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 Table of Contents  
Year : 2018  |  Volume : 18  |  Issue : 2  |  Page : 71-74

Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report

1 Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
2 Department of Neuro Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India
3 Department of Ortho Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Chennai, Tamil Nadu, India

Date of Web Publication16-Oct-2018

Correspondence Address:
Selvaraj Sudhakar
Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. M.G.R. Educational and Research Institute University, Maduravoyal, Chennai - 600 095, Tamil Nadu
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DOI: 10.4103/sjsm.sjsm_51_17

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Background: The upper crossed syndrome (UCS) is the one where participants present with rounded shoulders and a poked chin posture due to muscular imbalance that affects head position, spine, and shoulder girdle. The presence of this syndrome leads to secondary health problems such as myofascial trigger points, cervicogenic headache, impingement syndromes, neck pain, rotator cuff injury, and reduced lung capacity.
Objective: The objective of this study is to find the impact of UCS on respiration among the recreational male players.
Methodology: Sixty recreational male players were recruited in two stratified age groups, 21–30 years (Group A) and 31–40 years (Group B), and were recruited for this cross-sectional study. Among them, 30 were healthy male recreational male players while thirty recreational male players with UCS. The lung function in both the groups was compared with the two stratified age groups and analyzed.
Results: Recreational male players with UCS in both the stratified age groups, 21–30 years and 30–40 years, have reduced maximum voluntary ventilation when compared to their healthy counterparts.
Conclusion: Recreational male players with UCS have lower pulmonary performance when compared with their age-matched normal individuals.

  Abstract in Arabic 

تأثير متلازمة المتقاطعة العليا على وظيفة الرئة بين اللاعبين الذكور الممارسين للرياضة الترفيهية: تقرير أولي.


الخلفية: المتلازمة المتقاطعة العليا (UCS) هي الحالة التي يظهر فيها المشاركون بأكتاف مدورة وبروز الذقن بسبب عدم التوازن العضلي الذي يؤثر على وضع الرأس والعمود الفقري وحزام الكتف. وجود هذه المتلازمة يؤدي إلى مشاكل صحية ثانوية مثل نقاط الزناد الليفي العضلي، والصداع العنقي، ومتلازمات الاصطدام، وآلام الرقبة، وإصابة الكفة المدورة، وانخفاض طاقة الرئة.

الهدف: الهدف من هذه الدراسة هو العثور على تأثير UCS على التنفس بين اللاعبين الذكور الممارسين للرياضة الترفيهية.

المنهجية: تم استقطاب 60 لاعبًا ذكورًا في فئتين عمريتين: 21 - 30 سنة (المجموعة أ) و 31-40 سنة (المجموعة ب)، وتم توظيفهم في هذه الدراسة المقطعية. ومن بين هؤلاء، كان هناك 30 لاعباً ذكراً من الذكور الاصحاء الممارسين للرياضة الترفيهية في حين كان هناك ثلاثون لاعباً من الذكور مع UCS. وتمت مقارنة وظيفة الرئة في كلا المجموعتين مع المجموعتين العمرية الطبقية وتحليلها.

النتائج: اظهر اللاعبون الذكور الترفيهيون الذين لديهم UCS في كل من المجموعات العمرية الطبقية، 21-30 سنة و 30-40 سنة، تدنى التهوية الطوعية القصوى بالمقارنة مع نظرائهم الأصحاء.

