Upper Crossed Syndrome – A foundation for failure

Are you aware of upper crossed syndrome? Does this postural shape look familiar to you? If yes, then you take a look at the corrective exercises I’ve included in the blog.

Posture follows movement like a shadow

Are you being double crossed by your posture? There is a chronic condition called Upper Crossed Syndrome (USC) which is expressed by the rounding of shoulders, forward chin poke of the head.  Mostly seen with elderly, but with an accelerated escalation of sedentary lifestyles and work environments, it has become a common sight for all ages.

Upper Crossed Syndrome Anatomy

The position of your head and shoulder is orchestrated by various opposing forces. These muscle balance forces vary depending on the positions we regularly find ourselves in. With UCS there is usually a weakness of the deep neck flexors and overactive/tightness of the upper traps and levator scapulae. This causes a forward head position with a hinge point at the lower cervical spine.

Lower down with weakness of rhomboids and lower traps, matched with overactive/tight pectoralis major and minor causes a rounding of the shoulders.Posture

The muscle imbalance can affect multiple joint levels of the spine, the glenohumeral joint, the acromioclavicular joint and scapulothoracic joint. These might all lead to dysfunctions and result in injury.

How does this impact me?

Well that depends on how you live your life. This is a chronic condition that affects multiple joints and progressively over years they become stiff or weak. This closes the window on living an active lifestyle and increases risk of injury.

With less mobility and stability, comes greater risk to injury. 

This is typical with most office workers, students or driver’s. Their neuromuscular system has adapted to the UCS shape for years. But the injury risk increases when activity and movement levels are pushed higher than normal, for example overhead lifting, throwing sports or freestyle swimming that requires a wider overhead range of movement and ends up putting undue stress on the upper body.

Have you got the following?

  • Chin Poke: Is your head sticking so far out it’s at risk of falling off! Next time you stop at traffic lights take a look at the other drivers posture, it’s common to see the drivers head stuck at least 12 inches from the head rest.
  • Rounding of the Shoulders: Due to a weakness of scapula retractors, the lower traps and rhomboids, the super tight Pec muscles draw the shoulders forwards. Look at overly developed bodybuilders for a great example of rounded shoulders.
  • Winging scapula: When the scapula lifts away from the wall of the rib cage, it’s usually the result of a muscle imbalance. This might take a friend to spot this one for you.
  • Creasing in the neck: It’s the last places you want to see a crease. At the base of the neck and accompanied by the start of a hump in the thoracic spine.

Change starts now – How do I get there?

Expecting to do an overhead squat or chest to bar pull up straight away might be unrealistic if you’ve spent years holding a UCS posture. But there are ways of getting there…

  • Scaling the new movement that your practicing and working within the ranges that your body allows. Giving the joints time to adapt, without risking injury.
  • Working on individual muscles that developed the weakness and tightness over the years. This requires specific strengthening and stretching exercises.
  • Muscle tightness in your neck and chest may benefit from soft tissue work to release the muscle, like massage or dry needling.
  • Correcting form, sometimes we don’t have the body awareness to identify poor technique. Having the coach or physio look at your movement to correct where it’s needed.
  • Change can only be enforced through repetition and habit. The positions you’re in most of the day dictate your posture. At work, in the car, or at home, try to change your posture regularly.

Below are some basic examples of exercises to get you started with organising the shoulder and head. Try following them regularly to give your body the opportunity to change.

Continue reading “Upper Crossed Syndrome – A foundation for failure”

Study: Resistance training on neck pain

This study found positive results with strengthening exercises to reduce muscle tension and pain with office workers suffering with neck pain.

Lindegaard 2013

Working in the office you’re bound to suffer with neck pain at some stage. If poorly managed this can progressively become chronic. Not only can this impact your function, but interferes with your levels of concentration and performance at work. This then feeds into your mood and becomes a negative loop which is then difficult to break.

When treating a patient with chronic neck pain there’s a range of manual techniques that have strong evidence to support them. But in addition to hands-on therapy, exercises are provided to assist in the recovery. These could be in the form of stretches, postural setting or strengthening.

This study focused on strengthening exercises using a resistance band  (Theraband). Over a 10 week period they performed lateral raises with the resistance band once per day to the point of fatigue or up to 2 minutes. They found at the end of the 10 weeks through EMG testing the neck muscles were more relaxed and had reduced pain levels.

Original Abstract

Background: This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain.

Methods: 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n = 15) or in control receiving weekly email-based information on general health (n = 15). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday.

