Crossed Syndromes Part 1: Upper Cross

by Oct 24, 2022

The human body is an amazing system.

An ever-adapting machine, it can rearrange its structures to fit environmental changes.  For example, our bodies adjust when we travel from low altitude areas to higher ones so our cells still receive the sufficient oxygen they need.  Our blood vessels dilate to induce sweat in hot temperatures and constrict to prompt shivering in winter weather.  Your body knows what to do to stay as comfortable and functional as possible!

However, thinning air and varying temperatures are natural occurrences.  You know what isn’t quite as natural?  Sitting.

Our bodies aren’t meant to remain in a seated position for extended periods of time, yet pretty much all of us find ourselves in one on a daily basis.  It’s nearly impossible to avoid.  A good portion of us have desk jobs, which means we’re hunched over at a computer for hours at a time.  Most of us have at least a mild addiction to our small electronic devices, but we don’t sit upright or stare straight ahead when we text our friends or play the daily Wordle.  Driving the car isn’t usually accompanied by great posture either.  Even the most posture-conscious people probably have less than perfect posture.

The modern world has set us up for postural faults, and the most commonly seen postural condition is upper cross syndrome (UCS).  Sometimes known as proximal or shoulder girdle crossed syndrome, UCS presents itself with forward head posture and rounded shoulders.  This structural imbalance causes muscles in the front of the body to shorten, muscles in the back of the body overstretch and weaken, and associated joints to fall out of alignment.  The head, neck, upper back, shoulders, and arms are most affected by UCS.

So about those bodily structures thrown out of whack – which muscles are locked short, which muscles are locked long, and which joints are misaligned?  How do we remove the muscular adhesions, lengthen the tight tissues, strengthen the weak muscles, and mobilize the joints?  UCS is treatable, now let’s find out how it’s done!


How is Upper Cross Syndrome Treated?

Locked Short (Facilitated) Muscles

These muscles have been shortened by fibrotic adhesions and require lengthening:

  • Pectoralis major and minor
  • Suboccipitals
  • Upper trapezius
  • Sternocleidomastoid
  • Subscapularis
  • Latissimus dorsi

Locked Long (Inhibited) Muscles

These muscles have been weakened through overstretching and require strengthening:

  • Middle and lower trapezius
  • Rhomboids
  • Serratus anterior
  • Infraspinatus
  • Teres minor

Impacted Joints

These joints have fallen out of optimal position:

  • Glenohumeral joint
  • Cervical spine
  • Thoracic spine


The Four-Step Treatment Approach to Treating Upper Cross Syndrome

1. Remove Knots From Adhesed Muscular Tissue

The first step is to apply compression techniques to tight muscular tissues listed above.  Trigger points are likely to be found in the trapezius, rhomboids, infraspinatus, teres minor, and latissimus dorsi.  A combination of deep tissue massage and trigger point therapy is the most common approach.  Heat therapy can loosen the muscles too!

2. Lengthen locked-short muscles

The facilitated muscles will respond well to lengthening techniques after knot removal.  This can be achieved through pin-and-stretch, a modality in which the therapist pins down the origin site of a targeted muscle and slides towards the insertion site while the patient activates the muscle

3. Mobilize Joints

The cervical and thoracic vertebral joints are impacted by the tight neck, shoulder, and back muscles.  The cervical spine can be mobilized with traction on the neck, and the thoracic spine with mid-back compression.

When the pectoral muscles roll forward, the glenohumeral joint is pulled forward and no longer centrated.  This contracture causes the joint to become subluxed, or partially dislocated, because the head of the humerus isn’t settled in the joint.  This is why people with UCS have poor shoulder range of motion.  The glenohumeral joint can be returned to its natural state through external rotation and distraction exercises.

4. Strengthen Weak Muscles

After the tissues lengthen and joints mobilize, assisted stretching can be used to strengthen the weak muscles.  This can be done through proprioceptive neuromuscular facilitation, or PNF, an advanced form of flexibility.  The stretches will be applied to the neck, shoulder, upper arm, and upper back muscles.


Now You Know!

Upper cross syndrome is a very treatable condition, and addressing it will lead to decreased pain, improved posture, enhanced physical performance.  It can also prevent the discomfort from progressing into something more serious, such as arthritis.

In Crossed Syndromes Part 2, we’ll talk about another postural imbalance that often coincides with Upper Cross Syndrome.  Lower Cross Syndrome needs attention too!

Katrina Jenkins

Katrina Jenkins

Author, Licensed Massage Therapist

Katrina Jenkins graduated from Towson University in 2013 with a Bachelor’s Degree in Health Science and worked as a nurse’s aide briefly before pursuing her true passion. She graduated from the Massage Therapy Institute of Colorado in April 2016 with honors and completed the Touch of Healers Scholarship Program the following summer. She has been a part of the Moyer Total Wellness Team since the summer of 2017.


Brennan, D. (2021). What Is PNF Stretching? [online] WebMD. Available at:

MedBridge. (n.d.). Long Axis Distraction. [online] Available at: [Accessed 21 Oct. 2022].

Physiopedia. (n.d.). Upper-Crossed Syndrome. [online] Available at:

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