gif of Tyler Read opening the NASM CPT textbook to the page describing lower crossed syndrome

Lower Crossed Syndrome is a postural imbalance that affects the muscles of the hip, core, and lower back. This syndrome is characterized by tightness and overactivity of the hip flexors and lower back extensors leading to anterior pelvic tilt and increased overarching of the lower back.

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This article will delve into everything you need to know about LCS, from its causes and symptoms to approved assessment techniques and corrective exercises. Whether youโ€™re a fitness professional preparing for your NASM or ISSA certification exam or someone seeking practical solutions to alleviate LCS-related problems, I’ve got you covered. Read on to find out how expert insights can help you conquer Lower Crossed Syndrome and improve your overall well-being. Below Iโ€™ve detailed what lower crossed syndrome is, what causes it, and how to correct it.

This is my complete coverage of lower crossed syndrome based on my experience of 12+ years as a personal trainer coming across many clients who have this condition.

I also use specific details that NASM, and ISSA teach you in several of their certifications. 

Overview of Lower Crossed Syndrome

Tyler Read holds up the NASM textbook showing lower crossed syndrome

Lower Cross Syndrome, as defined by the National Academy of Sports Medicine (NASM), is a muscular imbalance pattern that commonly affects the lower back and hip joints.

Weakness and under-activity of the glutes and abdominal muscles can worsen lower cross syndrome. This imbalance can lead to postural deviations, such as an anterior pelvic tilt and increased lumbar lordosis, resulting in chronic lower back pain and decreased functional movement. Any issue with the LPHC (lumbo-pelvic-hip complex) needs to be resolved immediately.

NASM recommends a comprehensive approach to address lower cross syndrome, including targeted stretching exercises for the tight muscles and strengthening exercises for the weak muscles, along with proper posture correction techniques and core stabilization exercises.

NASM describes how to recognize and treat lower crossed syndrome in the NASM Personal Training Certification and the Corrective Exercise Specialist

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ISSA covers lower cross syndrome in the ISSA Corrective Exercise Specialist, describing it as an excessive anterior pelvic tilt of more than 5 degrees for men and 10 degrees for women, when viewed from the side.

Anatomy and Muscles Involved

Tyler pointing out which muscles are involved in Lower Crossed Syndrome with NASM

Weakness and underactivity in the glutes and abdominal muscles are common in individuals with Lower Cross Syndrome.

The glutes are responsible for extending the hips and when they donโ€™t function, the pelvis can stay tilted.

Lower cross syndrome places the body in a position that can lead to lower back pain, hip pain, and limited range of motion in the hips.

Corrective exercises, such as strengthening the glutes and core while stretching the hip flexors, can be effective in addressing Lower Cross Syndrome issues. 

Causes and Risk Factors of Lower Cross Syndrome

While there may be several contributing factors to Lower Cross Syndrome, the most common causes can be attributed to a combination of muscle imbalances and poor posture. One primary cause is prolonged sitting or sedentary lifestyle, which leads to weakened gluteal muscles and tight hip flexors. Additionally, weak abdominal muscles and tight lower back muscles can also contribute to the development of lower cross syndrome. Other potential causes include improper lifting techniques, excessive high-impact activities, and genetic predisposition.

Common Signs and Symptoms of Lower Crossed Syndrome

The key symptoms of lower cross syndrome include an exaggerated curvature of the lower back, tight hip flexors, weak gluteal muscles, and a forward tilting pelvis. This can lead to problems like lower back pain, hip discomfort, and limited range of motion in the hips and lower spine. Additionally, individuals with lower cross syndrome may experience muscle imbalance in the abdominal region, resulting in weakened core stability. It is important to address these symptoms through targeted exercises and stretches to restore proper alignment and function to the affected muscles and tissues.

Lower Crossed Syndrome: Complete Guide ([year]) 2

Corrective Exercises for Anterior Pelvic Tilt

Individuals with lower crossed syndrome often have the following overactive and underactive muscles:

Overactive

โ€ข Hip flexors

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โ€ข Lumbar extensors

โ€ข Gastrocnemius/soleus

Underactive

โ€ข Abdominals

โ€ข Gluteus maximus and medius

โ€ข Hamstrings

This means you use strength movements to engage the abdominals, gluteus medius and maximus, and hamstrings, and use static stretches to open up the hip flexors, lumbar extensors, and calves.

