The Chiropractic Doctors' Association of Hong Kong

Upper cross syndrome (UCS) is a condition caused from prolonged poor posture manifesting as thoracic hyperkyphosis with forward head and shoulder postures. It has been associated with several other secondary conditions, causing pain and discomfort to those with the condition. This is a case report of a 35-year-old female presenting to clinic with a sharp pain in the neck, upper back, and sternum area for 4 weeks and gastroesophageal reflux disease (GERD). She had been working at home for several months after the shelter at home order was issued. Following evaluation and corrective treatment with cervical adjustment and soft tissue massage, the patient's posture improved and reported full pain resolution. Her symptoms of GERD concurrently resolved as well. She continued to receive chiropractic adjustment two times per month for correcting spinal misalignment. Full restoration of posture was attained on the full spine radiographs at 9 months follow-up. The patient remained symptom-free at 12 months follow-up. Manipulative and preventive therapies aimed at treating and preventing UCS should be more widely adopted to prevent secondary conditions.

1. Vakili L., Halabchi F., Mansournia M.A., Khami M.R., Irandoost S., Alizadeh Z. Prevalence of common postural disorders among academic dental staff. Sports Med. 2016;7:e29631. doi: 10.5812/asjsm.29631. - DOI - PMC - PubMed

2. Han J., Park S., Kim Y., Choi Y., Lyu H. Effects of forward head posture on forced vital capacity and respiratory muscles activity. J. Phys. Ther. Sci. 2016;28:128–131. doi: 10.1589/jpts.28.128. - DOI - PMC - PubMed

3. Lee S.T., Moon J., Lee S.H., Cho K.H., Im S.H., Kim M., Min K. Changes in activation of serratus anterior, trapezius and latissimus dorsi with slouched posture. Ann. Rehabil. Med. 2016;40:318–325. doi: 10.5535/arm.2016.40.2.318. - DOI - PMC - PubMed

4. Raine S., Twomey L.T. Head and shoulder posture variations in 160 asymptomatic women and men. Arch. Phys. Med. Rehabil. 1997;78:1215–1223. doi: 10.1016/S0003-9993(97)90335-X. - DOI - PubMed

5. Raine S., Twomey L.T. Posture of the head, shoulders and thoracic spine in comfortable erect standing. Aust. J. Physiother. 1994;40:25–32. doi: 10.1016/S0004-9514(14)60451-7. - DOI - PubMed

6. Moore M.K. Upper crossed syndrome and its relationship to cervicogenic headache. J. Manip. Physiol. Ther. 2004;27:414–420. doi: 10.1016/j.jmpt.2004.05.007. - DOI - PubMed

7. Bayattork M., Seidi F., Minoonejad H., Andersen L.L., Page P. The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: Protocol for a parallel-group randomized controlled trial. Trials. 2020;21:1–10. doi: 10.1186/s13063-020-4159-9. - DOI - PMC - PubMed

8. Morris C.E., Bonnefin D., Darville C. The Torsional Upper Crossed Syndrome: A multi-planar update to Janda’s model, with a case series introduction of the mid-pectoral fascial lesion as an associated etiological factor. J. Bodyw. Mov. Ther. 2015;19:681–689. doi: 10.1016/j.jbmt.2015.08.008. - DOI - PubMed

9. Kim E.K., Kim J.S. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. J. Phys. Ther. Sci. 2016;28:2929–2932. doi: 10.1589/jpts.28.2929. - DOI - PMC - PubMed

10. Isabel de-la-Llave-Rincón A., Puentedura E.J., Fernández-de-Las-Peñas C. Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions. J. Man. Manip. Ther. 2011;19:201–211. doi: 10.1179/106698111X13129729551985. - DOI - PMC - PubMed

11. Bae W.S., Lee H.O., Shin J.W., Lee K.C. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J. Phys. Ther. Sci. 2016;28:1636–1639. doi: 10.1589/jpts.28.1636. - DOI - PMC - PubMed

12. Hidalgo B., Hall T., Bossert J., Dugeny A., Cagnie B., Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J. Back Musculoskelet Rehabil. 2017;30:1149–1169. doi: 10.3233/BMR-169615. - DOI - PMC - PubMed

13. Seidi F., Bayattork M., Minoonejad H., Andersen L.L., Page P. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: Randomized controlled trial. Sci. Rep. 2020;10:20688. doi: 10.1038/s41598-020-77571-4. - DOI - PMC - PubMed

14. Ruivo R.M., Pezarat-Correia P., Carita A.I. Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. J. Manip. Physiol. Ther. 2017;40:1–10. doi: 10.1016/j.jmpt.2016.10.005. - DOI - PubMed

15. Fathollahnejad K., Letafatkar A., Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: A six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20:86. doi: 10.1186/s12891-019-2438-y. - DOI - PMC - PubMed

16. Ghanbari A., Ghaffarinejad F., Mohammadi F., Khorrami M., Sobhani S. Effect of forward shoulder posture on pulmonary capacities of women. Sports Med. 2008;42:622–623. doi: 10.1136/bjsm.2007.040915. - DOI - PubMed

17. Watson D.H., Trott P.H. Cervical headache: An investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia. 1993;13:272–284. doi: 10.1046/j.1468-2982.1993.1304272.x. - DOI - PubMed

18. Huang M.H., Barrett-Connor E., Greendale G.A., Kado D.M. Hyperkyphotic posture and risk of future osteoporotic fractures: The Rancho Bernardo study. J. Bone Miner. Res. 2006;21:419–423. doi: 10.1359/JBMR.051201. - DOI - PMC - PubMed

19. Singla D., Veqar Z. Association between forward head, rounded shoulders, and increased thoracic kyphosis: A review of the literature. J. Chiropr. Med. 2017;16:220–229. doi: 10.1016/j.jcm.2017.03.004. - DOI - PMC - PubMed