Upper and Lower-Crossed Syndrome in Athletes

Gray Cook & Craig Liebenson
A Discussion on Upper and Lower-Crossed Syndrome

These are some key takeaways from a discussion Gray Cook and Craig Liebenson had that included this section on Vladimir Janda’s idea of Upper and Lower-Crossed Syndromes. There are nuances that were unknown during Professor Janda’s time, and the terminology is a little different today, but the underlying concepts still hold. Excerpted from the middle of the conversation:

Gray: Professor Vladimir Janda described Upper and Lower-Crossed Syndromes as situations where the cervical spine, the shoulder girdle and the thoracic or lumbar spine, the hips and the pelvis adopt a dysfunctional posture. He noticed it in sedentary cultures, but we also see it in highly fit people who may not be training in a balanced fashion.

This is a response the prime movers make when the stabilizers aren’t given enough time to adapt and maintain the role as an alignment facilitator. It’s very easy to see how prime movers will sometimes try to be stabilizers and put us into non-optimal postures.

Imagine what a deep squat or an overhead squat would look like if you had both of these “crossed” problems symmetrically on each side.

Or if you had one of these problems unilaterally, what would your hurdle step or inline lunge look like?

What would your pushup look like? What would your rotary stability look like, or your shoulder mobility or your active straight leg raise?

One of Janda’s quotes says something like Don’t just judge the posture in symmetrical stance because people could have a lazy stance. They could be hanging on their ligaments, but the minute we ask them to move, they could be an efficient runner, an efficient thrower or an efficient climber. If you want to make a call on posture, ask them to stand on one leg, because then the postural stabilizers are somewhat challenged.

Fighters commonly have a flexed, rounded posture—basically to protect the head and to quickly convert from a defensive to an offensive maneuver. Yet when we screen these athletes, they straighten up and competently get through the tests.

Janda gave us this profile of dysfunction both in inactive and maybe “too active” people and gave a perspective for posture that we shouldn’t just judge it in a comfort zone against a grid or a plumb line. We should put a person on one leg because the larger portion of the gait cycle is more on one leg than on both.

These two perspectives are so woven into my work, they can never be separated.

Craig: Professor Janda was focused on sedentary individuals. In the joint-by-joint approach you and Mike Boyle talk about we see a lot of the same patterns. We see great athletes who are kings of compensation. The way they compensate is often into certain defaults we also see in sedentary people.

If we trace that back to its origin where Janda captured the image he gave us in the Lower and Upper-Crossed Syndromes, it was because he was intimately familiar with polio, what cerebral palsy looked like and with people who’d had strokes. The same defaults in the nervous system for survival were present in a diluted form in people who simply became sedentary or didn’t have variety of movement. They had become one-sided in their activities or trapped into flexion positions because of the chair, the desk, the car.

The gestalts he saw were simply diluted versions of what he already saw in neurological impairments. The same muscles that tend to spasticity in somebody with cerebral palsy tend to tightness in people who are sedentary.

What we now realize is these are also the same muscle groups that tend to dominate the milieu in people who suffer overuse.

Gray: They run too much and don’t explore mobility, or they squat heavy and often, yet can’t bend over and tie their shoes.

We don’t need to be sedentary, but you’re also more than a marathoner. It wouldn’t do a marathoner any harm to put on a backpack and go on a hike or do some cross training every now and then. What happens is, those activities we do the most leave a thumbprint on us. Sometimes it’s a thumbprint that cannot be removed.

I’ll challenge anybody: If you want to have an epiphany moment, go to a triathlon or anything over a 10k and see how many people who are successful at distance running have not lost the ability to deep squat.

Why do you have to give up one to get the other?

People sometimes see a bad deep squat and assume something is stiff to make you perform badly, but maybe you’re performing badly because you can’t feel what your ankles would be telling you if they were mobile.

I don’t just look at the body biomechanically. I think: How many kinks do we have in the hose?

Long before I worry about the biomechanical inefficiency of movement, I obsess on getting more sensory input in there. If I can’t normalize your ankle but I can get you 10 more degrees of motion, I’m doing it. If I can get you five degrees of medial rotation in your hip and 13 degrees of thoracic spine rotation, every bit of that will be exponential because your brain can work with that new input.

Athletes are masters of compensation. What if we took away 50% of the reason they have to compensate? Think of how much better the reaction time would be or the efficiency would be.

Craig: Or how much more powerful they would be and how much more resilient they would be.

Professor Janda showed us these patterns of protective responses present in the neurally challenged individual, but they’re also there in the sedentary and those who suffer from overuse.

Professor Janda never actually focused on his six stereotypical movement patterns. His focus was on gait. And the primary function of man wasn’t even to be upright on two legs; it was movement.

We shouldn’t think about posture as being on two feet. We should think of posture on one foot since 85% of gait is on one foot.

It all comes back to function.

Gray and Craig have recorded several conversations for us, including the 30-minute recording this one was excerpted from, Gray Cook and Craig Liebenson on Vladimir Janda’s idea of Upper and Lower-Cross Syndromes.

The other two:

Craig Liebenson & Gray Cook Misunderstandings about The FMS and SFMA

Craig Liebenson & Gray Cook Talk about Function