Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture

lower-crossed syndromePoor posture, muscle imbalance syndromes, back and knee pain, and other disorders of the musculoskeletal system affect a large number of people in our society today. Every year, we spend millions of dollars on pharmaceuticals and other symptom-based treatments in an attempt to fix our maladapted bodies. This heavy reliance on “quick fixes” is unfortunate, because as most coaches/trainers and health practitioners who are knowledgeable about functional rehabilitation know, proper exercise is a far better treatment option for these disorders than a bottle of pain-relieving pills. Besides the Upper Crossed Syndrome (UCS), the most common muscle imbalance pattern I’ve encountered in my work as a trainer/coach is Lower Crossed Syndrome (LCS). This condition is extremely common, particularly among females.

As sitting for prolonged periods of time can lead to shortening of the hip flexors, increased tension on the lower back, and glute atrophy, it’s no surprise that LCS is so common in our society today. The problem develops over time, and suddenly a daily activity, like tying the shoes, causes pain.

As I noted in my article on UCS, it’s important to be aware of and able to correct muscle imbalance patterns, as they set the stage for poor exercise technique, compensation patterns, injuries, lower back pain, impaired physical performance, and in some cases, disorders such as osteoarthritis and degenerative joint disease. Moreover, poor posture generally isn’t aesthetically appealing. Exercises and mobility drills aimed at treating UCS and LCS may improve your physical appearance, as they will help you achieve a better posture.

What is Lower Crossed Syndrome?

Lower-Crossed Syndrome (LCS) is also referred to as distal or pelvic crossed syndrome. In LCS, tightness of the thoracolumbar extensors on the dorsal side crosses with tightness of the iliopsoas and rectus femoris. Weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius. This pattern of imbalance creates joint dysfunction, particularly at the L4-L5 and L5-S1 segments, SI joint, and hip joint. (1)

So, what does this mean exactly? It means that there is a weakening and lengthening of the abdominals and gluteals and a tightening and shortening of the hip flexors and lower back muscles. LCS involves reciprocal inhibition, a process where muscles on one side of a joint are relaxing to accommodate contraction on the other side of that joint.

Causes

  • Prolonged sitting, particularly with bad posture
  • Physical inactivity
  • Regular performance of sports and activities that involve an uneven stimulation of the muscles that are involved in LCS
  • Poor exercise technique (e.g., lumbar hyperextension in the deadlift, press, and squat).
  • Imbalanced strength training (e.g., a lot more lower back and/or hip flexor training than glute and/or abdominal training)
  • Genetic predispositions

The development of LCS initiates a vicious cycle. Because the gluteals and abdominals are weak, their function is compromised, and other muscles such as the hamstrings and lower back muscles are recruited to assist them in performing activities such as walking, running, and squatting. This leads to overuse and tightness of the hamstrings and lower back muscles, and a further weakening of the abdominals and gluteals.

Common signs and symptoms

  • Anterior Pelvic Tilt (APT). While a certain degree of APT is perfectly normal – and usually unproblematic – excessive APT leads to poor exercise technique and increased risk of knee pain, lower back pain/injuries, and other musculoskeletal disorders that run rampant in the modern world.
  • Increased lower back curve (sway back)
  • “Bulging” (not necessarily fat) abdomen
  • Knee hyperextension
  • Lower back pain (2, 3)
  • Poor exercise technique. Individuals with LCS typically display poor movement patterns in exercises such as the squat and deadlift. This pattern is characterized by overextension of the lumbar spine, lack of glute involvement, and quad and low-back dominance.

These signs and symptoms, in combination with a screening that reveals stiff hip flexors, poor glute and abdominal strength, and compensation patterns, are good indicators of LCS.

How to improve your posture

As I pointed out in my article on UCS, some health practitioners and coaches will say that treatment of muscle imbalance patterns requires chiropractic intervention, myofascial release, trigger-point therapy, and/or a wide range of exercises and mobility drills. I’ve found that a more straightforward approach that is largely based on postural awareness exercises and strengthening of the weakened musculature is also effective – and may be all that is needed for most people with LCS. This notion is supported by studies showing that exercise interventions can modify lumbar posture and relieve musculoskeletal pain associated with poor posture (4, 5).

I think most trainers will agree that one of the keys to being a good coach is to understand that all exercises, mobility drills, etc. should be included only if they serve a purpose. This is especially important when training clients with muscle imbalance patterns, as poor exercise technique and selection only will worsen the problem.
I’ve tried various approaches for dealing with LCS. After a lot of trial and error (there’s only so much you can learn from reading science and theory on the subject), I’ve discovered certain patterns regarding what works and what doesn’t. While there isn’t one standard approach that works for everyone, there are certain general principles that everyone should adhere to. These principles serve as the foundation for the step-by-step protocol in this article.

