Have you ever been told you had upper cross or lower cross syndrome and were given exercises that did nothing to relieve your back pain? If so, you are not alone. According to Webster’s dictionary, a syndrome is a group of signs and symptoms that characterize a particular abnormality or condition. It is merely a classification and an attempt to describe a condition that has been visualized and categorized by your treating healthcare provider. All too often, the syndrome is chronic because nobody has been able to help you solve the reason behind it. Vladimir Janda suggested the terms upper crossed or lower crossed syndromes in the 1980s, and he became famous for his work. It has been described as a notable reason for pain from sustained postures such as sitting but is it? Janda’s ideas were developed based on his observations before the fascial system was better understood for its role in function or posture and assumed these areas function in a vacuum. Many of the exercises work temporarily at best to strengthen the so-called weak muscles Like everything in the human body, fascia, vasculature, and nerves interconnect everything. The fascial system, as described by Myers, has deeper and superficial layers. As Rothbart had described, foot problems or postural asymmetries will show up in the upper body as predictable postural adaptations. The fascia holds these postures and alters how we move as it works in conjunction with the joints and muscular structures. Maybe we need a better definition other than Janda’s understanding. The role of cross patterning in back pain and the DNA spine idea. What reinforces the postures associated with upper or lower cross syndromes? Is it sustained postures or postural adaptations that are individual to a person since we all adapt differently? Patients with upper cross tend to also have a compensation we call lower cross due to fascia. They are distorted as they stand and these distortions cause pain while sitting and standing. In an earlier blog, I mentioned the idea of the DNA Spine. The idea is that the lower back and upper back compensate for one another and the result is a distorted spine that looks like DNA. Symptoms of this include waking in the morning feeling all kinked up, and back pain that worsens with standing as this causes the spine that has this compensation or syndrome further distort the body. Does your back feels twisted like this towel? If we look at this as a postural adaptation, we should consider the feet as the foundation and then the upper body as a secondary compensation. Balancing the person from the ground up with foot orthotics can make a huge difference in how the person feels and functions as a level pelvis has a better functioning foundation. A distorted pelvis affects everything you do and causes stress and tightness in the arms, legs, knees, feet, neck, hips, and back. Symmetry is your friend. Asymmetry causes physical pain over time. As a healthcare provider, it is healthy to challenge the status quo and question everything. By doing so, I have come to understand that when a patient is prone or lying on their stomach, I can test the posterior chain first to see if the patient can extend their leg straight while on their stomach. Then I test the latissimus dorsi which crosses over in between the shoulder blades. I look for one side recruiting from the leg into the lat with instability as you see in this photo. It is then noted in the patient file and retested after being treated for stability. Most patients notice they are standing better and their posture improves. The cross pattern or upper cross lower cross issue is fascial and must be understood as a poor full body adaptation rather than syndromes that imply it is just a chronic condition requiring treatment. If the patient has difficulty extending one, leg, or both, I note this in their file. I then test leg extension on one side and arm extension on the other, looking for instability when doing so where the body moves abnormally attempting to do the maneuver. People either recruit into their lats on the same side or the opposite and this can change as somebody re-adapts. Once the provider understands the adaptation, they can use myofascial release to loosen the cross pattern through the shoulder blades working the pattern. Since this is a part of my test-treat-test protocol, the provider should then retest and have the patient stand. Most will report that they are standing straighter and their posture has changed. How to successfully treat the cross-pattern Treating a cross-pattern issue is different for every patient as this compensation is as different as we are individually. There is no one size fits all but what does help are the following. Chiropractic Manipulation to improve joint function of the spine and extremities Foot orthotics to level the pelvis and improve function. Myofascial Release treatment Corrective exercises to the posterior chain muscles including Superman’s and McGill’s exercises such as Bird Dogs. There are others we use to instruct patients. Foam rolling to improve movement. Chiropractic care is the one-stop shop for most musculoskeletal problems. Our multi faceted approach is holistic meaning thorough and addressing the entire body. Segmenting the care to multiple specialists is both ineffective and costly. Keeping it simple is what chiropractors do best. Need help now? Book online today.