Have you ever rubbed your neck or shoulders and wondered why they feel so tight and painful? Maybe your upper back hurts when you turn your neck. Or perhaps you find it difficult for you to sit up straight.
If so, you might be suffering from upper cross syndrome, a condition connected to poor posture that can cause neck, upper back, and shoulder pain.
A combination of tight chest muscles and weak shoulder and neck muscles leads to muscular imbalances and pain.
What is Upper Cross Syndrome?
Upper cross syndrome (also called upper crossed syndrome, or UCS) is caused by a condition called forward head posture which happens when your neck cranes forward and your shoulders round.
Normally, your neck or cervical spine should have a slight curve, known as cervical lordosis. Prolonged poor posture can lead to an increased curve, causing your head and neck to jut forward.
With each degree forward, gravity weighs your head down which makes your neck muscles work even harder to keep your head straight so you can see the world.
The imbalance of tight and weak muscles can begin as temporary acute pain but can become chronic over time. Chronic neck pain can lead to functional disability and difficulty performing your work or daily activities. This is known as mechanical neck pain.
UCS also involves the structures of the shoulder and is often accompanied by a hunched upper back (or thoracic kyphosis) from both underactive and overactive muscles.
With a forward head posture, the shoulder blades flare out and tip forward, causing rounded shoulders. This decreases the stability of your shoulder joint, causing difficulty in performing basic movements like reaching or carrying objects.
The basic ability to maintain an upright, proper posture can become painful and difficult when you’re struggling with UCS.
Note: UCS is classified as a syndrome since this continuous forward head position is considered “abnormal” in comparison to a regular, upright posture.
What Causes Upper Cross Syndrome?
Muscles work their best when they are at the optimal length, and tight or weak muscles can become inhibited or dysfunctional. This is known as a muscular imbalance.
Several areas of your upper body can be affected by UCS, including:
Tight pectoral muscles in your chest abnormally draw your shoulders forward.
Tightness in your upper trapezius muscles and levator scapulae muscles in the back of your neck might elevate your shoulder blades up towards the ears.
Weak shoulder blade stabilizers inhibit raising your arms up, pushing, pulling, and carrying objects.
Tight suboccipital muscles at the base of your skull can cause headaches due to compression of the nerves in that area.
The muscles in the front of your neck, the scalenes and sternocleidomastoid, help you breathe during higher levels of activity. Tightness in this area can lead to breathing difficulty, favoring accessory muscles over deep belly breathing muscles, namely the diaphragm.
Scapular winging is a type of dysfunction that commonly occurs due to weakness in the serratus anterior muscles under your shoulder blade, in which the shoulder blade juts out like a “wing”.
Lastly, the deep neck flexors under your chin can become weakened and overstretched due to the head-jutting-forward position.
The muscles around your shoulder blades and upper back are also affected, influencing your shoulder range of motion and stability.
Rounded shoulders cause weakness in the muscles around the shoulder blades – your serratus anterior, rhomboid, and your middle and lower trapezius muscles.
In all these areas, when one muscle is weak, another muscle is overly tightened, resulting in a cycle of muscle imbalance.
Now that you have an idea of some of the affected areas, let’s look at the symptoms of UCS.
Upper Cross Syndrome Symptoms
The most common symptom of upper cross syndrome is neck pain and forward head posture, but many symptoms of UCS can affect your daily life, including
Neck and upper back pain or difficulty when turning your head, like when you’re driving.
Neck or chest tightness, shortness of breath, or tension headaches
Numbness and/or tingling in your arms or hands
Decreased range of motion in your upper back or shoulders, or pain when sitting for long periods.
Some people will only feel neck pain or have difficulty turning their heads while driving, and you don’t have to have all of these symptoms to be diagnosed.
How Is Upper Crossed Syndrome Diagnosed?
Your physical therapist or doctor will use both a description of your symptoms and an evaluation to determine if you have UCS.
For example, with a lack of regular exercise, excessive computer use, manual work with repetitive upper body tasks, or constant bending forward, a diagnosis of upper cross syndrome is likely.
Your physical therapist will also test your neck, upper back, and shoulder strength, and flexibility, as well as complete a postural assessment. Poor posture is the biggest indicator that muscle imbalances are contributing to your neck or upper back pain.
Tightness or tenderness to touch during a physical assessment can also indicate UCS.
Next, we’ll explore strategies you can use in your daily life to improve your posture and decrease pain.
Upper Cross Syndrome Treatment
Physical therapy is an excellent resource to treat upper cross syndrome symptoms and pain.
Physical therapy treatment might include:
Manual therapy: soft tissue massage and joint mobilizations
Stretching tight muscles in the neck, upper back, and shoulders
Strengthening weak muscles in the neck, upper back, and shoulders
Stabilization exercises to improve posture and weight-bearing ability
Functional exercise focused on motor control and proper muscle activation
Muscle energy techniques and reciprocal inhibition to retrain the muscles
Nerve stretches (neurodynamics) if you’re experiencing numbness and tingling in your arms or hands
Postural re-education to remind your body how to move normally again!
A combination of stretching, strengthening, and stabilization exercises provides the best method for UCS pain relief.
Certain exercises and functional movements have been shown to improve upper cross syndrome symptoms and reduce neck and upper back pain. Talk to your physical therapist to discuss which exercises are right for you.
Tips for Avoiding Upper Cross Syndrome
There are ways to avoid, reduce, and reverse upper cross syndrome symptoms and provide neck and upper back pain relief.
Alter your environment to set yourself up for success in the short and long term by using proper ergonomics: Change your desk setup to adjust your computer screen or reading surface to eye-level height so that you’re not looking down for long periods of time.
When sitting, ensure that you’re seated with your hips and knees in a bent 90/90 position with your feet flat on the floor.
Sit with a lumbar roll, pillow, or bolster behind your low back. If you start slouching forward, you will push into the pillow which will act as a cue to maintain good posture.
Set a reminder or alarm on your phone to check your posture throughout the day, especially if you sit on your phone, watch TV, stare at a computer or read for long periods of time.
Use proper lifting posture and technique if you perform repetitive upper body movements especially if you’re regularly bending forward or lifting heavy objects.
Take breaks as needed to stand, walk, or do a couple of your prescribed corrective or stretching exercises throughout the day, especially if you’re sitting for more than an hour.
Small daily actions will help you to make progress toward reducing your neck and upper back pain. Remember, you will need time and consistency to make a difference. Your back pain didn’t begin overnight, so celebrate the small wins as you notice them over time.
Upper cross syndrome doesn’t have to take over your life. It’s never too late to make changes to improve your posture – and your quality of life – so you can perform your daily activities pain-free.
Interested in more tips? Click here to watch our assessment video about strategies to correct your posture and decrease UCS symptoms: https://youtu.be/K6O-t7cqENQ
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
Ur-Rehman, S.S. (2019, December 10 – 2020, September 30). Concentric versus eccentric muscle energy technique on upper cross syndrome. Identifier: NCT04603716. https://clinicaltrials.gov/ct2/show/NCT04603716