to...

How does this happen? Great question! Everything that the human body does is to reach its ultimate goal of homeostasis, or state of equilibrium. When we sit behind a desk for hours on end, we typically relax into a “flexor-dominated” posture. You know the one I’m talking about- you’re typing on a computer and realize that both your head and arms have drifted forward. This posture is something that most likely started from a young age in the classroom and progressed into the working years. (5)

The problem with this is that when a muscle group is overused in a certain direction (i.e. neck and shoulders), that muscle group adapts by becoming shorter and tighter. During this movement pattern, it is the antagonist (opposite) muscles that are tasked with opposing this movement and are subjected to a prolonged stretch. This results in these muscles becoming longer and weaker. Thus, Upper Crossed Syndrome is a direct result of flexor-dominated postures. Furthermore, the term “Upper Crossed Syndrome” was coined because a line drawn to connect the tight muscles forms a cross with a second line drawn between the weak muscles. (2)

Since muscular balance is required for normal function, poor posture can affect perception, balance, gait, and functional performance. (5) It can also cause joint dysfunction and changes in motor control. Poor posture has even been linked to an increased mortality rate in older adults! (5) Patients with upper crossed syndrome often complain of neck pain, interscapular pain (pain between your shoulder blades), and headaches. If you find yourself constantly trying to stretch your neck and traps- you likely have Upper Crossed Syndrome. Other diagnoses related to this? TMJ issues, cervical disc issues, vertigo, rotator cuff syndrome, thoracic outlet syndrome, and more.

So, how do we fix it? Usually we start with joint mobilization (getting adjusted) and myofascial release (stretched, scraped, etc). Rehab then progresses with stretching and strengthening exercises, and finally, the facilitation of normal movement patterns. (3 ) If this sounds like you- give us a call. You are made to MOVE, pain free. Until next time, Dr. Amy


1. Page P., Frank C.C., Lardner R., Assessment and treatment of muscle imbalance: The Janda

Approach 2010, Champaign, IL: Human Kinetics

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

3. 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.


4. Thacker, D, Jameson J, Baker J, Divine J, Unfried A. Management of Upper Cross Syndrome

Through The Use Of Active Release Technique And Prescribed Exercises. Logan College

Senior Research Paper.

5. Page, P. Muscle imbalances in older adults: improving posture and decreasing pain. The

Journal on Active Aging. 2005;3:30.

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