UPPER CROSS SYNDROME
Upper Cross Syndrome describes a compromise in the musculoskeletal system which tightens or facilitates the anterior compartment of the “upper” torso while at the same time weakening the posterior. While the majority of muscles involved in Upper Cross Syndrome are anterior to the shoulders there are a few posterior elements to consider as well. The chest muscles become tight and shortened as well as the neck muscles (both posterior and anterior compartments). weakening or elongating of the scapular muscles. Consequently, you have a Anteriorly, you have a
tightening/shortening of the Pectoralis Major, Pectoralis Minor, Anterior Deltoid fibers, Sternocleidomastoids, and Scalenes. Posteriorly, you have tightening/shortening of the Levator Scapulae, Teres Major, Upper Trapezius, and Suboccipitals. The weakening of the Scapular muscles include the Rhomboids, Lower Trapezius, and Serratus Anterior. There is also a weakening of the Longus Coli and Capitus muscles. Where do you typically see Upper Cross Syndrome? Being that it is
predominantly a postural issue, it is seen in individuals who work at a desk or are constantly leaning forward. Through postural adaptation, your body adopts the classical hunching of the upper thoracic spine, internal rotation of the shoulders, and anterior head carriage. Symptoms typically associated with Upper Cross Syndrome include headaches, upper thoracic pain (commonly from trigger points, the Upper Trapezius, and Levator Scapulae), and Thoracic Outlet Syndrome.
TIGHT MUSCLES LONG, WEAK MUSCLES Pectoralis Major Rhomboids Pectoralis Minor, Levator Scapulae, Lower Trapezius, Serratus Anterior Teres Major, Upper Trapezius Anterior Deltoid Posterior Deltoid Subscapularis, Latissimus Dorsi, Teres Teres Minor, Infraspinatus, Posterior Major Deltoid Sternocleidomastoid, Scalenes, Rectus Longus Coli and Capitus Capitus * the bold type represents tight and weak muscles found in our case study below
LENGTH AND STRENGTH TESTING In assessing a patient for Upper Cross Syndrome, one must formulate an effective care plan. Initially, a postural analysis would be performed. After completing the postural analysis, the length and/or strength of each muscle typically involved with Upper Cross Syndrome would be assessed. This helps to determine which muscles are the culprits. The tight muscles found on Don Scheider, our 24 year old, bench-pressing barista were Pectoralis Major, Pectoralis Minor, Levator Scapulae, Teres Major, Upper Trapezius. Sternocleidomastoid, Scalenes, and Rectus Capitus. The weak or elongated muscles were the Rhomboids, Lower Trapezius, Serratus Anterior, Longus Coli, and Longus Capitus. The way we assessed the length and strength of each muscle is
different. Assessment is as follows for each muscle: TESTS FOR PHASIC MUSCLES INCLUDE: Pectoralis Major - To test the clavicular portion, the patient is supine with elbow extended, arm hanging off of table straight out, while Doctor supports shoulder. To test the sternal portion, repeat the clavicular test, but raise arm cephalad 45 degrees. Arm should be at or lower than the level of the table (bilaterally), otherwise possible tightness is indicated.
Pectoralis Minor - Patient is supine with hands by his side and Doctor observes to see that the shoulder lays flat on table (bilaterally). If shoulders do not lay flat, possible tightness is indicated. To assess strength of the muscle, patient is seated with the arm by the side and the forearm at a 90 degree angle. Then as the patient tries to internally rotate, Doctor applies resistance. Levator Scapulae – Patient is seated with hands by side. The Doctor observes the height of the shoulders to test the length. Doctor then places the hand on the shoulder and pushes down while the patient resists to test the strength. Teres Major - Patient is supine with arms directly above the head and next to the ears with elbows locked. The low...
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