Treatment of Upper Crossed Syndrome: A Narrative Systematic Review

Abstract

Background and Objectives: Upper crossed syndrome (UCS) is a common musculoskeletal condition that is characterized by tightness and weakness of the muscles of the neck, shoulders, and upper back. The aim of this current study is to summarize and provide an overview of the treatment in patients with UCS. Materials and Methods: A MEDLINE (PubMed), Cochrane library, Embase, Scopus, and Web of Science database search was conducted for English-language articles about upper crossed syndrome that were published until 19 January 2023. To identify potentially relevant articles, the following key search phrases were combined: “upper crossed syndrome”, “upper cross syndrome”, “diagnosis”, and “treatment”. A total of 233 articles were identified. After reading the titles and abstracts and assessing their eligibility based on the full-text articles, 11 articles were finally included in this review. The risk of bias (RoB) was assessed using RoB-2 and ROBINS-I for the randomized controlled trials (RCTs) and the non-randomized clinical trial (non-RCT), respectively. Results: Among eleven studies that investigated the effect of treatment programs for UCS, five studies compared the therapeutic effect of exercise programs with controls, whereas six compared different rehabilitative treatment strategies, such as the muscle energy technique, soft-tissue mobilization, and stretching exercises. In addition, regarding the study design, ten studies were RCTs and only one study was a prospective observational study. Conclusions: Treatment programs including various types of exercises and techniques to correct an abnormal posture and restore neuromuscular imbalances are effective for decreasing pain and improving neck disabilities and postural deviations in patients with UCS.

The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis

“…To explain why therapeutic exercises are effective in improving postural alignment in people with UCS, several points can be considered [ 2 ]. Muscle imbalances resulting from prolonged positioning or repetitive movements in a specific and static position can affect upper body posture.…”

“…Upper Crossed Syndrome (UCS) is characterized by upper quarter abnormalities, such as increased thoracic kyphosis, rounded shoulders, and forward head posture [ 1 , 2 ]. The prevalence of UCS ranges from 11 to 60% in different populations and age groups [ 3 ].…”

“…The prevalence of UCS ranges from 11 to 60% in different populations and age groups [ 3 ]. This disorder affects the upper quarter of the body and has multiple causes [ 2 , 4 ]. Musculoskeletal abnormalities may develop over extended periods due to biomechanical, psychological, and social stresses and repetitive activities [ 5 , 6 ].…”

“…In addition, it has been observed that UCS can lead to a chain reaction of disorders in more distant segments, such as the lower limbs [ 1 , 2 ]. For instance, an increase in lumbar hyper-lordosis resulting from changes in the thoracic hyper-kyphosis and cervical hyper-lordosis is one of the indicators of this chain reaction phenomenon, which affects the back muscles and anterior thigh muscles [ 9 ].…”

Kinematic Assessment Utilizing Xsens Gait Motion Analysis in Upper Cross Syndrome: A Case Report

“…Muscles such as the suboccipitalis, sternocleidomastoid, levator scapulae, pectoralis major and minor, scalene, and upper trapezius manifest tightness or shortening in individuals with UCS. Conversely, the deep neck flexors, serratus anterior, rhomboids, middle trapezius, and lower trapezius exhibit weakness, elongation, and restriction [ 1 ]. The presence of opposing muscle imbalances in UCS precipitates malalignments in the upper limbs and dysfunction in the atlantooccipital, cervicothoracic, and glenohumeral joints, subsequently contributing to postural irregularities [ 2 ].…”