March 31, 2021

Upper Crossed Syndrome: Symptoms, Diagnosis, And Management

Written by: Youssef Soliman, MBChB
Reviewed by: Mubashar Rehman, PHD

No doubt, the use of cell phones and computers has completely revolutionized our world. Many businesses now became online, and has reduced the need for 9 to 5 jobs.

Unfortunately, that must come with a price. The prevalence of heart disease, hypertension, and other chronic conditions had a monkey jump in the last few years. Additionally, postural problems, like upper crossed syndrome, become common due to the countless hours spent on computers and cell phones.

Specifically, the upper crossed syndrome has a prevalence of 37% among Pakistani students. This article will dig into the science of upper crossed syndrome, understanding its mechanisms and symptoms, and see if we can improve it by modifying our lifestyles(1).

What is Upper Crossed Syndrome?

Upper Crossed Syndrome refers to specific postural changes, including cervical lordosis (abnormal inward curve of spine), forward head posture, thoracic kyphosis (abnormal rounding of the upper back), protracted shoulders, and scapulae winging. These changes can lead to a decrease in the glenohumeral (shoulder) joint's strength and stability; furthermore, it is associated with various musculoskeletal symptoms in the shoulder, neck, and head.

Poor posture is the most critical risk factor for Upper Crossed Syndrome. Consequently, it is not unusual to expect it frequently among adolescents; it is associated with sustained periods of sitting behind monitors. Rarely, the condition can develop as a result of an injury or congenital defect(2).

Upper Crossed Syndrome Symptoms

Upper Crossed Syndrome symptoms can vary from person to person, depending on its severity. They tend to be found together rather than separately. They include:

● Headache

● Fatigue

● Lower neck back

● Back pain

● Pain around the shoulder

● Jaw pain

● Inability to sit to read or watch TV

● Chest pain

● Numbness and tingling of upper arms (usually indicates a severe condition due to impingement of nerves that supply your arms)(3)


What is the Mechanism of Injury in Upper Crossed Syndrome?

Postural muscles, as the name implies, are responsible for keeping our posture. Being able to stand or sit is maintained by different groups of muscles. The balance between these muscles is affected in upper crossed syndrome, leading to the characteristic features of the syndrome.

The weight of our head is about 1/7 of the whole body. So, maintaining a still position while the head is leaning forward exerts 3.6 times more force than otherwise required to maintain a straight standing posture.

The bending of the head puts pressure on the joints and muscles of the cervical cerebra, which can induce tension headaches, cervical headaches, and neck pain.

With time, there is an alteration in the muscle activation, such as overactivity of levator scapula pectorals muscles and upper trapezius. On the other hand, there is under activity of middle and lower trapezius, serratus anterior, and deep cervical flexors.

This imbalance between the different groups of muscles leads to the characteristic appearance of Upper Crossed Syndrome. Moreover, it can lead to movement and joint problems mainly at the C4-C5 segment, atlanto-occipital joint, cervicothoracic joint, T4-T5 segment, and glenohumeral joint(2).


Upper Cross Syndrome Test and Diagnosis

As of yet, no specific tests are available to diagnose the syndrome. Your physician may diagnose you based on the specific findings recognized in physical examination. For instance, the presence of forwarding head position, rounded or protracted shoulders, inward bend of your spine at the neck area, and outward curving of the spine at the shoulders and upper back are all suggestive of the Upper Crossed Syndrome.


What is the Treatment of Upper Cross Syndrome?

The treatment plan usually consists of a combination therapy of chiropractic care and physical exercises to correct upper cross syndrome. Chiropractic care and physical therapy optimize the correction process of affected muscles and joints. A licensed chiropractic practitioner will help to reduce the misaligned joints and relax the fragile muscles.


Correction Exercises of Upper Cross Syndrome

Exercises for upper cross syndrome target your upper body to increase its motion range. Usually, these exercises involve stretching the fatigued overactive muscles while reinforcing the neighboring underactive muscles.

The final physical plan should combine a synergistic muscle motion that helps maintain a correct upper posture. Your physical therapist can offer you the needed education about your posture, understanding your current motion range, and how to improve it.

Furthermore, there are also some braces to straighten posture if you choose to go for that option. Braces to straighten posture can help relieve neck and back pain and correct your posture.

In addition, you can learn exercises to perform at home. Here are some exercises that can help:

  1. Releasing of overactive muscles: the self-myofascial release of the upper trapezius, the Levator Scapulae, and sternocleidomastoid muscles by pressing the tension spots for 30 seconds.
  2. Stretching of overactive muscles: these exercises can help to lengthen the shortened muscles caused by overwork.
  3. Lengthening of the Upper Trapezius: tucking your chin and moving the left ear towards your left shoulder, and switching sides.
  4. Static Stretch of Levator Scapulae: increasing the chin rotation downward towards your left shoulder till you feel stretching on your right side and change sides.
  5. Extending the SCM(sternocleidomastoid muscle): tilting your chin upwardly on your left side till there's a mild stretch on your right side and exchanging the exercise for both sides.
  6. Activation of the Muscles: chin tucks and floor cobra can strengthen both the overactive and underactive muscles by creating an active movement pattern.

Home exercises can reduce symptoms of upper cross syndrome by introducing an equal range of motion balancing the work on all the muscles.



  1. Mubeen I. Prevalence of Upper Cross Syndrome among the Medical Students of University of Lahore. Int J Physiother. 2016;3(3):381–4.
  2. Kim E-K, Kim JS. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. J Phys Ther Sci. 2016 Oct;28(10):2929–32.
  3. Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther. 2004;27(6):414–20.
  4. Bayattork M, Seidi F, Minoonejad H, Andersen LL, Page P. 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. Trials. 2020 Mar;21(1):255.
Article written by Youssef Soliman, MBChB
Dr. Youssef Soliman has a deep passion for writing. He always loves to explain complex medical topics to laypeople. Youssef has over 1.6 Million views on his Quora account and thousands of followers who love to read his articles. He enjoys digging into the nitty-gritty of the most complex medical topics and come up with simplified, visual explanations for them. He also has interests in nutrition and biochemistry food because he believes that we are what we eat, and many diseases like heart disease are all related to what we eat and our lifestyle. This is why he wants to specialize to become an interventional cardiologist.

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