Lower crossed syndrome and corrective exercise

A postural concern that can have a negative impact on lower back pain and hip mobility is lower crossed syndrome.  This term was first defined by Janda, a physiotherapist and medical doctor, in 1979.  It refers to the position of the pelvis while standing and is more commonly thought of as “swayback posture.”  The easiest way to tell if you have lower crossed syndrome is to look at the back of your belt and compare its position to the front of the belt.  The back of the belt should be even or slightly higher than the front of the belt, with no more than a 10 degree slope.  If the back of your belt is greater than that, your pelvis is in an anterior tilt.  This causes the muscles in the front of the pelvis to be in a shortened position, making them tight, and the muscles in the back of the pelvis to be in a lengthened, or weakened position.  Basically, the butt muscles are weak, the low back muscles are overactive, causing discomfort, the hamstrings are overactive and appear tight, the hip flexors are overactive, and the abdominals are weak.  This can cause trouble in the form of injury or pain, either above or below the hip joint, usually appearing in the low back or knee.  Below are some exercises that can be performed to address lower crossed syndrome.  Similar to the corrective exercises for upper crossed syndrome, these can be performed in a circuit fashion, performing 1-3 circuits, depending on what time allows.

Warm-up:

Cat/Cow

Begin on all fours, with your knees under you hips and your feet hip distance apart.  As you inhale, draw the belly button in, round the back, and drop your chip towards your chest.  Exhale, take the back into a slight arch, lengthening the front of the neck and looking up at the sky.  Repeat 10 times.

Squat preparation:

Remaining in the same starting position, brace your belly as though someone were about to punch you.  Keep the back of the neck long and the chin slightly tucked.  Without changing your low back position, sit back towards your heels.  Do not arch or round your lower back.  Return to center.  If you feel your back round/arch, change the range of motion so the back remains neutral.  Repeat 10 times.

Quadraped:

Staying in a quadraped position, slide your shoulders away from your ears and press your hands firmly into the floor.  Gently engage the abdominals.  Extend your right leg straight back, without rotating your spine.  If you are able to do this easily, extend your left arm at the same time.  Do not add the arm if you feel your spine rotating when you extend the leg.  Pause for a count of 2, return to the starting position and switch sides.  Perform 10/side.

Circuit:

Prisoner squats:

Stand up tall, with your feet hip distance apart.  Toes either point straight ahead or turn out slightly.  Take your hands behind your head and gently engage the abdominals.  Squat back, like you are sitting in a chair.  There should be weight evenly across all parts of your feet.  Your heels should not come off the ground and the knees should not come over the toes.  Squat as low as you can, without arching or rounding the back.  Extend strongly through your hips, imagining the fronts of your thighs growing long as you come up.  Repeat 15 times.

 

Frontal plane stabilization with tubing: 

Stand sideways to the tubing.  Hold on to the handle with both hands.  Your feet should be shoulder width apart with knees slightly soft.  Press firmly into the ground with your feet.  Your weight should be even across both feet.  Start with the hands at the center of your chest, elbows bent.  Engage gently through the abdomen.  Extend your arms straight out.  Don’t let your back arch or round, or your body rotate.  Hold for a count of 5.  Bend the elbows, bring the tubing back into the chest.  Repeat 10-15 times.  Switch sides.

Bottoms up lunge:

Begin in a half kneeling position, with your right knee back and your left leg forward.  Dorsiflex the right foot so the right toes press into the ground, not the top of the foot.  Press your left foot firmly into the floor.  Think about extending the front of your right thigh and lifting out of the right gluteus to engage the glute muscles.  Straightening your right knee, lift your right leg off the ground.  Lower the right knee back down with control.  Repeat 10-15 times and switch sides.

Anterior reach:

Stand on your left leg, lifting the crown of the head up to the sky and lengthening the front of the left thigh.  Think about extending out of the left hip.  Gently engage your abdominals.  Keeping your body straight and your hips even, extend forward at the hips, reaching your arms over head.  Return to center.  Do not rotate the body and come forward as far as you can while keeping the hips even and the spine neutral or until the body is parallel with the floor.  Try not to touch the right foot to the floor.  Repeat 10-15 times and switch sides.

Bridge:

Lie on your back with your knees bent, feet flat on the floor and hip distance apart.  The feet should be about 12 inches from your hips.  Press firmly and evenly into your feet while gently engaging your abdomen.  Extend your hips up, attempting to make a straight line from your feet, to your knees, to your hips.  Rather than squeezing your glutes, think about extending out of the hips.  Pause for a count of 2 and lower down.  Repeat 10-15 times.

For questions, or for more advanced movements, please contact me at pilottij@gmail.com/www.bewellpt.com.