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 neighbouring 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).


Signs and Symptoms of UCS

  • forward head carriage
  • hunching of the thoracic spine (rounded upper back)
  • elevated and protracted shoulder blades (scapula winging)
  • decreased mobility of thoracic spine
  • reduced shoulder stability

Health Conditions associated with UCS

Corrective Exercises

  • Standing Theraband Row
  • Foam Roller Subscapular Activation
  • Prone Scapular Stabilisation
  • Foam Roller Thoracic Extension
  • Deep Neck Flexor (Chin Tucks)
  • Chest Stretch
  • Lat Stretch
  • Upper Trapezius Stretch
  • Levator Scapula Stretch