Poor 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.
- 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
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
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
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
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
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
Besides 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:
- 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.