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Postural Syndromes: The Low Hanging Fruit for Improving Fitness and Pain

Working from a desk is a reality for a majority of people in today’s world. The Covid-19 pandemic changed many things but creating an even greater shift toward remote desk work was definitely one of them. If working at a desk for multiple hours a day is as common as brushing your teeth, then we need to take a deeper look at postural syndromes and their effect on how we feel and function. The purpose of this blog is to explain some very basic postural mechanics and give you tools to go to war with your desk chair with big Leonidas energy.

First of all, what are postural syndromes??

Postural syndromes are not exact clinical diagnoses like a rotator cuff tear or achilles tendonopathy but instead are a cluster of clinical findings. If you have these postural deficits it doesn’t mean that injuries or things will happen to you. It means the likelihood skyrockets. Since statistically 80% of low back pain is “non-specific” (meaning there is no formal diagnosis other than back pain) it’s obviously worth exploring these other causative factors. Postural syndromes are nothing more than consistent patterns of tight and weak muscles as well as changes to spinal positioning.

There are two primary postural syndromes that I see consistently. We’ll break them down one by one using the picture as a reference. The red lines indicate patterns of tightness or restriction, and the green lines indicate patterns of weakness. These syndromes are called “crossed” syndromes due to the crossing pattern of the dysfunction.

Upper crossed syndrome (UCS):

This common upper body pattern can be seen in those with chronic forward head positioning and typical “slouchy” desk posture. What develops is a consistent and predictable pattern of deficits. The person develops significant weakness in their deep neck flexors (front of neck, needed for good cervical positioning) and their scapular musculature (needed for darn near anything you do with your arms). They develop significant tightness in the reciprocal pattern of musculature in the back of their neck and the front of their shoulder and chest. Conversely, these people will develop negative changes in the curvature of their cervical spine. UCS can lead to a myriad of problems ranging from headaches, neck pain, nerve entrapments, TMJ pain to problems with the upper extremity such as shoulder impingements or even rotator cuff injuries. Since your cervical and scapular region affect all aspects of upper extremity function, this can be a potentially painful and burdensome problem if left unchecked.

Lower crossed syndrome (LCS):

LCS is the same phenomenon but in the lower half of the body. Individuals develop significant tightness to their hip flexors and low back musculature with subsequent weakness to abdominals and gluteals. Again you can lose some of the curvature of your lumbar spine which is abnormal and can lead to a host of problems. LCS can play a role in injuries ranging from general low back pain to hip flexor tendonopathy or sciatica.

Hang in there. There is good news. YOU can take action.

Improving these deficits is low hanging fruit for pain and performance. Although not easy, the solution is incredibly simple. On each muscular group, spend time doing the opposite of the dysfunction. In simple terms if it’s tight stretch it, and if it’s weak strengthen it.

Here’s a few exercises than can be helpful.


Seated chin tuck: strengthens deep neck flexors and simultaneously provides a stretch to sub-occipitals.

Prayer stretch: stretches lats, pecs which restrict posture. You can do this at a desk.

Seated or standing external rotation isometric holds: strengthen lower trap and other scapular musculature.


Couch stretch: stretches anterior hip

Lumbar crossover stretch: stretches low back and hips

Pigeon press up: activates glutes and stretches ant hip

Is this list exhaustive? Heck no. There are dozens of exercises that could be useful for these deficits. These are simply ones that I like and are very simple.

The real challenge is not “which” exercise but the consistency which you do them. If you are sitting at work for 8 hours a day, you need proactive things built into your day.

What does this look like practically?

Let’s be honest with ourselves for one minute. You don’t work 60 minutes of every hour do you? You work, you text, you check emails, you listen to “jiggle jiggle” tik tok videos (so catchy right?). I say this to plant this seed.

You can find 2 minutes per hour to do positive things for you body. I promise you that you can. Set a timer on your phone every hour.

Choose 2 stretches or exercises from above or find your own, rotate through them, and do them every hour you’re at a desk. Over the course of weeks and months, you’ll be shocked at the difference it makes. If you train, you’ll see a difference in how your hips feel in a squat or your overhead positioning. Maybe that nagging back pain will go away. If you build these things into a reward system for yourself, you may even like it.

Postural syndromes are not formal diagnoses, but are just as pivotal to your health and how you feel. If you’re a desk athlete, let’s be proactive. Take charge of your positioning and posture. You’ll thank yourself for it later.

Stay kinetic friends!


Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.

If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.

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