Lower Crossed Syndrome describes a pattern of tension and weakness in muscles around the pelvis. It is associated with a specific posture where the lower back comes forwards.

Muscles Involved

The illustration above shows the pattern:

• the hip flexors (front of the thigh) are tight
• their opposing muscles in the glutes are weak
• the abdominal muscles are weak
• they are counteracted by tight muscles in the lower back

This pattern of tension and weakness reflects the demands and behaviour of the body. Tight hip flexors can be caused by prolonged sitting, allowing the muscles to shorten and tighten. Likewise, prolonged sitting puts a stretch on the buttock muscles, allowing them to weaken. This can happen in isolation, without the other muscles involved following the “cross”. Without the lower back tension, the muscles encourage a “sway back” posture, where your centre of gravity comes forwards. This tends to come with tension in the shin muscles and front of the neck.

Postural Effects of Lower Crossed Syndrome

This can lead to a kypholordotic posture, meaning the curves of the spine visible in a side view are exaggerated. Kyphosis is the outward curve in the upper back, and lordosis is the opposite (seen in the neck and lower back). This posture in itself may not cause any issues, but it does limit movement in comparison to a more balanced posture. Joints and muscles work best when they regularly move through their full ranges, so we would want to move back towards a more mobile posture.

Associated Pain

The joints most likely to be affected by this position are:

• the joints of the lower back
• hips
• knees

Holding the lower back in an arched position brings the joints of the spine closer together, which can cause pain. This is more likely in people who already have an issue with those joints, such as those with osteoarthritis (sometimes called spondylosis in the spine).

Hip arthritis often develops insidiously, with hip extension often the first movement to be affected. Lower crossed syndrome can feed into this by discouraging movement into the neutral or extended positions. By failing to move through these ranges, some areas of cartilage within the joint are left without the compression and decompression they need. Thus the joint health declines and cartilage develops arthritis.

Osteopathic Treatment for Lower Crossed Syndrome

Your osteopath’s job is to work out why the muscles are behaving like this and address that root cause. If the posture has developed due to behaviour and demands (such as being sedentary), it may be a simple case of counteracting it with stretches and strengthening. We can support the health and comfort of affected joints with treatment and exercises to mobilise them.

Deep abdominal weakness can result from diastasis recti due to pregnancy or obesity. For cases associated with pregnancy, strengthening and postural retraining after 6 weeks postpartum can be very effective. Your osteopath can quickly and easily diagnose diastasis recti in the treatment room- it’s common and often overlooked, with many new mums and health professionals unaware of it as a condition. Where obesity is the underlying cause, weight loss will likely be required before the muscles can come back together.

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