myosesh Musculoskeletal post Lower cross Syndrome

Lower cross Syndrome

Lower cross syndrome sometimes is called distal or pelvic cross syndrome as muscles cross through pelvic are affected.  On palpation, you will find hip flexors such as iliopsoas rectus femoris tight and hip extensors which is gluteus maximus weak as hip flexors are overactive and pelvis is prone to tilt anteriorly. Also, thoraco-lumbar spine tends to get shortened and abdominals is likely to be weak. Therefore, lordosis would be seen due to weak abdominals and contracture of thoraco-lumbar extensors. People with this condition sometimes complain about lower back pain but not always.

There are two types of lower cross syndrome.

One (type A) is anterior pelvic tilt, hip sticks out, knee flexion, lumbar lordosis and thoracic kyphosis, the other (Type B) is anterior pelvic tilt, thoracic kyphosis and forward head carriage.

Type A (left on the picture below): Because of the posture, abdominal muscles and hip flexors are shortened and pulls diaphragm and ribs down which affects breathing.

Type B (right on the picture below): Due to the posture, weak abdominal muscles, tight quads, tight trapezius which causes headache. This can happen to people on their feet for a long time such as waiter, chef and barista.


  • Weak abdominals and Gluteus maximus
  • Contracture in Iliopsoas and thoracic-lumbar extensors
  • Prolonged sitting
  • Injury which causes poor posture, tight hip flexors and shortened lower back muscles
  • Lean forward

Signs and Symptoms

  • Increased Lordosis in lower back
  • Anterior pelvic tilt 
  • Weak abdominals and gluteus maximus 
  • Pain in lower back

Treatment options

  • Trigger points
  • Muscle energy technique 
  • Position of release technique
  • Cupping and needling
  • Joint mobilization
  • Strength training for abdominals and gluts

When the patients have had this condition for a long time, they might have had a facet joint issues as a lot of loads on the facet joint of lumbar spine.  To assess this, get patients to do lumbar extension or do a special test called Quadrant test (Kemps test). 

 When patients come in with tight hip flexors, they are prone to have tight hamstrings too since hip flexors pull the pelvis anteriorly and hamstrings have to work to pull pelvis posteriorly. To extend the hip, Gluts have to work as a prime mover but hamstrings get activated due to mechanical imbalance. Thus, hamstrings do more job than they are supposed to do. Furthermore, as hamstrings start helping hip extension a lot, gastrocnemius  has to help hamstrings to bend the knee. BODY is all connected!!!!!

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