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| The Upper Crossed Syndrome, part I |
Vladimir Janda, MD, is an Eastern European physician
specializing in manual treatment of musculoskeletal
problems. During his career, he has identified and
organized treatment of two predominant muscular
imbalances. These imbalances are around the waist and
the shoulders, and are known respectively as the lower and
upper crossed syndromes. As the lower crossed syndrome
has been written about more extensively, we will delve into
the upper crossed syndrome, and we will divided it into
cases of neck pain and headache, upper back pain, and
shoulder pain. While this division is convenient, frequently
all three parts of the imbalance are present simultaneously;
the problem someone comes in with is simply a matter of
what starts hurting first. This month, we will deal with neck
pain and headaches in our examination of the upper
crossed syndrome.
As mentioned earlier, the upper crossed syndrome is a
muscular imbalance. What this comes down to is that
certain muscles have become shorter and more active than
they should be, and other muscles which oppose the first
group have become longer and less active than they should
be. The first group, when we deal with the neck and head,
consists of the big muscles on the front of the neck, known
as the sternocleidomastoids (or SCMs), and the little
muscles at the base of the skull, call the suboccipitals.
These are outlined in blue below.
specializing in manual treatment of musculoskeletal
problems. During his career, he has identified and
organized treatment of two predominant muscular
imbalances. These imbalances are around the waist and
the shoulders, and are known respectively as the lower and
upper crossed syndromes. As the lower crossed syndrome
has been written about more extensively, we will delve into
the upper crossed syndrome, and we will divided it into
cases of neck pain and headache, upper back pain, and
shoulder pain. While this division is convenient, frequently
all three parts of the imbalance are present simultaneously;
the problem someone comes in with is simply a matter of
what starts hurting first. This month, we will deal with neck
pain and headaches in our examination of the upper
crossed syndrome.
As mentioned earlier, the upper crossed syndrome is a
muscular imbalance. What this comes down to is that
certain muscles have become shorter and more active than
they should be, and other muscles which oppose the first
group have become longer and less active than they should
be. The first group, when we deal with the neck and head,
consists of the big muscles on the front of the neck, known
as the sternocleidomastoids (or SCMs), and the little
muscles at the base of the skull, call the suboccipitals.
These are outlined in blue below.
Opposing these two muscle groups are the deeper muscles of the neck
under the jaw in front and at the base of the neck in back, known as the
deep neck flexors and spinal erectors, respectively. This alternating
high and low imbalance, short at the top in back and low in front while
being too long high in front and low in back, gives the "cross" to the
syndrome.
The next issue to examine is how this imbalance comes about. While
resistance training can be a factor, this imbalance is seen throughout
the population, not just among weight-lifters, and is due primarily to the
amount of sitting we all do. Even those among us who are very active sit
in the car, at the computer, at the dinner table...etc. Modern life is very
sedentary; it's how we get around. More importantly, sitting is the most
common cause of all types of the upper crossed syndrome. Sitting
pulls the head forward to remain over the pelvis. This puts the
SCM and suboccipitals in a shortened position, and the deep
flexors and spinal erectors in a lengthened position. And, like
your mother used to tell you, if you keep making that face (or remain in
that position), it will stay that way. Neither group of muscles likes to be
in that position, so they start to complain. What's more, the imbalance
puts a great deal of pressure on the joints, and eventually they begin to
malfunction, locking into one position or another.
At this point, you may be wondering how you would know if you were
experiencing the upper crossed syndrome. Common symptoms of the
above imbalance include headaches, neck and jaw pain. The jaw pain
comes about because the forward position of the head pulls the jaw
open, and the muscles which close the jaw (like the one that bulges in
the cheek when someone is angry) tighten to resist.
But now it is time for the most important part: how to fix the upper
crossed syndrome. Janda and an American chiropractor named Dr.
Craig Liebensen who has written extensively about the subject laid out
three steps. After resolving any inflammation, first adjust the joints in
question. Fixing the joint dysfunction that's involved will decrease pain,
increase range of motion, and may cause some of the involved muscles
to return to their normal length spontaneously. Second, use manual
techniques such as ART and stretching to restore those that don't
spontaneously lengthen to their normal length. Finally, use
rehabilitative exercise to re-teach normal position and movement to the
body. This frequently comes in two phases. The first phase is any
isolation exercises needed to teach a specific motion. The second, and
more important phase is teaching whole body movements which to
return the patient to where they were before the problem on a
permanent basis. However, given the insidious nature of sitting,
maintenance in the form of regular exercise and quarterly adjustments is
often necessary.
under the jaw in front and at the base of the neck in back, known as the
deep neck flexors and spinal erectors, respectively. This alternating
high and low imbalance, short at the top in back and low in front while
being too long high in front and low in back, gives the "cross" to the
syndrome.
The next issue to examine is how this imbalance comes about. While
resistance training can be a factor, this imbalance is seen throughout
the population, not just among weight-lifters, and is due primarily to the
amount of sitting we all do. Even those among us who are very active sit
in the car, at the computer, at the dinner table...etc. Modern life is very
sedentary; it's how we get around. More importantly, sitting is the most
common cause of all types of the upper crossed syndrome. Sitting
pulls the head forward to remain over the pelvis. This puts the
SCM and suboccipitals in a shortened position, and the deep
flexors and spinal erectors in a lengthened position. And, like
your mother used to tell you, if you keep making that face (or remain in
that position), it will stay that way. Neither group of muscles likes to be
in that position, so they start to complain. What's more, the imbalance
puts a great deal of pressure on the joints, and eventually they begin to
malfunction, locking into one position or another.
At this point, you may be wondering how you would know if you were
experiencing the upper crossed syndrome. Common symptoms of the
above imbalance include headaches, neck and jaw pain. The jaw pain
comes about because the forward position of the head pulls the jaw
open, and the muscles which close the jaw (like the one that bulges in
the cheek when someone is angry) tighten to resist.
But now it is time for the most important part: how to fix the upper
crossed syndrome. Janda and an American chiropractor named Dr.
Craig Liebensen who has written extensively about the subject laid out
three steps. After resolving any inflammation, first adjust the joints in
question. Fixing the joint dysfunction that's involved will decrease pain,
increase range of motion, and may cause some of the involved muscles
to return to their normal length spontaneously. Second, use manual
techniques such as ART and stretching to restore those that don't
spontaneously lengthen to their normal length. Finally, use
rehabilitative exercise to re-teach normal position and movement to the
body. This frequently comes in two phases. The first phase is any
isolation exercises needed to teach a specific motion. The second, and
more important phase is teaching whole body movements which to
return the patient to where they were before the problem on a
permanent basis. However, given the insidious nature of sitting,
maintenance in the form of regular exercise and quarterly adjustments is
often necessary.
