Lower-Crossed Syndrome is a muscle imbalance pattern I frequently see in clients on a regular basis. Similar to Upper-Crossed Syndrome, there is a relationship between muscle groups where some become overdominant (facilitated) and others become weakened (inhibited). With Lower-Crossed Syndrome, this relationship occurs at the pelvis and surrounding musculature. Overdominant muscles groups include the rectus femoris, iliopsoas, and thoracolumbar extensors (or erector spinae), with weakened muscle groups including the rectus abdominus and gluteus muscle groups. I also throw in the hamstrings and quadratus lumborum muscles to the overactive group as well since when the glutes have lower activation the hamstrings often pick up the slack by extending the hip and the QL works to extend/stabilize the spine.

lower-crossed syndromeAccording to Janda, a leader in muscle imbalance and dysfunction, this faulty pattern leads to dysfunction at L4/L5 and L5/S1 spinal segments as well as the SI joints and hip joints. My theory is that too much time sitting on our underactive glutes in a hip flexed position is the main contributor to this pattern. With chronic hip flexion, iliopsoas and rectus femoris will be shortened as well as the hamstrings. There is little need to stabilize the trunk using the rectus abdominus when sitting so it becomes weak as well as the glutes that are in a both shortened (glute medius/minimus) as well as lengthened (glute max) position.

But, sitting isn’t the only culprit to Lower-Crossed Syndrome. I see this pattern in clients who run 100-mile trail races who have active jobs. With them, I think it may be an efficiency issue coupled with an endurance issue. At long distances, our body does its best to retain a homeostatic environment often at the cost of our biomechanics. Who needs to use the large glute max or core muscles when running anyways?! Repetitive high levels of use as well as the efficiency play a part in inhibiting our phasic muscles, what Janda described as the extensor groups developed after birth. When the tonic, or flexor muscles, get repeatedly used, without the proper conditioning of the phasic muscles, imbalances ensue.

Another leading theory as to why Lower-Crossed Syndrome is so popular is the fact that our internal structure is asymmetrical. I know, you thought you were perfectly balanced eh! Not so fast. Here is an excerpt from Postural Restoration Institute’s page:

The human body is not symmetrical. The neurological, respiratory, circulatory, muscular and vision systems are not the same on the left side of the body as they are on the right, and vice versa. They have different responsibilities, function, position and demands on them. This system asymmetry is a good thing and an amazing design. The human body is balanced through the integration of system imbalances. The torso, for example, is balanced with a liver on the right and a heart on the left. Extremity dominance is balanced through reciprocal function; i.e. left arm moves with right leg and vice versa. – PRI


So how do I coach my clients to stay out of or get out of Lower-Crossed Syndrome? Here’s how.

First Step: Posture and Alignment

If you can’t get into a good position, then any further movement demands will exacerbate chronic pain and dysfunctional relationships. Learning to center your head and ribcage over your pelvis with your pelvis evenly weight-bearing is a great start. From there allowing both shoulders to sit evenly as well as positioning the knees and feet to help the pelvis alignment is important. Yoga, qigong, and tai chi all teach a fundamental balanced posture that allows the force of gravity to move through our structure evenly thereby reducing the strain on any particular tissue. Once this neutral posture is practiced and hardwired, we can effectively move about our day with ease.

Second Step: Releasing tight tissues and activating weak tissues.

Start by looking at where you are feeling most of the work occurring in your muscles when you move. For an example, I’ll use the squat movement. If you squat down and feel your weight shift forward onto your toes with pressure traveling into your knees and quads, you’re using your quads to support your body weight instead of your glutes. So part of the solution is releasing your quads to allow your glutes to fire. This is because the rectus femoris muscle (one of the quads) is a hip flexor which inhibits the glute max (a hip extensor). Release the quad by foam rolling 3-4 minutes on each one. Stretch each quad for 30 seconds followed by a simple exercise to activate the glutes, like a glute bridge. Then start at the beginning with a squat to see if anything has changed. You may need to not squat as deeply with more emphasis on sitting your weight back in your heels. Part of the solution is re-training the movement pattern. If results are minor, move to release other compensatory muscles present in Lower-Crossed Syndrome such as the iliopsoas, spinal erectors, and hamstrings followed by activating the glutes then re-testing your movement.

Third Step: Have a daily intentional breathing practice.

Practice breathing fully into all parts of your lungs and ribcage without using accessory muscles such as the scalenes and pec minor. A regular breathing practice is vital to not only correcting imbalances such as Lower-Crossed Syndrome but can successfully prevent further issues from emanating down the road. Learn two ways to breathe in a previous post here.

Fourth Step: Change the environment or factor that is the most likely cause.

Too much sitting, improper movement mechanics, excessive exercise without sufficient recovery to the point of neuromuscular compensation, insufficient muscular strength and flexibility can all lead to Lower-Crossed Syndrome. Do the work up front to find the cause and make a change. Train smart and progressive. Take time to recover. Restore to perform!


[The steps listed above are general in nature and do not constitute medical diagnosis or advice. Each person represents unique patterns not always classified in a syndrome.]