Lower cross syndrome

Lower cross syndrome (LCS) occurs when there is an imbalance in the strength of the muscles around the pelvis. The condition can affect a person’s posture and movement, as well as causing pain or discomfort. Treatment can involve strength training and stretching. LCS is frequently caused by a sedentary lifestyle and/or poor posture. Prolonged sitting or injury can cause shortened hip flexor muscles, which can lead to tightened lower back muscles. The tightened hip flexors eventually lead to weakened abdominal/core muscles, along with weakened gluteal/butt muscles.

The postural effects of this condition are characterized by an increased forward tilt of the pelvis, which is accompanied by an excessive lower-back arch. However, the effects of this uneven muscle pull extend beyond the lumbo-pelvic-hip region. When this occurs, your back muscles and hamstrings must work harder, which can result in low back and hamstring injuries.

CAUSE

LCS is caused by the shortening and lengthening of muscles in the pelvic and lumbosacral region of the body. The name “Lower Cross Syndrome” stems from the visual of an X when viewing the muscles from a side view. The most common cause of LCS is a sedentary lifestyle. Sitting for prolonged periods can cause an imbalance between the muscles to develop.

Another potential cause is overtraining certain parts of the body while undertraining others. For instance, if a person strengthens their hip flexors and back without focusing on their glutes and abdominals, this could lead to an imbalance. Several muscle groups can potentially cause LCS when they become weakened or tight.

What Muscles are lengthened in Lower Cross Syndrome?

Lower cross syndrome occurs when there is a muscular imbalance between weak and tight muscles. Tight muscles are typically hip flexors, while weak muscles are the abdominals and gluteal muscles. The hip flexors are shortening, while the abdominals and gluteal muscles are weakening.

Symptoms of lower cross syndrome

People with Lower Cross Syndrome often suffer from lower back pain or pain in the pelvic or hip joints. In addition, people will also suffer:

• Reduced lumbar, hip, hamstring, or pelvic mobility or stiffness
• Hip flexor, groin, spine, or buttock muscle pain
• An overly arched low back causes a protruding stomach.
• Lower back and/or buttock muscle tension

LCS can cause two types of posture: type A and type B.

Both postures feature:

• Hyperkyphosis: This is the curvature of the spine that causes the top of a person’s back to appear more rounded.
• Hyperlordosis: This is a condition where there is excessive curvature of the lower back.

Type A posture: Type A posture occurs due to the pelvis tilting backward. It causes the buttocks to lift and protrude outward while the pelvic region tucks under the body. The lower back also arches inward.

Type B posture: Type B posture occurs due to an arch in the upper back near the shoulders. The arch forms a bulge in the upper back and forces the neck to tilt forward and appear outstretched.

PHYSICAL THERAPY MANAGEMENT

The goal of treatment is to correct the person’s posture through retraining the muscle groups responsible for the imbalance. Once a person corrects the imbalance, their posture and movement should return to normal. A person can talk to a physical therapist, certified personal trainer, or another healthcare provider about an exact exercise program to follow to help treat LCS.

Physical therapy and exercises

Physical therapy involves a variety of steps:

1. Relaxing the muscles

Firstly, a person should relax the muscles. To do this, they can use a foam roller and slowly roll parts of the body, such as the quads and inner thighs, over it.

1.  Lengthening and static stretching

The next step is to strengthen and lengthen the muscles. At this stage, a person should get into a static stretch and hold the position for 30 seconds. The following is an example of some stretches that a person can perform

Iliopsoas in Kneeling

• Kneel on the side you want to stretch.  
• Tuck your bottom under to flatten the lower back (labeled #1 below).  
• Tighten your buttocks on the side you are stretching and bring your whole trunk forward (labeled #2 below).  Do not lose the flattened position of your lower back.  
• You should feel the stretch along the front of the thigh. You should not feel back pain with this exercise.  If you feel back pain, start over and try again.  If you still feel lower back pain, ask your physical therapist to help you with this exercise.

Hold the stretch __8___ seconds and repeat ___15____ times

1. Activating and strengthening the muscles

At this step, a person needs to perform a strengthening exercise with little or no external resistance.

The following are examples of some stretches that a person can perform:

BRIDGING

Lie on your back with your knees bent.  Put your feet flat on the floor about waist distance apart. Tighten the deep lower abdominal muscles.  Squeeze your buttock muscles and lift your pelvis while maintaining a “neutral” lumbar spine.  Do not allow the lower back to arch or sag.

 If you get a cramp in the back of your thigh, lift your toes up off of the ground and concentrate on tightening the buttocks as you do the exercise. Hold for ___8__ seconds.  Repeat __15___ times.

Hip extensions

To perform this move, a person should take the following steps:

• Start on all fours with the hands under the shoulders, the knees under the hips, and the neck in line with the spine.
• Stretch out the right arm and left leg, resting the hand and foot against the ground.
• Once balanced, raise the outstretched right arm and left leg until they are both parallel with the back.
• A person should hold this before returning to the starting position and carrying out repetitions.

1. Integrating

At this point, integrated movement patterns can help the brain understand how to move the muscles. One should follow the exercises that the physical therapist advises.

When to see a physician

A person should talk to a physician if they have persistent lower back pain. It could be the result of LCS or one of several other underlying conditions that can potentially cause pain in the lower back.

It is also a good idea to talk to a doctor before starting any new exercise program, particularly one that aims to help correct a person’s posture.