Many patients wonder, “Why are you treating my chest muscles (pectoralis major and minor) when the tension and soreness are in my neck and upper back?”

Pain may seem isolated, but the body functions as a connected system, where imbalances in one area can create tension and dysfunction elsewhere. The true source of discomfort often extends beyond the point of pain itself—muscle imbalances can disrupt alignment and movement patterns, leading to compensation, strain, and chronic pain.

This is common in Upper Crossed Syndrome (UCS) and Lower Crossed Syndrome (LCS)—two postural patterns that cause pain, stiffness, and movement issues

Dr. Vladimir Janda and the Crossed Syndromes

Dr. Vladimir Janda, a Czech neurologist and physiotherapist, is well-known for his concepts of Upper Crossed Syndrome (UCS) and Lower Crossed Syndrome (LCS). His approach emphasizes the relationship between muscle imbalances and pain syndromes, particularly how postural dysfunctions contribute to pain and movement impairments.

Upper Crossed Syndrome (UCS)

• Common Presentation: Forward head posture, rounded shoulders, and increased thoracic kyphosis (exaggerated forward rounding of the upper spine, often called a “hunched back”).
• Muscle Imbalances:
  • Tight/Overactive Muscles: Pectoralis major and minor, upper trapezius, levator scapulae, sternocleidomastoid, suboccipitals.
  • Weak/Inhibited Muscles: Deep cervical flexors (longus colli and capitis), lower trapezius, rhomboids, serratus anterior.
• Pain Patterns & Dysfunction:
  • Common areas of pain: neck pain, headaches, shoulder pain, and upper back discomfort.
  • Cause vs. Pain: The pain often presents in the posterior neck and upper back, but the root cause can often be attributed to anterior muscle tightness (pectorals) and posterior muscle weakness (scapular stabilizers, deep neck flexors).
  • Movement dysfunctions: Poor scapular control, forward head posture, and shoulder impingement.

Lower Crossed Syndrome (LCS)

• Common Presentation: Anterior pelvic tilt, lumbar lordosis (exaggerated lower back curve), and poor core stability.
• Muscle Imbalances:
  • Tight/Overactive Muscles: Hip flexors (iliopsoas, rectus femoris, TFL), lumbar extensors (erector spinae).
  • Weak/Inhibited Muscles: Abdominals (transversus abdominis, obliques) and gluteals (gluteus maximus, medius).
• Pain Patterns & Dysfunction:
  • Common areas of pain: low back pain, hip pain, knee pain, and sometimes sciatic-like symptoms.
  • Cause vs. Pain: The pain often presents in the lower back and sometimes the knees, but the root cause can often be due to weak core stability and overactive hip flexors/lumbar extensors.
  • Movement dysfunctions: Poor pelvic control, excessive anterior pelvic tilt, and hamstring compensation leading to strain.

Janda’s Key Takeaway on Pain vs. Cause

Janda emphasized that pain is often not where the actual dysfunction originates. Instead of treating the site of pain directly, he advocated for:

1. Identifying muscle imbalances that lead to altered movement patterns.
2. Restoring proper neuromuscular control by inhibiting overactive muscles and activating weak/inhibited ones.
3. Addressing postural and movement dysfunctions rather than just focusing on pain relief.

Clinical Application

• In UCS, treating neck pain without addressing forward head posture and weak scapular stabilizers rarely leads to lasting relief.
• In LCS, treating low back pain without improving core stability and hip mobility will often result in recurring pain.

Janda’s approach is foundational in rehabilitation, chiropractic, physical therapy, and strength training for correcting postural imbalances and reducing pain by targeting the true source of dysfunction.

How to Fix Upper & Lower Crossed Syndrome

Step 1: Stretch the Tight Muscles

✅ UCS Fixes:
✔ Pec stretch (against a doorway)
✔ Upper trap & levator scapulae stretch
✔ SCM stretch (gently tilt head to the side)

✅ LCS Fixes:
✔ Hip flexor stretch (deep lunge)
✔ Lower back decompression (child’s pose)
✔ Quadratus lumborum release (side stretch)

Step 2: Strengthen the Weak Muscles

✅ UCS Strengthening:
✔ Chin tucks (improve neck alignment)
✔ Scapular retractions (engage mid-back muscles)
✔ Wall angels (strengthen postural muscles)

✅ LCS Strengthening:
✔ Glute bridges (activate glutes & stabilize pelvis)
✔ Dead bugs (build core stability)
✔ Side-lying clamshells (strengthen glute medius)

💡 Pro Tip: Isometric exercises (holding a position) are great for neuromuscular re-education because they help activate weak muscles without excessive strain.

While some at-home exercises can be beneficial, my preferred approach is to consult with a professional physical therapist who can assess individual imbalances, tailor a rehab plan, and ensure proper form and progressions. A structured program with expert guidance reduces the risk of compensation patterns and maximizes recovery.

Takeaway: Small Changes, Big Results

Correcting Upper and Lower Crossed Syndromes requires a comprehensive approach:
✔ Stretch what’s tight
✔ Strengthen what’s weak
✔ Improve body awareness

Acupuncture can be highly effective in relieving pain and discomfort, but for long-lasting change, it is best supported with physical therapy. Combining acupuncture with a structured rehabilitation plan helps address both immediate symptom relief and the underlying movement patterns contributing to discomfort.

If you’re looking for professional support, we recommend local physical therapists such as Balanced Physical Therapy & Sports Performance, The PT Initiative, and Epic Physical Therapy, who specialize in movement assessment and rehabilitation.

References

• Aneis, Y.M., El-Badrawy, N.M., El-Ganainy, A.A. & Atta, H.K., 2022. The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial. J. Bodyw. Mov. Ther., 32, pp.130–136.
• Arshadi, R., Ghasemi, G.A. & Samadi, H., 2019. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys. Ther. Sport, 37, pp.113–119.
• Bae, W.S., Lee, H.O., Shin, J.W. & Lee, K.C., 2016. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J. Phys. Ther. Sci., 28, pp.1636–1639.
• Chang, M.C., Choo, Y.J., Hong, K., Boudier-Revéret, M. and Yang, S., 2023. Treatment of Upper Crossed Syndrome: A Narrative Systematic Review. Healthcare, 11(16), p.2328. https://doi.org/10.3390/healthcare11162328
• Mahmood, T., Afzal, W., Ahmad, U., Arif, M.A. & Ahmad, A., 2021. Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome. J. Pak. Med. Assoc., 71, pp.2304–2308.
• Page, P., Frank, C.C. & Lardner, R., 2010. Assessment and Treatment of Muscle Imbalance: The Janda Approach. 1st ed. Champaign, IL: Human Kinetics.
• Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L.L. & Page, P., 2020. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: Randomized controlled trial. Sci. Rep., 10, p.20688.