You can identify and offset the deleterious effects of sitting by understanding the muscles and mechanics involved with upper and lower crossed syndrome.

It’s no surprise that most Americans spend the majority of their day sitting and looking at a screen. If your client has an office job, is a student, or is retired, they likely suffer from some ill effect of staying in a fixed position for prolonged periods of time. From postural deviations to chronic pain, maintaining one position for too long impairs movement. 

man with bad posture at desk

Sitting is the New Smoking

According to a study from the Annals of Internal Medicine, adults who sit for 1-2 hours at a time have a higher risk of premature death than adults who sit for the same total amount of time but interrupt it with frequent stints of brief activity. In older adults, who are more predisposed to being sedentary, chronic prolonged sitting contributes to muscle atrophy and weakness, difficulty balancing, decreased cardiovascular fitness, increased risk of diabetes and cardiovascular disease, and overall reduced quality of life.

Signs of Excessive Sitting

The two most common conditions associated with prolonged sitting are upper crossed syndrome and lower crossed syndrome.

Upper crossed syndrome and lower crossed syndrome describe states of inappropriate length-tension relationships between opposing muscle groups. When the body stays in a particular position for too long, it can become “fixed” in this position. More simply, the body adapts to the demands imposed on it. If a person spends extended periods of time in a certain posture, the body adapts to become exceptional at maintaining that posture.

Excessive sitting typically leads shortening of the prime movers of the anterior chain (hip flexors, pectoralis major, anterior deltoid) and lengthening of the muscles of posterior chain (glutes, thoracic spine, posterior shoulder). In order to restore a proper length-tension relationship, the focus should be on relaxing and lengthening the short muscles, and strengthening and shortening the lengthened muscles.  

This overly-simplified view of these conditions should give a sufficient guide to remember what muscle groups to relax and lengthen (anterior chain), and what muscles to strengthen and shorten (posterior chain).

The “cross” of both upper and lower crossed syndrome comes from the contraposition of the tight muscles and lengthened muscles. When viewed from the side, an “X” can be drawn to show the relationship between the tight muscles and lengthened muscles.

Upper Crossed Syndrome

Tight (tonic/overactive/shortened) Muscles:

  • Upper Trapezius
  • Sternocleidomastoid
  • Levator Scapula
  • Pectoralis Major
  • Anterior Deltoid

Weak (lengthened/underactive) Muscles:

  • Cervical (neck) flexors
  • Middle and Lower Trapezius
  • Rhomboids

Altered Joint Mechanics

  • Increased protraction and elevation of the scapula (shrugged and rounded shoulders)
  • Increase cervical extension
  • Decreased external rotation of the shoulder
  • Decreased extension of the shoulder

Signs to Look For

  • Shrugged and/or rounded shoulders
  • Forward head position (“Text neck”)
  • Client complains of neck pain or a “tight” neck and upper back

Exercise Plan for Upper Crossed Syndrome

  • Self Myofascial Release
    • Using a theracane or other myofascial release equipment (tennis ball, peanut), teach your client how to search for and release trigger points of the upper trapezius, levator scapula, and pectoralis major. Breathe deeply upon locating a tender spot to help inhibit (relax) the tight muscle.
  • Static stretching
    • Doorway stretch
    • Chin Tuck
  • Strengthening Exercises
    • Prone “I’s”, “Y’s”, “W’s”, “O’s”
    • Chest supported reverse flys
    • Rows (variations)
    • Prone Cobras
    • Side-lying dumbbell external rotation
    • Face pulls
    • Band pull aparts
    • Wall Slides (aka wall angels)

Lower Crossed Syndrome

Tight (tonic/overactive/shortened) Muscles

  • Hip Flexors
  • Erector Spinae
  • Adductors

Weak (lengthened/overactive/shortened) Muscles:

  • Transverse Abdominus
  • Internal Oblique
  • Gluteus Maximus
  • Gluteus Medius

Altered Joint Mechanics

  • Increased Lumbar extension
  • Decreased Hip Extension

Signs to look for

  • Anterior Pelvic Tilt
  • Lumbar Lordosis
  • Positive Thomas Test

Exercise Plan for Lower Crossed Syndrome

  • Self-myofascial release
    • Using a foam roller or other myofascial release equipment (tennis ball, peanut, theracane), teach your client how to release their hip flexors and adductors.
    • Find a tender spot (trigger point) and practice deep breathing to inhibit (relax) the tight muscles.
  • Static Stretching
    • Half-kneeling hip flexor stretch or couch stretch
    • Half-kneeling adductor stretch
    • Butterfly stretch
  • Strengthening Exercises
    • Pelvic Tilt
    • Glute Bridge
    • Deadbug (variations)
    • Bird Dog (variations)
    • Banded Lateral Walk
    • Plank
    • Side Plank
    • Hip Thrust
    • Lunge (Variations)
    • Deadlift (Variations)
    • Romanian Deadlift
    • Bulgarian Split Squat

The Takeaway

Excessive sitting typically leads to shortening of the prime movers of the anterior chain (hip flexors, pectoralis major, anterior deltoid) and lengthening of the muscles of the posterior chain (glutes, thoracic spine, posterior shoulder).

To restore a proper length-tension relationship, the focus should be on relaxing and lengthening the short muscles, and strengthening and shortening the lengthened muscles.  

This overly-simplified view of these conditions should give a sufficient guide to remember what muscle groups to relax and lengthen (muscles of the anterior chain), and what muscles to strengthen and shorten (muscles of posterior chain).

While there is no single correct position for humans to maintain constantly, the inability to move in and out of many different positions unrestricted can lead to pain or potential injury down the line.  

One of the roles of a personal trainer is to ensure their clients maximize their ranges of motions in all planes. If you want your client to remain pain-free and able to engage in their life the way they want to, it is imperative that the positions they place their body in frequently are opposed during their training sessions.

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