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  • Writer's pictureRobin R Varghese, PT.

"A sneak peak into Crossed Syndromes."


What are Crossed Syndromes?

  • The “crossed syndrome” theory was developed by Dr. Vladamir Janda (1928-2002), a Czech physician in 1979

  • According to Dr Janda, when certain muscles become neurally overworked (facilitated), they tend to pull continuously on the bony framework of the body.

  • When this takes place, neurally underworked (inhibited) muscles tend to allow overworked muscles to continue to be tight.

  • Muscles that are facilitated appear along one straight line and those which become inhibited appear along another straight line.

  • These two lines cross in the appearance of the letter “X”; hence, “crossed” syndrome.

  • Humans tend to develop crossed syndromes at the level of the shoulders, which he termed “Proximal (upper) Crossed, and the pelvis/hips, or Distal (lower) Crossed Syndrome.

  • Muscles which lay along the “inhibited” (weak) line turn out to be functional opposites of those lying along the “facilitated” (tight) line.

  • The crosses result in predictable muscle imbalances.

Causes of crossed syndromes.


  • Two main causes are poor postural habit and neural inhibitions.

  • However, the precise trigger is much more often assumed rather than found, because the event might have happened many years previous and is long forgotten, or it may have been a chain of non-recurring events.

How do muscles get weak in crossed syndromes?


  • When muscles are not stimulated to resist gravity for an extended period, e.g., during prolonged sitting or lying, their stabilizing function is disturbed by the hypoactivity reaction resulting in muscular weakness and atrophy and is overtaken by the mobilizing muscles

  • such compensation leads to increased activity of the mobilizing muscles and, subsequently, their decreased flexibility, which may finally lead to a pathological chain of reactions within the musculoskeletal system

What leads to inappropriate movement patterns ?


  • muscle imbalance arises, in which some muscles become inhibit and weak and others become short and stiff. These changes in tissues may cause inappropriate movement patterns in the individual.

  • When muscle imbalance impairs function, it is considered to be pathological which occurs in response to adaptation to complex movement patterns.

Upper crossed syndrome



  • Upper-crossed syndrome (UCS) is also referred to as proximal or shoulder girdle crossed syndrome.

  • 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.

  • Focal areas of stress within the spine correspond to transitional zones in which neighboring vertebrae change in morphology.

  • Specific postural changes seen in UCS includes forward head posture,

  • increased cervical lordosis, thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae.

  • These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness, leading to abduction, rotation, and winging of the scapulae.

  • This loss of stability requires the levator scapulae and upper trapezius to increase activation to maintain glenohumeral centration

Symptoms of Upper Crossed Syndromes


Complaints of people with upper crossed syndrome are typically stiffness in the neck, headaches, tension and soreness along the slope of the shoulder, front of shoulder, and tight, sore, upper back. Upper crossed may also result in neurological problems (from tingling or pins and needles to shooting pain and numbness) extending into the arms, hands, and fingers.


Lower crossed syndrome



  • Also called as the The ‘Unterkreuz syndrome’ or as the pelvic crossed syndrome,

  • Lower crossed syndrome takes place in the low back and pelvis, although its affects can be seen and felt through the entire body. A force couple between the neurally excited and inhibited muscles lead to joint dysfunction, joint pain and postural changes.

  • Other problems and complications also arise such as sciatic pain, sacroiliac joint dysfunction (SIJD), and muscular strain patterns extending up into the neck and down the legs into the ankles and feet.

  • There are two known subtypes, A and B, of lower crossed syndrome. The two types are similar and involve the same main muscle imbalance characteristics. For type A the imbalance manifests mainly in the hip, while for type B the imbalance mainly manifests in the lower back.


Watch out for more on these subtypes, muscle involvement and physical therapy management of crossed syndromes in our upcoming blogs.


At Valley Healing Hands, Brownsville, Texas, we provide the best Physical Therapy treatment for Crossed Syndromes. Our therapists are highly qualified and will perform a complete assessment and get to know the root problems that cause these syndromes to impose it’s restrain on you. They will work on a personalized treatment plan and help you reach your goal at ease. Our patients are completely satisfied with our services. You may learn what they have to say about us here and get connected to us here. Our patients love us, you too will!



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