Upper/lower crossed and layer syndrome

Crossed syndromes have been defined by Prof. MUDr. Vladimír Janda. It is caused by typical muscle imbalances, during which some muscles have a tendency to get shortened (postural muscles - are hyperactive, hypertonic and their length in relaxed condition is getting shorter) it can also lead to weakening (muscles are phasic - they are less active due to the adaptation).

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UPPER CROSSED SYNDROME

This syndrome leads to shortening of the upper muscle fibres of the trapezius muscles and the levator scapulae muscles as well as excessive burdening of the sternocleidomastoid muscles. One of the most frequently shortened muscles is the pectoral muscle. Deep flexors of the head and neck and lower fixators of the shoulder blades are usually weakened. At the same time the paravertebral muscles (alongside the spine) in the thoracic segments are usually weak as well.


The mentioned muscle imbalance is followed by significant change in the static and motion stereotypes. It leads to pushing the head forward and overloading the transition between the cervical and thoracic spine, cervical hyperlordosis is supported by shortened upper fibres. These problems can result in the so called “gothic shoulders” with elevation of the shoulder girdle, round back and adduction with rotated shoulder blade. Changed position of the shoulder blade is very important during the differential diagnosis of some painful conditions of the shoulder joint. Adduction and rotation of the shoulder blade leads to steeper course of the axis of the shoulder socket, which overloads the above mentioned muscles and the whole shoulder girdle.

Options od remedy:

  1. Adjustment of the work space according to the ergonomic principles
  2. Including ideal exercises focused mainly on:
  • Stretching (pectoral muscles, upper parts of the trapezius muscles, levator scapulae muscles, postural muscles of the cervical spine and sternocleidomastoid muscles).
  • Strengthening (deep flexors of the head and neck and lower fixators of the shoulder blades )
  • Training the correct postural stereotype and motion stereotype of the head flexion
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LOWER CROSSED SYNDROME

Within this syndrome are the flexors of the hip joints shortened along with the erectors of the lower back. It leads to lowered and weakened activity of the gluteal muscles. Insufficiency of the gluteal muscles is important and it has a crucial meaning for the body posture and stability of the pelvis. The weakened abdominal muscles are considered to be one of the most common causes of lumbar hyperlordosis. Formation of hyperlordosis is depending on imbalance of the core system (m. transversus abdominis, diaphragm, muscles of the pelvic floor and muscles alongside the spine). The mentioned imbalance can also lead to changed static and dynamic changes. It can lead to flexion of the pelvis and hip joints and to the mentioned lordosis in the lumbosacral segments. That is accompanied by changed distribution of the pressure involved on the hip joints and lumbosacral segments. Besides the changed statics, the dynamic changes are more important - incorrect walking stereotype.

Options od remedy:

  1. Adjustment of the work space according to the ergonomic principles
  2. Including ideal exercises focused mainly on:
  • Stretching the flexors of the hip joints, erectors of the lumbar spine and the quadratus lumborum muscle
  • Strengthening the core system, abdominal muscles (lower part of the abdomen, and strengthening the muscles by stamina training), pelvic floor and gluteal muscles
  • Training the correct postural stereotype - tilting the pelvis, motion stereotype with extension of the lower extremities (walking)

LAYER SYNDROME

In this syndrome are changing layers of the shortened and weakened muscles. When we look at the human body from a profile from below and from the back, at first we observe the shortened flexors of the knees, weakened gluteal muscles, less developed lower back erectors, overloaded thoracic erectors, weakened muscles between the shoulder blades and hypertrophic stiff upper fixators of the shoulder girdle. The most affected parts on the front side of the body are lower parts of the weakened abdominal muscles. Significant role is also played by the feet dysfunctions. Healthy person should be able to deal with losing balance by using his toes -  that means muscles of the feet and lower leg. Wearing improper shoes can weaken these muscles, and their role is being taken over by other muscles - thigh muscles, gluteal muscles and muscles of the torso, which become hyperactive.



Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Sources:  https://is.muni.cz/do/fsps/e-learning/ztv/pages/05-oslabeni-pohyb-text.html

https://theses.cz/id/yg8v2r/BP_-__urdov.pdf

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