The Study: Upper Crossed Syndrome in the Workplace: A Narrative Review with Clinical Recommendations for Non-Pharmacologic Management
Upper Crossed Syndrome: A Common Cause of Neck and Shoulder Pain in Office Workers
Modern work environments often require long hours at a computer. While technology has improved productivity, it has also contributed to a growing problem affecting the neck, shoulders, and upper back. A recent narrative review published in the International Journal of Environmental Research and Public Health examined a condition known as Upper Crossed Syndrome (UCS) and its impact on workplace-related neck and shoulder pain. (PubMed)
Understanding this condition can help explain why many people who work at desks experience persistent tension, stiffness, and headaches.
What Is Upper Crossed Syndrome?
Upper Crossed Syndrome was originally described by Czech neurologist Vladimir Janda. It refers to a predictable pattern of muscle imbalance affecting the neck, shoulders, and upper back.
In this pattern:
The upper trapezius and levator scapulae become tight.
The pectoralis major and minor in the chest become tight.
The deep cervical flexor muscles in the neck weaken.
The middle and lower trapezius muscles in the upper back weaken. (PubMed)
This imbalance creates a “crossed” pattern between tight and weak muscle groups. Over time, it can lead to postural changes such as:
Forward head posture
Rounded shoulders
Abnormal shoulder blade movement (scapular dyskinesis)
These postural changes place increased stress on the neck and upper back.
The review highlights several effective conservative strategies for managing Upper Crossed Syndrome.
These include:
Postural Correction
Improving posture helps reduce strain on the cervical spine and shoulder girdle.
Targeted Stretching
Stretching tight muscles such as the chest, upper trapezius, and levator scapulae can restore balance.
Strengthening Exercises
Strengthening the deep neck flexors and the middle and lower trapezius muscles helps stabilize the upper spine.
Workplace Ergonomics
Adjusting workstation setup is a key prevention strategy. Proper monitor height, keyboard position, and chair support can reduce stress on the neck and shoulders. (PubMed)
Regular Movement Breaks
Standing and moving every hour can significantly reduce prolonged strain.
Chest or stomach breather? How an altered breathing pattern causes pain
Belly breathing
The way you breathe impacts you from a muscle and joint perspective. Poor breathing mechanics can lead to neck pain, core stability issues, low back pain, and other issues. Who knew that a simple in-out process could be so complex?
Normal breathing, also known as lung ventilation, is an automatic and seemingly effortless action. Breathing involves inspiratory (breathing in) expansion and expiratory (breathing out) contraction of the rib cage. The act of normal breathing has a relatively constant rate and volume, or amount of air that enters the lungs.
However, breathing is a coordinated effort! The act of breathing requires our lungs to expand as well as a series of coordinated muscle efforts. Starting from the chest wall, the rib cage, movement of large and small muscles, nerve signaling, ligament stretch, and even the spine.
Although we often think of our lungs as being within our chest, the top of our lungs extends quite high: almost to the very base of our neck and shoulders.
When breathing issues arise and the lungs aren’t the cause, other sources like the muscles and bones must be taken into consideration. In medical literature, the term “dysfunctional breathing” refers to a group of disorders: paradoxical breathing (upper chest breathing), erratic breathing, breath holding, and breathing too deeply or erratically (hyperventilation syndrome).
For this article, we will focus on the first: paradoxical breathing. While these disorders can create significant oxygenation deprivation problems, the focus of this article will be on the biomechanical effects of poor breathing mechanics.
It is important to assess breathing mechanics to determine if someone is using the appropriate muscles to engage in this vital task. Breathing is a complex activity involving the rib cage, joints of the spine and ribs, ligaments, connective tissues, muscles, and the lungs.
Breathing performance is drastically affected if one or more of these structures are injured, damaged, or otherwise unable to work properly. One such common condition is upper chest breathing.
What is chest breathing?
Paradoxical breathing, or chest breathing, is a sign that you aren’t breathing properly. Chest breathing refers to chest, midback, and lower neck muscles that become overworked due to poor biomechanics.
Normal breathing involves expansion and contraction of the rib cage with our breath. Breathing also uses the diaphragm, a dome-shaped muscle located at the base of our rib cage below the lungs and heart. The diaphragm is a major muscle mover that works with the lungs to inhale and exhale.
