Lower Crossed Syndrome: Diagnosis + Corrective Strategy For People Who Sit All Day

Plenty of research studies have demonstrated the deleterious effects of sitting all day or sitting for the majority of the day.

From an increased risk of obesity and heart disease to hypertension and diabetes, it seems that there are stories that crop up in the news every so often, relaying the results of new research that further demonstrate the dangers of a sedentary lifestyle.

Another potential risk of prolonged sitting is lower crossed syndrome, which some people refer to as lower cross syndrome.

But, what is lower cross syndrome, and what are the symptoms? Is there an upper and lower cross syndrome? What can you do to prevent lower crossed syndrome?

In this article, we will take a deep dive into lower cross syndrome, including what it is, how it occurs, common risk factors, as well as corrective exercises and tips to prevent lower crossed syndrome.

We will cover the following: 

• What Is Lower Crossed Syndrome?
• How Does Lower Crossed Syndrome Occur?
• Symptoms of Lower Crossed Syndrome
• How to Treat and Prevent Lower Crossed Syndrome

Let’s jump in! 

What Is Lower Crossed Syndrome?

Unless you have been officially diagnosed with lower crossed syndrome or know someone who has, there is a good chance you may be unaware of what lower crossed syndrome is and the common symptoms of lower crossed syndrome.

Lower crossed syndrome, LCS, is a postural condition that can occur due to muscle imbalances and tightness, which leads to compensatory movement patterns and static postures.

Although many people refer to lower crossed syndrome as lower cross syndrome, the technical term is lower crossed syndrome. 

How Does Lower Crossed Syndrome Occur?

So, what causes lower crossed syndrome?

Lower crossed syndrome is so named because the “crossed” term refers to the crossing pattern of the overactive muscles with the counter-crossing of the underactive muscles in the front and back of the hip region.

The overactivity of certain muscles often causes these muscles to become tight and shortened, while underactive muscles are prone to becoming weak and overstretched.

This imbalance between opposing muscle groups in the front and back of the pelvis causes an anterior tilt of the pelvis, which is accompanied by an arched lower back or exaggeration of the lordosis curve in the lower back.

Unfortunately, because the entire lower body is connected in what is known as the kinetic chain, the anterior tilt of the pelvis and the excessive arching of the lower back affects the entire body, causing alignment issues down the leg with the thigh, knee, shoulder, ankle, and foot complex, and can also affect the spine and shoulder girdle above the pelvis.

To understand the symptoms of lower crossed syndrome, it is helpful to look at the muscle groups affected.

The muscles that become overactive, tightened, and shortened with lower crossed syndrome include:

• The hip flexor complex (the iliopsoas, rectus femoris, and tensor fascia latae) at the front of the hip
• The adductor muscle group in the inner thighs (adductor magnus, adductor longus, adductor brevis, and pectineus)
• The latissimus dorsi and erector spinae in the back

Further down the kinetic chain, lower crossed syndrome can also cause overactivity and tightness in the gastrocnemius and soleus muscles in the calf muscle group.

Countering the overactive muscles in lower crossed syndrome are the underactive, weak, and lengthened or overstretched muscles.

The primary underactive and weak muscles in lower crossed syndrome are:

• The glute muscles in the butt (mainly gluteus maximus and gluteus medius)
• The abdominal and core muscles, such as the deep transversus abdominis and the internal obliques

Further down the kinetic chain, lower crossed syndrome can cause weakness, under-activity, and overstretching of the anterior tibialis muscle at the front of the shin and the posterior tibialis muscle along the lateral shin.

Again, the reason that lower crossed syndrome is called lower crossed syndrome is due to the processing of the overactive and underactive muscle groups on the front and back sides of the hip complex and body overall.

When considering the body from the side view, on the back of the body, you have overactivity, tightness, and contraction in the lower back muscles, such as the latissimus dorsi and erector spinae muscle groups just above the gluteus maximus and gluteus minimus, which are under active and weak as well as lengthened in the prolonged sitting position.

On the front side of the body, a similar pattern occurs.

There is tightness and shortening in the overactive hip flexor muscle growth and adductor complex just below the underactive, lengthened, and weak abdominal muscles, such as the internal oblique and transversus abdominis.

In this way, there is a crossing of the overactive, tight, shortened muscles with the counter crossing of the weak, stretched, underactive muscles like a big X when viewing the body from the side.

In the back of the body, you have the tight and overactive muscles above the weak and underactive muscles, and in the front of the body, you have the reverse, with the weak and underactive muscles above the tight and overactive muscles.

Symptoms of Lower Crossed Syndrome 

If you have not yet been formally diagnosed with lower crossed syndrome but think you may be delving with some sort of alignment or imbalance issue in the pelvis or lower body, it can be helpful to be aware of the common symptoms to see if this condition is something you need to look into.

However, it is important to note that just because you may be displaying many of the common symptoms of lower crossed syndrome, these symptoms are not necessarily diagnostic of this syndrome, as there can be overlap with other musculoskeletal conditions.

You should consult a physical therapist for your healthcare provider for a thorough exam for a potential lower crossed syndrome diagnosis.

Common symptoms include:

• Arched lower back
• Anterior pelvic tilt
• Tight and sore hamstrings 
• Tight calves
• Weak core muscles
• Poor posture
• Reduced range of motion in the hips
• Knee pain

According to the American College of Osteopathic Family Physicians, lower crossed syndrome can result in one of two types of posture abnormalities: type A and type B.

Both LCS postures feature hyperkyphosis (exaggeration of the curve in the upper back like a rounded upper back) and hyperlordosis, which is the swayback or inward curve of the lower back.

Type A posture also has the anterior pelvic tilt, slight hip flexion, and slight knee flexion.

Type B LCS posture has more of an arch in the upper back near the shoulders, which forces the neck to tilt forward and causes head protraction. There is also knee recurvatum, which means that the knees bend backward.

How to Treat and Prevent Lower Crossed Syndrome

The primary issue with conditions like lower crossed syndrome is that the problem is apt to snowball unless you deliberately take steps to either stop doing the activity causing the issue (prolonged sitting) or spend time correcting the muscle imbalances in your workout program.

Otherwise, the weak muscles will continue to get weaker and weaker, and the tight muscles will become tighter and more dominant.

As the discrepancies in strength, muscle activation, and muscle strength increase (with continued reinforcement with the same problematic sedentary cause), the severity of LCS symptoms—muscle imbalances escalates, movement dysfunction, joint malalignments, and decreased range of motion—escalates.

Lower crossed syndrome is usually best treated by working one-on-one with a physical therapist. Tight muscles need to be relaxed and lengthened through modalities like foam rolling and stretching.

Weak muscles need to be strengthened with target exercises.

Here are some helpful stretches for LCS:

• Hip flexor stretches
• Pigeon pose
• Butterfly stretch
• Iliopsoas stretch
• Calf and Achilles stretch
• Lower body, back, and neck foam rolling exercises

Here are some helpful strengthening exercises for lower crossed syndrome:

• Glute bridges
• Superman/back extension
• Bird dog
• Unilateral hip and glute exercises
• Quadruped hip extensions
• Core strengthening exercises

However, the best prevention and treatment is to consider getting a standing desk or making sure you’re getting up at least once an hour and trying to stand or change postures.

For more information about correcting muscle imbalances and improving functional mobility, check out our guide to Functional Range Conditioning here.