Upper Crossed Syndrome Breakdown (2025)

Upper crossed syndrome (UCS) is a postural issue where clients may have a forward head, overextended cervical spine, with rounded shoulders. NASM states that people with upper crossed syndrome may also have thoracic spine kyphosis, raised shoulder or scapular winging.

Over time this dysfunction can lead to joint issues and muscle imbalances, so it’s important to correct this postural problem so that people can live healthy active lives. 

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I’ve come across many clients dealing with upper cross syndrome in my own decade plus life as a NASM personal trainer and exercise coach. This is a common postural issue that exists in our modern world.

This article will address what upper crossed syndrome is, and how the major fitness organizations like NASM and ISSA defines it and teaches you to correct it, so you can root it out and help your clientele fix their nagging corrective issues.

Overview of Upper Crossed Syndrome

What is Upper Crossed Syndrome?

Upper crossed syndrome is a postural imbalance that primarily affects the upper body. It is characterized by tightness and overactivity in the muscles of the chest, upper back, and neck, combined with weakness and underactivity in the muscles of the mid-back and shoulder blades.

This muscular imbalance leads to a forward head posture, rounded shoulders, and an exaggerated curvature of the upper spine.

The NASM CPT suggests that this syndrome is commonly caused by prolonged sitting, poor posture, and repetitive movements involving the upper body.

The ISSA Corrective Exercise Specialist recommends using the sagittal plane postural assessment to recognize is your client has upper crossed syndrome.

Causes and Risk Factors of Upper Crossed Syndrome

Upper cross syndrome is a condition characterized by muscle imbalances in the upper body, particularly the neck, shoulders, and chest. While the exact causes may vary from person to person, there are several common factors that contribute to the development of this syndrome. 

All the top personal training certifications cover this syndrome because of how common it is in the world’s population today. Be sure to include this as part of your NASM study guide work.

One primary cause is prolonged poor posture, such as sitting for extended periods with rounded shoulders and a forward head position. This posture places excessive strain on certain muscles while weakening others, leading to imbalances. 

Additionally, repetitive movements or activities that involve prolonged overhead reaching or lifting can also contribute to upper cross syndrome. 

Lastly, stress and emotional tension can lead to increased muscle tension and contribute to the development of this condition.

how is upper crossed syndrome characterized?

Upper crossed syndrome is a condition characterized by a specific pattern of muscle imbalances and postural abnormalities in the upper body. The symptoms of upper cross syndrome typically include rounded shoulders, forward head posture, and a hunched upper back. 

These postural deviations can lead to muscle tightness and weakness in certain areas. Common symptoms may include neck pain, shoulder pain, headaches, and limited range of motion in the neck and shoulders. Additionally, individuals with upper cross syndrome may experience muscular imbalances between the chest muscles (pectoralis major and minor) and the upper back muscles (rhomboids and lower trapezius), as well as between the front neck muscles (sternocleidomastoid) and the deep neck flexors.

Assessment and Diagnosis of Upper Cross Syndrome

NASM (National Academy of Sports Medicine) utilizes specific postural assessments for diagnosing upper cross syndrome. One commonly used assessment is through a basic postural assessment where you evaluate the individual’s posture, focusing on the alignment and balance of the head, neck, shoulders, and hips. This includes observing any forward head posture, rounded shoulders, elevated or protracted shoulder blades, and excessive curvature in the thoracic spine. 

Additionally, the NASM CES incorporates functional movement assessments to identify any muscle imbalances or weaknesses that may contribute to upper cross syndrome. These can include an overhead squat assessment and, more specifically, the pectoralis minor test. 

In the pectoralis minor test, or shoulder retraction test, the client lies flat on a table with their arms at their sides and elbows extended with palms facing up. If they can hold the position without compensating, their mobility is good. If they need to overextend the spine to hold the position or elevate the shoulders, they need to increase their range of motion.

By utilizing these assessments, certified professionals can accurately diagnose and develop targeted corrective exercise programs for individuals with upper cross syndrome.

If you want to be a good trainer or top corrective exercise specialist, you should know how to assess and correct upper crossed syndrome. 

