Upper Cross Syndrome is a pattern of myofascial tension related to poor posture, muscle imbalances, and behavioral holding patterns. UCS is also referred to as shoulder girdle crossed syndrome due to the specific postural changes including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation and abduction and winging of the scapulae (1)These postural changes decrease the stability of the GH joint placing more demand on the upper trapezius and levator scapula to maintain GH stability through over-activation. Ever wonder why your upper shoulders get tight and your neck gets stiff after staring too closely at your computer or phone for too long? There is a direct muscular and neurological and thereby fascial response to our sustained postural habits. How we reside in space affects how we are able to function and perform. This can be clearly seen from the picture below showing how heavy our head loads our spine with an increase of inches forward of the midline.

upper cross syndrome

UCS syndrome is a great example of how our neuromuscular system deals with posture and pain. With a forward head and shoulders and accentuated cervical and thoracic curves, certain muscles become tight and facilitated while other muscles, commonly the antagonists to the tight muscles, become weak and inhibited. Tight muscles are the upper trapezius, suboccipital, pectoralis minor and major, SCM, and levator scapulae. Weak muscles are the deep neck flexors, serratus anterior, rhomboids, and middle and lower trapezius (1). Once a muscle becomes chronically held in a shortened position the muscles opposite of that action become weak and “turn-off”. The inhibited muscles are now more difficult to activate making poor posture a downward spiral making it more difficult to be in a neutral functional position.

As a massage therapist and personal trainer, I see varying grades of UCS syndrome every day whether it’s in the office, in the gym, or out at the store. Poor posture is easily spotted but is never as easy as limiting its cause only to one factor. Environment, injury, learned postural behavior, and habits all affect how we as humans hold our bodies upright. The key to any holistic approach to myofascial imbalance such as upper cross syndrome is to include both awareness exercises, massage, and stretching to reduce the tone of the tight muscles, followed by strengthening the weak muscles. With regular treatment sessions, daily awareness, and posture exercises, environmental alterations such as ergonomic positioning, whole-body movement practices,  UCS can become a syndrome of the past. As with anything in life, it’s better to catch it early to avoid the potential risks that lead to injury or pathology.

The risks associated with Upper Cross Syndrome are C5-C6 pathology such as local osteophytes and a narrowing of the foramen, aka spinal stenosis. Muscle imbalances found in UCS are also known to cause posterior rotator cuff and deltoid weakness jeopardizing the cuff-deltoid force couple. Further weakness found in the lower trap and serratus anterior muscles results in scapular instability due to the imbalance in the serratus-trapezius force-couple (1). This means that overdominant muscles overpower the weaker ones leaving room for faulty scapular mechanics, GH joint mechanics, and instability which lead to injury. You don’t have to be a pro athlete to suffer from this either. Recreational swimmers, climbers, and paddlers who are also working jobs with poor postural habits are at risk for the effects of UCS.

So how do we correct Upper Cross Syndrome once it has taken hold of our posture and positioning? I recommend good bodywork to address not only the hypertonic musculature but also the fascial patterning of tension that spans multiple joints and will continue to restrict posture even after the tight muscles are relaxed. Follow-up the massage with strength training targeted at building healthy muscle tone and neuromuscular feedback for the inhibited musculature. Use awareness drills to remind yourself daily to stand tall, neutral, and supported without hinging at joints that are not built to sustain chronic loading. A foam roller is also a great tool for opening the front of the body as well as restorative yoga postures.

Check out this link my NASM, the leaders in corrective exercise and sports medicine regarding how to identify and correct UCS.

(1)- Page, Frank, Lardner. The Janda Approach: Assessment and Treatment of Muscle Imbalance. Human Kinetics, 2010.