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Lower Cross Syndrome: Causes, Symptoms, Treatment

What is Lower Cross Syndrome?

A person is said to have Lower Cross Syndrome when there is some type of strength mismatch in the pelvic musculature. This imbalance of strength tends to affect the way a person sits or walks. It sometimes also causes pain in the hip and surrounding areas. The National Academy of Sports Medicine explains Lower Cross Syndrome stating that the body tries to add a movement to compensate for the lack of strength or movement in one part of the body.[1,2]

In Lower Cross Syndrome, the muscles that lack proper strength or are weak include the abdominal muscles and the gluteus maximus. The muscles which are tight in people with Lower Cross Syndrome are the hip flexors and lumbar erector spinae muscles.[1,2]

These tight muscles try to move the pelvis out of its normal anatomical position. When this happens, the abdominal and the gluteus maximus muscles try to put up a counter force to keep the pelvis in its place but because of the weakness are not able to do so. To compensate for this, the lower back of the person arches and the pelvis tilts forward thereby changing the posture of the person significantly. The changes in posture as a result of Lower Cross Syndrome can be variable depending on which muscles are most affected.[1,2]

Lower Cross Syndrome: Causes, Symptoms, Treatment

What Causes Lower Cross Syndrome?

Inactivity and sedentary lifestyle is perhaps the most common cause for Lower Cross Syndrome. Also, people who have a desk job and sit for abnormally long periods of time without a break are also vulnerable to this condition. In some cases, people who over-train certain muscles in the gym and undertrain other muscles can also cause Lower Cross Syndrome.[2]

This can be best explained that a person strengthens the hip flexors and back muscles and does not pay much attention to the gluteus maximus and the abdominal muscles is prone to Lower Cross Syndrome due to this strength imbalance.[2]

There are also other major muscle groups that become weak and cause a person to have Lower Cross Syndrome. These muscles include transverse abdominis, gluteus minimus, posterior tibialis, and anterior tibialis. The muscles that become too tight and cause Lower Cross Syndrome include erector spinae, latissimus dorsi, and soleus muscles.[2]

What are the Symptoms of Lower Cross Syndrome?

As stated above, Lower Cross Syndrome can affect the posture and alignment of the pelvis in a person. The person will not be able to do any kind of stretch involving the hip musculature as it would cause severe pain and discomfort. The American College of Osteopathic Family has categorized that people with Lower Cross Syndrome have two types of posture, namely Type-A and Type-B.[2]

The common feature seen with both posture is hyper-kyphosis in which the person’s top of the back appears rounded. Another feature that is common in both postures is hyperlordosis in which the lower back appears abnormally curved.[2]

Type-A Posture: This posture occurs when the pelvis tilts backwards. This results in the buttocks appears protruded outwards. There is also arching of the lower back. Some of the features specific to Posture-A in people with Lower Cross Syndrome include thoracic hyper-kyphosis, lumbar hyper-lordosis, and anterior pelvic tilt. People with Type-A posture of Lower Cross Syndrome have their hips and knees bent.[2]

Type-B Posture: This type of posture occurs when there is an arch near the shoulders and upper back. This arch forces the neck to tilt forwards and appear abnormally stretched. People with Type-B posture will have their heads protracted due to problems with alignment of the spine. They also have thoracic hyper-kyphosis and lumbar hyper-lordosis. The knees in such people are bent backwards.[2]

How is Lower Cross Syndrome Treated?

For pain relief, people with Lower Cross Syndrome are prescribed pain medications. They can also apply hot and cold packs around the affected region for symptom relief. It should be noted here that people should consult a physician when it comes to taking medications as excessive medications may worsen the condition. This is especially for people who are also on medications for other health conditions.[2]

The primary aim of the treatment for Lower Cross Syndrome is to correct the misalignment and posture of the patient. This is mainly done through muscle retraining. Once the strength imbalance is addressed then the posture and movement generally normalizes. For this, the patient can consult with a physical therapist who can design an exercise protocol best suited for the person.[2]

Physical therapy will involve muscle relaxation techniques, static stretching, and strengthening exercises. For muscle relaxation, the therapist will use a foam roller over the affected areas. Upon identifying the area that is most tender they will position the roller at that point for about half a minute. This will relax the muscles. The next step in physical therapy involves stretching and strengthening the muscles. There are a variety of exercises which accomplishes this purpose.[2]

In summary, Lower Cross Syndrome develops when there is an imbalance in the strength of muscle groups involving the pelvic musculature. This causes issues with alignment of the pelvis and spine resulting in various movement and posture abnormalities. Additionally, due to these abnormalities, the person may also experience significant pain and problems with ambulation or carry out activities of daily living.[1,2]

The primary cause for Lower Cross Syndrome is believed to be inactivity or a sedentary lifestyle. Also, over-training or undertraining of muscles in the hip and pelvis also can cause Lower Cross Syndrome. Physical therapy is the best way to treat Lower Cross Syndrome.[1,2]

It is best to consult with a physical therapist who can design the best exercise plan that is best suited for the patient. In majority of the cases, once the alignment and the strength of the muscles is addressed, the posture and other abnormalities normalize that are seen in people with Lower Cross Syndrome.[1,2]


Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 14, 2023

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