Upper Crossed Syndrome: 4 Steps to Correct Rounded Shoulders and Hunchback Posture

upper-crossed-syndromeDo you have good posture? If you spend hours sitting at a desk reading and/or working on a computer every day, then the answer is probably no… Protracted, hunched shoulders, excessive anterior pelvic tilt, and other postural problems are extremely common these days. These conditions, which usually go hand-in-hand with a muscle imbalance pattern of some sort, are manifistations of a mismatch between our ancient physiology and the modern lifestyle. Humans are designed to move; we’re not adapted for a sedentary life.

The two 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, and Upper Crossed Syndrome (UCS), which is typically characterized by rounded shoulders and a “hunchback posture”.

It’s important to be aware of and able to correct these conditions, as they set the stage for poor exercise technique, compensation patterns, injuries, lower back pain, and in some cases, disorders such as osteoarthritis and degenerative joint disease. UCS may also impair athletic performance, since bad posture can set the stage for poor exercise technique (e.g., people with UCS often have trouble getting their chest up in the bench-press) and depression of the sternum can make it more difficult to breathe. Last but not least, poor posture isn’t aesthetically appealing. Exercises and mobility drills aimed at treating UCS can make you look better, as they will help pull your shoulders back and make your chest/breasts look bigger!

What is Upper Crossed Syndrome?

Upper Crossed Syndrome (UCS) is described as a muscle imbalance pattern located at the head and shoulder regions. It is most often found in individuals who work at a desk or who sit for a majority of the day and continuously exhibit poor posture. In UCS, tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. (1)

So, what does this mean exactly? It means that there is a weakening and lengthening of the posterior upper back and neck muscles and a tightening and shortening of the opposing anterior pectoral (chest) and neck muscles. UCS 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 (e.g., cycling, swimming) and activities (e.g., typing on a computer, painting) that involve an uneven stimulation of the muscles that are involved in UCS
  • Poor exercise technique (e.g., failure to retract the shoulders during bench-pressing and squatting)
  • Imbalanced strength training (e.g., a lot more pressing movements than pulling movements)
  • Genetic predispositions

The development of UCS initiates a vicious cycle, in the sense that the muscle imbalance pattern in UCS worsens posture and exercise technique further.

Common signs and symptoms

  • Forward head posture
  • Rounded shoulders/abducted scapulae
  • Hunched upper back
  • Headache
  • Pain in the shoulders, upper back, and neck

How to improve your posture

While some health practitioners and coaches will say that treatment of UCS 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.

This notion is supported by studies which show that exercise interventions can decrease forward head and protracted shoulder postures and produce a more erect upper trunk posture (2, 3, 4, 5). Moreover, prospective intervention studies have shown that stretching the anterior chest muscles on its own or in combination with strengthening the scapular retractors can alter the position of the scapula at rest in individuals with abducted scapulae (2). That being said, more high-quality studies are needed to establish the actual mechanism behind the change and to determine which component of the intervention is most effective.

Over the years I’ve tried many different strategies for treating UCS. One of the things I’ve learned is that while there isn’t one standard approach that works for everyone, there are certain general principles that everyone should adhere to. It’s important to note that fixing UCS requires persistency and effort. Simply doing some chest stretches at the office 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 UCS, then I recommend that you seek out an experienced coach or therapist that can help you treat this condition.

I want to make it clear that this is not intended to be a comprehensive guide to the many different treatment protocols and exercises that can be used for the correction of UCS. Rather, for this article I wanted to turn my experience with treating UCS into a do-it-yourself guide that everyone should be able to follow. The guide only includes exercises and drills that don’t require any special equipment.

1) Learn how to “set” the shoulders and tuck the chin

eirik-garnas-scapular-retractionAs many people with UCS don’t know how to correctly retract their scapula and pull their shoulders back and down, the first step when correcting this muscle imbalance pattern is to learn to “set the shoulders”.

In a standing position, tuck your chin and pull your shoulders down and back by thinking about sticking your shoulder blades in your back pockets.

Having problems? Try this…

  • Place a tennis ball under the chin. This forces you to tuck the chin.
  • Have someone place their hands on your shoulders to help you initiate the movement.
  • Begin by performing retracting the scapulae in a push up position (pinch the shoulder blades together) or standing position with hands against the wall (think about pushing the wall).

Some people have to stay on this step for a while before they get it, while others get a grasp of things pretty quickly. It’s important to memorize this movement, as it lays the basis for correcting UCS.

