HomeHealth articlesback painUpper Crossed Syndrome - Causes | Symptoms | Diagnosis | Treatment | Prevention

Out-of-balance muscles of the shoulders, neck, and chest are suggestive of an Upper Crossed Syndrome. Read the article to know more.

Written by

Dr. Sneha Kannan

Medically reviewed by

Shakti Mishra

Published At October 24, 2019
Reviewed AtSeptember 22, 2022

What Is Upper Crossed Syndrome?

When poor posture deforms the muscles in the neck, shoulders, and chest, it is called an Upper Crossed Syndrome. It makes these muscles overlap, overactive, or underactive. The upper trapezius and levator scapula, which are the Upper Crossed Syndrome muscles of the neck and shoulders, become overactive and strained. The major and minor pectoralis muscles, which are the muscles in the front of the chest, become tight and short. Because of this deformation, the surrounding muscles become weak and underused. This condition results in the muscles in the front of the neck and lower shoulders becoming weak.

Upper Crossed Syndrome is commonly seen in people who have desktop jobs, read, or drive, as they usually slouch while performing these activities. It commonly causes neck and back pain and stiffness. Stretching and strengthening exercises can help relieve these symptoms. It is not a serious condition, but it can lead to chronic pain, so it is important to get it treated.

What Are the Causes of Upper Crossed Syndrome?

Any of the following factors can cause UCS:

  • A Sedentary Lifestyle With Poor Posture - People who spend long hours in meetings or in front of a computer, with long commutes, and frequent travel are more prone. These people slouch, that is, they sit with their head bent forward and upper back hunched.

  • Poor Exercise Technique - Unbalanced training, like doing bench presses thrice a week but not doing push-ups or spending half of each workout doing crunches with the head bent forward, can overwork certain muscles in the neck and shoulders, resulting in Upper Crossed Syndrome.

Poor posture while reading, watching TV, driving, etc., can also cause this condition.

What Are the Muscles Affected in Upper Crossed Syndrome?

Because of improper posture, the following muscles become stretched or tight:

  • Suboccipitals.

  • Upper trapezius.

  • Levator scapulae.

The pectoral muscles become short and tight. The deep cervical flexors, and the muscles on the front and sides of the neck, become weak. The name Upper Crossed Syndrome is derived from the “X” shape that forms when the overactive and underactive muscles overlap.

What Are the Symptoms of Upper Crossed Syndrome?

Upper Crossed Syndrome results in the following symptoms:

  • Neck pain.

  • Muscle weakness in the front of the neck.

  • Muscle strain in the back of the neck

  • Upper back and shoulder pain.

  • Chest pain and tightness.

  • Jaw pain.

  • Fatigue.

  • Low back pain.

  • Pain while sitting and reading.

  • Problems driving for long periods.

  • Restricted neck and shoulder movement.

  • Rib pain.

  • Reduced movement in the ribs.

  • Numbness and tingling sensation in the upper arms.

How Is Upper Crossed Syndrome Diagnosed?

The doctor will diagnose this condition based on certain identifying characteristics. The common characteristics include:

  • Head consistently bent in a forward position.

  • Increased cervical lordosis (the cervical spine is too curved).

  • Increased thoracic kyphosis (the outward curvature of the spine in the upper back, shoulders, and chest is more).

  • The shoulders are elevated, protracted, or rounded.

  • Scapula winging (the shoulder blade sits out).

What Are the Treatment Options for Upper Cross Syndrome?

The treatment options include:

Physical Therapy - A physical therapist will first educate the person and give advice related to his condition so that he can understand the cause and work towards preventing more damage. The therapist will demonstrate exercises that the person needs to do regularly at home. They might also relieve pain and stiffness through manual therapy. Some of the exercises that are suggested include:

  • Lying Exercises - Place a thick pillow under the back about a third of the way up to the back while laying flat on the ground. Keep the arms, shoulders, and legs falling out in a natural position. Pillow can be used to support the head as to avoid it stretching or straining. Maintain this position for ten to fifteen minutes. Repeat this exercise several times a day.

  • Sitting Exercises - Keep the back straight, sit and place the feet flat on the floor and bend the knees. Keep the palm flat on the ground behind the hips. Now, rotate the shoulders backward and down. Maintain this position for three to five minutes and keep repeating this exercise as many times as possible.

  • Standing Exercises - Stand with the feet apart, turn the right foot out 90 degrees, and rotate the left foot inwards to about 30 degrees. Try placing the arms at shoulder height in line with the legs. Then turn the head to look at the right fingers and bend the right knee as much as possible while keeping the left leg and torso straight.

Chiropractic Care - Muscle weakness and poor posture can also misalign the joints in your spine. A chiropractor can realign these joints with spinal manipulation or adjustment. Always get this done by a licensed practitioner. Chiropractic care can also increase the range of motion as it stretches and relaxes the shortened muscles.

What Are the Ways to Prevent Upper Crossed Syndrome?

Some ways to prevent Upper Crossed Syndrome are:

  • Avoid activities that require bending the head forward for a long time.

  • Take frequent breaks while sitting or working on computers (preferably every 15 to 20 minutes).

  • Walk or swim for 30 minutes daily.

  • Spend less time watching TV, reading, using computers, and driving.

