Wednesday, January 21, 2015

Upper and Lower Crossed Syndromes

New Year, New Resolutions, And (Avoiding) New Injuries (Part 1)

“Ok, THIS is the year. I swear. It’s time to be healthy. No more cookies. No more chips. DEFINITELY no more ice cream. AND I’m going to the gym. Everyday. Maybe twice a day. I’m very serious. Have I mentioned that THIS IS THE YEAR?!”

Sound familiar? I’m guessing almost all of you have heard someone resolve to make similar changes since the first of the year. Maybe that someone was you? Personally, I’m a big fan of resolutions and their ability to change the trajectory of our lives when we commit to them. The New Year happens to be a fantastic time to take inventory of our finances, relationships, lifestyle, and health. Obviously, one of the most common commitments for people to make is to workout more. Why do you think gyms love January 1st? More members, more money! The problem is, when we jump into a new activity that our bodies aren’t used to, it’s a shock to the system. Now originally, this blog was supposed to be about common injuries sustained at the gym when we throw ourselves into our New Year’s resolutions. What I realized, however, is that the potential for injury starts well before we step foot in the gym. Remember the desk that most of you are tethered to 40+ hours/week? We need to address that first; the desk, all of the sitting, and what it does to our bodies by the end of the day. Once we understand that, we can figure out how to counteract the effects of sitting and prepare for exercise. (Coming in Part 2!) This way, we have at least half a shot of getting through a workout injury free!

Take a second to think about how you spend most of your day. Are you imagining yourself not only at your desk, but also in the car and then on the couch after work? Don’t worry. You’re among the majority. (Actually, I need you to worry JUST a little bit because all that sitting is making your body pretty unhappy with you. But again, don’t worry because there are ways to make improvements!) The problem is, when you force your body into one (poor) posture all day long, eventually your body adapts. Trust me when I tell you that these particular adaptations are not in your best interest. And I’m sure you started your day with the best of intentions! You got to the office, sat down in your (hopefully ergonomically sound) desk chair, and situated yourself the way every “Proper Sitting Technique” article ever written has instructed you to. Your posture is perfect…for about the next 12 seconds. Then someone calls, so you shove the phone between your ear and your shoulder in order to continue typing. You get tired and distracted and before you know it you’re hunched over your computer, shoulders are rounded forward, your head and chin are jutting out toward the screen, and you’re cursing at whoever made the chair because obviously they didn’t SIT in the chair before they mass-produced it.  Combine all that with thinking you’re doing yourself a favor by jumping head first into a workout after 8 hours at your desk, and we’ve got a problem.

Your discomfort, and this posture, actually has a few names. They are the Upper and Lower Crossed Syndromes. These syndromes both describe the adaptations that the soft tissues/muscles have made in response to the hunched-over posture you’ve subjected them to while at your desk. They describe the pattern of some muscles contracting, shortening, and tightening all day, while others are stretching, weakening, and underutilized. To get an idea of which muscles are doing what, imagine looking at someone from the side (their profile) and drawing one X right through their upper body, and another through the lower body. Get it now? Upper and Lower CROSSED Syndromes. Pretty creative, right? You can draw a diagonal line through the weak muscles (front of the neck and down through the body to the muscles between the shoulder blades), and another through the tight ones (chest muscles up through the body to the back of the neck), front to back.

In Upper Crossed Syndrome, the muscles in the front of the neck are responsible for neck flexion (chin to chest) and chin retraction (chin straight back to the spine). Go ahead and sit up tall and a place your pointer finger on your chin. Now push your chin straight back to the spine (you should see a nice double chin forming), remove your finger, and hold this position. Do you feel the muscles in the front of the neck activating to keep your head back, ears over shoulders? Now relax and jut your chin forward. Those same muscles go totally slack. This is the exact position you end up in at your desk. Those muscles don’t do any work all day long, and as a result get progressively weak over time. Now the muscles in the back of the neck are there to lift the chin up and extend the head back. When your chin is jutting forward, however, those muscles are back there just holding on for dear life. They’re keeping your head up so that you can see the computer screen, and not just the floor of your office. Expecting these posterior neck muscles to work non-stop during your work day is crazy! They end up tightening and shortening, and causing all sorts of neck tension and headaches.

The chest and back also suffer. With your shoulders rounded over a keyboard all day, your chest muscles shorten and tighten. Opposing this are the muscles of the mid back that are trying to pull your shoulders back and shoulder blades together. Because of your position, they can’t, and just like the anterior neck muscles, when they aren’t used they give up. They get weaker. The problem is that the changes to the muscles that I just described aren’t transient. They don’t just ‘go back to normal’ once we shut down our computers and stand up. Those changes have now affected your posture, and pretty soon you’re just as “hunched over” when you’re up and walking around as you were at your desk.

As I’m sure you can imagine, Lower Crossed Syndrome follows the same pattern in response to habitual sitting. A diagonal line of weakness can be drawn from the abdominal muscles, down through the body to the glutes. Another can be drawn for the tight muscles from the front of the hips up through the low back. Our abdominal muscles aren’t engaged to keep us sitting tall, and thus they weaken. The low back muscles, on the other hand, work all day long to keep you upright as you lean forward toward your desk. Your glutes aren’t activated at all when you sit contributing to their weakness, and sitting in a chair all day with our hips flexed means the anterior hip muscles shorten and tighten over time. When you stand after a long day, muscle adaptations have occurred and you’re walking around with a lot less mobility in the hips and low back, while other muscles aren’t doing their jobs! Bad combo.

The point of all this is to show you how far from normal your bodies are functioning after a long day (or after 20 years) of sitting.  (As a chiropractor who takes care of people all day long who are coming in with desk-related aches and pains, I think it’s kind of my job to do so!) Just as you can imagine it’d be a bad idea to get up from your office chair and start sprinting, our bodies are also not 100% ready to walk into a gym and start with a set of dead lifts. This doesn’t mean that you shouldn’t go to the gym though. In fact, it’s a great idea. We just need to PREPARE for it. Next week we’ll talk about some quick things to do before your workout to attempt to un-do the sitting, and warm up. In the meantime, Dr. Luke wrote a great blog called “Sitting Is The Problem.” ( Take a minute to look over some of the other problems that sitting can cause, as well as some great tips for making your 10hr day at a desk more manageable. Check back next week for Part 2, and until then get up out of the chair that you’ve been sitting in to read this blog, and take a lap!

-Dr. Doscher