Hip flexor stretches are often considered essential for the treatment of LCS. However, I’ve found that it’s generally more important to strengthen the muscles that produce Posterior Pelvic Tilt (PPT) and ingrain good movement patterns.

I want to emphasise that there are a range of spinal alignments that are considered “normal”, and although a lot can be done through strength training, some people will naturally have a more anteriorly tilted pelvic alignment. Also, it’s important to note that fixing LCS requires persistency and effort. Simply doing some light pull throughs at the gym every now and then is not going to get you very far. If you don’t have the will or knowledge to attack this problem on your own and/or are severely affected by LCS, then I recommend that you seek out an experienced coach or therapist that can help you treat this condition.

1) Perform the lying pelvic tilt

lying-pelvic-tilt

People with LCS often have no idea that their low back sway, bulging abdomen, and/or back pain are actually manifestations of a muscle imbalance pattern that to a great extent can be treated. Moreover, individuals with LCS typically have no idea how to posteriorly tilt their pelvis. For these people, step 1 is to learn how to get the pelvis into a neutral position and posterior tilt. The lying pelvic tilt is a great exercise for achieving this, as “push the lower back into the ground” is an easy cue for most people to understand.

Instructions: Lie on the floor and push the lower back into the ground, then anteriorly tilt the pelvis (curve the lower back) before repeating the exercise.

2) Perform the standing pelvic tilt/glute squeeze

standing-pelvic-tilt

When you manage to perform the lying pelvic tilt and understand how to control the alignment of your pelvis, performing the standing pelvic tilt is the natural next step.

Instructions: Stand with your feet shoulder width apart. Squeeze the glutes (this triggers you to posteriorly tilt the pelvis), hold the contraction for some time, relax, and then repeat the exercise.

3) Learn and ingrain the hip hinge pattern

band-pull-through

The pull through is an excellent exercise for learning the hip hinge pattern. The movement pattern in the pull through closely resembles that of the deadlift, kettlebell swing, and other hip dominant exercises. However, there’s one key difference. In the pull through, the band or cable is attached behind you, thereby “forcing” you into a posterior weight shift.

Instructions: Concentrate on keeping the chest high (without overarching the lower back), pushing the hips back (rather than bending the knees and entering into a quad-dominant squat), and finishing the movement by squeezing the glutes.

4) Strengthen the muscles that produce posterior pelvic tilt

plankcable-pull-throughs

I’ve found that the cable pull through and a modified version of the plank are among the most effective exercises for treating LCS. PPT hip thrusts, american deadlifts, and other exercises that strengthen the PPT movement pattern and weak muscle groups (especially glutes and abdominals) are also great additions.

Instructions for the modified plank: Perform a regular plank, but this time focus on squeezing the glutes all you can.

Instructions for the cable pull through: Concentrate on keeping the chest high (without overarching the lower back), pushing the hips back (rather than bending the knees and entering into a quad-dominant squat), and finishing the movement by squeezing the glutes.

5) Perform squats, deadlifts, presses, and other multi-joint exercises with good technique

eirik-garnas-organic-fitness-hip-position-deadlift

As many lifters tend to round their backs when doing hip dominant exercises, “arch!” is often a good cue for getting people into a better movement pattern. However, when coaching someone who possesses APT, this cue typically does more harm than good as the lifter ends up with an exaggerated lumbar curve.

While many inexperienced lifters (even those with no apparent postural problems) have a tendency to overextend their backs when locking out the deadlift, people with LCS often display excessive back arch during the entire lift. This position is generally considered more damaging than the more commonly seen spinal flexion.

People with LCS typically also overextend their lumbar spine during presses, pulldowns, and a wide range of other exercises. In combination with quad dominant lifting, poor glute involvement, and forward knee drift (e.g., in the squat), this poor alignment strengthens muscle groups that are already strong and increases the risk of injuries.

While some experienced lifters prefer a rounded (upper) back position in exercises such as the deadlift, the general recommendation is to keep the spine in neutral. The best strategy for achieving this position varies from person to person. For someone with a normal (neutral/slight APT) or posteriorly tilted pelvis, it is often useful to think about arching the back or perhaps even better, pulling the chest tall. For someone with excessive APT, getting the chest up  is still important, but focusing on arching the back may be a mistake, as this can quickly lead to overextension of the lumbar spine.