Keywords: Forward head posture, maximum voluntary ventilation, spirometer, upper crossed syndrome

How to cite this article:
Kirthika S V, Sudhakar S, Padmanabhan K, Ramanathan K. Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report. Saudi J Sports Med 2018;18:71-4

How to cite this URL:
Kirthika S V, Sudhakar S, Padmanabhan K, Ramanathan K. Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report. Saudi J Sports Med [serial online] 2018 [cited 2021 Sep 17];18:71-4. Available from: https://www.sjosm.org/text.asp?2018/18/2/71/243355

  Introduction Top

Upper crossed syndrome (UCS) is a condition characterized by muscular imbalance where muscles of the neck and the shoulder girdle present with weakness and tightness. It is also referred to as proximal or shoulder girdle crossed syndrome, cervical crossed syndrome, student syndrome, forward head posture, or slouched posture. UCS was first described by Czech physician and physiatrist Dr. Vlandimir Janda. This syndrome is commonly seen in individuals with a prolonged sitting posture, those who sit especially in front of a computer also known as “white-collar job” workers with excessive neck bending[1],[2] and thus exhibit a poor posture. These people commonly present with a tightness of the upper trapezius and levator scapulae on the posterior aspect which crosses with tight pectorals both major and minor, and on the other hand, the weak deep cervical flexor anteriorly crosses with the weak middle and lower trapezius.

According to Janda, weakness is due to reciprocal inhibition of tight antagonist.[3] This abnormal posture for long-term creates muscular imbalance, dysfunction of atlanto-occipital joint, middle cervical segments, cervicothoracic joint,[1] shoulder joint, and T4–T5 segment. Moreover, it results rounded shoulder, scapular misalignment, forward head posture, reduced stability and mobility of the shoulder joint, cervicogenic headache, neck pain with referred pain to upper limb,[4],[5] and back pain. Postural stress syndrome is yet another complication due to tight neck extensors and weak neck flexors causing stress in the neck.[6] There is also reduced scapulohumeral rhythm and chest wall mobility.[1] According to Kang et al., forward head posture leads to balance disturbances among those who adopt prolonged sitting positions.[2]

The long-term effect of UCS causes low back pain due to constant structural overloading[1],[7] and also flattening of the lumbar lordosis due to kyphotic posture and causes posterior pelvic tilt.[8] This results in weakness of multifidus, abdominals, erector spinae, and gluteus. In participants with UCS, the tightness seen in the secondary muscles of inspiration makes them to get excessively activated during normal breathing. Poor activation of the diaphragm and intercostals also leads to overactivation of the secondary muscles. This leads to an abnormal breathing pattern.

This study is an attempt to study the effects of UCS on breathing and to compare the maximum voluntary ventilation exhibited by participants with UCS and normal individuals of two different age groups.

  Methodology Top

Sixty recreational male players with the age between 21 and 40 years are recruited for the study by simple random sampling. Among them, 30 are of with UCS and other 30 are physically and mentally well-being. Then, they were randomly allocated in two groups. Group A consisted of 30 recreational male players between 21 and 30 years and Group B consisted of recreational male players between 31 and 40 years to document the effect of UCS in different age groups. Each group covers 15 recreational male players with UCS and other 15 recreational male players who were healthy in the same age group (without UCS). The dully signed consent form was collected from all the participants. Then, the anthropocentric features are recorded. After documenting the anthropometric parameters, maximum voluntary ventilation (MVV) was recorded for 15 s (L/min) from all recruited participants in both the groups in comfortable sitting position using spirometer. These values were used for analysis between the groups.

Data analysis

The collected data were assessed for their normality using Kolmogorov–Smirnov test. As the data follow normal distribution, all the descriptive were expressed in mean ± standard deviation. Paired t-test was incorporated to find the statistical difference within Group A and B in participants with stress-induced asthma while independent t-test (Student's t-test) was utilized to compare the changes in mean values of all parameters between Group A and B. The data were analysed using statistical software, the Statistical Package for the Social Science (SPSS), IBM SPSS version 20.0 (IBM Corp., Armonk, NY, USA). P ≤ 0.05 was considered to be statistically significant.