During inhalation, the lungs expand, and the diaphragm pushes down to make room for the lungs to expand with air. This presses the rib cage outward. During exhalation, the diaphragm muscle moves up to its starting position, which helps move air out of your lungs and brings the ribs inward.
During paradoxical breathing, this action is reversed. During inhalation the lungs still expand but, the diaphragm contracts. During exhalation, the lungs relax, but the diaphragm expands.
As a result, the chest and lower neck muscles become overactivated. This targeted group of muscles work together to compensate for the diaphragm. They help inflate the lungs by pulling on the rib cage to expand the upper portion.
These extra, or accessory breathing muscles in the chest and lower neck still have their own responsibilities to perform as they help with our breathing activity. The result is tight, achy muscles that aren’t effective at either job. The upper back and thoracic spine may also become stiff due to poor muscle engagement from the diaphragm, resulting in muscle tightness. Sometimes, this can even extend into the low back!
By itself, chest breathing is not necessarily a bad or pathological condition. Certain scenarios are noted for chest breathing: some examples include a sudden sprint across a lawn or a pang of anxiety while taking a test. However, when chest breathing becomes our normal method of breathing, the result is the upper chest expanding and contracting with each breath while the abdominal area does not function properly. The diaphragm is not used well during chest breathing.
What can happen from chest breathing?
Chest-focused breaths tend to be short and quick. Chest breathing uses only a small portion of the lungs and delivers a relatively minimal amount of oxygen to the bloodstream. The result is poor oxygenation to the body’s soft tissues.
In addition, excessive chest breathing causes the muscles of the chest, neck, upper back, and lower back to work too much. This can lead to tightness and strain to these areas due to overuse. The muscles become tight and ropy to the bare eye.
Chest breathing is a form of diaphragmatic dysfunction that can have many causes including trauma to the chest wall, mineral deficiencies, weak respiration muscles, sleep apnea, and nerve injury.
Symptoms of chest breathing can include:
Frequently waking up at night
Shortness of breath
Excessive sleepiness that doesn’t respond to additional sleep
Diminished or poor exercise performance
Muscle soreness in the neck and chest
Abnormally fast breathing
Poor posture in the upper back
Rounded shoulder posture
Tight musculature along the front of the neck
Do I have chest breathing?
Maybe. Here is a simple test and exercise you can do at home to improve your breathing.
Description: Breathing test to assess if patient is a stomach breather or chest breather. How to perform:
Lay on a comfortable surface on your back with your knees bent.
Place one hand on your chest and the other hand on your stomach.
Take 5 normal deep breaths and take notice of your breathing.
Up to 80% of breathing should come from the belly rising and falling; 20% should come from the chest rising and falling.
Chest breathing is more dominant than belly breathing when the belly barely moves. Here, the upper chest expands more than the abdomen, and the shoulders elevate towards the ears during inspiration. Excessive chest breathing causes overuse of the neck musculature and can lead to pain syndromes in the neck, shoulders, and upper back.
Here is a video from our friends at ChiroUp you can reference for proper breathing patterns initiated at the abdomen:
How can I learn more about changing my chest breathing?
There are a few quick exercises you can perform to help begin retraining your diaphragm and other breathing muscles to work effectively. Here’s a common one:
Corrections for Chest Breather:
Place a light book over the stomach and focus on elevating and lowering it during inspiration and expiration.
Lay on back.
Push belly outward.
Pull belly button down towards floor.
Repeat ten repetitions for two sets.
If your chest breathing has occurred over time or because of trauma, nerve injury, or other causes, other interventions may be required. It is not uncommon to manage this condition with targeted exercises, postural improvements, and even changes to your workplace setup to help proper muscle function.
How we address chest breathing
Our goal is to not only provide you with the correct diagnosis of your breathing pattern, but also determine the underlying root cause and create an individualized treatment plan specifically for you. We have many tools in our toolbox to conduct an effective evaluation and create an appropriate treatment.
Conservative care is a keystone for our Boca Raton Sports Chiropractic practice. We have many treatment options for you!
