Lower Crossed Syndrome (LCS), also
known as pelvic crossed syndrome, is described as a muscle
imbalance pattern that affects the lower kinetic chain which
includes the lumbopelvic hip complex, knee, and ankle (1, 2).
This syndrome can be found in individuals who sit for prolonged
periods, continuously perform tasks for extending periods of
time utilizing poor posture, or have been immobilized (1). It
can also be found in individuals who perform repetitive actions
such as running or jumping (1).
Vladimir Janda, MD, an expert in the research of muscle
imbalances, characterized Lower Crossed Syndrome by over
activity of the thoraco-lumbar extensors, rectus femoris, and
iliopsoas, as well as reciprocal weakness of the abdominals and
the gluteal muscles (1, 2, 3). The image above illustrates Lower
Crossed Syndrome where tightness of the thoracolumbar extensors
on the dorsal side crosses with tightness of the iliopsoas and
rectus femoris (4). Weakness of the deep abdominal muscles
ventrally crosses with weakness of the gluteus maximus and
medius (4). Table 1 lists the actions of muscles involved in
Lower Crossed Syndrome.
Table 1 - Actions of
Muscles Involved in Lower Crossed Syndrome (5)
Rectus Abdominis – Action: Flexion and lateral
flexion of the trunk. In standing position, supports organs
anteriorly, gives anterior support to lumbar spine. With aid
of gluteus maximus and hamstrings keeps pelvis from going
into anterior pelvic tilt, decreasing lumbar lordosis.
Erector Spinae – Iliocostalis Lumborum - Action: Acting
bilaterally, extension of the spine, acting unilaterally,
laterally flexes the spine. Iliocostalis Thoracis – Action: Acting
bilaterally, extension of the spine. Acting unilaterally,
laterally flexes the spine. Longissimus Thoracis – Action: Acting
unilaterally, laterally flexes the vertebral column. Acting
bilaterally, extension of the vertebral column; draws ribs
down. Spinalis Thoracis – Action: Acting
unilaterally, lateral flexion of the spine. Acting
bilaterally, extension of the spine.
Iliopsoas – Psoas Major - Action:
Flexion of the thigh at the hip. Minimal action in lateral
rotation of the thigh. Iliacus – Action: Flexes thigh at the
hip. Minimal action in lateral rotation of the thigh.
Rectus Femoris – Action: Extension of leg at
the knee. Flexion of thigh at the hip. Reversed
Origin-Insertion Action: Flexes the pelvis on the femur
and gives anterior stabilization to the pelvis.
Tensor Fasciae Latae – Action: Thigh flexion
at the hip, abduction and medial rotation. Stabilizes the
knee laterally. Tenses the ITB tract.
Adductor Group (pectineus, adductor brevis, adductor
magnus, adductor longus) – Action: Adduction of
thigh at hip. Assistance in thigh flexion and medial
rotation at the hip.
Gastrocnemius –Action: Plantar flexion and
inversion of the foot. Reversed Origin-Insertion Action:
Flexes leg at the knee. Dorsiflexion of foot increases knee
flexion capability.
Soleus – Action: Plantar flexion and inversion
of the foot at the ankle. Reversed Origin-Insertion
Action: When standing, the calcaneus becomes the fixed
origin of the muscle. The soleus muscle stabilizes the tibia
on the calcaneus limiting forward sway.
Gluteus
Maximus – Action: Extends thigh at the hip,
assists in laterally rotating the thigh. The upper 2/3 of
the musculature are abductors and the lower 1/3 is inactive
as an abductor or an adductor in the standing position.
Glutues Medius – Action: Abducts femur at the
hip and rotates it medially. Possible lateral rotation. With
gluteus minimus is major lateral pelvic stabilizer. Aids in
early activity of hip flexion.
Hamstrings – Biceps Femoris (lateral hamstring) – Action:
Flexion and lateral rotation of the leg at the knee,
extends, adducts and laterally rotates the thigh at the hip.
Reversed Origin-Insertion Action: The long head gives
posterior stability to the pelvis and extends the pelvis on
the hip. Semitendinosus (medial hamstring) – Action:
Flexes and medially rotates the leg at the knee. Extends,
adducts and medially rotates the thigh at the hip.
Reversed Origin-Insertion Action: When thigh is fixed,
assists posterior stability of the pelvis and extends the
pelvis on the hip. Semimembranosus (medial hamstring) – Action:
Flexes and medially rotates the leg at the knee. Extends,
adducts and medially rotates the thigh at the hip.
Reversed Origin-Insertion Action: When the thigh is
fixed, gives posterior stability to the pelvis and extends
the pelvis on the hip.
This imbalance of the muscles at the lower kinetic chain will
result in postural changes and movement dysfunction for
individuals who present with LCS. These individuals with LCS
will likely display excessive arching of the back, a
protruding stomach, and a flat butt due to weakness in the glutes (6). They may complain of symptoms such as low back pain,
knee pain, piriformis syndrome and hamstring pain given the
compomised posture which results in added stresses to the
various surrounding structures & tissues (1, 7).
PT Findings in Patients with Lower Crossed Syndrome
Besides the imbalances and postural deviations found in patients
with LCS such as an anterior pelvic tilt, lateral lumbar shift,
lateral leg rotation and knee hyperextension, physical
therapists may also find joint dysfunction, particularly at the
L4-L5 and L5-S1 segments, SI joint, and hip joint (1, 4).
Lower Crossed Syndrome Treatment Options for a PT
• Postural Training / Functional Training
• Sensorimotor training
• ROM exercises
• Stretching (see videos
36,
25,
31, &
28 for
lumbar spine/back and hip/groin/knee)
• Strengthening/Stabilization (see videos
37,
Z9,
& Z11 for lumbar
spine/back and hip/groin/knee)
• Manual Therapy / Joint Mobilization / STM / Myofascial Release
• Modalities
When treating patients with LCS the shortened muscles must be
restored before embarking on training of the weakened muscles.
This is based on Sherrington's Law of reciprocal inhibition
which states that when one muscle is shortened or tightened its
opposite muscle relaxes (2, 3).
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