Crossed Syndromes

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Myoskeletal Alignment Techniques


Dr. Vladamir Janda (1928-2002), a Czech physician, developed the “crossed syndrome” theory in 1979 while he was working with the human body’s proprioception and mechanoreception sensors, focusing on functional movement and balance. This new theory bucked popular methods at the time of rehabilitating by strength training. He observed that chronic instability in the ankles followed with chronic pain in the low back. He coupled this information from studies he conducted a decade or two earlier, when he found that when leg extension by appropriate musculature (most notably, the gluteals) failed, the body compensated by tilting the pelvis forward (anterior tilt). For more information about Dr. Janda and his development of the crossed syndromes, follow this link.

What Is The Crossed Syndrome

Janda noted that in cases where 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. Furthermore, muscles performing movement at the pelvis and shoulder region which become 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.

lower crossed syndromeupper crossed syndrome

Janda observed that 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. Primarily, crossed syndrome is observed in the front-to-back (sagittal) plane, but can also be found in the side-to-side (coronal) plane.

Interestingly, but not surprisingly, 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. The two charts presented here note the various muscles affected in each cross. It’s not necessary to become technically knowledgeable in regards to names of muscles and how they work on the body’s framework. A simple observation of these charts depict how crossed syndrome appears on the human form. Most people you see display similar appearances in their form, although to what extent the severity is apparent can be significantly different from person to person.



Of considerable note, crossed syndrome is not an answer to the question of what caused the muscle pain or skeletal misalignment, itself. Rather it is a symptom or set of symptoms resulting from other origins. The two main causes we see here at MBM are poor postural habit and neural inhibitions. However, the precise trigger is much more often assumed rather than found. Usually, that’s because the event might have happened many years previous and is long forgotten, or it may have been a chain of non-recurring events.

Description of Upper Crossed Syndrome
upper crossed

Upper crossed syndrome

military neck

Military neck

Upper crossed is evident with the appearance of forward head-on-neck and/or neck-on-ribcage posture. An exaggerated curve appears in the cervical spine (neck) beginning at the cervicothoracic junction (C7/T1 vertebrae) and extending to the skull. However, this syndrome may also appear in what is termed “military neck” or a straight cervical spine. In this latter presentation, vertebrae are aligned directly over the top of each other like a tower, but the entire tower is tilted at the cervicothoracic junction, like the leaning tower of Pisa. In even rarer cases, a kyphotic curve, that is a backwards or convex curve resembling a hump, develops in the cervical spine and leans forward at C7, resembling a flexible table lamp stand.

cervicothoracic kyphosis

Dowager’s hump

The forward posture may or may not exaggerate the normal kyphotic curve in the upper thoracic spine, but it often does. This gives the appearance of what is called a Dowager’s Hump, and is typically seen in the very elderly as the body naturally degenerates.

Both shoulders generally slump forward, giving the appearance of a caved-in upper chest. Since the shoulder blades are connected to the shoulder, they too  slide forward and winged scapulaaround toward the outer sides of the ribcage (protract). The lax musculature between the shoulder blades allows the scapular borders of the blades nearer the spine to come away from the ribcage and become prominent, or “winged”. In some people, a therapist can slide their fingers relatively easily underneath the winged scapula. (There is no pain from the therapist doing this, but it’s a strange sensation to have that done to you.)

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.

While upper crossed tends to allow the neck to lean forward, the eyes always seek the horizontal. To accomplish this when our necks are craned forward means that the upper vertebrae in the neck must be bent backward to hold the head up. This action over extended periods of time create exceedingly tight neck and head stabilizing and extensor muscles and put the squeeze on nerves running from the upper vertebrae into your head.


Description of Lower Crossed Syndrome
lower crossed syndrome

Anterior pelvic tilt

Lower crossed syndrome takes place in the low back and pelvis, although its affects can be seen and felt through the entire body. Characteristically, muscles of the abdomen, rear end, and back of the legs are generally inhibited and slack in lower crossed, while muscles of the low back, groin, and front of legs are stretched tight, and neurally facilitated. This force couple shifts the top of the pelvis forward (anteriorly), rotating about the hips as an axis.

As the pelvis rotates forward, an excessive low back (lumbar) curve is introduced, giving a person the appearance of their rump sticking out and low back having a deep, concave curve. Eventually, low back pain seeps in and becomes chronic. 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.

crossed syndrome


Since most of the nerves found in the pelvis and all of those found in the legs leave the central nervous system in the lumbar spine (low back), lower crossed syndrome tends to affect systems and muscles found there. Examples are reproductive and elimination systems, leg coordination and sensation, and, of course, muscle strain. The sciatic nerve and its many branches are eligible to be affected, from shooting pain to muscle tightness to range of motion problems in hips and ankles.

Not always!

People are all individuals and not every person presenting with symptoms of upper or lower crossed syndrome will have problems resulting from them. Many people are perfectly functional as their bodies adapt to skeletal misalignment. Cultural acceptability of what people perceive to be acceptable or desired often have us actually attempting to create the look of upper and lower crossed. An example would be the so-called “bubble butt” resulting from excessive lumbar (low back) curve or the laid-back look of slouching shoulders.

Not all people have pain with crossed syndromes. Indeed, it is possible for a person to have both syndromes, yet never have a single complaint until very late in life. However, many symptoms may appear during a person’s life which are never actually attributed to crossed syndrome. Migraine symptoms, headaches, sinus problems, shoulder tension, low back problems, incontinence, sore calves, and breathing problems, are all common complaints most people experience during their lifetime. We usually just take an over the counter medicine to deal with it. Yet, all of these could be symptoms of the crossed syndrome.


Myoskeletal Alignment Techniques
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