Upper and Lower Crossed Syndrome Reading

Question 1

What occurs at the cervical & thoracic spine during forward head posture?

Answer 1

increased lower C-spine lordosis and thoracic kyphosis

Question 2

What spinal segments are typically affected by forward head posture?

Answer 2

C4-T4

Question 3

What is the rule of thumb pertaining to FHP and the additional pressure it can place on the cervical structures?

Answer 3

Average head weighs 10lbs and for every 1 inch it is forward it multiplies
2 inches=20lbs
3 inches=30bs
4 inches=40lbs

Question 4

What is tired neck syndrome?

Answer 4

sustained FHP causing painful fatigue of levator scap, rhomboids, and lower traps

Question 5

What role do the scalenes play in FHP?

Answer 5

as the head is brought forward by flexing the cervical segments, the scalene muscles are permitted to adaptively shorten, thus lessening the support of the upper ribs

Question 6

Under normal circumstances, where does the COG fall?

Answer 6

slightly anterior to the ear

Question 7

In forward head posture, the head is consistently placed in front of the COG, causing undue stress on what three things?

Answer 7

1. TMJ
2. Cervical facet joints
3. Upper thoracic facet joitns

Question 8

Discuss how a mechanical impairment of the shoulder can come about from FHP

Answer 8

protraction of the shoulders causes lowering of the coracoid process, producing adaptive shortening of the pec minor, which in turn may flatten the anterior wall altering the motion of the scapula

Question 9

Protraction of the shoulder girdles limits extension of the T-spine, which limits elevation & abduction of the shoulders. What other pathologies can this biomechanical alteration lead to?

Answer 9

-hypermobility or instability of the GH joint
-overuse syndromes of shoulder elevators/abductors
-could also IR the humeurs stretching the posterior GH joint capsule (posterior instability & rotatory hypermobility)
-increases the anterior force at the joint (anterior instability & biceps tendinitis)

Question 10

What have studies shown that the primary dysfunction in neck muscles is?

Answer 10

a loss in the tonic supporting capacity, with the dysfunction being greater within the neck flexors

Question 11

What degenerative changes take place to the spine as we age? (3)

Answer 11

1. Disk degeneration & vertebral wedging
2. ligamentous calcification
3. reduction in cervical/lumbar lordoses

Question 12

What is marginal osteophytosis?

Where does it most often occur?

Answer 12

-FHP causing the zygapophyseal joints in the midcervical region allowing this process to occur

-C5 to C6 & C6 to C7

Question 13

With marginal osteophytosis, what else can it affect in the body? (2)

Answer 13

-scapulothoracic rhythm (alterations in the muscle tone of rhomboids & serratus)

-increase distance between origin/insertion of traps, rhomboids, and levator scap

Question 14

What are some recommended exercises to include in a postural correction program? (5)

Answer 14

1. Head nod exercise progression
2. Return to normal exercise progression
3. Shoulder retraction exercises (theraband & prone DB) and unilateral/bilateral pec stretching
4. Exercises to reposition head to natural position w/mirror
5. Exercises to retrain oculomotor system

Question 15

What specific pathology could be present if a patient has an anterior pelvic tilt?

Answer 15

spondylolisthesis (protective mechanism)

Question 16

What might we suspect if a pt has a flattened back? (3)

Answer 16

-lumbar spinal stenosis
-lateral recess stenosis
-lateral shifting of spinal column

Question 17

What might cause a flattened lordosis? (3)

Answer 17

1. posterior pelvic tilt
2. adaptive shortening of hamstrings or weakness of hip flexors
3. disk protrusion

Question 18

What is a sway back?

Answer 18

reversed lordosis or thoracic kyphosis + posterior pelvic tilt