Upper Cross Syndrome

Upper cross syndrome was first described by Dr. Vladimir Janda as a predictable pattern of alternating tightness and weakness involving neck and shoulder muscles. (1) This often contributes to neck and back pain along with diagnoses like cervical radiculopathy, cervicogenic headaches, cervicogenic vertigo, TMJ dysfunction, cervical disc pain, cervical sprain/strains, thoracic outlet syndrome, rib dysfunction and rotator cuff pathology. (2-4) This predictable pattern of dysfunction occurs as certain muscles sustain overuse and undergo shortening and tightening and the muscles in their opposition become longer and weaker. (5) Muscle balance is required for normal function and any imbalance will change movement patterns leading to dysfunction and pain. Long standing postural dysfunction can cause joint degeneration (1) and motor control of muscles. (6)


Upper cross syndrome typically comes with a forward head carriage and rounded forward shoulders. Contributing factors to upper cross syndrome are things like prolonged time sitting either at work or children in school, overall sedentary lifestyle, and even prolonged smartphone use. 


Care for upper cross syndrome is aimed at changing the overall function of the neck and shoulders. Rehabilitation exercises are targeted at changing how the brain creates stability and movement around the neck and shoulders. Soft tissue techniques and joint mobilizations are used to facilitate this process. 


If you have an issue that you would like some guidance with, give us a call at (616) 301-1702.

  1. Frank C, Page P, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. Human kinetics; 2009. 

  2. Hertling D, Kessler RM. Management of common musculoskeletal disorders: physical therapy principles and methods. Lippincott WIlliams and Wilkins; 2006

  3. Chu EC, Lo FS, Bhaumik A. Plausible impact of forward head posture on upper cervical spine stability. Journal of Family Medicine and Primary Care. 2020 May;9(5):2517

  4. Szczygie E, Fudacz N, Golec J, Goelc E. The impact of the position of the head on the functioning of the human body: a systematic review. International JOurnal of Occupational Medicine and Environmental Health. 2020 Jul 23;33(5):1-0

  5. Kendall FP, McCreary EK, Provance PG. Muscles:testing and function with posture and pain. Lippincott Williams & Wilkins; 2005 

  6. Janda, V. 1987 Muscles and motor control in low back pain: assessment and management. In: Twomey, L.T. (Ed.), Physical Therapy of the Low Back. Churchill Livingstone, New York, pp. 253-278.