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Upper Crossed Syndrome

Upper Crossed Syndrome

Upper-Crossed Syndrome (UCS) is also referred to as proximal or shoulder girdle crossed syndrome. In UCS, tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Janda noted that these focal areas of stress within the spine correspond to transitional zones in which neighboring vertebrae change in morphology. Specific postural changes are seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988).

From Assessment and Treatment of Muscle Imbalance: The Janda Approach Human Kinetics Publishers

{ 19 comments… read them below or add one }

Rishikesh sah January 17, 2012 at 7:24 am

i had very inspired with this article, and i am also practicing a lot of patient like this , but i wd like to follow your patterns, how can i got your articles, ??


Dr. Phil January 18, 2012 at 2:49 pm

I receommend you purchase the textbook, “Assessment and Treatment of Muscle Imbalance”: see http://www.jandacrossedsyndromes.com/


Vanessa February 12, 2013 at 9:50 pm

I have had shoulder/arm pain that has resembled bursitis/thoracic outlet syndrome for a few years. It has only recently been diagnosed. I’m in the midst of doctor appointments right now, and my next step is an EMG/MRI, but from what I can understand so far, I may have an elevated first rib. After looking up information online, I came across “Upper Crossed Syndrome,” and thus this informative article. Is this something genetic? What causes this muscle imbalance? I do not play sports and have not experienced any accidents/falls.


Dr. Phil March 1, 2013 at 9:10 am

Vanessa, UCS is not genetic, but Dr. Janda would have suggested that genetic factors play a role in developing muscle imbalance syndromes. in other words, your body structure may be at risk for muscle imbalances. The cause is not well established, but we know they are generally regulated by the nervous system and perpetuated by normal daily movements.


Sue March 2, 2013 at 1:00 am

Hi Vanessa,
I have exactly the same thing and same experiences! It just doesn’t seem to improve… Despite having a talking computer, …dragon speak, physio every week and massage … What works for you?!


Declan March 28, 2013 at 7:35 pm

Hi Sue II am also having the same issue and can’t seem to find any improvement. I also get tingling in my hands and general fatigue through my forearm extensors. Dr Phil would you say there is a chance my problem could stem from muscle imbalance or more likely nerve impingement on the brachial plexus? I am experiencing sensory/motor dysfunction in all 3 peripheral nerves. Finding it extremely hard to find an answer, any suggestions on a course of action to get diagnosed.


kevin pisani May 28, 2013 at 7:31 am

From experience I can tell that massage and stretching would certainly help. But The most important thing is:
a) eliminate all culprits of bad posture, tv computer, too much pressing exercises
b) strengthening of rhomboids, lower trapezius and serratus anterior with resistance exercises


Christine May 26, 2014 at 7:27 am

Release under the chin and then release the first ribs most tender spot. Old stuff lives under the chin so clear that first.


Renee April 24, 2013 at 7:24 pm

I’ve been experiencing vertigo/ general dizziness for awhile now. A chiropractor told me about UCS and I’ve been working on balancing my muscles, it has helped. I’m wondering though, if vertigo is a “symptom” of UCS?
I’m also very excited to get the book Assessment and Treatment of Muscle Imbalance, hopefully it has very specific exercises on fixing this issue. I have found that many general exercises make the dizziness much worse. Bummer!!


Brian Simpson May 3, 2013 at 6:54 pm

Can the imbalances in UCS be the reverse of what is diagrammed above?


fucklittlebich November 20, 2013 at 6:26 pm

Dang, my left upper soldier hurts like f**** I ponder if I have ubs please let me know


joey kay February 13, 2014 at 3:28 am

I’m a 30 yo male who has always had that forced head posture forward. Have always tried to correct by pulling it back. This past year I have been having swallowing difficulties. Seems like a lump im my throat around c5-c6. I’ve had three endoscopies with dilations only to have symptoms to return again. Ive had a swallowing study and esophageal manometery….and a ct scan. My posture is bad like I said but I am a healthy person often working out although im a nurse who bends often and spends hours on a ccomputer. My whole right side slightly rolls inward due to being a twin that laid transverse in my mothers belly…..what a dr told her when I was a kid. My swallowing study had altered esophageal tilting on my right side which is oddly where my neck stiffness and trap tightness is always at. Are there any studies assessing the physiological effects of this syndrome on nerve compressions in the cervical region. I feel like this is finally the answer ive been searching for. Do you know of anyone who specializes in this syndrome. I would like to find them and get an appointment. Currently in texas but going to northern california bay area in a couple months for work. Appreciate any info you might have available.


Dr. Phil February 15, 2014 at 4:02 pm

Hi Joey. Sorry to hear about your condition. I’m not aware of any research on this condition. There are several nerve compression syndromes from the cervical spine that you should have checked out. It sounds like an upper crossed syndrome may not be the cause of your problems, but perhaps a result of your structural design. It wouldn’t hurt to try addressing some of these muscle imbalances as long as they don’t exacerbate your symptoms. I hope this helps!


josh schultz May 9, 2014 at 9:40 pm

Great article. I was wondering if there is a correlation between UPS muscle imbalance and having a pelvic rotation. I have a pretty significant pelvic rotation and have had a a lot of issues as a result including UPS. I was just wondering if UPS can be a result of a pelvic rotation.

Josh S.P.T.


MG June 16, 2014 at 5:23 pm

Have a question: I recently returned to the throws events and am trying to compete at the national/world level. Although I am well-versed in A&P/kinesiology principals, it’s hard to get it right all the time when we’re applying it to our own workouts, especially at this level. I am a 500lb+ bench pressing machine, only problem is each time I see gains, I have new pains (severe shoulder pains to be exact). Anterolateral abduction is painful. Throwing isn’t painful, it’s after/sometime during lifting sessions(due to how tight the muscles of my shoulder girdle/RC have become… I’ve gotten suggestions from chiropractors, an ortho, and an AT, no amelioration, wish I could be done with this so I could train harder. Any suggestions?



MG June 16, 2014 at 5:31 pm

some of my post ‘disappeared’, also heavy inclines/military presses, but perform twice as many pulls than presses; the converse (pulling) apparatus is adequately balancing the pressing, but shoulder exercises have turned to mush as I am not able to perform some of them anymore, although presses are still fine, still seeing gains.


Dr. Phil June 18, 2014 at 9:07 am

Hi Mike, while I can’t respond to your specific problem without an evaluation, you might need to focus on strengthening your rotator cuff. Lifting heavy weights may require more activation of the larger muscles than the smaller rotator cuff. Scapular stabilizer exercises, particularly the lower trap may also help. I hope this helps. Dr. Phil


Navjot October 8, 2014 at 5:44 am

hi dr phil, i have a muscle imbalance in shoulders with one shoulder higher and longer than other.However my main issue is that i suffer 24*7 head heaviness which converts into a migraine like throbbing headaches ocassionaly.Interestingly those occassional throbbing headaches are more pronounced on the left side and feel uneven with a tingling and off centered feeling throughout the left side upto the leg.Could my 24*7 head heaviness and body pain be caused by shoulder imbalance or i am suffering from emotional troubles only?Thanks


Dr. Phil October 11, 2014 at 2:32 am

Navjot, while I’m not able to comment directly on your condition without a proper evaluation, it sounds like this is not related to a shoulder imbalance. You should have a healthcare provider evaluate your neck for problems related to your headaches.


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