Hereโ€™s a sample exercise program for someone with lower crossed syndrome:

  1. Hip extensions 3×15
  2. Planks 2×20-40 seconds
  3. Banded Side clams 2×12-15
  4. Bird dogs 2-3 sets of 5-8 reps
  5. Cat/cow stretch 2 sets of 5-8 reps alternating between positions
  6. Seated hamstring stretch, 2 sets of 60 second holds 

Strengthening and Stretching Protocols for LCS

Exercises play a crucial role in alleviating symptoms of lower cross syndrome (LCS). By targeting the imbalances between the tight and weak muscles involved in LCS, exercises can help restore proper alignment and function of the pelvis and spine. Specifically, focusing on strengthening the weak abdominal muscles and glutes while stretching the tight hip flexors (iliopsoas) and lower back muscles can help rebalance the body. Additionally, incorporating exercises that promote core stability and improve posture can further enhance the effectiveness of the treatment. Regular exercise not only helps alleviate pain and discomfort associated with LCS but also promotes overall musculoskeletal health and prevents future occurrences.

Stretching can be a beneficial tool in managing lower cross syndrome. By targeting the tight muscles and increasing their flexibility, stretching helps to alleviate muscle imbalances and restore proper alignment in the pelvis and lumbar spine. Specifically, focusing on stretching the hip flexors and lower back muscles can help lengthen these tight areas, reducing the anterior pelvic tilt commonly associated with lower cross syndrome. Additionally, stretching the weakened gluteal and abdominal muscles can help activate and strengthen them, further promoting postural stability and reducing strain on the lower back. Incorporating regular stretching exercises into a comprehensive treatment plan for lower cross syndrome can contribute to improved posture, increased athletic performance, reduced pain, and enhanced functional movement patterns.

Foam rolling can also be a good technique for helping release tender spots and decrease overall tightness. A foam roller provides an inexpensive solution as well when compared to massage therapist sessions, which can also help alleviate syndromes like upper and lower cross. 

Postural Corrections and Alignment Strategies for LCS

Often, the first step for people to take when fixing their own poor posture is recognizing that they have it. 

Upon doing basic postural assessments, you may notice a client has a forward head posture with increased thoracic kyphosis.

Or the person may have excessive lumbar lordosis with anterior pelvic tilt. 

Taking photographic evidence (with their permission, of course) and showing a client that their hips are tilted, or showing them in the mirror can be of great help.

Also, illustrating the concept of neutral posture can give clients something to strive for in their everyday life. If you can show them what good posture looks like, they can strive to fix their dysfunction.

Other tools you can use to assess include the overhead squat assessment and a pushing assessment or plank/push-up test to look for hyperlordosis of the lumbar spine.

I like using simple yoga positions like cat/cow to teach how to unlock the neutral spine position.

Some of these strategies can also be applied to other postural deviations, like upper crossed syndrome, as well.

Lower Cross Syndrome Prevention and Management Strategies

To prevent or manage this syndrome, it is important to make certain lifestyle changes. 

Firstly, incorporating regular exercise into your routine can be highly beneficial. Focus on strengthening the weak muscles such as the glutes and abdominal muscles while stretching the tight hip flexors and lower back muscles. 

Additionally, maintaining good posture throughout the day is crucial. This can be achieved by using ergonomic furniture and taking frequent breaks to stretch and move around. Lastly, practicing stress management techniques like meditation or yoga can help reduce muscle tension and promote overall well-being. By implementing these lifestyle changes, individuals can effectively prevent or manage Lower Cross Syndrome.

Lower Crossed Syndrome FAQs (Frequently Asked Questions)

Who should be aware of the signs and symptoms of lower crossed syndrome?

Lower cross syndrome, marked by muscular imbalances in the lower back and hips, leads to an exaggerated lumbar spine curvature. Common in sedentary individuals, it causes chronic low back pain, hip tightness, and limited mobility. Awareness helps prevent it through targeted exercises, postural corrections, and regular physical activity.

