Lower Crossed Syndrome: Physiotherapy Management


The concept of lower Crossed Syndrome defined by Vladimir Janda, is actually a postural imbalance in which muscle are either too tight or too weak, that cross between the dorsal and ventral sides of body, this imbalance pulls the body into unfavorable condition. It is characterized by anterior tilt of pelvis(increased flexion of hip) with hyperlordotic lumbar spine and sometimes also have forward head posture.

Crossed” defines as crossing patterns of over active (shortened and tight) with counter crossing of under active muscle (weak and lengthened)

crisscross pattern

Source: https://www.wholebodyhealth-pt.com/wbhptblog/lower-crossed-syndrome


A person who sit for a long time is also a cause of shortening of hip flexor, holding a static position constantly creates imbalance in muscle of pelvic region and in athletes with performance of incorrect exercise(improper techniques) or overwork can have trouble with lower crossed syndrome. Sedentary lifestyle is another cause for LCS which increase anterior tilt with excessive lower back arch.Also effects above and below region as well.The condition is caused by poor posture and lack of core stability for spine.

That’s why it’s important to observe pelvic region as it connects the upper and lower body.Even with each step pelvis move by tilting forward and backward, on the upper part of body shoulder and arms swing opposite to the legs.This counter-rotation makes the back and hips important for integrity of body.

Lower crossed syndrome is a combination of four factors:

  • Weak abdominals/trunk muscles (rectus abdominis, internal abdominal oblique, external abdominal oblique and transverse abdominis) and
  • Weak Gluteal Muscles(maximus,medius and minimus)
  • Tight Hip flexors(iliopsoas,tensor fascia latae) and
  • Tight Low back Extensors(erector spinae, multifidus, quadratus lumborum and latissimus dorsi)

Sometimes hamstrings also tight in this condition

This weak and tight muscles form a “crisscross” or “X” shape pattern

Tight Lower back

Due to tension in iliopsoas and rectus femoris which pull the pelvis in compromised position and lack of strength in trunk and gluteal muscles which maintain spine in neutral position.

Tight Hip flexor

When downward pull is exerted on the pelvis by hip flexor it moves forward into a position of anterior tilt which inhibits the force producing capacity of the gluteus leads to low back pain.

Weak Abdominals

Abdominal, oblique and inner unit core muscles resist extension, and when they can’t resist to extend lower back discomfort happens.

Weak Gluteus

Gluteus maximus help in hip extension and posterior tilt of pelvis, when they don’t perform well, hamstrings and quadriceps take over the movement which cause hamstring strain and back pain issues because of incomplete hip extension and decreased work capacity.


  • This postural imbalance increase pressure at specifically at L4, L5 and S1
  • SI joint and hip joint imbalance
  • Joint pain (includes lower back, knee, hip)
  • Postural changes e.g. anterior pelvic tilt,  hyperlordotic lumber spine, lateral shift lumber, external rotation of hip and hyperextension of knee which also effect the other parts of body e.g, forward head posture
  • Poor physical performance

Special Test 

  • Kemp’s test
  • Thomas Test
  • Forward Bending Test
  • Gluteus Maximus Strength Test
  • Psoas Major Strength Test
  • Schober’s test

Physiotherapy Treatment

  • Tight muscles should be stretched, which improves the strength of inhibiting antagonistic muscle, strengthening is not effective for tight muscles because it may cause further tightness and weakness.

Half kneeling hip flexor stretch

So, to lengthen the muscles, pelvis need to go into posterior tilt direction to stretch the hip flexor, as shown in image below

flexor stretch


  • For Weak Abdominals: It’s important to strengthen those muscles which are weakened in order to increase the muscle’s function and to improve posture.

Hardstyle Plank

During this exercise the quadriceps, glutes and abs are all squeezed to create full body tension.The lower back is in a neutral position.


  • For Weak Glutes

Glute Bridge

This exercise helps to train glutes when you achieve full hip extension with bridge.

glute bridge

  • Posture training  (Avoid posture which aggravate lumbar lordosis or other posture related conditions)
  • Joint mobilization/Manual therapy
  • Self Myofascial release with biofoam roller massage
  • Modalities  includes Ultrasound, laser therapy, thermotherapy


To prevent lower crossed syndrome, sitting by taking breaks or avoid prolonged sitting: correct your posture. Avoid overwork or improper exercise: consult healthcare professionals. For treatment stretch tight muscles and strengthen weak muscles.




  1. http://studio-element.net/a-brief-introduction-to-jandas-lower-crossed-syndrome/
  2. https://www.physio-pedia.com/Lower_Crossed_Syndrome
  3. https://www.physiotherapy-treatment.com/lower-crossed-syndrome.html