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What Is Upper Crossed Syndrome?

Reviewed by Dan Brennan, MD on April 14, 2021

When the muscles of your shoulders, neck, and chest are out of balance — some too weak and some too tight — that's called Upper Crossed Syndrome (UCS). In side views of the upper body, these muscles seem to group in the shape of an X, which has led to the name of the condition. When your shoulder, neck, and chest muscles do not work together as they should, the results can be quite noticeable and painful for you. 

What Causes Upper Crossed Syndrome?

Poor posture is the main driver of UCS. Researchers have long seen the syndrome among laundry workers and others whose work demands a lot of bending and twisting. 

‌But more frequently these days, people who are at risk for UCS are spending too much time hunched over a laptop or a smartphone. In fact, UCS has even come to be nicknamed “iHunch”.  

How Is Upper Crossed Syndrome Diagnosed?

If you have UCS, you're likely feeling some stress in your neck and shoulder area. Perhaps you’ve noticed that it's been getting worse with time. ‌You typically feel such stress while doing things that caused the imbalance in the first place.

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You may have one or more of these particular symptoms: 

  • Frequent shifting while sitting, using the computer, or watching TV‌
  • Difficulty driving because of muscle tightness or pain‌
  • Lower back pain
  • Soreness around the shoulder blades‌
  • Tight or painful neck muscles 

You should tell your doctor if you have these symptoms. Your doctor will pay special attention to the forward angle of your head, which can appear “hunched” with UCS. The doctor will check the position and movement of your neck and shoulders too. 

Your doctor will likely notice if you are showing one or more of these classic outward signs of UCS: 

  • An inward curving spine at the neck.
  • ‌Shoulders that are rounded forward.
  • ‌Protruding shoulder blades.
  • ‌Head or neck slouched forward.

Be sure to tell your doctor if you have started to suffer from frequent headaches, especially tension headaches. UCS has been found to be a cause of headaches as well.

Treating Upper Crossed Syndrome

If you think you have UCS, you should seek treatment. UCS will worsen and can lead to you having trouble breathing, spinal issues, and less range of motion than usual. Treating UCS with physical therapy (PT) has been proven to work. In one case, researchers had 30 university students with UCS go through PT, and they found that PT helped. Almost all of the students became better aligned and could move their upper shoulder muscles more easily.  

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A doctor who thinks that PT will help make your weak muscles stronger and relax your tight muscles will give you a prescription for PT. You should take that prescription to a licensed physical therapist. That person will customize your exercises for your specific needs. 

These exercises progress in stages and can include:

  • Lying on large training balls to stretch and engage the back. ‌
  • Stretching the shoulders and arms with Thera-bands.‌
  • Weight training with both dumbbells and barbells. 

Typically, you would warm up and then do these and other types of UCS exercises in five sets of 10 repetitions or six sets of 15 repetitions. Your physical therapist will check your progress and help fix your form when necessary. You would cool down at the end of a session.

So UCS is serious but treatable. Like others who have gone through exercise programs for the condition, you may feel lasting improvement. Just be sure to follow the physical therapist’s guidance.‌

Tips for Avoiding Upper Cross Syndrome in the Future

Start by practicing good posture, being sure to avoid positions that create discomfort or numbness. In particular, don’t give slouching a chance to become a habit. 

Here are some other things to try for better posture:

  • ‌Watch your weight.
  • Wear shoes that offer support.
  • Instead of leaning your head down to look at a book or screen, raise the book or screen up to eye level. 
  • Set the height of your chair or desk so you can attain proper posture. 
  • If you sit for long periods of time, remember to take a break and stretch every so often. 
  • ‌If you stand for long periods of time, support one foot on a short, sturdy object.
  • ‌When in bed, support your neck and lower back with rolled towels or pillows of that size.
  • ‌Exercise the muscles around your neck, shoulders, and chest at least two or three times per week. 
  • ‌Try to exercise the muscles of your core, your back and abdomen, every day, even if just by taking a short walk.

Alongside the advice of your doctor or physical therapist, these tips will help lessen your risk of having to deal with UCS.

WebMD Medical Reference

Sources

Sources: 

Applied Ergonomics:  “Texting on Mobile Phones and Musculoskeletal Disorders in Young Adults: A Five-year Cohort Study.”

Harvard Health Publishing:  “Posture and back health.” 

Indian Journal of Occupational and Environmental Medicine: “Prevalence of Upper Cross Syndrome in Laundry Workers.”  

Journal of Manipulative and Physiological Therapeutics: “Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache.”

Kai tiaki: “Avoiding the ‘iHunch.’” 

NASM: “Correcting Upper Crossed Syndrome.” 

Physical Therapy in Sport: “Effects of an 8-Week Selective Corrective Exercises Program on Electromyography Activity of Scapular and Neck Muscles in Persons With Upper Crossed Syndrome: Randomized Controlled Trial.”

Reneu Health:  “Crisscrossed.”  

Trials: “The Effectiveness of a Comprehensive Corrective Exercises Program and Subsequent Detraining On Alignment, Muscle Activation, and Movement Pattern in Men With Upper Crossed Syndrome: Protocol for a Parallel-Group Randomized Controlled Trial.”

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