How long does it take to recover from lower crossed syndrome?

Recovering from lower cross syndrome typically takes several weeks to a few months, depending on severity and individual factors. Proper treatment, including physical therapy and postural correction, can expedite recovery. Lifestyle changes like regular exercise and ergonomic adjustments also help. Consult a healthcare professional for personalized guidance.


Which muscles are typically underactive in association with lower crossed syndrome?

Muscles typically underactive in lower crossed syndrome include the gluteus maximus, gluteus medius, transverse abdominis, and internal oblique. These muscles often exhibit reduced activation, leading to imbalances that affect posture and movement efficiencyโ€‹.


Which muscles are typically overactive in association with lower crossed syndrome?

In lower crossed syndrome, the hip flexor complex, adductors, latissimus dorsi, and erector spinae are typically overactive. These muscles compensate for weaker muscles, leading to poor posture and movement dysfunctionsโ€‹โ€‹.


How is upper crossed syndrome characterized?

Upper crossed syndrome is characterized by forward head posture and rounded shoulders. Overactive muscles include the upper trapezius and pectoralis major/minor, while underactive muscles are the deep cervical flexors and lower trapeziusโ€‹.


What does activation refer to regarding underactive/lengthened myofascial tissue?

Activation refers to exercises targeting underactive or lengthened myofascial tissue to strengthen them. This process corrects muscle imbalances and improves functional movement, crucial for restoring proper biomechanicsโ€‹.

When is a muscle considered overactive?

A muscle is considered overactive when it compensates for weaker muscles, leading to imbalances and altered movement patterns. Overactivity often results from repetitive stress, poor posture, or improper training techniquesโ€‹.

What are lower cross syndrome symptoms?

Lower Cross Syndrome (LCS) symptoms include an anterior pelvic tilt, excessive lower back arch, and muscle imbalances where the hip flexors and lumbar extensors are tight, while the gluteus maximus, abdominals, and hamstrings are weak. This imbalance often results in lower back pain, limited hip mobility, and compensatory movement patterns.

How to test for lower crossed syndrome?

ย Lower Crossed Syndrome can be tested using dynamic assessments such as the Overhead Squat, Single-Leg Squat, or Pushup assessments. Key indicators include an increased lower-back arch, anterior pelvic tilt, and compensatory movements like knee valgus or forward trunk lean. You can also use a basic posture assessment to view LCS.

Which exercise would help to correct a lower cross syndrome?

ย Exercises to correct Lower Cross Syndrome include glute bridges, which strengthen the gluteus maximus, and quadruped hip extensions, which activate underactive muscles. These exercises are essential to reestablish balance and reduce the overactivity of opposing muscle groups.

Can lower cross syndrome be fixed?

Lower Cross Syndrome can be corrected through a targeted exercise program focusing on stretching tight muscles like the hip flexors and strengthening weak muscles such as the glutes and abdominals. Consistent corrective exercises can restore balance and alleviate associated symptoms.

How to fix lower back muscle imbalance?

ย  Fixing lower back muscle imbalance involves a combination of stretching overactive muscles (e.g., hip flexors) and strengthening underactive muscles (e.g., glutes, core). Incorporating exercises like planks and glute bridges into a routine can help restore muscle balance.

What is the cause of cross syndrome?

Cross Syndrome, such as Lower Crossed Syndrome, is typically caused by prolonged periods of sitting and a sedentary lifestyle. These habits lead to muscle imbalances, with some muscles becoming overactive and tight while others weaken and lengthen.

References

  1. Clark, M. A., Lucett, S. C., Mcgill, E., Montel, I., & Sutton, B. (2018). NASM essentials of personal fitness training. Burlington Jones & Bartlett Learning.
  2. Miller, K. (n.d.). Lower crossed syndrome: Starting from the center. NASM. https://blog.nasm.org/lower-crossed-syndrome
  3. Waterbury, Chad. Corrective Exercise: A Comprehensive Guide to Corrective Movement Training. 1st ed., International Sports Sciences Association, 2021.
Tyler Read - Certified Personal Trainer with PTPioneer

Tyler Read


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