Have you ever heard of lower cross syndrome? It’s a surprisingly common cause of lower back and hip pain – particularly among runners! – yet many people don’t know anything about it.
In this post, we’ll break down all the key causes and symptoms of lower cross syndrome. Fortunately, there are some steps you can take to prevent, manage, and recover from it – including strengthening, stretching, proper posture, and good overall biomechanics.
Disclaimer: This post was written by JayDee Vykoukal, Doctor of Physical Therapy. It has been reviewed by Chrissy Carroll, MPH, RRCA Running Coach, ACSM cPT. This post is for informational purposes only and does not constitute medical advice. Please consult a physician for any medical concerns.
Lower cross syndrome (LCS) is characterized by signature muscle imbalances across the pelvis and lower back (in specific myofascial patterns).
Essentially, it’s a compensatory muscle pattern – certain muscles are overactive, short, and tight, while others are underactive, lengthened, and weak.
Specifically, the hip flexors end up quite tight, which can cause the glutes to become weak and lengthened.
Similarly, the lower back muscles end up overworked and tight, while the deeper abdominal muscles end up weak and lengthened.
These muscle imbalances can lead to pain and injury of the hips, pelvis, and/or low back. The primary reason that you are at a higher risk for injury with lower cross syndrome is the way that it affects your mechanics. Your muscles and posture are now favoring muscles that aren’t meant to support the core and trunk. This leads to overuse, while the muscles that are specifically designed to provide efficient core stability get progressively weaker.
Essentially, it’s a recipe for disaster, particularly tissue strain!
What muscle imbalances first initiate LCS is hard to determine and can vary from person to person. However, in general hip flexor tightness tends to be a common problem that can lead to lower cross syndrome. Why is this? The simple answer is: sitting.
These days, the average person sits for the large majority of their day, whether at a desk for work or school, sitting on the couch, or any other leisure activity that involves using technology. Unfortunately, even if you dedicate time to your running training plan or gym routine, you can still experience LCS.
Other causes of LCS include poor biomechanics with daily activities and exercise. For example, overtraining the hip flexors can easily occur with activities like running, contributing to LCS (source).
It can be a perpetuating cycle, because running with tight hip flexors, weak glutes, and weak abs can cause an overreliance on the hamstrings and lower back muscles. On long runs, this can stress those muscles leading to potential injuries.
Previous athletic injuries or being in a larger body can also contribute to LCS as well.
Regardless of cause, these imbalances lead to a signature LCS posture. The natural “S” curve of the spine becomes exaggerated as the stomach protrudes forward, known as an anterior pelvic tilt. This commonly leads to other changes in posture such as rounded shoulders, excessive arching of the low back, a head that sits forward from the rest of the body. Less commonly, it can also lead to a very flat spine with rounded shoulders as well.
There are a few primary symptoms associated with LCS. The most common complaints include pain in the hips, low back, pelvis, and/or low back. Due to postural changes, it can also lead to secondary pain in the neck, shoulders, and beyond.
Additionally, the hip flexors, hamstrings, and lumbar spine are stiff and tight. Finally, the glutes and abdominals are overstretched and weak, often making it difficult to complete normal daily activities like reaching, lifting, and squatting without feeling unsteady.
Other less obvious symptoms may include fatigue on your runs (due to the inability to hold proper form for long periods of time) and muscle cramps (from overworking certain muscles due to the weaknesses in other muscles).
Preventing and managing lower cross syndrome all starts with one simple step: building awareness. Understanding what lower cross syndrome looks like and what muscle imbalances are involved will help you detect any potential issues quickly and address them before they get worse. This equates to a few key factors to keep in mind:
1. Keep good posture
While sitting, standing, and sleeping, your spine should remain relatively neutral. While a slight “S” curve of the spine is normal, keep an eye out for exaggerated curves (particularly at the low back) and do your best to keep good posture throughout the day.
Keeping good posture is significantly easier when setting up your everyday spaces for optimal ergonomics. For example, an adjustable desk and chair can make it easy to keep your body in good alignment.
Unfortunately, even if you exercise regularly and pay attention to your posture, sitting so much each day can negate these efforts. So don’t forget to change positions often to keep the body from getting too stiff. When sitting, try to stand up and stretch at least once an hour for at least a few minutes.
2. Keep good mechanics
Our bodies adjust to the activities and postures we subject them to regularly. Thus, when you’re moving for sport, exercise, or any daily activity it’s important to use your muscles in a way that promotes balance.
For example, as we discussed above, runners can easily overuse their hip flexors since they are the primary muscle group for bringing the legs forward with each step. This makes it important to incorporate appropriate core activation and glute activation into each stride to maintain balance.
If you’re not sure where to start, you can use a mirror for visual feedback, have someone record you on video, or talk to a movement expert like a physical therapist.
3. Exercise regularly to promote balance
It’s always a good idea to keep up with a balanced exercise routine. Many runners are drawn to the time pounding the pavement, but it’s important to complement that with cross training like strength work.
For example, runners and walkers should incorporate at least 1 to 2 days per week of strength training, specifically including exercises that address muscles which are frequently neglected like the core and glutes.
For lower cross syndrome prevention and good general health, the stretches and strength exercises listed below will be a great start. By regularly working the muscles in sync, your muscle memory will help keep you in balance.