As for the position of the neck/head, tucking the chin and maintaining a neutral neck position is always a safe tip, That being said, many of the strongest deadlifters and squatters in the world look straight ahead during the lift. Some coaches argue that you’re strongest when lifting with a neutral neck position, but if there really is an advantage to this position, then it’s probably quite small.

Besides the focus on spinal alignment, my two top tips for a perfect deadlift and squat are to spread the floor apart (push against the outside of your heels like you’re literally trying to pull the floor apart beneath you) and drive through the heels. It’s also important to remember that the bar should travel in a vertical line over the mid-foot.

It’s not just during lower body exercises that the alignment of the pelvis and spine is important. Squeezing the glutes and posteriorly tilting the pelvis during exercises such as the press, push-up, chin-up, pushdown, and bicep curl is a good general recommendation. While it’s not a requirement, posteriorly tilting the pelvis during these types of exercises stabilizes the spine and even gives you some static glute training. Also, when performing hip dominant exercises such as the deadlift, hip thrust, and box squat, a good tip is to finish the concentric part of the lift by squeezing the glutes.

6. Pay attention to your everyday posture, and incorporate some mobility drills, stretches, and/or strength exercises into your daily life

postureBesides performing the aforementioned exercises, it can be a good idea to incorporate some mobility drills, stretches for the lower back and hip flexors, and/or strength exercises into your daily life. For example, the isometric glute squeeze shown in step 2 can easily be performed at home every day and will provide you with postural awareness and stronger glutes. Perform the exercise several times, holding the contraction for 20-40 sec. every time.

Finally, perhaps needless to say, postural training is an important part of treating LCS. Especially paying attention to sitting posture is vital.

How to incorporate this plan into a training program

Here are a couple of suggestions as to how you can include these steps into a workout routine:

Resistance training

  • Incorporate step 1, 2, and 3 into your warm-up routine prior to strength training sessions.
  • Spend 10-20 minutes on step 4 every workout by focusing specifically on exercises that target the muscles that produce PPT. If you’re training the lower body one day, simply perform these movements as part of your workout. If not, include the pull through, plank, and other exercises that strengthen the PPT movement pattern at the end of your training session. Also, remember to squeeze the glutes during exercises such as the press, push-up, etc. (step 5).

Endurance workouts and group training

  • Spend 15-30 minutes after you’re done with your endurance workout and/or group training session where you go through step 1, 2, 3, and 4. Spend the most time on step 4.

Workouts where the sole purpose is to treat LCS

  • Spend 10-20 minutes on step 1, 2, and 3, and then move on to the cable pull through, box squat, and/or other exercises that target the weakened musculature.

Comments

  1. Nice work Eirik, full of easy actionable hips. As coaches we can easy recognize LCS but how does the individual know when they have full blown LCS? How can they diagnose themselves? I had poor posture for years and I didn’t know.

    • whoops tips, not hips 🙂

    • Hi Shane!

      My advice for someone who’s trying to determine whether they have LCS or not is to go through the lists of causes and signs and symptoms I’ve presented in this article.

      For example, make a set of questions based on the list of signs and symptoms (e.g., Is my pelvic anteriorly tilted? Am I incapable of properly activating my glutes when I’m doing squats and deadlift?). If the answer to several of these questions is yes, then chances are LCS is an issue.

  2. Excellent article Eirik, thanks for the tips & wishing you all the best for the Holidays!

  3. Sequoia Gaines says:

    Eirik thank you for this article. I suffer from LCS and it’s been an issue for 4 years now…There are so many terms for this condition, anterior pelvic tilt, piriformis syndrome, sciatica, etc. Noe the sciatic pain due to the LCS has become unbearable and now my job is in the line. I’ve taken all kinds of pain meds and the doctors say nothing. Physical therapy doesn’t work, and nothing seems to help. Thank you for this article. Please send all of the articles that you have on this condition.

    • Hi Sequoia,

      I’m sorry to hear about your situation.

      I understand you’re confused regarding the terminology. Anterior pelvic tilt and lower crossed syndrome tend to go hand in hand, but they are not the same thing.

      Usually, anterior pelvic tilt develops as a result of the muscular imbalances present in LCS. In other words, APT can be said to be a symptom of LCS. Not all cases of APT develops as a result of muscular imbalances, but many, if not most, do.

      I do offer online coaching so if you need someone who can help you treat this condition then send me an e-mail through the contact form here on the blog.

