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The Lower Crossed Syndrome


By Spencer Chang, MD Sports Medicine Fellowship Trained Orthopaedic Surgeon at Straub Medical Center WSL Orthopaedic Consultant

The Lower Crossed Syndrome


The lower crossed syndrome (LCS) is the result of imbalances in the lower half of the body. In LCS, there is an overactivity and hence tightness of hip flexors and lumbar extensors (lower back muscles). In addition, there is an underactivity and therefore weakness of the deep abdominal muscles and the gluteus maximus and medius (butt muscles). Hamstrings are also commonly tight. Consequently, the imbalances result in an anterior tilt of the pelvis, and increased curvature in the lum-bar spine (hyperlordosis). You look like you’re standing with your butt hanging out and your belly falling forward… sound familiar? The muscle imbalances create joint dysfunction (ligamentous strain and increased pressure especially at the L4-L5, and L5-S1 levels, as well as the sacroiliac joint and hip joint), joint pain (lower back, hip, and knee), and specific postural changes such as: anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, external rotation of the hip, and knee hyperextension. It can also lead to increased thoracic kyphosis and increased cervical lordosis. There are two subtypes A and B as shown by the pictures below.

The Lower Crossed Syndrome
The Lower Crossed Syndrome


Type A                                                                            Type B


Type A is the type I see most commonly in surfers and nearly everyone who has a sit-down job at work. So, if your posture looks like either A or B, you probably have lower crossed syndrome, and may have back problems, hip, or knee problems. These can often be worked out in physical therapy, mostly focusing on specific stretching. Let me know if we can help. For an appointment call the Straub Bone and Joint Center at 522-4232. Just say Dave from Hawaiian South Shore sent you! Also, if you have any questions shoot me an e-mail at Reference: Physiopedia.

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