Recently in the gym, I’ve seen a case of Vladimir Janda’s Lower-Crossed Syndrome (Type A). In today’s blog, I’m going to briefly discuss LCS, tell you what it’s all about, and share with you some thoughts on how to go about correcting it. So, here we go!
Lower-Crossed Syndrome is a specific pattern of lower body muscle tightness and weakness that cross between the dorsal (back) and ventral (front) sides of the body. LCS is characterized by tightness of the thoracolumbar extensors which crosses with tightness of the iliopsoas and rectus femoris (two of the hip flexors). It is also characterized by weakness of the abdominals (particularly the deep abdominal muscles) which crosses with weakness of the gluteus maximus and medius.
Janda classified the thoracolumbar paraspinals, iliopsoas, and rectus femoris as tonic muscles, which are prone to tightness. He classified the rectus abdominis, transverse abdominis, gluteus maximus, and gluteus medius as phasic muscles, which are prone to weakness. There are also certain postural changes that are consistent with Lower-Crossed Syndrome. Two of the most prevalent ones, which I’ve seen in the case in question, are an anterior pelvic tilt and an increased lumbar lordosis. So where do we go from here, you might ask? Well, below are just some thoughts off the top of my head on where to begin when addressing Lower-Crossed Syndrome.
1. Tissue Quality!
I included the exclamation point because I can’t stress this enough. We need to get some length out of the hip flexors and thoracolumbar extensors. This starts with some dedicated SMR (self-myofascial release), or foam rolling. Of course, be sure to concentrate on the rectus femoris and the thoracolumbar region, but do not neglect other areas of the body. For example, while foam rolling your legs, get the TFL/IT band, adductors, glutes, hamstrings, and calves/peroneals. While foam rolling your back, spend some time on the upper, middle, and lower traps as well as the lats. Hit the posterior rotator cuff and pectorals while you’re at it. Our body is essentially a linked chain, so when an issue arises in one part of the chain, it is important not to forget about the surrounding areas, as that is where the true source of the problem may be.
Feel free to make a tennis or lacrosse ball your friend, too. These are great for digging into certain parts of the body. A personal favorite of mine is to use a lacrosse ball on the rectus femoris. While rolling out this muscle, pause when you feel a trigger point, and flex your knee with the ball applying direct pressure to the spot. This hurts like hell, but it works like a charm in breaking up nasty adhesions.
To further promote length in the hip flexors, include plenty of hip flexor mobilizations in your dynamic warm-up. Wall hip flexor mobilizations, as seen below, are an excellent choice, and I’d also recommend lunging variations.
A couple of my favorites are reverse lunges with posterolateral reach and walking spiderman lunges, but your basic forward lunges will suffice as well.
Also, even though there may be some debate questioning its overall effectiveness, I still believe in static stretching. Take the time after a training session to stretch your hip flexors. My favorite stretch is shown below by my co-worker Josh. With this stretch, make sure your chest is up tall and your spine is in neutral. Squeeze your hamstrings and glute hard, and hang out here for 30 seconds to a minute on each leg before repeating. To enhance the stretch, rotate towards your forward leg. To enhance it even further, rotate and reach posterolaterally (back and to the side). Always focus on rotating through your chest.
Lastly, find a good manual therapist, preferably one who practices ART (Active Release Technique) or Graston. It’s a step above SMR and will benefit you even more. I’ve been seeing an ART practitioner every week for a couple of months now and it has certainly made a difference in how I feel and move, which has positively affected my training in the gym.
2. Anterior Core Progressions
The anterior core needs plenty of attention and strengthening. The true function of the core is to stabilize the spine, so we will train the anterior core with stability in mind. A good place to start is with low-level strengthening exercises, such as front planks against a wall. I like the front plank against the wall because it allows the individual to find neutral spine without a huge challenge to the core. However, you may find that these are actually harder than they look! Stick with holds of 8-10 seconds for the appropriate number of repetitions. To add difficulty, perform one-arm holds or “march” your arms by retracting and protracting the scapula. Once the plank against the wall has been mastered, progress to a plank with arms on a table, and then to a plank from the floor.
From there, consider advancing to stability ball rollouts and TRX fallouts.
3. Glute Activation and Hip Hinging/Hip Thrust Progressions
In addition to the anterior core, the glutes need to be woken up and strengthened. One of the primary roles of the gluteus maximus is hip extension and a great place to start is with the tall-kneeling hip thrust. I like the tall-kneeling hip thrust because it makes it easier for the trainee to separate hip extension from lumbar extension. Let the individual master the tall-kneeling hip thrust and really feel the glutes working before moving on to supine hip thrust variations. Below, Mike Reinold shows the tall-kneeling hip thrust utilizing a dowel rod and tubing. I would start with just bodyweight and then progress to this version.
Notice the position of Mike’s feet in the video: they are together, with his feet about shoulder width apart. This is a very advantageous position for people with LCS, as it “slackens” the hip flexors and allows for more hip extension and a better glute squeeze at the top of the movement. Progress to bilateral and unilateral supine hip thrust variations after proper technique and glute firing has been achieved in the tall-kneeling hip thrust.
To hit more of the glute medius, toss in some hip abduction movements, such as mini-band walks and x-band walks.
4. Proper Coaching and Cuing
Those demonstrating LCS will need a healthy amount of coaching and cuing. Coaches must make sure that these clients are using correct technique at all times, especially during exercises aimed at activating and strengthening the anterior core and glutes. LCS clients are highly susceptible to compensating during these movements, so be certain that the exercises they are performing are consistent with their current level of ability. With their permission, be hands-on and ensure that they’re activating the targeted muscles.
Assist your client in finding neutral pelvis and neutral spine, especially during core exercises. A great cue I learned from Mike Reinold is, “Neutral, brace, breathe.” Find neutral pelvis/spine, brace the core musculature, and breathe. Remember, those with LCS have been stuck in this posture for a considerable amount of time; it is going to take tons of coaching, cuing, poking, and prodding to reverse it, which leads me to my final point…
Coaches and clients should understand that, like most training and rehabilitation, correcting LCS requires time and effort. As a client, it is going to demand some changes in your training and possibly your lifestyle. For instance, are you a runner who constantly hangs out in anterior pelvic tilt? It may be worth your while to consider limiting your miles for a while during your off-season and focusing on correcting your LCS. Know that you will be starting your corrective regimen with repetitions of very basic exercises. You must master these exercises before your coach or therapist will consider giving you slightly more advanced movements. Foam rolling, manual therapy, stretching, and mobility will also be a regular part of your routine. If you buy into these modalities and your prescribed program, then you will ultimately reap the benefits of improved muscle balance and posture.
By no means is this an exhaustive list, but hopefully you’ve learned something about LCS and how to go about treating and addressing it.