Figure 1 - uploaded by Phil Page
Content may be subject to copyright.
Janda's Upper Crossed Syndrome. Reprinted, with permission, from Page et al, 2010, Assessment and Treatment of Muscle Imbalance: The Janda Approach (Champaign, IL: Human Kinetics).
Source publication
Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth o...
Context in source publication
Context 1
... Janda suggested that subacro- mial impingement results from a characteristic pat- tern of muscle imbalance including weakness of the lower and middle trapezius, serratus anterior, infra- spinatus, and deltoid, coupled with tightness of the upper trapezius, pectorals and levator scapula. 1 This pattern is often referred to as part of Janda's "Upper Crossed Syndrome." (See Figure 1) While structural impingement sometimes requires surgery to alleviate pain, functional instability requires the implementation of precise therapeutic exercises Imbalances or deficits in muscular strength and activation levels can lead to functional impinge- ment. Both glenohumeral and scapulothoracic mus- cle imbalances can contribute to shoulder complex dysfunction. ...
Similar publications
Objectives
To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth.
Data sources
The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta‐analysis were selected. If there was no such article, the authors selecte...
Recent developments in the study of recrystallization and grain growth in rocks and minerals are briefly reviewed and key issues discussed.
Stable crack growth has been observed in molybdenum, iron-silicon and magnesium oxide single crystals. The experimental data are reviewed and a new model for the process proposed.
Citations
... [4][5][6] Upper crossed syndrome (UCS) is an aberrant posture that, according to Vladimir Janda , refers to a specifically changed muscle activation pattern (especially in the neck, trunk, and scapular muscles), altered movement patterns (scapular dyskinesis), and postural deviations (forward head and shoulder posture and increased thoracic kyphosis). [7][8][9] In persons with UCS, the deviation from optimal posture 10,11 is associated with changes in muscle activity, movement patterns, 8,10 and biomechanics. 12 It is well established that biomechanical deficiencies, including excessive adduction and internal rotation of the scapula, and altered muscle activity patterns during functional activities can be associated with overuse injuries. ...
... [4][5][6] Upper crossed syndrome (UCS) is an aberrant posture that, according to Vladimir Janda , refers to a specifically changed muscle activation pattern (especially in the neck, trunk, and scapular muscles), altered movement patterns (scapular dyskinesis), and postural deviations (forward head and shoulder posture and increased thoracic kyphosis). [7][8][9] In persons with UCS, the deviation from optimal posture 10,11 is associated with changes in muscle activity, movement patterns, 8,10 and biomechanics. 12 It is well established that biomechanical deficiencies, including excessive adduction and internal rotation of the scapula, and altered muscle activity patterns during functional activities can be associated with overuse injuries. ...
... Exercise 8: Standing diagonal fexion with Tera-band. (7,8) ...
Purpose : Poor posture has a negative impact on physical capability and is associated with changes in biomechanics and motor control. The purpose of this study was to assess the effect of corrective exercises on ground reaction forces (GRFs) in male student handball players with upper crossed syndrome (UCS) during throwing. Methods : Thirty male handball students with UCS participated in this single-blind randomized controlled trial (IRCT20200622047888N2; IR.HUMS.REC.1402.135). Fifteen received an 8-week corrective exercise intervention (exercise-intervention group [EG]), consisting of exercise targeting muscles involved in the UCS, and 15 served as the control group (CG). During handball throwing, GRF was measured by force plate. The forward head and rounded shoulder angles were measured with a photogrammetric method. All measurements were repeated 8 weeks later. Results : Significant interactions for virtually all parameters indicated that changes over 8 weeks differed between the CG and EG. A reduction in GRFs and a delayed occurrence of peak GRFs were observed in the EG, but not in the CG ( P < .05). This was accompanied by a significant reduction in forward head ( P < .03; effect size: 0.87; 95% confidence interval, −2.34 to 0.13), rounded shoulder ( P < .05; effect size: 0.68; 95% confidence interval, 0.32 to 1.22) and thoracic kyphosis ( P < .02; effect size: 0.64; 95% confidence interval, 0.54 to 1.25) angles in the EG ( P < .05) with no significant change over 8 weeks in the CG. Conclusion : Corrective exercises targeting muscles directly involved in UCS induces functional and postural improvements in male student handball players with UCS.
