Upper Cross Syndrome

Written by Dr. Jason Ngan, DC

What is Upper Cross Syndrome?

Upper cross syndrome (UCS) is a condition where the muscles in the neck and upper back are imbalanced. This imbalance is increasingly common since everyone are looking down on their smart phones and computers. If untreated, UCS can lead to osteoarthritis (wear-and-tear on the joints), thoracic outlet syndrome, and even abnormal lung function.

What Causes Upper Cross Syndrome?

UCS is caused by imbalance of the neck and upper back. Repetitive slouching posture causes the muscles in the back of the neck and chest muscles to be overworked. The opposing muscles will be under-used and weakened.

  • The muscles that are over-stressed (tight, hyperactive) include pectoralis major/minor, levator scapulae, teres major, upper trapezius, anterior deltoid, subscaularis, latissimus dorsi, SCM, scalenes, rectus capitus.

  • The muscles that are under-stressed (weak) include rhomboids major/minor, lower trapezius, serratus anterior, teres minor, infraspinatus, posterior deltoid, longus coli/capitus.

Some common activities that cause UCS include:

  • Slouching, poor posture, rounded shoulders, forward head posture such as when looking down on the phone.

  • Office workers constantly looking at the computers.

  • Athletes such as baseball, tennis players, weight lifting, and swimmers.

  • Poor eye sight can cause UCS because patient will move their head forward to try to see better.

What are the Signs and Symptoms?

  • Muscle tightness

  • Trigger points (knots)

  • Pain, numbness, tingling, weakness if it compresses on the nerves (thoracic outlet syndrome)

  • Breathing dysfunction if severe

  • Decreased range of motion due to tight muscles

How is Upper Cross Syndrome Diagnosed?

UCS is diagnosed with a medical history, physical examination, orthopedic testing, x-ray diagnostic imaging, CT scan, EMG/NCV, and MRI.

  • Abnormal sensation (pain, numbness, tingling)

  • Tender-to-touch area (trigger points)

  • Muscle weakness

  • Decreased range of motion

  • Diagnostic imaging looks increased or decreased curves of the spine, bony changes, and inflamed soft tissue

    • The normal curvature of the cervical spine (neck) will straighten or curve the other way (military neck)

    • The normal curvature of the thoracic spine (upper and mid back) will curve more forward (kyphosis)

  • EMG/NCV checks for function of nerve and muscles.

What are the Treatment Options?

Patients with upper cross syndrome find chiropractic care helps them a lot.

  • Chiropractic manipulation and mobilization

  • Flexion-distraction

  • Spinal traction

  • Soft tissue therapies

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Ergonomic/postural counseling

  • Rehabilitative exercises and stretches

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, and pain relief medication.

References

  1. Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther. 2004 Jul-Aug;27(6):414-20. doi: 10.1016/j.jmpt.2004.05.007. PMID: 15319765.

  2. Muscolino, J.E. (2015). Upper crossed syndrome. Journal of The Australian Traditional-medicine Society, 21, 80.

  3. P. V., C., & Vishwanath, S. (2022). Prevalence of upper-cross syndrome in college going students-a cross sectional study. International Journal of Research in Medical Sciences, 11(1), 284–288. https://doi.org/10.18203/2320-6012.ijrms20223652

  4. Ranđelović, Ivan & Jorgic, Bojan & Antić, Vladimir & Hadžović, Miljan. (2020). Effects of Exercise Programs on Upper Crossed Syndrome: A Systematic Review. Physical Education and Sport Through the Centuries. 7. 152-168. 10.2478/spes-2020-0012.