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Guide to Costovertebral Dysfunction

What are the symptoms of upper crossed syndrome?

Upper crossed syndrome is a term that is used to describe when the muscle in the neck, shoulders and chest become deformed usually as a result of prolonged poor posture. The muscles that are affected the most are the upper trapezius and the levator scapula which are the muscles of the neck, shoulder and upper back.

The symptoms vary between patients however, the majority of patients will present similarly with the following signs and symptoms:

  • Neck pain
  • Headache
  • Rounded shoulder
  • Pain in the shoulders
  • Upper back pain
  • Weakness in the front of the neck
  • Stiffness in the neck and shoulder
  • Trouble sitting for long periods without pain or discomfort


What causes upper crossed syndrome?

Upper crossed syndrome is not a result of a one of injury but as a result of sustained poor posture such as that of sitting behind a desk for hours on end with the head pushed forwards. Humans naturally adopt this position while reading, watching TV, biking and using the phone or laptop

How is upper crossed syndrome diagnosed?

The diagnosis of an upper crossed posture will be based on the presenting symptoms and the completion of a complete physical examination which will have the practitioner assessing your posture and palpating for areas of tightness and pain in muscles as well as other various tests that will help them with their diagnosis. 

Upper crossed syndrome has various identifying characteristics which helps practitioners in their diagnosis such as:

  • The head is often in a forward’s position
  • Rounded and protracted shoulders
  • Curving inwards of the spine at the neck

How is upper crossed syndrome treated?

The main treatment modality for upper crossed syndrome is physical therapy and exercise. The treatments will aim to release the tight muscles, get the neck joints and upper back joints moving as well as focus on strengthening the weak muscles that oppose the strong muscles to create a balance between them. The aim is to revert the forward head carriage which puts a lot of strain on the neck joints and muscles. Practitioners may also use different treatment modalities such as Dry needling (acupuncture), myofascial therapy, Graston and specific stretching techniques.


Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach. Journal of orthopedic & sports physical therapy. 2011 Oct;41(10):799-800

Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. Journal of manipulative and physiological therapeutics. 2004 Jul 1;27(6):414-20. 

Hertling D, Kessler RM. Management of common musculoskeletal disorders: physical therapy principles and methods. Lippincott Williams & Wilkins; 2006.

Vizniak, N., Carnes, M. and Vizniak, N., 2007. Quick Reference Conservative Care Conditions Manual. Vancouver: Professional Health Systems.

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