A few ones include specific stretches for muscles and tendons of the affected muscle, joint mobilization of the thoracic spine near the ribs, tendon loading and specific exercises to strengthen the surrounding muscles, hands-on soft tissue work into muscles, changes in exercise routine or modifications at work or at home, home exercise and stretching programs, and more.
All of these depend on if your chest breathing is caused by poor biomechanics of the muscles and joints. If your chest breathing is caused by mineral deficiencies, we may need to co-manage your care with a primary physician or specialist to determine the best course of action to address the root cause.
If there has been trauma to the chest wall, such as a motor vehicle accident, a full examination is imperative and may require imaging. The best way to determine your treatment approach is to make an appointment in our office for a full evaluation.
If you are dealing with poor exercise performance due to chest breathing, muscle tightness of the chest wall, upper back, or neck, excessive daytime sleepiness, or other symptoms of chest breathing, give us a call. We are happy to evaluate you and often can provide you with a same-day examination.
Call our Sikorsky Chiropractic Clinic at 847-695-0464 or schedule online!
New research has re-affirmed that weakness of one cervical muscle group is closely tied to chronic neck pain. This unit is also implicated as a provocative factor for cervical radiculopathy, cervicogenic headache, and cervicogenic vertigo.
A 2020 JMPT study re-affirmed that weakness of the deep neck flexors is common in cervical radiculopathy patients:
“Current results confirmed the presence of cervical multifidus and longus colli muscle atrophy in subjects with chronic radicular neck pain.” (1)
The deep neck flexors include four muscles that lie behind the trachea on the front of the cervical spine. The group includes the longus colli, longus capitis, rectus capitis, and longus cervicis. Due to their proximity to the spine and their short length, the muscles are primary stabilizers of the cervical spine.
If you’re experiencing neck pain contact the office! We help ease neck pain every day.
Amiri-Arimi S, Bandpei MA, Rezasoltani A, Javanshir K, Biglarian A. Asymmetry of Cervical Multifidus and Longus Colli Muscles Size in Participants With and Without Cervical Radicular Pain. Journal of Manipulative and Physiological Therapeutics. 2020 Mar 1;43(3):206-11.
Monitors should be visible without leaning or straining, and the top line of type should be 15 degrees below eye level.
Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
Keep your shoulders relaxed and elbows bent to 90 degrees.
Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
Keep frequently used objects, like your telephone, close to your body to prevent excessive reaching.
Take a 10-second break every 20 minutes: Micro activities include: walking, stretching, or moving your head in a “plus sign” fashion.
Do a micro break.
Another video about the desk set and suggestion on how a workstation should.
Have a question about your workstation? Dr. Steve can help with that! Contact our office so you can make sure you’re workstation isn’t contributing to pain.
Neck pain and Headaches are a very common issue in our
society, and understanding the causes and prevention of them will go a long way
to leading a healthy and pain free life. In this educational summary, we
discuss some of the most common conditions we see in our office. Below we will
discuss the following neck-related pain conditions.
Upper Crossed Syndrome
Headaches
Neck Sprain/Strain
Disc Pain
Cervical Radiculopathy
TMJ Dysfunction
Potential causes of
Cervical Discogenic Pain Syndrome
Direct trauma – falls, motor vehicle accident, whiplash, sports injury
Overuse, fatigue, repetitive microtrauma – over hours, days, months of the same position
Postural – can be either an intrinsic postural problem (e.g. loss of cervical curvature) or an extrinsic postural problem (e.g. prolonged stressful position, protruded head posture).
Sudden unguarded movement.
Degenerative disc disease.
Photo by cody berg This workstation is not set up correctly
Symptoms of Cervical Discogenic Pain Syndrome
The symptoms will vary
depending on whether the condition is caused by a herniated disc or by a
degenerative disc. With a herniated disc, some people will not experience pain
in the neck but will have radiating pain, tingling, and numbness down the arm or
around the shoulder blade due to pressure put on the nerve root. Discogenic
pain due to an injury can result in immediate pain or pain shortly after the
injury. Headaches (usually cervicogenic)
can also result from cervical disc pain.
Treatment of Cervical
Discogenic Pain Syndrome
Treatment for cervical discogenic pain will depend on the clinical
presentation. Conservative treatment can successfully manage many cervical disc
herniations. Initial treatment will focus on controlling pain and inflammation.
