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.

Upper Crossed Syndrome and Corrective Exercise

            Many of us are required to sit for many hours a day performing work on computers.  This can cause upper crossed syndrome, a posture that is characterized by a forward head, rounded shoulders, and rounded upper back.  If you can identify with some or all of these postural traits, it is important when you go to the gym to perform exercises that counterbalance this by strengthening the back of your body, as well as stretch the front of the body.  Below is a sample routine that takes about 15 minutes.  All exercises should be performed with good form.  It is also important to note that none of the exercises are performed sitting; to train the body to re-establish good postural patterns, standing is more effective at engaging not just upper back muscles that are weak, but the muscles that stabilize the spine.

Dynamic warm-up:

Arm circles, 10 forward, 10 back

Bear hug- arms extend directly in front of you, palms facing each other as though you were clapping.  Extend the arms away from each other, as though you were preparing to give someone a big hug.  Take your hands back together.  Repeat 20 times.

Leg kicks: Standing tall, feet pointing straight ahead, shoulders back, and abdomen engaged, transfer all of your weight to your left foot.  With your right leg, kick your bottom, then extend the leg directly in front of you as though you were kicking a ball, and set the leg down.  Alternate sides.  Repeat 10/leg.

Exercises:

• Straight arm pull-down with tubing.  Place tubing over something so the handles are about at chest level.  Hold on to handles, palms facing down.  Think about keeping your posture tall, chest open, and a sense of strength in the abdomen.  Keeping the palms facing down and your arms straight, pull your arms straight down by your sides.  Think about keeping the shoulders down and back and engaging from the middle of your back.  Repeat 15 times.
• Tubing squat to row.  Adjust tubing so the handles are at waist level.  Hold on to the handles, palms facing each other.  Scoot back, so you have a fair amount of tension on the tubing.  With your arms extended and palms facing each other, squat down.  As you stand up, row your arms back, keeping the elbows in by your side.  Repeat 15 times.
• PNF pattern.  Adjust tubing so it is low and loop one handle through the other.  Stand sideways to the tubing, holding on the handle the hand farthest away from the anchor point.  Begin with the palm facing the opposite thigh.  Lift the arm up and out, rotate the palm so it faces forward and bringing the tubing up to chest level.  Return to starting point.  Repeat 15 times.  Switch sides.
• Single arm low row with static lunge.  Keep the tubing in single handle mode and adjusted low.  Face the tubing and place the tubing in the left hand.  Lunge your left leg back, lowering the back knee towards the floor.  The right leg glute should be active and the right knee should stay right over the ankle.  Row the left arm back, initiating from the shoulder blade area.  Perform 10-15.  Switch sides.
• Straight arm plank to forearm plank.  Begin in a push-up position (if you are unable to maintain good alignment with straight legs, lower to your knees).  Feet should be hip distance apart, quadriceps should be gently engaged, core should be gently engaged, and shoulder blades should be flat against your back.  Neck should be long, with ears over the shoulders and chin should be slightly tucked.  Hold for 10 seconds.  With control, lower down on to your forearms, maintaining the same alignment.  Hold for 10 seconds.  Rest for 5 seconds, and repeat the first position.  Perform 3 rounds.