  4. Mark Bisson says:

    Hi Eirik,
    I can’t thank you enough for this article and I’m so glad I found it. I was diagnosed with Lower Crossed Syndrome by a Chiropractor nearly 6 years ago and have suffered for a long time. It has affected every aspect of my life and has kept me from doing many of the things I love to do. Unfortunately, none of the dozen or so Chiropractors I’ve seen over the last 6 years have given me much help on correcting the problem. Even searching on line hasn’t produced much info that was helpful…until a week or so when I found your article. I’ve been following your exercises and have noticed an improvement in my posture already. I haven’t been able to stand straight for years and it is finally starting to change. I wish you were local where I live (Palm Springs, CA) because I would hire you to train me, but, I will keep doing your recommendations and hopefully soon I will feel “normal” again!
    Thanks,
    Mark

    • That’s great, Mark. Just keep doing the exercises and I’m sure you’ll notice further improvements over the coming weeks.

      Master the hip hinge pattern and the pelvic tilt movement, and then move on to PPT planks, pull-throughs, etc. Go heavy, but not so heavy that your form is compromised.

      Unfortunately, most health practitioners, PTs, etc. know little to nothing about LCS. So, I’m not susprised to hear that none of the Chiropractors you’ve seen know how to address this problem.

      I do offer online coaching so if you need someone who can help you treat this condition then send me an e-mail through the contact form here on the blog.

      • I liked your article,specially the hip hinge pattern exercise. Can u suggest abdominal strengthening in LCS, as they often complaint of low back ache,a nd becomes difficult to teach or else

    • Cynthia retarides says:

      Mark.. I have a similar problem. I go to PS for 3 months in the winter starting Jan 1. I have spent so much time trying to find someone to help me through this process . Kind of frustrating

  5. how much time after you start the stretching and strengthening exercises does it take to cure this imbalance ?.

    • Hi Vikram,

      The treatment of LCS is a gradual process. The time it takes to see improvements differs from person to person, depending on the severity of the condition, the structure and intensity of the treatment program, and a variety of other factors.

  6. I have been dealing with pain in my low back, hip flexors and piriformis daily for almost 3 years. At times it’s been excruciating and other times it’s just there and I don’t have to give it much thought. My primary care doctor said that my muscles have learned to be injured and that it’s a chronic condition that I’ll likely deal with for the rest of my life. I’m only 46 and it makes me tear up to think that I’ll always have to deal with this.

    Two and half years ago I did 8 weeks of PT, the PT said I had a pelvic tilt with the right side of my pelvis tilting forward, consequently one leg is shorter than the other. I spent 8 weeks walking on a treadmill, doing some strength training and relaxing on a TENS with no improvement and no real understanding of what was needed to fix this. I have been to a chiropractor twice which caused excruciating pain afterward. I’ve done Egoscue, yoga, various youtube videos that claim to help these issues and am guilty of sporadic weight training. I am almost ready to try acupuncture even though I don’t believe in it or rolfing even though it’s really expensive. Walking a lot or hiking makes it worse. Bike riding seems to make it temporarily better, so I love bike riding.

    Throughout all of this I’ve never heard of LCS and this article is kind of blowing my mind. Based on the common signs and symptoms I believe I have LCS. I’m committing to doing these exercises starting today and I feel hopeful. Thank you for posting this.

    • Hi Kim,

      Based on your description of your problem, it sounds to me that you are indeed suffering from LCS.

      LCS is an extremely common condition. Over the years I’ve helped a lot of people correct this problem. One of the online clients I work with at the moment is also on a quest to overcome LCS.

      If you feel like you need help/coaching, then don’t hesitate to contact me. You can find info about my coaching services and a contact form on the page entitled “Work With Eirik”.

    • Mark Bisson says:

      Hi Kim,
      After reading your post I felt compelled to respond. I am that client Eirik mentioned in his response to you. Reading your post was like hearing my own words. I have suffered for 6 years from LCS. It started in my late 40’s and I went from being healthy and feeling great my whole life to being in almost constant pain/discomfort. I was a gymnast and have lifted weights, running, biking, hiking, swimming…basically very active my whole life. About 6 & 1/2 years ago a friend who was a yoga instructor convinced me that yoga was a better way to go. So, I started doing yoga every day and dropped out most everything else I was doing. Within 6 months, I started to have sciatica type pain and started noticing bad changes in my body/posture. Unfortunately, I thought more stretching would help and it took me years (and EIrik) to teach me that the fix required building certain muscles back up in my body. I’ve tried many things over the years (Chiropractors, including a Neurologist Chiropractor, Acupuncture, lots of nutritional supplements, massage, special mattress, different car, magnetic pads,meditation, food allergy testing and treatment…pretty much everything except pain pills and muscle relaxants since I’m not a big fan of medication or western medicine.) Basically, nothing helped give me more than a few hours of relief at times. I never gave up, but I wondered if I would ever feel good/normal again. I even took an early retirement from my profession (Optometrist) and sold my practice last year so that I could try to get myself better again…the big problem was I couldn’t find anyone who knew how to “fix me”. Then, last August I found Eirik’s blog while googling LCS. I started doing the exercises and started feeling a bit better until I did a cross country drive for the month of October which set me way back again. Then I had some house issues that caused me to live in a hotel for the next 3 months. Finally, 5 weeks ago I started training with Eirik and with his specific guidance, I am feeling better than I have in many years. I still have bad days and some pain/discomfort…but, my posture is getting better and I feel strength in my core for the first time in a long time. I would highly recommend you try the online training with Eirik. It’s not easy and it does take time…but, it is working for me and I am so excited to be finally getting my life back! Hope this helps.
      Best,
      Mark

