Upper Cross Syndrome: Learning To Recognize and Correct The Issue

by MICHAEL RAY, M.S.

Last blog I discussed Lower Cross Syndrome and how it wreaks havoc on an athlete’s low back. This week we are discussing the upper body version of lower cross syndrome….appropriately coined Upper Cross Syndrome by Vladimir Janda. I want to preface this discussion with a note: everything that is about to follow is meant to help coaches IDENTIFY possible muscular imbalances in athletes that are causing improper movement mechanics and thus creating breakdown and injuries. First and foremost, you must ensure your assessment of the athlete is correct before attempting to make cues and accessory exercises. I am a big fan of Gray Cook and his book Movement as tools for assessing an athlete. Joint by Joint mechanics based on regional interdependence just makes biomechanical sense to me.

Identifying Upper Cross Syndrome

Let’s first begin with how to identify Upper Cross Syndrome in an athlete. Typically, you are going to find visual cues from an athlete’s posture identifying possible UCS.

If you examine an athlete from the side, you should be able to see a perfect line going from their external auditory meatus (ear) –> anterior to lower neck (C7) –> middle of shoulder –> posterior to patella –> 1″ anterior to lateral malleolus (ankle). An athlete’s posture should be your first sign of possible UCS.

Ideal Posture

Anterior head carriage is a common visual sign that a person has developed UCS.

Next, listen for subjective statements from athletes like “I have regular neck pain/shoulder pain/mid back pain/headaches…” Now obviously, most of you reading this are not doctors and you do not have to be to address this issue. However, be able to recognize the difference between complaints of muscular aches and severe issues that could be underlying, like radiating pain or deep boring pain.

Then come objective issues — these are biomechanical breakdowns you can observe in your athlete while s/he is moving.  Utilize your “coach’s eye” and watch for breakdowns in positioning and movement mechanics. Or actually use the app Coach’s Eye…..love that app. Another free option is ubersense and I find it is just as sufficient.

With either app, you can record the athlete’s movement and slow the video down or do line analysis to analyze what is happening. But if you don’t want to bother with recording movement, my best recommendation is to SLOW the athlete down, as slowing down movement will reveal the biomechanical breakdowns. Often athletes hide poor mechanics by speeding the movement up.

Because UCS can affect a multitude of movements, here are a few examples that you may want to observe:

• T-Spine extension during squat or deadlift setup
• Scapular motion
• Overhead positioning (overhead squat is a great one)
• Front rack position during front squat
• Ability to push head through window during jerk, thrusters, push-press, etc.

Now on to the good stuff — let’s talk about what UCS actually is. Like lower cross syndrome, UCS is based on musculature that is overly active, causing hypertonicity and muscles “turned-off” or underactive.

Overactive muscles are typically a product of horrible daily posture. These muscles include Upper Trapezius, Levator Scapula, and Pec Major/Minor. Now let’s go over some of the ways to release these muscles.

Addressing Overactive Muscles

Upper Trap and Levator Scap.

Upper Trapezius: I typically recommend a T-spine smash with foam roller, levator scap trigger point release with lacrosse ball, and then an upper trap stretch.

Upper Trap Stretch: Perform seated. If athlete is stretching right side, have them place their right arm behind back and grip something to allow them to pull their shoulder down on the right.  Then, have them flex their chin to chest –> laterally flex head to the left. Now have them gently place their left hand on top of crown and allow the weight of hand to gently pull head towards the left. Athlete can rotate head to the right to target various fibers of trap.

Levator Scap lacrosse ball trigger point release

First let me mention the anatomy of the levator scap so there is a better understanding of how it can cause neck/midback pain and alter mechanics.

The L.S. originates on the posterior portion of transverse processes of C1-C4 and inserts on the medial border of the scapula. Since the upper traps’ and levator scap’s primary actions are concerned with scapula elevation, you can see how a person gets what I call “no neck” syndrome. Usually, we focus on the insertion point of the levator scap — at the superior medial border of the scapula.

Overactive Pec Major/Minor

These muscles can become so tight they are painful to palpate. Usually tight pec groups are going to exacerbate forward rounding shoulders and just pull athletes further into an internally rotated position —  now talk about ruining shoulder mechanics (!)… But that’s a topic for another article.

Typically I will try to release this group for athletes and give them homework to use — wait for it — a lacrosse ball (again) to smash the hell out of it over…and over…and over again. I also recommend a “doorway stretch” to be completed throughout the day.

             

Addressing the Weak/Under-active Muscles

Now it’s time to strengthen the muscles not pulling their weight.

First let’s address the deep neck flexors like longus capitis and longus colli.

I’ve found the best way to address these muscles is through chin tucks but done correctly. DO NOT just retract your chin back. First slightly flex the chin and then retract back. This is an easy exercise that can be done throughout the day — while driving, for example.

Finally — and in my opinion, most importantly — we need to strengthen the scapular stabilizers, rotators, and depressors.  

The muscles I am primarily speaking of are the rhomboids (major and minor) and trapezius (middle & lower fibers). Also, usually I will address rotator cuff muscles for external rotation, such as infraspinatus and teres minor.

Starting point: Initially begin with demonstrating proper posture and try to get the athlete to correct their posture regularly throughout the day. Remember: an hour in the gym is NOT going to correct biomechanical dysfunction. The athlete must cue the body constantly to proper posture throughout the day in order to exact a change on their motor recruitment pattern. That’s the name of the game right? Correct improper mechanics in order to prevent injury and promote functional longevity.

My version of proper posture

While seated, athlete should have knees and hips at 90 degrees with back flat against the back of chair by scapula retraction. The computer screen should be at eye level, and the keyboard should be in the lap when possible. When standing, the athlete should have feet directly beneath pelvis and feet hip width apart with natural stance. Athlete should contract glutes/hamstrings to pull pelvis over center of gravity, with slight contraction of abdominals to maintain ribcage over pelvis and spinal stability. Externally rotate arms to pinch scapula together and slightly tuck chin.

First exercise: I typically begin with scap pinches.

I am also a big fan of fascial movement taping, as I am certified with and utilize RockTape. Below is a taping protocol I use A LOT.

In this instance the tape should be used to cue the athlete to pull the shoulder blades back and down continuously.

 

Another taping option:

Often, I will simply use a piece of “big daddy” tape and place it directly in mid back at T4-6 area while patient retracts scapulas.

Next, I will progress to Brugger banded exercises.

Instructions:

Begin with a long band wrapped on each hand with palm open. Next:

1. Thumb and finger abduction and extension
2. Wrist Extension
3. Forearm Supination
4. Shoulder external rotation and Elbow Extension
5. Shoulder Abduction and Extension
6. Scapular retraction

Slowly return in exactly the reverse order.

You can also have the athlete perform banded rows:

As soon as the athlete is able, I progress them on to weighted movements like bent over barbell rows, lat pull-downs, and/or strict pronated pull-ups.

If you have access to a gravitron then I recommend doing some reps with that and toss in some eccentric loading.  

Bear in mind that you are attempting to correct improper mechanics that could have been occurring over decades, potentially. This will be a process and will take time. Be patient, but these accessory exercises will help.

Next topic:  PROPER BREATHING!

As always, if you have any questions, comments, or concerns, please feel free to post below or e-mail me at raytrainingconcepts@gmail.com.