... Shoulder impingement syndrome (SIS) is characterized by the compression of subacromial structures between the humeral head and coracoacromial arch [3], particularly prevalent among overhead athletes [1,4]. The primary clinical features of SIS include pain, a restricted range of motion (ROM), and diminished strength in the arm [5,6].Contributing factors to shoulder impingement include mechanical compression of the rotator cuff structures (6), improper scapular stabilization [7], weakness of the rotator cuff muscles, acromial morphology, muscle imbalances, joint capsule laxity or tightness, dysfunctional glenohumeral and scapulothoracic kinematics, as well as degeneration and inflammation of the tendons or bursa [8].The implications of SIS for athletic performance are significant, as it can lead to altered proprioception [9,10], muscle imbalances, impaired motor control [11], and disruptive movement patterns [12]. ...
Objectives
To assess whether the combination of scapular-focused training and mulligan mobilization (SFTMM) improves pain and proprioception compared to scapular-focused training (SFT) and a control group in female rock climbers with shoulder impingement syndrome (SIS).
Design
Three-arm randomized controlled trial (RCT).
Setting
Outpatient setting.
Subjects
Individuals were randomly assigned to SFTMM, SFT alone, and control group.
Interventions
8 weeks of SFTMM and SFT.
Main measures
Outcome measures were pain and proprioception.
Results
The results revealed significant differences in pain scores and proprioception among female rock climbers with SIS who participated in SFTMM, SFT, and a control group (F(2, 32) = 81.01, p = 0.001, η2 = 0.83 for pain scores; F(2, 32) = 178.2, p = 0.001, η2 = 0.91 for proprioception scores). Post-hoc tests via the Bonferroni test indicated that both SFTMM and SFT significantly reduced pain levels (p = 0.001) and improved proprioception levels (p = 0.001) compared with the control group. There was no significant difference in pain scores and proprioception between the SFTMM group and the SFT group (p > 0.05).
Conclusions
In conclusion, the study indicates that SFTMM significantly reduces pain and improves proprioception in female rock climbers with SIS, as shown by notable changes compared to the control group. However, no statistically significant difference was found between the SFTMM (combined intervention) and SFT alone. Therefore, while the incorporation of SFT and MM shows promise; further research is needed to fully understand its long-term benefits and clinical implications.
Ethical Code Registration
The study was approved at Ethics.research.ac.ir, code: IR.SSRC.REC.1402.170 on 2023-10-22.
... Greater anterior tilt can significantly decrease the subacromial space, potentially leading to various long-term pathologies such as subacromial bursitis, rotator cuff tendinopathy, tightening of the posterior capsule, and fullthickness rotator cuff tears. 21,29,31 . ...
... Abboud and Soslowsky [13] concluded that altered force couple vectors of the rotator cuff can lead to instability and thus destabilization of the humeral head on the glenoid cavity. An imbalance in this muscular system might be conducive to the development of structural damage in the glenohumeral joint [14]. ...
The objective of this systematic review of etiology and risk was to determine the association between modifiable musculoskeletal factors and shoulder dysfunction in an adult population.
There is still a paucity of evidence in the literature on shoulder function and the influence of modifiable musculoskeletal factors on function. The present study aimed to explore current and past research on all reported modifiable musculoskeletal factors to clarify the multifactorial etiology of shoulder dysfunction in an adult population.
The methodology and meta-analysis process were performed as detailed in the JBI Reviewer’s Manual for Etiology and Risk, and the following guidelines were used according to the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. When a meta-analysis of the data was not possible, the SWiM (synthesis without meta-analysis) approach was used for the synthesis of pooled modifiable musculoskeletal factors. The outcome measure considered was shoulder dysfunction. The exposure parameters measured were modifiable musculoskeletal factors leading to the development of shoulder dysfunction. Patients aged between 18 and 75 years were included. A total of 7628 studies were identified worldwide through searching 12 databases. The results yielded by 91 studies were included in the systematic review. The risk of bias was low for 88 studies. Both females (2441) and males (3117) were included. The systematic review included cross-sectional and longitudinal studies investigating most sporting subpopulations (swimming, rugby, weightlifting, wheelchair, volleyball and baseball; 1003 participants) and members of the general population (4651). Pooling of the results into five meta-analyses was possible.
The results revealed that affected musculoskeletal factors led to a decrease in the strength of shoulder dysfunction during external rotation, with I2 = 0 indicating a large positive effect size of 0.59 (p = 0.00), a decreased external versus internal muscle strength ratio, with I2 = 46 indicating a large negative effect size of − 0.69 (p = 0.002); decreased flexibility of the posterior capsule, with I2 = 0 indicating a small negative effect size of -0.0 (p = 0.45); decreased internal rotation, with a large negative effect size of − 1.00 (p = 0); and a glenohumeral internal rotation deficit. Participants were 1.29 times more likely to develop shoulder dysfunction in the presence of decreased external rotation strength.
