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Lower Crossed Syndrome

Lower Crossed Syndrome: An explanation of inactivity and muscle imbalance.

By Cate Airoldi

As promised in my previous article, I will continue the discussion of postural health by moving on to the very common muscle imbalances of the lower body collectively labeled as Lower Crossed Syndrome. Posture and postural dysfunction have everything to do with our physical activities, so let’s start there. Being at the height (heat) of summer means that many of us are being much more active than we are during the winter months: hiking, biking, swimming, running and gardening. Since I generally run on the trails in Ashland year-round, I’ve noticed that trail traffic drops off steeply in the fall, when school begins and vacations finish.

For many of us, come fall, our active summer days are replaced with more sedentary ones. So, what does this change in lifestyle do to our bodies? It’s not too hard to guess the answer to that one; decreased fitness, strength, and muscular stamina are common side effects of a lifestyle oriented toward more sitting.

If you read my earlier blog post on Upper Crossed Syndrome (UCS), you’ll see how too much sitting can adversely affect the upper body. The lower extremity does not escape unscathed either. This is where we come to our discussion of Lower Crossed Syndrome, or LCS.  As with UCS, Lower Crossed Syndrome is mainly a biomechanical adaptation to what we do (or don’t do!) with our bodies. It’s a syndrome of muscle imbalances resulting in the decreased ability to support a healthy posture.

Lower Cross SyndromeThe main posture present with LCS is an anteriorly rotated pelvis, exaggerated lordosis (low back curve), and tight (shortened) hamstrings and hip flexors. The weak (elongated) musculature includes the abdominals, glutes, and sometimes the medial and lateral quadriceps.

Why this pattern? Well, while we’re sitting, the hips remain in a flexed position. Since many of us sit more than we would wish, these hip flexors are in a shortened position for long periods of time. The knees are also flexed while seated, which puts the hamstrings in a shortened position too. Poor abdominal strength means that the stomach tends to be lax and creep forward over the hips putting an increased curve in the low back. Like the abdominal muscles, the glutes are also in the category of weak, overstretched muscles. These muscles are designed to be powerful hip extenders; when we spend large amounts of time with the hips flexed (the opposite of what the glutes like to do), they don’t get the workout they need to support a healthy sitting posture which would take some of the strain off of the low back.

The question at this point is to decide if you have some of the common signs and symptoms of LCS, and what you can do to correct it. I would hazard a guess that the vast majority of the population probably displays some or most of the muscle imbalances and weaknesses present in Lower Crossed Syndrome. Despite this, it is important to remember that any one person’s LCS symptoms fall on a spectrum just like most other soft tissue issues, and can range from very mild to severe. Some people may only have portions of the classic LCS presentation whereas others may have developed different biomechanical adaptations that will demand further evaluation. It is also worth noting that a few easy exercises and stretches can work wonders in restoring strength and/or length to soft tissues, thereby supporting better overall body health (take a look at the exercises pictured at the end of this article).

There are a couple of things to consider when treating LCS. The first is bodywork! A therapist familiar with the myoskeletal patterns present in LCS should be able to evaluate your posture and perform treatments that will help mitigate the issues at hand. Massage therapy helps lengthen muscles that have become overly tight and can activate overstretched and weak muscle groups. I always remind my clients that the work we do in session is only part of the program though. It’s up to each client to continue stretching, strengthening, and exercising off the table in order to achieve the best possible results.

The second item to consider is how to make your workday more amenable to regaining a healthier posture. Many employers are beginning to offer standup or adjustable desks, which allow you to move your workspace up and down as you please. I am also an advocate of self-reminders and pairing up with a coworker so you’ll keep each other accountable to your goal of being more active. Whether it’s a note on your computer screen or an alarm that you set on your phone, a good goal is to get up every 30 minutes to stretch out and change position. An even better scenario (in addition to the 30 minute breaks) is to set aside a longer period of time, maybe during your lunch break, to get out and walk around the block or your office building. Not only will this prevent you from spending unhealthy amounts of time sitting thereby increasing your LCS symptoms, it’ll undoubtedly allow you to clear your head and return to work refreshed and more efficient.

Stretches and Strengthening to alleviate symptoms of Lower Crossed Syndrome:

hip flexor stretch

Hip flexor stretch to lengthen the front of hip.





Knee to chest stretch for loosening low back.

Knee to chest stretch for loosening low back.






Plank to strengthen abdominal muscles.

Modified Plank

Modified Plank

Glut strengthening. Clam Shell exercise.

Glut strengthening. Clam Shell exercise.