Results: Adherence to training and control interventions were 86% and 89%, respectively. Comparedh with control, training increased isometric muscle strength 6% (P < 0.05) and decreased neck/shoulder pain intensity by 40% (P < 0.01). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius.

Conclusion: While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.

Lidegaard M, et al. Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain: randomized controlled trial. Biomed Res Int. 2013.

Ligament Sprains & Timeframes

Ligament sprains are one of the most common injuries, as their main role is to support the
joint. If poorly managed there is a risk of further injury.

Patience is not about doing nothing. Patience is about doing everything you can. But being patient about Results

What are ligaments?

Ligaments are fibrous tissues that attach from one bone to another across a joint. The tissue is very strong, varies in thickness and is dense with nerve receptors. Its role is to provide stability, guide movement, maintain joint shape and act as position sensors for the joint.

Previously ligaments were thought of as inactive structures, they are in fact complex structures that influence the localised joint and the entire body once injured (1).

How are ligaments injured?

Ligament sprains are the result of loads exceeding the maximum strength of the ligament with little/no time to recover. This force causes acute tears of the ligament fibres.

These structures can be damaged through several mechanisms, like contact or direct trauma, dynamic loading, repetitive overuse, structural vulnerability and muscle imbalance (2). A sprain of ligaments usually affect the following joints:

How does it affect us?

As with most soft tissue damage there will be the typical acute pain and swelling. Injury to a ligament will compromise joint stability and ability to control movement. It can also reduce our balance, proprioception and muscle reflex time (3). With poor joint position comes restriction in movement and weakness of the surrounding muscles.

What types of ligament sprains are there?

The severity of ligament injury is graded using various clinical classifications. The most common is a three-level system that determines structural involvement.

Grade 1 Grade 1 sprain1

  • Slight stretching and microscopic tearing of the ligament fibres
  • Mild tenderness and swelling around the ankle
  • Heals within 1-2 weeks 

Grade 2

  • Partial tearing of 10-90% of the ligament fibresGrade 2 sprain1.jpg
  • Moderate tenderness and swelling around the ankle
  • Partial structural instability when tested by Physio or doctor
  • Healing takes up to 6 weeks

Grade 3

  • Complete tear of the ligamentGrade 3 sprain1
  • Significant tenderness and swelling around the ankle
  • Complete instability when put under stress
  • Poor weight bearing
  • Conservative treatment can take 12-16 weeks
  • Potential reconstructive surgery is required

*Timeframes are based upon the guidance of a professional. Treating injuries on your own poses a risk of not fully recovering and a greater chance of re-injury.

For an appointment, call on 095290990 

  1. Frank, (2004) Ligament structure, physiology and function. J Musculoskelet Neuronal Interact
  2. Gabriel (2002) Ligament injury and Repair: Current concepts. Hong Kong Physiotherapy J
  3. Hauser (2013) Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics. The Open Rehabilitation Journal

Improving press position

The final part to the 4 shoulder positions that give us stability. The press position is used in so many ways, failing to find a good press shape can produce poor results and pose a risk to injury.

This is the final part of the 4 shoulder shapes we should all be able to achieve. Creating these shapes provides more efficient transitions when under load, making it easier and posing less risk to the shoulder.

So we’ve opened up the over head, front rack and hang shape. The last position is a press. Think of so many positions, bench press, rowing, burpee, chest to bar pull up, muscle up, ring dip….. If we create a poor, unstable position from this point it will make the movement much more difficult.

With the press we need to achieve full shoulder extension without the elbows flaring. Rarely do we get full extension in the shoulder. Even when sat at a desk typing were put in a perfect opportunity to hold the press position, but we get too flexed through the spine and the keyboard is placed to far away.

The other movement is internal rotation, which was part of our hang position. Good internal rotation at the shoulder will stop the elbows from flaring.

The last part being the lack of mobility of our lower cervical and upper thoracic spine. Which when stiff takes us into a rounded shoulder position. Trying to mobilise this area will help improve shoulder and head position.

Below are a series of mobility exercises to help with these directions.


Barbell hold – With the bar racked up to shoulder level and secure in the rack. Reach back with both hands, hold onto the bar and gentle lean forwards till you feel a stretch in the front of the chest and shoulders. Hold for 2 minutes. Gradually work your hands closer together.

Peanut lower cervical – This one you’ll have to get hold of a peanut (two lacrosse balls stuck together). Place the peanut at the base of the neck. Lift the hips to the ceiling. Some gentle rocking or arm movements through flexion or behind the back will help mobilise this point. 2 minutes

Lats smash with LaX ball – Take the ball under the arm pit into the meaty portion at the back, which is your lats. Roll into the lats with the arm in over head position lying on your side. 2 minutes.

