UPPER CROSSED SYNDROME: WHAT IS IT AND HOW TO DETECT IT?

What is posture?

For more than 30 years, the term posture has been defined as a "set composed of the articular positions at each moment" (Kendall, 2007). The physiognomy of the human being needs certain types of postures to maintain its muscular and skeletal balance, defined as correct posture or harmonic posture (Kendall, 2007). The misalignment and consequent distancing of this harmonic posture will overload the active and passive structures, affecting above all the spinal column, due to the unnecessary stress in it. This type of posture is called vitiated postures.

Poor posture affecting women by Beth Scupham.  CC BY 2.0


What are "crossed syndromes"?

Unfortunately, these vitiated postures are more common in the population than they should be, given that sedentarism and lifestyle have caused us to modify our body positions, giving rise to what are called "crossed syndromes" (Janda, 1983). These "crossed syndromes" generate a very marked muscular imbalance, which leads to stress in the passive structures that support these positions. They are called "crossed" because some muscles shorten and contract permanently, while others remain inhibited and weakened. Next, we provide a presentation with the shortened and inhibited musculature in this syndrome.



However, the fact that there is musculature that remains in constant shortening does not mean that its strength increases as a result. In fact, it could happen that in certain cases of pronounced tension, it leads to a weakening of the strength, calling this "tension weakness" (Liebenson, Liebenson, & Padró, 1999). 

These imbalances occur between the two types of musculature found in the human body, depending on whether it is tonic musculature (static or postural musculature) or phasic musculature (dynamic musculature). The first type is more abundant in the human being, and they have certain characteristics that make them not very fatiguable, hence they are able to maintain the day-to-day posture. The second type is musculature more involved in movements, which remain inhibited under normal conditions, and due to these decompensations their non-use may lead to a loss of strength (Liebenson et al., 1999). It even seems that this syndrome is related to the appearance of headaches (Moore, 2004).

How to detect the "upper crossed syndrome"?

Under normal conditions, a person with this syndrome is very likely to have chest, shoulder, arm, or neck pain. The first step is to evaluate the individual's posture from a sagittal plane, since it will be the one that provides us with the most information. Also, later, analysing the frontal plane can provide us with information about the laterality of the problem, observing lateral decompensations, if any. 

From this sagittal plane, the most common visible postures are:
  • Head tilted forward
  • Cervical Hyperlordosis
  • Thoracic hyperkyphosis
  • Drooping shoulders and forward
  • Shoulders in internal rotation

Posture & pain by Beth ScuphamCC BY 2.0



In the next post we will deal in detail with how to correct this syndrome, which is not difficult to apply if certain criteria are followed. The postural hygiene and the decrease of sedentarism will be key factors in our objective. In addition, there is also the "lower crossed syndrome", and it is very probable that if a person suffers from the "superior syndrome", he will also end up suffering from the inferior one, given its high degree of correlation. We are not going to treat the "lower crossed syndrome" now, although it will be analysed in later entries.

Without further ado, see you in the following post.

May the force be with you!

References

Janda, V. (1983). Muscle function testing. Butterworths. Retrieved from https://www.elsevier.com/books/muscle-function-testing/janda/978-0-407-00201-2
Kendall, F. P. (2007). Músculos : pruebas funcionales, postura y dolor. Marban. Retrieved from https://www.casadellibro.com/libro-musculos-pruebas-funciones-y-dolor-postural-5-ed/9788471015273/2777782
Liebenson, C., Liebenson, C., & Padró, J. (1999). Manual de rehabilitación de la columna vertebral. Paidotribo. Retrieved from https://www.casadellibro.com/libro-manual-de-rehabilitacion-de-la-columna-vertebral/9788480194051/653777
Moore, M. K. (2004). Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache. Journal of Manipulative and Physiological Therapeutics27(6), 414–420. https://doi.org/10.1016/j.jmpt.2004.05.007

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