Upper Crossed Syndrome

Upper Crossed Syndrome is a posture with the head forward in relation to the body and shoulders that are rounded forward and an exaggerated thoracic kyphosis (rounding of thoracic spine). This mis-alignment of the head on the spine creates a hyperextension of the upper cervical vertebrae and increases pressure on the disks and facet joints.

Additionally, for every inch the head moves forward, the cervical vertebrae are compressed 1x the weight of the head (2 inches = 2 x the weight, 3 inches = 3 x the weight).

The thoracic kyphosis (rounding of shoulders) will change the biomechanics of the glenohumeral joint, placing increased tension on the rotator cuff muscles and increasing the chance of shoulder impingement injuries.


  • Ear canal (auditory meatus) forward of shoulders
  • Hyperextension of occiput on C1 vertebraChin pokes forward
  • Shoulders round forward and humerus is internally rotated
  • Sternum is depressed
  • Shoulders elevated / Clavicles are angled downward toward sternum
  • Dowager’s hump (raised tissue at C7-T1 area)
  • Arms hang forward of the body & palms of hands face posteriorly
  • Complaints of pain between scapulae
  • Usually present with anterior pelvic tilt
  • Shoulder Impingement
ObservationLocked Short (Postural)Locked Long (Phasic)
Ear Forward of ShoulderSCM
Upper Trapezius
Levator Scapula
Upper Cervical Extensors
Lower Cervical Extensors
Cervical Flexors
Shoulders RoundedPectoralis Major
Pectoralis Minor
Latissimus Dorsi
Serratus Anterior
Middle Trapezius
Lower Trapezius
Humerus Internally RotatedPectoralis Major
Teres Major
Latissimus Dorsi
Anterior Deltoid
Posterior Deltoid

Corrective Approach

When working with upper crossed syndrome, it is important to assess the hips. You can bring some short-term relief by releasing the shortened muscles involved with this posture, but to provide long-term correction, you must also balance the pelvis if there is a strong anterior pelvic tilt.

In some cases, the client may have a flat lumbar posture and a posteriorly tilted pelvis. This is referred to as a “swayback posture” and is also associated with thoracic kyphosis. In this situation, the hamstrings will be in a shortened position and must be released to allow normal pelvic positioning.