ANATOMY & PHYSIOLOGY OF THE PELVIC REGION: LOWER CROSS SYNDROME

Common symptoms of Lower Cross Syndrome include tight lower back muscles, potentially with lower back pain. Th e condition was fi rst documented by Vladimir Janda, who identifi ed groups of hypertonic and hypotonic muscles around the pelvis.

HOW DOES LOWER CROSS SYNDROME DEVELOP?

Lower Cross Syndrome develops when someone sits for long periods of time, leaning in a slightly flexed position. In this forward position you have poor posture. This causes the lower back muscles or erector spinae to continually contract in an attempt to bring your torso back into a vertical position. In the front of your body the constantly flexed position shortens the muscle length of the hip flexor muscles: the iliopsoas and rectus femoris muscles. Through the continued concentric contraction (or in a shortened position), the hip fl exor muscles adapt and shorten in length. This leads to muscle tightness, while the antagonist gluteal muscles lengthen and become weak.

THE MECHANISM OF MUSCLE IMBALANCE

The muscles attached to the spine act like a series of pulleys and levers. When one muscle gets shortened, it usually means that another muscle gets lengthened. This is oft en referred to as reciprocal inhibition. When a muscle is contracting, the muscle opposite of its function (or the antagonist muscle), is turned off so that both muscles don’t contract at the same time.

In LCS, the hip flexors start to become hypertonic and tight (due to poor posture). As a result of reciprocal inhibition, the gluteals and abdominals on the opposite side of the body become hypotonic and weak. The muscle strength imbalance causes the curve in the lower spine to be exaggerated with lumbar muscles overactive or hypertonic. In bad cases the vertebrae are put under stress and lose their ability to function correctly and you end up suff ering low back pain.

While the gluteal muscles become hypotonic and weak, they fail to activate normally and this causes the hamstrings and back muscles to be more active during walking. The overuse and tightness of the hamstrings and back muscles ultimately weaken the abdominals and further increases the curve of the lower spine.

If these muscle differences are left untreated, the joints and muscles around may undergo changes progressively. Strength, flexibility and range subsequently decrease, which contributes to degenerative changes and pain in the lower back.

SYMPTOMS OF LOWER CROSS SYNDROME

Individuals with hypertonic and hypotonic muscles of the pelvis will typically present with anterior pelvic tilt. Th e lumbar curve will be increased and the abdomen will protrude as in a pot belly. Here you haven’t put on weight, but your stomach will look larger due to poor posture.

Muscles that are commonly tight (hypertonic or shortened) in LCS include:

• Iliopsoas
• Rectus femoris
• Erector spinae
• Piriformis
• Tensor fascia latae (TFL)
• Leg adductors

The weakened (hypotonic or lengthened) muscles include:

• Abdominal group
• Gluteal group

Hint:

Lower back lowdown – start building a strong and healthy lower back today, and you’ll improve your posture, maximise weight-room results and minimise the risk of injury.

TREATING LOWER CROSS SYNDROME

Correcting the muscular imbalances associated with LCS is not complicated. You must restore the normal length and tonicity of the hypertonic (tight) muscles while increasing the tonicity (and strength) of the weakened musculature.

Take breaks during prolonged sitting

One of the primary hip flexors (the psoas) attaches to the lumbar spine and when it is tight/shortened it can further exaggerate a hyperlordotic curve. You should take regular, frequent breaks when sitting for long periods of time (over one hour).

Stretch the hip flexors and lower back

Kneel with one knee on the floor and the other foot in front with the knee bent. Push your hip forwards and keep the back upright. Hold for between 10 and 30 seconds.

VARIATIONS

1. Lie on the ground on your right side.
2. Bend your left leg at the knee.
3. Hold your left ankle with your left hand.
4. Draw the bent leg back so the knee moves towards your back and you feel a stretch around your left hip.
5. Hold for 20 seconds.
6. Repeat for the other side.

Rx: Do 3 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week

Posterior Pelvic Tilt: lower back stretching and abs strengthening exercise

1. Lie on back, knees bent, feet flat on floor.
2. Do not push your feet into the floor to assist with the move – use your abs. Hold for a count of five.
3. NOTE: Exhale as you pull your back toward the floor: inhale as you relax.

Rx: Do 5 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week Basic

Twist: lower back stretching exercise.

Lie on back, arms stretched out to the sides. Bend knees and bring them up close to your chest.