The following exercises are broken up into three categories. It’s best to start with the stretches and then progress to strengthening and functional training from there.
Below are three of the most basic and easy to start stretches that will give you the best results. Each addresses a specific muscle group that tends to be stiff with LCS.
Ideally, try to hold each stretch for a minimum of 30 seconds for 2 to 3 sets each day. These are great to do throughout your day when you take a break from sitting or you’re warming up and cooling down.
1. Half-kneeling hip flexor stretch
Kneel in a half lunge position with the leg you want to stretch behind you. The key is to keep the low back from arching as you shift your weight into your front foot to get a deep effective stretch. You should feel a nice stretch down the front of the hip. This is a runner favorite![View instructional visuals of the half-kneeling hip flexor stretch.]
2. Cat stretch
Getting on your hands and knees is a great way to stretch the low back. First, take a deep breath. Then as you exhale, round the spine up toward the ceiling and hold.
(This exercise is frequently done as a “flow” called the cat-cow stretch, where you then relax and arch your back.)
Another effective way to stretch the low back involves lying on your back and bringing both your knees to your chest.
[View instructional visuals of the cat-cow stretch.]
3. Side stretch
This stretch can be done sitting or standing. Choose a position that is comfortable and keeps your body in good alignment. To stretch your left side, stretch your left arm upward and then reach across toward the right side and hold. Avoid rotating or flexing at the spine and don’t forget to stretch both sides.
Another version of this exercise can be done in a straddle position, with raised arms and bent elbows. [View instructional visuals of a seated side-straddle stretch.]
The following strength exercises are designed to restore strength to weak muscles while also counteracting the tight muscles that work in opposition. Learning to use the pelvic and core muscles in sync will help you gradually restore balance.
A classic bridge move is one of the best ways to restore balance to the trunk muscles because it works the glutes and core while also stretching the hip flexors all at once.
Lie on your back with your feet flat on the floor and lift your butt off the ground as you tighten the abs and glutes. Make sure to move slowly and with control- never forcing a range that is painful or hard to coordinate.
It may be extremely difficult at first but you should be able to progress how high you lift your hips over time. You should start with the feet hip width apart and slowly bring them closer together to add a stronger hip flexor stretch (as long as you can do so without arching the low back). Ideally, complete this exercise for 10 to 15 repetitions at a time for up to 3 sets.
As you continue to progress, you can work towards marching one foot at a time with the bridge (keeping the pelvis stabilized), or working your way up towards single leg bridges.[View instructional visuals for a glute bridge.]
2. Lower abs activation
The deep abdominal muscles, particularly the lower abdominals known as the transverse abdominis, are probably weaker than you realize with LCS.
Surprisingly, even athletes can perform at high levels without realizing that their lower abs are not doing their job and putting them at risk for injuries. Thus, it’s best to go back to the very basics first by lying on your back with your feet flat on the floor.
Here, you will place your hands inside your hip bones and practice tightening your lower abs (you’ll feel them tighten under your fingers). You should be able to do so while breathing comfortably and without tensing up other areas of your body.
It’s easier said than done! However, it’s been proven to be an effective way to reduce low back pain (source).
Once you’ve mastered this exercise (you can comfortably hold your abs for 5 seconds for 3 sets of 10 repetitions), you can then progress to more traditional ab moves such as lifting the legs (one or both), planks, and beyond.
This is the final and arguably most important step in addressing LCS. You can do all the stretching and strengthening in the world, but if it doesn’t translate to better daily posture and mechanics then you won’t get the results you are hoping for. All that hard work should translate to better movement patterns and awareness to reduce your symptoms and help prevent future issues.
1. Running and walking mechanics
While we don’t normally have to think too hard about how we run or walk, it’s worth taking some time to re-train these everyday movements when dealing with LCS.
For example, the lower abs should be keeping your trunk stable and prevent the hip flexors from getting too tight and low back from arching excessively.
Additionally, with each step as you push off you should feel the glutes activating and working to propel you forward. Thus, practice keeping your abs tight and squeezing your glutes as you push forward.
Admittedly, it can feel very awkward to play with your running and walking mechanics. However, it’ll be worth the effort to ensure you get the best results from your LCS exercise program.
2. Dynamic movement
Each day we find ourselves in positions that require adequate abdominal and glute strength. If your muscles are imbalanced and tight, continually moving incorrectly will result in an exacerbation of symptoms and long term chronic issues.
Just like walking and running, pay close attention to your mechanics, posture, and how you’re activating your muscles with moves such as lunges, squats, and steps. Take time to incorporate these types of moves into your exercise routine while being laser focused on your mechanics.
(For more ideas on dynamic moves, check out this post about resistance band exercises for runners).
The truth is that many people unknowingly suffer from issues with lower cross syndrome for years before they do anything about it. Whether you want to prevent onset, are experiencing mild symptoms, or they’ve become chronic and are affecting your quality of life, now is the best time to start making changes!
It all starts with a big dose of understanding and then getting to work on a few basic exercises. From there, you will tap into your body’s own potential when you start efficiently using your muscles in a way that minimizes your effort and risk of injury.
Want to run a marathon? Or maybe just run a mile without stopping? Regardless of your fitness goals, addressing underlying issues associated with lower cross syndrome will help you feel in control of your fitness potential.
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