      • Thanks for your thoughtful response, Mark. It helps a lot. I’m on the less-stretching, more muscle-building bandwagon now and am willing to invest the time it takes to fix this. It’s already been a long road. I sent Eirik an email on his “work with me page” and am looking forward to hearing back from him.

        It sounds like you’ve had to give up a lot to be able to work on this. I’m encouraged by your progress and wish you the best!

  7. Hi Eirik,

    I developed pretty severe LCS over the course of a few years, and for the last 3 or so I’ve been working on fixing it. I’m into weight lifting/bodybuilding so this was a difficult setback for my training. I’ve definitely made a lot of progress and things are much better than they were before. However, I feel like I’m not quite back to normal. My left side seems to be good but my right seems to be still having problems (tight adductors, weaker glutes & abdominals as compared to the other side). Do you have any recommendations for me? Also, I’m a 3rd year DPT student so I generally have a good understanding of the terminology etc. My goal is to get back to to progressing in the gym again and regain normal mechanics/motor patterns for walking and normal functional activities.

    • Hi Nish,

      I’m glad you’ve been making progress.

      It’s very difficult for me to give you any good recommendation without knowing more about what you’ve been doing so far, how you perform different exercises, and what your posture looks like.

      I do offer online coaching. If you’re interested in working with me one-on-one, you can contact me via the contact form here.

Trackbacks

  1. […] all most likely suffer from some type of evolutionary mismatch disorder, whether it’s myopia, lower crossed syndrome, acne vulgaris, asthma, or more serious conditions such as type-2 diabetes or cardiovascular […]

  2. […] most common muscle imbalance patterns I’ve encountered in my work with clients over the years are Lower Crossed Syndrome (LCS), which is characterized by excessive anterior pelvic tilt and a protruding abdomen; and […]

  3. […] most common muscle imbalance patterns I’ve encountered in my work with clients over the years are Lower Crossed Syndrome (LCS), which is typically characterized by excessive anterior pelvic tilt and a protruding abdomen, […]

  4. […] on a regular basis you can build a leaner, stronger body, correct muscle imbalance patterns such as lower crossed syndrome, and prevent and slow down chronic disease […]

  5. […] tight hip flexors, hamstrings, and pecs are caused by muscular imbalances, such as those present in Lower Crossed Syndrome or Upper Crossed […]

  6. […] Swayback posture Explanation: Lower Crossed Syndrome (LCS), accompanied by poor posture and excessive anterior pelvic tilt, is an extremely common […]

  7. […] exercise (in particular correction of Lower Crossed Syndrome (LCS) and Upper Crossed Syndrome […]

  8. […] Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture – These signs and symptoms, in combination with a screening that reveals … However, I’ve found that it’s generally more important to strengthen the muscles that produce Posterior Pelvic Tilt (PPT) and ingrain … […]

  9. […] recently started coaching a new client who contacted me because he wanted me to help him combat Lower Crossed Syndrome (LCS), an extremely common disorder in today’s society. When I instructed him to do the […]

  10. […] your glutes, tilt your pelvis, and correctly retract your scapula. My guides for correcting Lower Crossed Syndrome (LCS) and Upper Crossed Syndrome (UCS) can help you achieve these […]

  11. […] and doing a variety of different exercises aimed at correcting muscle imbalance syndromes such as lower crossed syndrome and upper crossed […]

  12. […] Treat any potential muscle imbalance syndromes (e.g., lower crossed syndrome). […]

  13. […] I’ve discussed in many of my articles on musculoskeletal problems (e.g., this one, this one), hamstring tightness often develops as a result of muscle imbalances in the hip region. Typically, […]

  14. […] while back I put up an article here on the site in which I described the general plan I’ve been using to correct LCS. That […]

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