  • Do exercises that stretch the sore muscles of the neck, shoulders, and chest.

  • Use a lumbar roll in chairs.

  • While answering long phone calls, use a headset or speakers.

  • Use a pillow that retains its shape.

  • Avoid doing things that aggravate the pain and discomfort.

  • Do strengthening exercises that target the muscles of the shoulders and neck.

  • Keep the book, TV, or computer screen at eye level.

Stretching Exercises:

  • Upper cervical stretch.

  • Rhomboid muscles and trapezius muscle stretching is of utmost importance.

  • 'Yes,' and 'No' nodding movements of the head can be performed while sitting.

  • Push-ups and wall presses can also be included.

  • Pectoralis major and minor muscle stretching are required.

  • Maintain posture with correcting in mirror and back support.


The Upper Crossed Syndrome can generally be prevented. Practicing proper posture is very important in treating as well as preventing the condition. Be aware of the posture and correct it whenever adopting the wrong position. With proper treatment, the symptoms of this condition are relieved or resolved completely.

Frequently Asked Questions


What Causes Upper Crossed Syndrome?

Upper crossed syndrome is usually caused by improper or poor posture over an extended period. This results in the formation of rounded shoulders, the head seems to be in front of the body, and there will be an apparent curve in the neck and upper back. Older adults often suffer from this upper crossed syndrome; it is also commonly seen in office workers and athletes.


How Do You Fix Upper Crossed Syndrome?

There is a four-step corrective exercise process for the upper crossed syndrome. This exercise starts by inhibiting or relaxing the possible overactive muscles, then lengthening the same muscles, followed by strengthening of complementing underactive muscles and then the last step, integrating the involved muscles to reestablish functional synergistic movement patterns.


What Does Upper Cross Syndrome Feel Like?

The upper cross syndrome presents symptoms at the base of the neck and shoulders, and sometimes it can also be felt in the upper back region. Pain from the upper crossed syndrome feels tight especially when bringing the head towards the chest.


How Do You Sleep With Upper Cross Syndrome?

The recommended way of sleeping with the upper crossed syndrome is to lie similar to yoga’s corpse pose, with a pillow supporting back. To avoid neck and upper back pain, the pillow should be used in a neutral position while sleeping on the side or back. Excessively thick or multiple pillows should be avoided.


Can Upper Crossed Syndrome Be Corrected?

Upper crossed syndrome is usually due to improper or poor posture or incorrect repetitive movements. This can be corrected with proper and consistent corrective exercises. Focussing on the relief of tight muscles of the head relieves some pain. You should ask your doctor to advise on the treatment options.


Which Muscles Are Tight in the Upper Crossed Syndrome?

The muscles that are tight in upper crossed syndrome are typically the upper trapezius and levator scapula, which are back muscles of the shoulders and neck. Initially, they become extremely strained and then overactive. Later, the muscles in front of the chest, major and minor pectoralis, become tight and shortened.


Is Upper Cross Syndrome Real?

Upper crossed syndrome is real; it is caused due to improper or poor posture. It affects the muscles of the back and chest. There will be weakening in one group of muscles and tightness in another group of muscles.


Can Upper Crossed Syndrome Affect Breathing?

Due to improper postures, the efficiency of breathing will also become compromised. The progressive postural collapse into thoracic flexion makes it more challenging to open the thoracic cavity and fill in the lungs.


Why Is My Upper Back Always Tight?

Upper back tightness may be of various causes like sports injuries, overstraining and even accidents. Even the day to day activities such as sitting for long periods, incorrect sleeping positions can cause tightness. Shoulders may feel tight and stiff due to stress, tension, or overuse.


Which Exercise Is Most Beneficial for Correcting Lower Crossed Syndrome?

The lower crossed syndrome occurs due to muscle strength imbalances in smaller segments. Physiotherapists recommend foam rolling exercises for the iliopsoas muscles, floor exercises to stretch the lumbar spine, pelvis, and hip joint.


How Long Does It Take to Correct Posture?

There is no definite period on how long it will take to correct posture. It depends on the type and severity of the condition, and the effort one takes. Generally, 30 days can make a real difference in improving one’s posture because research shows it takes about three to eight weeks to establish a routine.


What Muscles Are Weak in Upper Cross Syndrome?

The muscles which become weak are the back muscles of shoulders and neck- upper trapezius and levator scapula. Then the muscles in front of the neck major and minor pectoralis become vulnerable too.


What Are the Upper Crossed Syndrome Exercises?

The exercises for upper crossed syndrome involves lying down exercises and sitting down exercises. Lying down exercise involves placing a thick pillow below the spine and keeping the head in a neutral position. Exercises that involve sitting with your back straight and feet flat on the floor is good for the upper crossed-syndrome condition.


Can Upper Cross Syndrome Cause Chest Pain?

The upper cross syndrome can cause chest pain. This happens due to straining in the back of the neck and often a weakness in front. There will be chest pain and tightness—the presence of pain in the upper back, usually shoulders and neck.


How Long Does Upper Cross Syndrome Last?

Upper cross syndrome lasts as long as the muscles are in a strained or improper position. Correcting postures will relieve one of the upper crossed syndromes. Therefore, the physical therapies should be properly carried out to get the best result.
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Shakti Mishra
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