Upper Crossed Syndrome (UCS)

Upper- Crossed Syndrome (USC) is a muscle imbalance pattern located at the head and shoulder regions.

It is most often found in individuals who work at a desk or who sit for a majority of the day and continuously exhibit poor posture.

It 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.

These focal areas of stress within the spine correspond to transitional zones in which neighboring 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).

The first stages in rectifying this condition is to implement myofascial release of the affected areas through massage, followed by exercises to help strengthen the alignment.

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