At Blackberry Clinic we treat musculoskeletal disorders affecting the spine, muscles and joints. A holistic approach to treatment involves looking at the whole picture and working out what is causing the pain. It is not always as straightforward as a sprained ankle, although we treat plenty of those too. Something you may have read about is lower crossed syndrome or LCS. Here is some more information about this syndrome that may be the underlying cause of your pain. Our physiotherapists, chiropractor and osteopaths are able to treat all areas of the body and offer slightly different approaches and treatments.
What is it?
Lower crossed syndrome is a postural imbalance that occurs in the muscles of lower back, pelvis, and hip joints. It is often a result of long periods of sitting and will be made worse by poor posture.
This involves weakness of the trunk muscles, along with the gluteal muscles.
The trunk muscles consist of:
- Rectus abdominis
- Obliques internus abdominis
- Obliques externus abdominis
- Transversus abdominis
The gluteal muscles consist of:
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
These muscles are inhibited and substituted by superficial muscles. This is because the co-existing over-activity and tightness of the thoracolumbar extensors and the hip flexors gives rise to muscle imbalance and creates joint dysfunction. The hamstrings can also compensate for anterior pelvic tilt or an inhibited gluteus maximus.
Thoracolumbar extensors include:
- Erector spinae
- Multifidus
- Quadratus lumborum
- Latissimus dorsi
Hip flexors include:
- Iliopsoas
- Tensor fasciae latae.
Clinical Presentation?
The joint dysfunction caused includes ligamentous strain and increased pressure, particularly at the L4-L5 and L5-S1 segments, the SI joint and the hip joint.
This results in joint pain (lower back, hip and knee) and specific postural changes (anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, external rotation of hip or knee hyperextension).
It also can lead to postural changes such as increased thoracic kyphosis or increased cervical lordosis.
Subtypes?
Type A, ‘Anterior pelvic crossed syndrome’:
The imbalance manifests mainly in the hip.
The hip flexors are shortened, the pelvis is tilted anteriorly and the hip and knee are in slight flexion.
The thorax will often lift during inspiration, causing an upper chest breathing pattern, because coordination between the transverses and the diaphragm is missing. Active exhalation will be difficult because the abdominal activation cannot bring the thorax back down into a more neutral ‘expiratory caudal’ position. This fails to create the essential intra-abdominal pressure and thus the expiratory phase is shorter. As a result, iliopsoas can become overactive.
Type B, ‘Posterior Pelvic Crossed syndrome’:
The imbalance mainly manifests in the lower back.
The abdominal muscles are too weak and short. The axial flexor is overactive so to compensate, there is minimal hyperlordosis of the lumbar spine, hyperkyphosis of the thoracic spine and protraction of the cervical spine. As a result, the pelvis is tilted more posteriorly and the knees are in hyperextension.