2) Strengthen the weakened musculature

eirik-garnas-face-pullseirik-garnas-seated-rowOnce you’ve learned how to “set” the shoulders, the next step is to perform this movement with added resistance. Two examples of good exercises that can be used at this step are the face pull (begin with a band or use light loads on the pulley machine) and the seated cable row.

Some quick tips:

  • Don’t go heavy in the beginning.
  • Don’t use the low back to gain momentum.
  • Do sets of 10-15 reps.
  • Make sure you’re pulling the shoulders back and down.
  • Hold the contraction at the midpoint for 1-2 seconds (when you’re squeezing the scapulae back/down).
  • Although it’s a good idea to never go so heavy on these exercises that you need to use a lot of momentum to finish the last couple of reps, I want to emphasise that you should be training to near failure as soon as you master the technique. As with resistance training in general, focus on progressive overload (e.g., by increasing the load every time you reach your desired rep target).

3) Set your shoulders correctly when you’re exercising

eirik-garnas-scapular-retraction-squat-organic-fitnessAs mentioned at the beginning of the article, people with UCS generally display poor technique in a wide range of exercises. This is partly because UCS inhibits the trainee’s ability to get into a position to lift correctly (e.g., inability to set the shoulders in the bench-press). Moreover, muscle imbalance patterns such as UCS set the stage for compensation patterns during lifting. In other words, it’s not enough to target the muscles involved in UCS through specific exercises, you also have to pay extra attention to your exercise technique in general.

Here are some quick tips for the big three:

  • The bench press: Set your shoulders down and back. Keep your delts locked in during the entire lift.
  • The squat: Pinch the shoulder blades together, get your chest high, and try not to lose the solid upper back position during the lift.
  • The deadlift: The deadlift is a tough one. For people with upper crossed syndrome it’s especially important to get into a good set-up and avoid a flexed upper back position.

4) Pay attention to your everyday posture, and incorporate some mobility drills, stretches, and corrective exercises into your training sessions and daily life

eirik-garnas-home-drill

Although you can achieve a lot by having a workout program that’s specifically designed to correct poor posture, it’s important not to forget that most of your time is spent outside of the gym. Naturally, paying attention to your posture – both when sitting and standing – is an important part of treating UCS.

If you sit for prolonged periods of time each day, taking a break here and there to perform some upper back exercises, mobility drills, and stretches is a good idea. Have a band or rope available when you’re at your desk, so you can perform some simple exercises every now and then. These types of drills and exercises can also be performed as part of your warm-up routine prior to workout sessions.

I’m not convinced that stretching of the anterior musculature is as important for the treatment of UCS as some people make it out to be. In general, I’ve found that strengthening the posterior musculature is far more important than stretching. However, that doesn’t mean that performing some static or dynamic stretches for the tight anterior musculature is necessarily a waste of time. Also, since stretching and mobility work are easy to perform both at home and at work, its something you should consider incorporating into your routine.

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 and 4 into your warm-up routine prior to strength training sessions. Do several sets of 10-15 reps where you “set” the shoulders, and then perform some mobility drills, stretches, and corrective exercises.
  • Spend 10-15 minutes on step 2 every workout by focusing specifically on exercises that target the weak upper back musculature. If you’re training back one day, simply perform these movements as part of your workout. If not, include seated rows, face pulls, and/or other similar exercises at the end of your training session. Also, remember to “set” your shoulders correctly during all the exercises you perform (step 3).

Endurance workouts and group training

  • Spend 15-25 minutes after you’re done with your endurance workout and/or group training session where you go through step 1, 2, and 4 (corrective exercises and mobility drills). Spend the most time on step 2.

Workouts where the sole purpose is to treat UCS

  • Spend 10-20 minutes where you perform simple retraction exercises, stretches, band face pulls, etc., and then move on to several sets of seated rows, cable face pulls, and other exercises that specifically target the weak posterior musculature.

Again, it’s not just about what you do in the gym. Pay attention to your posture throughout the day, and try to make time for some corrective exercises (e.g., scapular retractions, face pulls with band) as often as you can.

Comments

  1. Great article! I needed this reminder. Thank you!

    • I think we all need to be reminded of this every now and then. I know I do. It’s easy to forget that sitting for hours every day wreaks havoc on posture and health, since the change doesn’t happen overnight, but rather is very gradual.

  2. Fantastic thanks for the tips…found myself straightening up while reading this post 🙂

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  1. […] 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 […]

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