“Posture is usually defined as the relative arrangement of the parts of the body. Good posture is that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, and stooping) in which these structures are working or resting.”
Janda’s Postural Crossed Syndromes includes two postural distortion patterns know as the “Upper Crossed Syndrome” and “Lower Crossed Syndrome”. The Postural crossed syndromes are characterized by alternating sides of inhibition and facilitation in the upper quarter and lower quarter as illustrated below.
Lower Cross Syndrome
The lower cross syndrome is characterized by an increased lumbar lordosis and an anterior pelvic tilt. The common muscular imbalances seen with the lower cross syndrome include short and tight hip flexors and lumbar erectors (erector spinae) crossed with lengthened and inhibited gluteus maximus and lumbo-pelvic-hip stabilizing mechanism (transverse abdominis, internal oblique, multifidus, pelvic floor muscles and diaphragm). Also commonly involved are the piriformis muscles which in 20% of individuals are penetrated by the sciatic nerve so that piriformis syndrome can produce direct sciatic pressure and pain. Arterial involvement of piriformis shortness produces ischaemia of the lower extremity, and through a relative fixation of the sacrum, sacroiliac dysfunction and pain in the hip.
Upper Cross Syndrome
The upper cross syndrome is characterized by rounded shoulders and a forward head posture. This pattern is common in individuals who sit a lot or who develop pattern overload from uni-deminsional training protocols. The common muscular imbalances seen with the upper cross syndrome include short and tight latissimus dorsi, pectoralis major and minor, upper trapezius, levator scapulae, and sternocleidomastoid (SCM) crossed with lengthened, weak stabilizers of the scapula (serratus anterior, rhomboids, middle and lower trapezius) and deep neck flexors. The result of these changes is greater cervical segment strain plus referred pain to the chest, shoulders and arms. Pain mimicking angina may be noted plus a decline in respiratory efficiency.
There are several assessments that can be used to determine the type of postural distortion pattern and help to determine the underlying cause. Remember you want to treat the cause and not necessarily the symptoms, the postural distortion pattern being a symptom.
We start with an assessment looking at respiratory pattern because we want to look at the natural breathing pattern without the individual being aware that they are being assessed as this may cause them to alter their breathing pattern. Once they feel like they are being assessed they may unconsciously alter their breathing pattern and provide false information towards the assessment.
Next is the postural assessment. This can either be very in-depth which I prefer or can be a simple postural alignment assessment using a plumb line. In particular we are looking at pelvic tilt and thoracic curvature when looking at the upper & lower crossed syndromes but that is not to say that all information collected is not important and contributes to the final conclusion or diagnosis (being the underlying causes).
For this point we move to the muscle length tension assessment looking at passive range of movement of individual joints using a goniometer to accurately measure joint angles.
From the information above a plan can be made towards correcting the postural distortion pattern. This is discussed further in the show linked above and the how to apply the exercises below into a corrective program to correct the postural distortion pattern.
There some useful tools available that can help release the soft tissue. Many already know foam rollers but you may not be aware of The Body Wrench.
Thoracic mobilization is to regain mobility of the thoracic spine into extension. Must be used with care and individuals with a flat thoracic spine should avoid these techniques.
Standing Cobra is an exercise I developed to address many of the postural weaknesses seen in the upper crossed syndrome.
The Standing Cobra exercise is to replace the traditional prone cobra exercise that loads the lumber disks with loads the potentially exceed their capacity. This also trains poor postural alignment. See the video below for a sample of the prone cobra.
DO NOT USE THIS EXERCISE
Hip re-stabilization and glute activation