Upper Crossed Syndrome

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19 Jul 2016 - General


We often find ourselves slouching while in the middle of a consult. It is no big secret that doctors are big slouchers. Countless hours of sitting down in lectures and during studying probably programmed us to hunch our shoulders and heads forward. Unfortunately, this poor posture can lead to upper crossed syndrome.

What is upper crossed syndrome?

Upper crossed syndrome pertains to a condition caused by repetitive rounding of shoulders and forward protrusion of the neck. The syndrome is composed of tight and weak muscles. Slouching leads to chronic shortening and eventual tightness of the neck extensors and pectoral muscles. On the other hand, opposing neck flexor and upper back muscles become chronically stretched and subsequently weak. Upper crossed syndrome may lead to chronic upper back pain and early onset of osteoarthritis if not addressed immediately. Fortunately, stretching of the tight and strengthening of the weak muscles can prevent unwanted complications. Moreover, these exercises can be done in the clinic!

2-way attack against upper crossed syndrome

1st part: Stretching of the tight neck extensors, levator scapulae, and pectorals

Stretching the tight muscles prior will permit greater range of motion during strengthening exercises.

Important tip: Stretch should be felt as gentle pull of the muscle. Pain is NEVER a part of proper stretching. Perform stretching ONLY until the range tolerated by your body to avoid muscle strain.

Neck extensor and levaor scapulae stretch

1. While sitting upright with your chest out and shoulder blades drawn together, draw your chin toward your chest slowly until you feel a stretch at the back of your neck. This stretches the neck extensors.

2. Hold this position for 30 seconds.

3. While maintaining the head in a flexed position, gently rotate your head as tolerated up to a 45 degree angle to the left. Gently pull your head down towards your right knee as tolerated using your right hand. This streches your left levator scapulae. Hold this position for 30 seconds.

4. Rotate your head towards the right side as tolerated up to a 45 degree angle. Gently pull your head down towards your left knee as tolerated using your left hand. This streches your right levator scapulae. Hold this position for 30 seconds.

Pectoral muscle stretch

1. While stading upright with your chest out and shoulder blades drawn together, clasp your hands behind the buttocks with the palms facing up.

2. Gently pull your arms up and back while keeping the hands clasped together. You should feel a stretch over your chest. Hold this position for 30 seconds.

2nd part: Strengthening of the weak neck flexors and upper back muscles.

Chin tucks

1. While sitting upright with your chest out and shoulder blades drawn together, gently pull down your chin towards the front neck. This will only produce a small motion yet you will feel contraction of neck muscles under your jaw.

2. Do 3 sets of 10 repetitions.

Scapular retraction

1. While sitting upright, gently draw your shoulder blades down and toward each other while simultaneously keeping your chest out and high. Pretend that a drawstring is pulling your chest from the ceiling.

2. Do 3 sets of 10 repetitions.

With the combination of stretching and strengthening exercises, we can banish upper crossed syndrome and serve as role models for proper posture to the patients.


*Photo above courtesy of



Marinelle, thank you for finding the article informative. I will write an article on lower crossed syndrome as well. As for your question, the exercises are designed to reinforce proper especially when done in timed intervals in the workplace. One caveat though is conscious reinforcement of proper posture (shoulder blades drawn back and down with the chest lifted high and out) throughout the day to ensure posture correction. Also, making adjustments outside of the workplace is crucial to good po...
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Ziwei, great to hear that you find the article very helpful! I appreciate your comment on providing more images to improve the article. As for your question, one way to diagnose upper crossed syndrome is through physical examination. A normal finding via inspection in the sagittal view is an ear lobe aligned with the acromion ( at about middle of the deltoid muscle). An ear lobe that is anterior to the middle of the deltoid would point to an imbalance between the pectorals and the upper back mus...
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Thanks. Excellent education since poor posturing and upper back and shoulder pain is such a common compliant among office workers. I always teach my patient proper ergonomics and simple stretching exercises as well as core muscle strengthening exercises. How do we diagnose upper cross syndrome if we are not familiar with it? Any issue if we advised patient with recurrent upper back pain due to poor neck and upper back posture at work ie from prolonged use of lap top. Will the exercise help. I a...
 (Total 124 words)