A comprehensive evaluation of the shoulder joint should include all identified musculoskeletal factors of the present systematic review at one point in time. Modifiable musculoskeletal factors include the strength of the (ERs) and the (IRs); the strength ratio of the (ERs): (IRs); the IR ROM movement; the TROM; GIRD; PMm length; and scapular stabilizer strength and strength ratios.
Trial registration This protocol has been registered in PROSPERO (CRD 42021261719)
... This syndrome is characterized by forward head posture, increased kyphotic angle, and a rounded shoulder [1]. In this syndrome, there is overactivation of the upper trapezius, pectorals, and levator scapula and underactivation of the serratus anterior, infraspinatus, middle, and lower trapezius muscles [2]. These alterations can lead to multiple problems in the head, neck, and shoulder resulting in headache, neck and back pain, chest discomfort, upper arm neuropathy, and gastroesophageal symptoms [3,4]. ...
... Janda has already suggested that there is a pattern of muscular imbalance in UCS due to the tightness of the upper trapezius, pectorals, and levetor scapulae and weakness of the middle and lower fibers of the trapezius, infraspinatus, and serratus anterior [1]. This muscular imbalance can lead to altered arthrokinematics and movement patterns [2]. Muscle imbalance can have an impact on movement patterns. ...
Background: Upper cross syndrome (UCS) is one of the most common postural dysfunctions due to prolonged flexed attitude. Good posture plays an important role in maintaining musculoskeletal balance and protecting it from further injury. Conducting research on the conceptual framework will help clinicians to identify and plan treatment strategies for the correction of this syndrome and prevent secondary complications. Thus, the aim of this study was to develop a conceptual framework for UCS.
Methods and material: The Delphi method was used to conduct the study and develop a conceptual framework. A total of 30 multidisciplinary experts participated in the study, and a list of 41 items was finalized after an extensive literature review. A cover letter along with all the items was mailed to the experts to obtain their input. Three rounds of Delphi were conducted until a consensus was reached. The following parameters were used to determine consensus: moderate Kendall's coefficient of concordance (Kendall's W), agreement greater than 51.0%, interquartile range (IQR) below 1.5, and standard deviation (SD) below 1.
Results: By the end of the third round, 37 items were finalized. The conceptual framework consisted of four items in postural alignment, eight items in muscular imbalance, 20 items in functional limitation, and five items in the psychosocial domain.
Conclusion: We successfully developed a conceptual framework for UCS. Four domains, including postural alignment, muscular imbalance, functional limitation, and psychosocial, were identified. This will lead to a deeper comprehension of UCS, which will facilitate its early detection and treatment. The multidimensional approach of the study will provide a better scope for the clinicians to educate the patient about good posture, which not only will impact physical performance but also improve quality of life. The development of this framework will help to prevent, monitor the progress, and correct UCS.
... This syndrome is characterized by forward head posture, increased kyphotic angle, and a rounded shoulder [1]. In this syndrome, there is overactivation of the upper trapezius, pectorals, and levator scapula and underactivation of the serratus anterior, infraspinatus, middle, and lower trapezius muscles [2]. These alterations can lead to multiple problems in the head, neck, and shoulder resulting in headache, neck and back pain, chest discomfort, upper arm neuropathy, and gastroesophageal symptoms [3,4]. ...
... Janda has already suggested that there is a pattern of muscular imbalance in UCS due to the tightness of the upper trapezius, pectorals, and levetor scapulae and weakness of the middle and lower fibers of the trapezius, infraspinatus, and serratus anterior [1]. This muscular imbalance can lead to altered arthrokinematics and movement patterns [2]. Muscle imbalance can have an impact on movement patterns. ...
... Tightness of the pectoral muscles and weakness of the scapular muscles, especially the lower trapezius and serratus anterior, subsequently lead to a forward alignment of the shoulder posture. 10,11 A reduction in pulmonary function is related to an increase in FSP. 12 Therefore, poor posture resulting from FSP in COPD patients not only leads to musculoskeletal problems, but also causes deteriorating effects on the pulmonary system. ...
... 20 In addition, the viscoelastic effect of muscle stretching increases the range of motion, which is related to a reduction in the resistance to stretch and muscle stiffness, and an increase in muscle compliance. 11 Reducing tension in the stretched pectoral muscles allows them to lengthen and also decreases FSP. ...
Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60–90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p<0.001, p<0.001). Middle and lower chest mobility markedly increased (p<0.001, p<0.001) and the pectoralis minor index significantly improved (p<0.001). The strength of the lower trapezius and serratus anterior muscles significantly increased at week eight of the exercise training (p<0.003, p<0.001). There was a marked increase in maximum inspiratory pressure and maximum expiratory pressure (p<0.001, p<0.001). Conclusions The eight-week combined pectoral muscles self-stretching and serratus anterior and lower trapezius strengthening exercises could be an effective treatment and/or prevention strategy for FSP reduction, leading to improved respiratory function in male COPD patients.
... Abboud and Soslowsky [13] concluded that altered force couple vectors of the rotator cuff can lead to instability and thus destabilization of the humeral head on the glenoid cavity. An imbalance in this muscular system might be conducive to the development of structural damage in the glenohumeral joint [14]. ...
Objective:
The objective of this systematic review of etiology and risk was to determine the association between modifiable musculoskeletal factors and shoulder dysfunction in an adult population.
Background:
There is still a paucity of evidence in the literature on shoulder function and the influence of modifiable musculoskeletal factors on function. The present study aimed to explore current and past research on all reported modifiable musculoskeletal factors to clarify the multifactorial etiology of shoulder dysfunction in an adult population.
Methods:
The methodology and meta-analysis process were performed as detailed in the JBI Reviewer’s Manual for Etiology and Risk, and the following guidelines were used according to the PRISMA (Preferred Items for Systematic Reviews and Meta-Analysis) statement. When a meta-analysis of the data was not possible, the SWiM (synthesis without meta-analysis) approach was used for the synthesis of pooled modifiable musculoskeletal factors. The outcome measure considered was shoulder dysfunction. The exposure parameters measured were modifiable musculoskeletal factors leading to the development of shoulder dysfunction. Patients aged between 18 and 75 years were included. A total of 7628 studies were identified worldwide through searching 12 databases. The results yielded by 91 studies were included in the systematic review. The risk of bias was low for 88 studies. Both females (2441) and males (3117) were included. The systematic review included cross-sectional and longitudinal studies investigating most sporting subpopulations (swimming, rugby, weightlifting, wheelchair, volleyball and baseball; 1003 participants) and members of the general population (4651). Pooling of the results into five meta-analyses was possible.
Results:
The results revealed that affected musculoskeletal factors led to a decrease in the strength of shoulder dysfunction during external rotation, with I² = 0 indicating a large positive effect size of 0.59 (p = 0.00), a decreased external versus internal muscle strength ratio, with I² = 46 indicating a large negative effect size of -0.69 (p = 0.002); decreased flexibility of the posterior capsule, with I ²=0 indicating a small negative effect size of -0.0 (p = 0.45); decreased internal rotation, with a large negative effect size of -1.00 (p = 0); and a glenohumeral internal rotation deficit. Participants were 1.29 times more likely to develop shoulder dysfunction in the presence of decreased external rotation strength.
Discussion:
A comprehensive evaluation of the shoulder joint should include all identified musculoskeletal factors of the present systematic review at one point in time. Modifiable musculoskeletal factors include the strength of the external and internal rotators; the strength ratio of the external rotators: internal rotators; the internal rotation range of motion movement; the total range of motion; glenohumeral internal rotation deficit; pectoralis minor muscle length; posterior capsule and the glenohumeral posterior musculature flexibility; and scapular stabilizer strength and strength ratios.
This protocol has been registered in PROSPERO (CRD 42021261719).
... Abboud and Soslowsky [13] concluded that altered force couple vectors of the rotator cuff can lead to instability and thus destabilisation of the humeral head on the glenoid cavity. Imbalance in this muscular system might be conducive to the development of structural damage of the glenohumeral joint [14]. ...
Objective:
The objective of this systematic review of etiology and risk was to determine the association between modifiable musculoskeletal factors and shoulder dysfunction in an adult population.
Background:
A paucity of evidence still exists in the literature on shoulder function and the influence of modifiable musculoskeletal factors on function. The present study aimed to explore current and past research of all reported modifiable musculoskeletal factors to clarify the multifactorial etiology of shoulder dysfunction in an adult population.
Methods:
The methodology and meta-analysis process as detailed in the JBI Reviewer’s Manual for Etiology and Risk, were followed, and the guidelines as proposed by the PRISMA (Preferred Items for Systematic Reviews and Meta-Analysis) statement were adhered to. Where meta-analysis of data was not possible the SWiM (Synthesis without meta-analysis) approach was followed for synthesis of pooled modifiable musculoskeletal factors. The outcome measure considered was shoulder dysfunction. Exposure measured was modifiable musculoskeletal factors leading to the development of shoulder dysfunction. Age groups between 18 to 75 years of age were included. A total number of 7628 studies were identified worldwide through searching of 12 databases. The results yielded by 91 studies were included in the systematic review. The risk of bias was low for 88 studies. Females (2441) and males (3117) were both included. The systematic review included cross-sectional and longitudinal studies investigating most sporting sub-populations (swimming, rugby, weightlifting, wheelchair, volleyball and baseball (1003 participants) and members of the general population (4651). Pooling of results into five meta-analyses was possible.
