Lower Crossed Syndrome

Lower Crossed Syndrome involves the postural distortions of anterior pelvic tilt and hyperlordosis of the lumbar vertebrae (hyperextension).

Observe the pelvis anteriorly, laterally, and posteriorly. An anterior pelvic tilt occurs when the hip flexors and lumbar extensors become tight, causing the pelvis to rotate anteriorly on the femurs, so the client is standing is slight hip flexion. A normal pelvis has 5-10 degrees of anterior tilt — some tilt is normal.

Incorrect Assessment

Many educators have given instruction to assess an anterior pelvic tilt by comparing the height of the ASIS and PSIS, stating the ASIS should be less than 15 degrees below the PSIS. While this is an easy assessment, unfortunately it is incorrect.

Due to anatomical variations in our pelvis, this is not a good indicator of an anterior pelvic tilt.

Correct Assessment

A better assessment for anterior pelvic tilt is to compare the position of the ASIS with the pubic bone. Ideally, they are in vertical alignment when looking at the pelvis from a side view. If the ASIS is anterior to the pubic bone, there is an anterior pelvic tilt. If the ASIS is posterior to the pubic bone, you guessed it, you are seeing a posterior pelvic tilt.

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Common Observations

Besides the assessment of the pelvis, there are a few common postural observations that can lead you to an assessment of Lower Crossed Syndrome:

  • Excessive lumbar lordosis
  • Protruding abdomen (distended)
  • Hyperextended Knees
  • Flattened medial longitudinal arch of foot (pronation)
  • Femoral Internal Rotation
  • Head forward of shoulder
ObservationLocked Short (Postural)Locked Long (Phasic)
Hip FlexionPsoas
Rectus Femoris
Tensor Fascia Latae
Gluteus Maximus
Gluteus Medius (Posterior)
Lumbar HyperextensionQuadratus Lumborum
Lumbar Erectors
Latissimus Dorsi
Internal Oblique
Rectus Abdominis
External Oblique
Hip Internal RotationTensor Fascia LataeGluteus Maximus
Gluteus Medius (Posterior)
Observations with target muscles to release and activate

Corrective Approach

When treating a client with anterior pelvic tilt, it is essential to release the tight muscles with massage and stretching before trying to activate or strengthen the weak muscles. Until the overactive muscles have been returned to normal resting length, any strengthening attempts will be in working against the current “normal”.

The key muscles to target are the psoas, iliacus, rectus femoris, quadratus lumborum (QL), and tensor fascia latae (TFL).

This is because we are often sitting for long periods, and this holds the hip flexor muscles in a shortened position, promoting a “locked-short” resting position.