Take a deep breath. Exhale as you slowly lower the knees (keeping them together) to the floor to the right or as close to the floor as is comfortable. Pause.

Inhale as you slowly return your knees to chest. Exhale as you slowly lower knees to left side. Inhale as you return your knees to chest.

Rx: Do 5 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week

The Cat: back stretching exercise

1. Begin on all fours, hands directly under your shoulders and knees directly under your hips.
2. Exhale as you drop your tummy towards the floor and look up over your head.
3. Inhale as you bring your tummy back up, rounding your back as you tuck your chin in and tuck your tailbone in.
4. Move slowly back and forth between these two positions pausing on each pose.

Rx: Do 5 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week

The Cobra: abdominal, lower back and chest stretching exercise

1. Lay flat on the stomach, forehead to ground, with arms bent and palms down on the ground under the shoulders. Push downward with arms as you raise your upper torso and arch your back.
2. Hold for three full breaths before slowly bringing the upper torso back down to the ground.

Rx: Do 5 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week

“Lower Cross Syndrome develops when someone sits for long periods of time, leaning in a slightly flexed position.”

Knee to Chest: Gluteal/lower back stretching exercise

Lie on back, knees bent, feet flat on floor. Grasp left leg behind the knee/back of thigh and pull the knee towards the chest. (Right leg may be either bent with foot fl at on fl oor or straight with leg on fl oor to simultaneously stretch the front of your right hip). Hold 20 seconds. Switch sides and repeat.

Rx: Do 5 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week

STRENGTHEN ABDOMINALS AND GLUTES

Glute Bridges

Lie on the floor with your knees bent to 90 degrees and your feet flat on the fl oor. Put your arms out to the side for stability. Begin by pushing through your heels to bring your hips off the ground. Push your hips up as high as you can. Hold this position for a second before lowering them back down.

Rx: Do 3 sets of 15 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week.

Prone Glute Extensions

1. Begin in an all-fours position with your shoulders over your wrists and your hips over your knees. Extend your right leg out behind you, fully contracting your right glute. Your leg will end up parallel to the floor or slightly higher.
2. After pausing in the contracted position for a second, reverse the movement by drawing your right leg in towards your torso, keeping it off the ground until you’ve completed the appropriate number of repetitions. Repeat with your left leg.

Rx: Do 3 sets of 15 repetitions. If you’re serious about improving your posture quickly, do this exercise six days per week. Otherwise, do it at least three times per week.

Contralateral Dead Bug Abduction

1. Start by lying on your back with your legs and arms straight up in the air. (You may want to place your right hand on your left obliques to ensure that you’re bracing forcefully.) Begin the movement by lowering your right leg and left arm out to the side while keeping your torso rigidly still.
2. Once you’ve lowered to the point where you can no longer keep your torso perfectly still, return back to the starting position. Once you’ve done the appropriate number of reps, switch sides and repeat.

Rx: Do 3 sets of 10-15 repetitions on each side. Do this exercise on three nonconsecutive days per week (i.e. Monday, Wednesday and Friday).

Kettlebell Swings

1. The starting position of the Two Arm Kettlebell Swing is with the kettlebell on the ground in front of you, knees bent, your weight centred towards your heels and your back flat.
2. Start the movement by hiking the kettlebell behind you and then drive your hips forward to propel the kettlebell through its arc. The movement is similar to performing a standing broad jump, but of course you stay in the same spot.
3. Your arms are just hooks and the power comes from the movement of the hips and the muscles of the posterior chain ie, hamstrings, glutes, lower back.
4. Swing the kettlebell to about chest height. At the top of the movement breathe out whilst contracting your quads, glutes and your abs (by tilting your pelvis up).
5. Let the kettlebell free fall back between your legs so that it passes through your legs as high as possible (to keep the arc tight and to stop unnecessary pulling on your back). Aim for your groin and then get your groin out of the way by taking your hips back.

Although different trainees will have varying amounts of knee bend, the important thing is that the hips go back and thrust forward and that the quads do not take over the exercise. You should feel the movement in your hamstrings. If your quads are fatiguing then you’re not taking the hips back at the bottom of the movement.

Hint

Before starting any of these exercises consult your allied health professional and have your back checked out for any structural damage. It is a good idea for a qualifi ed fi tness trainer to demonstrate all the exercises before you commence and then have them shadow you until you become competent.