At Blackberry Clinic we know it is important to get an accurate diagnosis for painful symptoms and sometimes this is not all that straightforward. Here is a blog about treatment of a complex syndrome known as posterior lower crossed syndrome.
What is it?
The ‘Unterkreuz syndrome’ (pelvic crossed syndrome/lower crossed syndrome/distal crossed syndrome) occurs as a result of muscle strength imbalances in the lower body.
The imbalance mainly manifests in the lower back. It is characterized by patterns of muscle weakness and tightness in the front (ventral) and back (dorsal) of the body. These imbalances happen when muscles are shortened or lengthened in relation to each other for a continued length of time.
Common biomechanical patterns:
- Abdominal muscles are too weak and short.
- 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. This tilt of the pelvis and increased flexion of the hips causes a compensatory sway back in the lumbar spine.
What are the causes?
Posterior lower crossed syndrome is often caused by an overly sedentary lifestyle and/or poor posture.
- Prolonged sitting or injury can lead to the development of shortened hip flexor muscles.
- Poor posture causes tightened lower back muscles.
Tightened hip flexors will eventually lead to weakened abdominal/core muscles, along with weakened gluteal/butt muscles.
When this happens, your quads have to work harder, which can lead to injuries.
Common symptoms
People with Lower Crossed Syndrome often suffer from lower back pain or pain in the pelvic or hip joints. In addition to this, people will suffer from:
- Reduced mobility or stiffness in lumbar, hip, hamstring, or pelvic region
- Pain in hip flexors, groin, spine, or buttock muscles
- Sway back with an overly flat back
- Tension in the core or hip flexors and/or quadriceps muscles
Management of posterior pelvic crossed syndrome
It is important to improve active exhalation to gently bring the thorax caudally (towards the bottom of the body) on the stable pelvis.
When retraining active exhalation, the patient will need help maintaining the neutral position. The patient should breathe down, not up and should be able to create enough intra-abdominal pressure while maintaining a regular breathing pattern.
- Lying on the back (supine) with hip support to allow some hip flexion, removing gravity, is very beneficial.
- Place a hand on the lower abdomen and breathe down into this.
- Encourage active and long exhalation to give a sense of the required action.
- Progress the pattern into unsupported hip flexion when the correct pattern is mastered
It is important to push the ribs wide and back, without lifting the thorax during this breathing exercise. Use a hand to push out sideways into it as a prompt.
