Janda's Upper Cruciate Syndrome: What It Is, Causes, Symptoms, and Treatment

What is Janda Upper Crossed Syndrome?

Upper Crossed Syndrome (UCS) was described by Vladimir Janda in 1979. It is characterized by a set of postural changes that affect the position of the cervical and thoracic spine, the position of the head, and the posture of the shoulders. These four postural conditions, when sustained over time, cause muscular dysfunctions in the cervical and thoracic spine and shoulders, which can be the source of chronic cervicodorsal pain, headaches, subacromial impingement (pinching of the rotator cuff tendons of the shoulder), or compression of the brachial plexus (nerves that run from the neck to the armpit and provide mobility and sensation to the arms) at different points.

This dysfunctional posture leads to:

• Forward head (Figure 1, blue line): The head is projected forward, as if reaching for something. This is evident by observing the patient's profile, where the ear is positioned in front of the imaginary line that joins both shoulders.
• Rounded and raised shoulders (Figure 1, green line): The shoulders are rounded and project forward. In many cases, they even appear higher than normal.
• Dorsal hyperkyphosis (Figure 1, red line): The normal curvature of the thoracic spine (kyphosis) is increased.
• Cervical hyperlordosis (Figure 1, yellow line): To compensate for thoracic hyperkyphosis (anterior point), the normal curvature of the cervical spine (lordosis) is increased, causing the neck to arch backward excessively.

Figure 1

Which muscles are affected?

These dysfunctional postures cause the shortening or facilitation of certain muscle groups, which will be the focus of increased muscle tension and pain, and other muscle groups will be lengthened or inhibited, resulting in decreased muscle function.

Thus, when examining the patient, we will find the following shortened or tense muscles:

• Upper trapezius muscles
• Levators of the scapulae
• Pectoralis major and minor muscles
• Sternocleidomastoid muscles
• Suboccipital muscles (muscles at the back of the base of the skull)

And the following inhibited or lengthened muscles:

• Middle and lower trapezius muscles
• Deep neck flexors
• Rhomboid muscles
• Serratus anterior muscles

Tightness in the upper trapezius muscles will cause neck and shoulder pain. Its increased tone will elevate the shoulder and disrupt the scapulohumeral rhythm (the synchronized and harmonious movement between the scapula and humerus that allows for optimal arm movement).

A tight levator scapulae muscle will also cause neck pain and altered scapular mobility, known as scapular dyskinesis (see article about scapular dyscinesis) . A tight and shortened pectoralis minor muscle pulls the scapula forward and contributes to scapular dyskinesis. Its shortening is also implicated in irritation or compression of the brachial plexus, which runs closely beneath it. (see article about pectoralis minor syndrome).

Shortening of the sternocleidomastoid muscles can cause neck pain and headaches.

Tight suboccipital muscles will be the focus of chronic neck pain and headaches or migraines due to their close connection with the occipital nerves.

All these shortened and tense muscles will be unopposed by their antagonist muscles (those that oppose their action), which will be elongated and weak. The serratus anterior (the main scapular muscle that helps raise the arm overhead) and the lower trapezius (its main assistant) will be weak, contributing to loss of control over scapular mobility (scapular dyskinesis) and difficulty raising that arm overhead (shoulder pain and functional impotence).

What are the causes of Upper Crossed Syndrome?

The most common causes include:

• Chronic poor posture: Spending too much time in front of a computer, prolonged use of a cell phone, or sitting incorrectly are key factors in the development and perpetuation of poor postural hygiene. These postures predispose to overload and cause chronic pain and decreased cervical and shoulder function.
• Unbalanced physical training: Training the anterior muscles of the body (pectorals and shoulders) without working the posterior muscles (cervico-thoracic spine) can create this imbalance.
• Stress and anxiety: These can cause patterns of muscle tension overload that alter posture.

What are the most common symptoms of Upper Crossed Syndrome?

There are a significant variety of symptoms that can occur as a result of all these postural imbalances and their resulting poor muscular compensation:

• Chronic neck pain and headaches.
• Shoulder pain.
• Upper back pain.
• Vertigo, commonly associated with neck pain attacks.
• Tingling or numbness in the arms, in cases of irritation or dynamic compression of the brachial plexus or peripheral nerves. (see article about thoracic outlet syndrome). 
• Winged scapulae (scapular dyskinesis): The scapulae separate from the thorax, and their medial border (closest to the spine) becomes more evident.
• Pain in the jaw (temporomandibular joint - TMJ) due to muscle tension, although there is controversy regarding the relationship between a forward neck and TMJ problems.

What are the treatment options for Upper Crossed Syndrome?

The main goal is to correct the imbalance, relieve pain, and improve your posture. Treatment typically includes:

Physical Therapy:

• Manual Therapy: Massage, myofascial release techniques, or dry needling can be used to improve pain and relax muscles.
• Therapeutic Exercise:
  • Stretching: Stretching exercises for shortened muscles are beneficial for restoring normal muscle length, tension, and function, as well as for improving postural health. The goal is to return the body to an optimal posture that does not overload or inhibit any muscle group and helps the body regain balance.
  • Strengthening: After restoring normal muscle length and tension, the next step is to strengthen inhibited or weakened muscles (middle and lower trapezius, rhomboids, serratus anterior, etc.). This includes pulling exercises, rows, and specific work for the neck and shoulders.
• Postural Reeducation: Learning to maintain correct posture during work, daily life, and sports activities. (See article about body posture: recommendations for your daily life) ).

Lifestyle Changes:

• Ergonomics: Adjust your chair, monitor, and keyboard at work and at home to promote a healthy posture.
• Active Breaks: If you spend a lot of time sitting, stretch and do small movements regularly.
• Stress Management: Practice relaxation techniques to reduce muscle tension.

It is essential to address upper crossed syndrome with a comprehensive approach that strengthens weak muscles and stretches tight ones. If you experience these symptoms, I recommend that you consult a medical specialist for an accurate diagnosis and an appropriate treatment plan.