Do You Suffer from Neck pain, Shoulder Pain or Headaches? You Could Have Upper Crossed Syndrome



Upper Crossed Syndrome (UCS) is a pattern of muscle imbalance primarily affecting the head, neck, shoulders and upper extremities.

It is common in individuals who work at a desk or who sit for a majority of the day, perform repetitive types of activities or continuously exhibit poor posture.

In UCS, tightness of the sub-occipitals, upper trapezius and levator scapula on the posterior side crosses with tightness of the SCM, scalenes, pectoralis major and minor on the anterior side.

Weakness of the deep cervical flexors anteriorly crosses with weakness of the middle and lower trapezius posteriorly.

This pattern of imbalance creates joint dysfunction, particularly at the C1-C2 (top of the neck), C4-C5, cervicothoracic joint, glenohumeral (shoulder) joint, and T4-T5 segments.

UCS can lead to a chain of events resulting in shoulder pain and dysfunction, neck pain and headaches.


Common static postural changes in the UCS include:

  • Forward head posture
  • Increased cervical lordosis and thoracic kyphosis
  • Elevated and protracted shoulders
  • Rotation or abduction and winging of the scapula


How is the UCS assessed?


1. Start with a postural and movement assessment to identify the patterns of dysfunction

2. Assess range of motion

3. Evaluate muscle strength

4. Palpate for trigger points and joint dysfunction


How is the UCS treated?

1. The overactive muscles are released with trigger point therapy, e.g. dry needling and  deep massage, followed by stretching

2. The underactive muscles are activated through manual techniques such as positional isometrics

3. Corrective exercises are prescribed to reinforce the above, consisting of:

Inhibit- Self- myofascial release with the Grid or TP massage balls

Lengthen- Stretching

Activate- Isolated exercises to increase intramuscular strength

Integrate- Functional compound exercises to increase intermuscular coordination


Sample exercise program for managing the Upper Crossed Syndrome

Inhibit- -Sub-Occipitals, Upper trapezius, levator scapulae, pec minor and Latissimus using the Grid and TP massage balls. 1-2 sets.  Hold the most tender areas for 30 s.

Lengthen- Sub-Occipitals, Upper trapezius, levator scapulae, pec minor and Latissimus using static stretching. 1-2 sets, for 30 s.



1. Middle – lower traps with a prone cobra- – 2 sets 10-15 reps, 2 seconds isometric and 4 seconds eccentric. 0-30 sec rest between sets.


2. Chin-Tucks- 2 sets 10-15 reps. Hold chin tuck for 2 seconds.  0-30 sec rest between sets.


3. Push-up plus for Serratus anterior- 2 sets 10-15 reps, 2 seconds isometric and 4 seconds eccentric. 30 sec rest between sets



1. Ball Combo 1 – 1-3 sets. 10-15 reps slow and under control. 30 sec rest between sets.


2. Single-Leg Romanian Deadlift – 1-3 sets.  10-15 reps slow and under control. 0-30 sec rest between sets.


3. Standing 1-Arm Cable Chest Press- 1-3 sets. 10-15 reps slow and under control.0-30 sec rest between sets.


Take a look in the mirror. Do you have Upper Crossed Syndrome?          


About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin