myosesh Musculoskeletal post Myotherapist should not use the term “Upper cross syndrome”

Myotherapist should not use the term “Upper cross syndrome”

 This condition refers to an overactive and underactive muscles in neck, shoulder and chest.

Basically, In upper cross syndrome, tightness in upper trapezius and levator scapula, and contracture in pectoralis major and minor. The weakness in deep cervical flexors (longus coli and longus capitis) and middle and lower trapezius. However, everyone is different and just because tightness in the pectoralis major or minor and weakness in rhomboids does not mean tightness in upper traps or levator scapula. Or say horizontal abduction is restricted. That may be from tightness in pec major (less extensibility of the muscle fibre), weakness in mid traps (weak concentric phase), humeral pronation or limited thoracic extension. Myotherapist should identify what needs to address to improve the movement.


  • Stay in awkward position for long time such as sedentary work, or the position when using gadget, reading the books and driving.
  • Thoracic kyphosis and cervical lordosis
  • Muscle imbalance
  • Stress

Signs and symptoms (2)

  • Tightness in neck and shoulder
  • Headache
  • Sore along the scapula
  • Restricted ROM (shoulder, cervical and thoracic)
  • Elevated and protracted scapula


  • Tight muscles need to be worked on to improve extensibility of the muscle
  • Weak muscles such as serratus anterior, deep cervical flexors, mid and lower trapezius. need to be strengthened
  • Avoid prolonged sitting
  • Joint mobilization
  • Exercise to not limit the ROM (Tx extension with form roller, prone abduction etc…)


 People who have this condition might have joint dysfunctions in

  • Atlanto-occipital joint
  • C4-C5 segment
  • Cervicothoracic joint
  • Glenohumeral joint
  • T4-T5 segment

People tend to get hunching and elevated shoulder when they are stressed out which causes this problem. As we stay in awkward position like sedentary work, prolonged sitting (2) and bending forward (1), breathing is not done properly. Also, when the shoulder goes forward, glenohumeral joint becomes unstable that causes shoulder issue.

Posture is the outcome of the position against gravity (static) and the ability to keep the position during movement (dynamic) (3).

  1. Mujawar, J. C., & Sagar, J. H. (2019a). Prevalence of upper cross syndrome in laundry workers. Indian Journal of Occupational and Environmental Medicine23(1), 54.
  2. Mubeen, I. (2016). Prevalence of Upper Cross Syndrome among the Medical Students of University of Lahore. International Journal of Physiotherapy3(3), 381–384.
  3. Carini, F., Mazzola, M., Fici, C., Palmeri, S., Messina, M., Damiani, P., & Tomasello, G. (2017). Posture and posturology, anatomical and physiological profiles: overview and current state of art. Acta Biomedica, 88(1), 11–16.
  4. Muscle Imbalance Syndrome

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