Lower Crossed Syndrome in Runners: Why your posture may be hurting you

By Mike Virgile – Pawtucket

Running is a dynamic activity that requires several different body systems to be working together in order to avoid injury or breakdown.  If one of these systems is not working properly, then the body will find ways to adapt, and most of the time these small adaptations go unnoticed by the runner until it is too late.  For example, if an athlete is missing the range of motion in their ankle necessary to properly advance the body over the foot while running, then they will usually make up for that lack of motion by compensating through their hip joint.  When repeated, long-term adaptations occur, the result is usually the same:  pain and injury.

From plantar fasciitis to low back pain, runners experience a wide range of different injuries and many of these injuries can be traced back to one cause: faulty posture.  Looking to see if certain landmarks on the body line up correctly from the front and side views assesses posture.  Symmetry across the body, muscle tone, and spinal curves are also examined to help a health care professional determine if any muscles in the body are too long or short, or are being over or underused.

There are many different postures seen in the clinical setting, but one of the most commonly found is referred to as lower crossed syndrome.  It’s characterized by a large inward curve in the lower back and a shift of weight from the center of our body towards the front of the body.  This change in alignment often occurs due to an imbalance in the length, strength, and function of the muscles crossing the front and the back of the hips.

In lower crossed syndrome, the iliopsoas and rectus femoris (hip flexor muscles) are shortened.  This shortening occurs due to the large amount of time we all spend sitting each day. These sitting activities keep the hip flexors in a shortened position and eventually the body feels that to be its normal length.  Over time, the constant contraction of the hip flexors causes the glutes in the back of the hip to become weak and stretched because these two muscle groups have opposite functions. The glutes’ major job is to extend the leg backwards on the body, but during running, the leg is in contact with the ground so the glutes work to advance the body forward over the stance leg.  When these become weak and can no longer perform this function effectively, then the hamstrings and the back extensors need to take over for the glutes.  This overworking of the hamstrings and lower back leads to pain and injury.  To make matters worse, when the back extensors are constantly being contracted, the lower abdominal muscles become weak and inactive (similar to the hip flexor/glutes relationship), further feeding into the lower crossed syndrome. Distance runners are even more at risk due to the repetitive overuse of the hip flexors during their runs.

We can now begin to look at different techniques we can use to correct our posture and lower our risk of injury. The general idea is simple: look at the imbalances listed above and lengthen the tight muscles and strengthen the weak ones.  First, we can stretch our hip flexors/quadriceps and lumbar spinal muscles, then strengthen the glutes and lower abdominals.  The important thing to focus on during these exercises is that the glutes, not the hamstrings, are doing the work.  This will address the factors contributing to lower crossed syndrome and improve muscle function for running.  A skilled physical therapist or exercise professional can show you the best ways to do this for your body.

Now that the muscle imbalances have been addressed, it is important to avoid putting ourselves into positions for long periods of time that reinforce lower crossed syndrome. Setting a timer at work to remind you to stand up, walk around, or even stretch every hour (every half hour would be better, but we can’t get greedy) is one way to prevent the hip flexors from getting too tight.  Ergonomic workstation evaluations can be performed to ensure that computer monitors, chairs, and desk height are all at their ideal positions to avoid increasing stress on the back and hips.

Keeping up with these tips and performing exercise as discussed above will help to prevent lower crossed syndrome and keep you injury-free.  As always, getting the help of a physical therapist or other health/fitness professionals is the best way to find out exactly what you need.

Mike Virgile DPT, CSCS

Mike is a physical therapist at FOUNDATIONperformance sports medicine’s Plainville, MA and Pawtucket, RI locations.  FOUNDATIONperformance, with offices in Pawtucket, RI; Plainville, MA; and Warren, RI, has been providing fitness, physical therapy, and performance enhancement services since 2003.  [email protected]

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