Treatment and Management Approaches for Upper Cross Syndrome

How to Fix Upper Cross Syndrome

If you want to fix upper cross syndrome, you need to correct muscle imbalances and improve overall posture through a combination of corrective exercises, stretching, and strengthening techniques.

The first step is to assess the individual’s posture and identify the specific muscles that are contributing to the syndrome. Certified trainers then design a personalized exercise program that targets these specific muscles, aiming to strengthen weakened muscles and lengthen tight ones. This approach helps restore proper alignment and function, alleviating pain and discomfort associated with upper cross syndrome. Additionally, make sure to educate clients on proper ergonomics and postural awareness to prevent future recurrence of the condition.

Upper crossed syndrome is a common postural imbalance characterized by tightness in the chest, neck, and upper back muscles, along with weakness in the deep neck flexors and lower shoulder blade stabilizers. To manage this condition, you should prescribe a complete exercise program that focuses on stretching the tight muscles and strengthening the weak ones.

Upper Cross Syndrome Exercises

Some upper cross syndrome exercises you might use include pec stretches to alleviate tightness in the chest, chin tucks to strengthen the deep neck flexors, scapular retractions to activate the lower shoulder blade stabilizers, and thoracic spine mobilizations to improve posture. Additionally, incorporating exercises that target the core and gluteal muscles can address any associated imbalances and promote proper alignment

You can use myofascial release techniques to release the trapezius and levator scapula. 

Stretching and Mobility Exercises for Upper Cross Syndrome

NASM (National Academy of Sports Medicine) recognizes the importance of addressing upper cross syndrome symptoms through targeted stretches. One highly recommended stretch is the Pectoralis Major Stretch. To perform this stretch, stand in a doorway with your arms bent at 90 degrees and your forearms resting against the doorframe. Gently lean forward until you feel a stretch in your chest muscles. Hold this position for 20-30 seconds, repeating it several times throughout the day. This stretch helps to lengthen the tight pectoralis major muscles, which are often associated with upper cross syndrome. Remember to always consult with a certified fitness professional or healthcare provider before starting any new exercise or stretching routine.

If you want to learn more about corrective exercise, I recommend looking at the best corrective exercise specializations. This includes not only the NASM CES, but also the ISSA Corrective Exercise Specialist. 

Upper Cross Syndrome Stretches

A few upper cross syndrome stretches and exercises include:

• Pec stretch
• Levator scapula stretch
• Myo-ball roll upper trapezius

Strengthening Exercises for Muscular Imbalances

To relieve upper crossed syndrome, there are several effective exercises that you could incorporate into a daily routine. Firstly, stretching exercises targeting the tight muscles in the chest and front of the shoulders should be performed. This includes exercises such as doorway stretches and pec stretches. Secondly, strengthening exercises for the weakened muscles in the upper back and neck should be emphasized. Examples of these exercises include rows, reverse flies, and shoulder blade squeezes. 

Additionally, it is important to focus on improving posture through exercises like chin tucks and scapular retractions. You can use also use a foam roller to open up the T-spine.

ISSA recommends using chin tucks with lacrosse ball, along with cervical rotation exercises.

Lastly, incorporating regular cardiovascular exercise can help improve overall muscle balance and reduce muscle imbalances associated with upper cross syndrome.

Prevention of Upper Crossed Syndrome and Long-Term Maintenance

Upper cross syndrome, a common postural imbalance, can certainly be prevented with the proper training techniques. Use a comprehensive approach that includes exercises targeting specific muscle groups to correct imbalances and promote proper alignment. By focusing on strengthening the weak muscles and stretching the tight ones, individuals can improve their posture and reduce the risk of developing upper cross syndrome. 

Additionally, an emphasis on proper form and technique during exercise will help individuals maintain optimal alignment and prevent the development or worsening of postural imbalances. With consistent adherence to training principles, individuals can effectively prevent upper cross syndrome and maintain a balanced musculoskeletal system.

Upper Crossed Syndrome FAQs (Frequently Asked Questions)

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, Ken. “Correcting Upper Crossed Syndrome.” NASM, blog.nasm.org/correcting-upper-crossed-syndrome.
3. Fahmy, R. (2022). NASM Essentials of Corrective Exercise Training. Jones et Bartlett Learning.