Results:
Results concluded that musculoskeletal factors leading to shoulder dysfunction to be decreased external rotation strength, with I²=0 a large positive effect size 0.59 with p=0.00, decreased external versus internal muscle strength ratio, with I2 =46 a large negative effect size -0.69 with p=0.002, decreased flexibility of the posterior capsule, with I ²=0 small negative effect size -0.0 p=0.45, decreased internal rotation with I²=0, with a large negative effect size -1.00 p=0, and glenohumeral internal rotation deficit. Participants were 1.29 times more likely to develop shoulder dysfunction in the presence of decreased external rotation strength.
Discussion:
A comprehensive evaluation of the shoulder joint should include all identified musculoskeletal factors of the present systematic review at one point in time. Modifiable musculoskeletal factors comprise of the strength of the external and internal rotators; the strength ratio of the external rotators: internal rotators; the internal rotation range of motion movement; total range of motion; glenohumeral internal rotation deficit; pectoralis minor muscle length, posterior capsule and the glenohumeral posterior musculature flexibility and scapular stabilisers strength and strength ratios.
This protocol has been registered in PROSPERO (CRD 42021261719).
... Despite all the aforementioned facts, discrepancies have arisen during the characterization of subjects with shoulder pain. For instance, there are conflicting findings regarding the activity level of scapular muscles, such as increased activation [37,38] or no changes [26,37] of the LT or increased SA [30,39]. Similarly, there are conflicting reports regarding UT's activity level, with some studies indicating a decreased activity of this muscle and others recommending promoting higher UT activity levels [22,40,41]. ...
... Despite all the aforementioned facts, discrepancies have arisen during the characterization of subjects with shoulder pain. For instance, there are conflicting findings regarding the activity level of scapular muscles, such as increased activation [37,38] or no changes [26,37] of the LT or increased SA [30,39]. Similarly, there are conflicting reports regarding UT's activity level, with some studies indicating a decreased activity of this muscle and others recommending promoting higher UT activity levels [22,40,41]. ...
... A previous study comparing overhead athletes with shoulder impingement and healthy athletes during push-up exercises on an unstable surface also reported increased activation of the MT muscle of symptomatic subjects, suggesting that MT may be providing more stabilization in this group [15]. On the other hand, previous studies have reported a decreased MT activity level [37,98] (particularly related to its timing activation) or no differences in this muscle's activity [30,83] during other tasks. Although some of these findings were reported for subjects with shoulder pain without reference to the assessment of scapular dyskinesis [30,37,83], a study comparing subacromial impingement with and without scapular dyskinesis also did not find differences between groups during shoulder flexion [101]. ...
Despite the existence of several studies about the scapula’s position and motion, in shoulder pain conditions, there are still conflicting findings regarding scapular adaptations and reduced research about the scapula’s role during functional tasks. The present study aimed to compare scapular-related kinematic and electromyographic outcomes during different shoulder movements (with and without load) and the drinking task, between symptomatic and asymptomatic subjects. Forty subjects (divided into two groups) participated in this cross-sectional observational study. Scapulothoracic motion, scapulohumeral rhythm, and movement quality (considering trunk compensation, time-to-peak acceleration, and smoothness), as well as the relative surface electromyographic activity and muscle ratio considering the trapezius, serratus anterior, and levator scapulae (LS), were assessed. The symptomatic group presented the following: (1) changes in scapular upward rotation (p = 0.008) and winging (p = 0.026 and p = 0.005) during backward transport and drink phases; (2) increased muscle activity level of the middle trapezius (MT) in all tasks (p < 0.0001 to p = 0.039), of LS during shoulder elevation with load (p = 0.007), and of LS and LT during most of the drinking task phases (p = 0.007 to p = 0.043 and p < 0.0001 to p = 0.014, respectively); (3) a decreased serratus anterior lower portion activity level (SAlow) during shoulder lowering with load (p = 0.030) and drink phase (p = 0.047); and (4) an increased muscular ratio between scapular abductors/adductors (p = 0.005 to p = 0.036) and elevators/depressors (p = 0.008 to p = 0.028). Compared to asymptomatic subjects, subjects with chronic shoulder pain presented scapular upward rotation and winging adaptations; increased activity levels of MT, LT, and LS; decreased activity levels of SAlow; and increased scapular muscle ratios.
