The amount of people experiencing bad posture and back or knee pain is steadily increasing. Modern lifestyle increases the risk of muscle imbalances, bad posture, back pain, knee pain etc., and we are spending billions each year on pharmaceuticals to alleviate the pain. A minimal amount of proper training is a far better long-term option. One of the most common postural problems is lower crossed syndrome, also called excessive anterior pelvic tilt or lordosis.
LCS, lower crossed syndrome, is very common especially among females, and visual cues include a forward tipped pelvis, increased lower back curve (sway back) and a “bulging” (not necessarily fat) abdomen. Muscle imbalances are also present, but can be harder to spot by the average layman.
Sitting down for hours each day, often in a flexed position, leads to shortening of the hip flexors and increased tension on the lower back. A minimal amount of physical activity, genetic predispositions and imbalanced training are also major causes of LCS. The problems usually develop over time, and suddenly a daily activity, like tying the shoes, cause pain.
Reciprocal inhibition means that when muscles on one side of the joint are contracting, the muscles on the other side of the joint are relaxing. In LCS, the most important muscles include over-active and tight hip flexors and lower back muscles, and weak gluteals, abdominals and sometimes hamstrings. The strong muscles become over-active in daily chores, making the condition even worse.
LCS doesn’t necessarily cause pain in itself, but leads to poor movement patterns, several muscle imbalances and increased susceptibility to especially knee and back pain. A forward head posture and upper crossed syndrome, another common condition, can also result from LCS.
Treating lower crossed syndrome
Some believe that chiropractic and rehabilitative intervention are necessary to improve LCS. Coaching people with LCS shows that this is not the case, and although seeking professional help is recommended, most people are able to significantly improve the condition even by performing simple exercises at home or at the gym. The most important aspect is to have a purpose with every exercise, as certain movement patterns only make the condition worse.
Postural training is an important part of treating LCS, and especially paying attention to sitting posture is vital. The training program should include exercises to strengthen the gluteals and the abdominals. Strengthening the obliques and sometimes hamstrings can also be beneficial.
Muscles that need to be stretched include the hip flexors and lower back muscles.
People with LCS usually have difficulty performing proper squats and lunges, and in the beginning the emphasis should be to activate the gluteal muscles with exercises such as glute bridge, hip thrust, reverse hyperextension and quadruped hip extension. Start with no added weight, use perfect technique and strive to get proper contraction. When you progress you can slowly add weights and begin to experiment with other exercises.
Good starting exercises for the abdominals include reverse crunch and a properly performed plank.
Static or dynamic stretching of the hip flexors and lower back muscles is a good start for beginners.
More experienced individuals or people seeking professional help also can use foam rolling, massage etc. for even better results.
Sources for this article include
Lee JH, Yoo WG. The mechanical effect of anterior pelvic tilt taping on slump sitting by seated workers.
Ind Health. 2011;49(4):403-9. Epub 2011 Jun 21.
Chaleat-Valayer E, Mac-Thiong JM, Paquet J, et al. Sagittal spino-pelvic alignment in chronic low back pain.
Eur Spine J. 2011 Sep;20 Suppl 5:634-40. Epub 2011 Aug 26.