Band hold – The other alternative to the bar hold is a band hold. Same position but hold the band behind you. Hold the stretch for 2 minutes.

Improving overhead position

Often we are restricted with overhead movements as it is an action we don’t use often enough. Try these exercises to increase movement if your tight reaching above your head.

So from the last blog we’ve learnt there are 4 positions of high torque when we wind up the shoulder capsule and surrounding muscles. By utilising these positions they will produce better pathways to move from and minimise the risk of injury.

We’ll start off with the over head positions. In every day life we don’t take our hands above our shoulders often enough. It’s understandable the shoulder will feel tight in these positions. But with a little regular mobilising we should be able to feel more comfortable holding our arms up there.

In the shoulder we have big internal rotators and some small external rotators which can cause a bit of an imbalance. Both internal and external rotation needs to be stretched to achieve full over head movement.

The other thing restricting our overhead movements is thoracic mobility. Another area that often gets stiff with a sedentary life. Additional extension at the Thoracic region without hyper extending at the lower back will give us better shoulder flexion.

Below are some basic mobility drills to improve Thoracic extension.

Foam Roller – Slowly moving over the foam roller, trying to extend over the top, keeping steady breathing throughout. Try to keep the neck in a stable position avoiding hyper-extending, also avoid rolling into the Lumbar spine.  Try this for up to 2 minutes. Once you find some stiffness, stay on that point and lift your arms straight above your head. 1 minute.

https://www.instagram.com/p/BT2yyupFzCP/?taken-by=fundamentalphysio

T spine extension – Kneeling, put both elbows up on the step/box. Drop the chest down to the ground. Feeling a stretch at the Thoracic spine and lats. Hold the stretch for 2 minutes. Try to stay strong at the lumbar spine avoiding extending.

https://www.instagram.com/p/BT2zxQgFaYu/?taken-by=fundamentalphysio

Below are just some stretches you can do to access both the internal and external rotation restrictions at the shoulder.

Pec major stretch – Using a resistance band, taking up the slack with the hand behind, turn your body away, producing a large stretch in the chest. Hold for 2 minutes.

https://www.instagram.com/p/BT20WulFJyD/?taken-by=fundamentalphysio

Under arm stretch – Attach a light resistance band to the opposite frame. Hold the other end with your hand behind the neck, pull into the opposite rack and drive the armpit into the poll. You’ll get a good triceps and lats stretch. 2 minutes.

https://www.instagram.com/p/BT20x4YFGYp/?taken-by=fundamentalphysio

Infraspinatus LaX ball smash – Direct the ball into the shoulder blade. With the pressure, take the hand across the body and over head. 1 minute each direction.

Does your shoulder get the green light?

Are you able to achieve full shoulder range and move efficiently with speed and load. Essential to preventing injury and getting the most out of your training.

The shoulder is such an interesting part of the body. It’s a joint that’s suspended by muscles and fascia and its only point of contact with the rest of the skeletal system is a dinky little joint at the collar bone. Which means that our musculature is doing all the work to maintain stability while moving through huge ranges.

Underneath the layers of muscle, the shoulder has a capsule and it has four positions where it winds up and reaches its highest levels of tension and stability. If we can achieve these positions from start to finish when transitioning through movement, particularly under load we’ll have less chance of injury.


  1. The first movement being overhead a combination of external rotation and flexion at the shoulder and protraction of the scapula (moving forward around the rib cage). Examples of this being the start position of chest to bar pull up or end position of push press. Our arms should get past our ears with the elbow pits facing each other.
  1. Next the front rack position is also flexion and external rotation of the shoulder. Obvious examples are a front squat or the bottom of a hand stand push up. This is elbows up to shoulder level, with the hands outside the shoulders and palms turned up.
  1. Hang position is a full internal rotation of the shoulder. This can be seen when we clean or Snatch. Elbows out to the side at shoulder level and hands down to floor, aiming for the forearms to be in line with the body.
  1. The press position consists of internal rotation and extension. Seen with the start of a bench press or bottom of a ring dip. The elbows are taken past the body as far as possible with hands at chest level.

Failing to maintain shapes of stability becomes more difficult to transition and finish safely to the next position. Make sure you have competency in all 4 positions. If you’re struggling with a position you need to be mobilising. If you’re having pain with these positions you should have it assessed to avoid being side lined.