Once pain and inflammation have
decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft
tissue therapy, activity as tolerated, and pain-free
range of motion exercises. Late rehabilitation will be administered as the condition improves and will include
stabilization exercises, patient education, and postural training. Education in
proper training, biomechanics, and a home exercise program will help strengthen
the spine and decreases the likelihood of future injury. If you fail to respond
to conservative treatment, or in cases of severe pain, diagnostic imaging
(x-ray, MRI) will be warranted, and an
orthopedic consult may be necessary.
Cervical Radiculopathy
Cervical Radiculopathy is a
dysfunction of the cervical nerve roots resulting in various neurologic
findings. The cervical spine consists of seven cervical vertebrae and eight
cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or
weakness and though the problem occurs at the nerve root of the cervical spine,
these symptoms will often radiate to parts of the body controlled by that
nerve. The seventh (C7) and sixth (C6) cervical nerve roots are most commonly
affected.
In younger patients,
cervical radiculopathy is usually the result of a disc herniation or an acute
injury causing foraminal impingement of the exiting nerve. In the older
population, cervical radiculopathy is usually due to foraminal narrowing from
osteophyte formation, decreased disc height, or degenerative changes. In
elderly patients with osteophyte formation, repetitive neck movements may
result in a more insidious injury. Cervical radiculopathy due to sports
injuries can result from several mechanisms. Typical these injuries occur from
forced extension, lateral bending, or a rotation mechanism, which closes the
foramen and results in the exiting nerve root being
injured.
Risk Factors for Cervical
Radiculopathy
Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain or arthritis of the cervical spine. The pain may range from deep aching to severe burning neck pain. Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved. Occasionally, a motor weakness may develop of the shoulder or arm. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.
Treatment of Cervical
Radiculopathy
Initial treatment will
focus on reducing pain and inflammation and prevention of further neurological
loss. The focus will also be on centralizing (reducing) any radicular symptoms
by decreasing nerve root compression and pressure within the herniated discs. This will consist of manual traction and pain-free active non-resisted ranges of motion
while avoiding positions that increase neck and
arm symptoms. A cervical pillow at night can be helpful in maintaining the neck
in a neutral position and limiting head positions that cause foraminal
narrowing. Electrotherapy modalities may be used to help reduce any associated
muscle pain and muscle spasms. Once pain and inflammation have decreased, therapy will progress to
restore full range of motion and mobility of the neck and shoulder. This will include muscle stretching,
strengthening and proprioceptive training, and corrective exercises as
tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and as long as it
does not cause an increase in symptoms. If you fail to respond to conservative
treatment, or in cases of severe neurological loss, a secondary consultation
with a neurologist or neurosurgeon will be
recommended.
TMJ Dysfunction
“I’ve got TMJ” It’s a pretty common statement which is a bit of a misnomer. Everyone has TMJ. Why? The TMJ is the tempo-mandibular joint(TMJ). We all have it. What people are probably trying to say is that they have TMJ disorder, aka pain and dysfunction of the jaw while opening or closing your mouth.
What happens is the mandible (your jaw) connects to the rest of your head at the temporal bone. It’s a hinge joint that pivots through a cartilage disc called a meniscus in between the two bones of this joint. Unfortunately, it’s a common place for the TMJ to become subluxated or in other words, a little bit dislodged. After that, you can get overuse and degeneration of that joint. One way to tell if you have this disorder is to open your mouth and measure, can you open your mouth the height of 3 fingers for your hand? If not, you might have TMJ disorder.
The
main physical causes of this condition are:
trauma
overuse
from a commonly chewing on one side of
your mouth
keeping
the mouth open for extended periods of time (like at the dentist)
improper
bite
grinding
From a physical standpoint, the best way to prevent TMJ disorder is to wear proper mouthpieces while playing sports, wearing mouth guards while sleeping, making sure to chew food evenly on both sides of your mouth, cutting tough meats and other foods into small pieces and minimizing gum chewing. Having better posture also improve the alignment of the TMJ.
Dr. Steve Sikorsky | Chiropractic Care Elgin, Illinois
