Correcting Bad Posture: Your Guide to Upper Crossed Syndrome

Posture is something we can control. Yet, look around and you’ll notice that, for many people, their posture is not good. This is due largely to our increasingly sedentary, technology-driven lifestyles. But, if left uncorrected, bad posture can easily lead to negative health consequences.

As a personal trainer, your career is built on identifying and helping to correct physical deviations. This is important when working with clients to achieve their health and fitness goals.

Upper crossed syndrome is one of the most common posture-related conditions you will see with clients. Being able to identify and address this condition with corrective exercise is key to getting and keeping clients who rely on your expertise.

What Is Upper Crossed Syndrome?

Often referred to as UCS, upper crossed syndrome is characterized by muscle imbalance. Specifically, it refers to an imbalance in the neck, upper back, chest, and shoulder muscles. 

The deep neck flexors, lower trapezius, and serratus anterior are weakened and lengthened. Conversely, the upper trapezius, levator scapula, and pectoralis major and minor are overactive and tight.

The shoulders roll forward in upper cross syndrome. This creates a rounded upper back and a forward head. 

Causes of Upper Crossed Syndrome

Research indicates that poor posture is the leading cause of upper crossed syndrome (1). Poor posture can be a result of many things. Sometimes, it’s just a matter of not paying attention to how you sit or stand. Other times, structural issues in the skeletal system make a healthier posture difficult.

Upper cross syndrome can also be caused by repetitive movements. One example of an at-risk population is laundry workers. A 2019 study found that a large number of these workers have this syndrome (2). The nature of their work contributed to weak neck flexors and tight pecs.

Overuse of smartphones, computers, and tablets contributes to forward-rounded shoulders. So does sitting or driving for extended periods. Both of these activities can lead to unconscious shoulder rounding.

Consequences of Upper Cross Syndrome (and Poor Posture)

Sitting with a slouched posture reduces the engagement of the core and the glutes. It shortens the hamstrings and hip flexors, placing stress on the lower back. This can lead to pain.

For people with upper cross syndrome due to repetitive movements involving the neck muscles, shoulders, and chest, pain can also result. In the study of laundry workers mentioned above, neck pain was the most common symptom. They also had a forward head posture.

Over time, bad posture leads to overactive and underactive muscles in the upper back, neck, chest, and shoulders. This contributes to an even greater muscular imbalance. This creates an unhealthy cycle. Poor posture increases muscle imbalance which leads to poorer posture. Stopping this cycle is critical to improving health and wellness.

If upper cross syndrome is left undiagnosed and uncorrected, kyphosis can develop. Kyphosis is a deviation of the cervical and thoracic spine. It is often referred to as having a hunched back. While this condition can be treated, it is more challenging to address.

How to Recognize Upper Crossed Syndrome

The rounded shoulders, overactive pectoral muscles, and forward head posture aren’t difficult to identify. This is good news for trainers. It’s also beneficial for other healthcare professionals who may assist with treating upper crossed syndrome. A physical therapist, massage therapist, and chiropractic care professional are on this list.

Clients with upper crossed syndrome may also experience certain physical symptoms. Among these symptoms are:

• Neck pain

• Shoulder pain

• Low back pain

• Jaw pain

• Numbness or tingling in the arms

• Difficulty turning the neck

• Restricted movement

• Headaches (cervicogenic headache)

Many clients can minimize these effects by practicing good posture. Standing or moving more during the day helps as well. So does engaging in some very specific exercises. 

5 Corrective Exercises to Improve Upper Crossed Syndrome

With the proper, consistent corrective exercise, upper crossed syndrome can be corrected. Relieving muscle tightness in the upper back and neck can reduce the chronic pain symptoms your client may feel. Stretches for upper back dysfunction are good for this purpose.

Beyond stretching overactive muscles, strengthening the deep neck flexors, serratus anterior, and lower trapezius will be vital for improvement. Here are five exercise options that hit these muscle groups.

1. Plank

Planks are so simple, yet highly effective. A basic plank allows you to focus on the client's flat back and pull their shoulders back and into alignment. A side plank variation works as well. 

To do this exercise, have the client lie on their stomach. Their hands are next to their chest, palms on the floor. Next, they push their upper body up, until they are in a push-up position. Their body is straight from the shoulders to the heels. 

Have them hold this stretch for up 60 seconds, or as long as they can. Planks are a great total core challenge. 

2. Opening the Chest

Have the client stand upright and clasp their hands behind their back. While pressing their hands down and away from their back to retract the shoulder blades, they will raise their chest and lift their chin. The deep chest stretch can be held for 15 to 30 seconds.

This stretch opens the chest. It does this while engaging the upper back and shoulder blades. This helps the shoulder girdle return to a healthier position. 

3. Shoulder Blade Retraction

This exercise encourages the client to engage weak muscle in the upper back. It also gives them a feel for what proper posture should be. 

They start by standing or sitting up tall. Their shoulders are down and pulled back. In this position, their shoulders should be away from the ears.

In 10 to 15-second intervals, have them squeeze their shoulder blades together. To help with this, ask them to imagine holding a pencil between the blades. 

4. Wall Arm Angels

This exercise encourages a full range of motion. It also engages the upper back with the support of a wall. 

To do it, have the client stand with their back to the wall. Their feet should be slightly out in front. Their palms are facing forward, and their arms are against the wall at the hips. Next, have them slowly begin to abduct from the shoulder, keeping the arm against the wall. 

The movement continues until their arms have reached the maximum range of motion without raising the shoulders or separating the shoulder blades and upper back from the wall.

To progress this exercise, move the arms from overhead and drop the elbows until the arms form a letter "w."

5. Pull-ups

This is one of the most under-performed strength movements in fitness. Yet, the pull-up is a functional way to strengthen the back and encourage proper range of motion in the shoulder joint and upper back.

There are several ways to perform a pull-up:

• Machine-assisted

• Band-assisted

• Unassisted

• Band pull-down for those with grip issues

Using a wide grip will target the latissimus dorsi and teres the most. Using a close, underhand grip focuses on the latissimus dorsi and the biceps.

How to Design a Corrective Exercise Program to Improve Upper Crossed Syndrome

Trainers can design an entire corrective exercise program for clients with upper crossed syndrome. Alternatively, you can add these five stretches and strengthening movements to any fitness program. 

With corrective exercises, the warm-up is a key time to ensure an ideal range of motion and muscle alignment. This is especially true with stretching and self-myofascial release movements. It helps prevent injury, improves posture, and works to warm up the upper back.

Teaching clients about the importance of corrective exercise will encourage them to do these movements on their own as well. The more frequently they strengthen and stretch, the faster they will see physical changes. It also speeds the relief of any symptoms they are feeling due to this syndrome.

It’s important to consider that upper crossed syndrome includes chest muscle tightness. So, back and core exercises should be the focus, helping to relieve the tight muscle.

If you're ready to take your personal training certification to the next level and help clients with movement and postural deviations, get started on your ISSA Corrective Exercise Certification.

References

1. Muscolino, J. (2015). Upper crossed syndrome. Journal of the Australian Traditional-Medicine Society, 21(2), 80+. https://link.gale.com/apps/doc/A455284963/HRCA?u=anon~312446f4&sid=googleScholar&xid=96cb65d2

2. Mujawar, J. C., & Sagar, J. H. (2019). Prevalence of Upper Cross Syndrome in Laundry Workers. Indian Journal of Occupational and Environmental Medicine, 23(1), 54–56. https://doi.org/10.4103/ijoem.IJOEM_169_18