  Result Top

The demographic characteristic of the recreational male players recruited was displayed in [Table 1]. The comparison of mean MVV values of Group A and Group B suggests that Group 1A (HI [healthy individuals], aged 21–30 years) showed a significant difference in mean values with Group 1B (HI, aged 31–40 years) at P < 0.05. Moreover, among Group 2A (UCS, aged 21–30 years) and Group 2B (UCS, aged 31–40 years), Group 2A showed a significant difference in mean values with Group 2B at P < 0.05, [Figure 1]. The result suggests that there is significant reduction in MVV among the recreational male players with UCS.
Table 1: Demographic characteristics between the groups recruited

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Figure 1: Comparison of maximum voluntary ventilation between Group A and B

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  Discussion Top

The present study measured the MVV in recreational male players with UCS and is compared with healthy participants of similar demographic characteristic. The results say that the participants with UCS were present with an abnormal breathing pattern with a decreased MVV value which is tested with a spirometer. Kapreli et al. in their findings reported that respiratory dysfunction exists in chronic neck pain patients and also that MVV is a sensitive indicator to elicit the neuromuscular control of respiratory muscles.[9] Rasouli et al. correlated slouched posture and decreased activation of transverse abdominis.[10] The amplitude of diaphragmatic movement is reduced and leads to activation of accessory inspiratory muscles.[11] Kaneko and Horie observed that prolonged sitting posture decreases the mobility of the chest and abdomen.[12] Forward head posture affects respiratory function by affecting the muscles of respiration,[9],[13] especially accessory muscles of inspiration.[13],[14] UCS and forward head posture cause accessory respiratory muscles to become shortened and weakened and reduce the MVV and in long term can produce respiratory dysfunction.

The increased kyphosis associated with this condition causes reduction in the rib-cage volume. The endurance and proprioception of the accessory muscles of respiration are also reduced. Cervical and thoracic stability is important for a smooth respiratory function. Increased muscle tension around thoracic spine causes reduced range of motion in the thoracic region.

It is necessary to consider the effects of UCS with its relation to breathing pattern apart from considering its musculoskeletal implications. Participants with UCS have to be treated keeping in mind the secondary respiratory dysfunction. Postural correction, strengthening and stretching exercises, has to be administered for early correction of the disorder.

  Conclusion Top

Recreational male players with UCS had reduction in the MVV values as compared to the recreational male players with the same age without UCS and BMI. Early physiotherapy intervention with postural correction, stretching and strengthening exercises, is absolutely necessary keeping in mind the long-term complications.


The authors would like to thank Dr. Asir John Samuel, MPT, (PhD), Associate Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana, India, for providing logistic and technical support in manuscript editing.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Groszek M, Babula G, Nagraba Ł, Stolarczyk A. Risks connected with a wrong sitting position Zagrożenia powstające w wyniku niewłaściwej postawy siedzącej. Arthrosc Joint Surg 2011;7:50-61.  Back to cited text no. 1
Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI, et al. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med 2012;36:98-104.  Back to cited text no. 2
Page P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics; 2010.  Back to cited text no. 3
Harrison DE, Harrison DD, Janik TJ, William Jones E, Cailliet R, Normand M, et al. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clin Biomech (Bristol, Avon) 2001;16:276-84.  Back to cited text no. 4
Fernández-de-las-Peías C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache 2006;46:454-60.  Back to cited text no. 5
Caneiro JP, O'Sullivan P, Burnett A, Barach A, O'Neil D, Tveit O, et al. The influence of different sitting postures on head/neck posture and muscle activity. Man Ther 2010;15:54-60.  Back to cited text no. 6
Leavitt SB. Sitting smarter. Health Facil Manage 1995;8:22, 24, 26-8.  Back to cited text no. 7
Mörl F, Bradl I. Lumbar posture and muscular activity while sitting during office work. J Electromyogr Kinesiol 2013;23:362-8.  Back to cited text no. 8
Kapreli E, Vourazanis E, Billis E, Oldham JA, Strimpakos N. Respiratory dysfunction in chronic neck pain patients. A pilot study. Cephalalgia 2009;29:701-10.  Back to cited text no. 9
Rasouli O, Arab AM, Amiri M, Jaberzadeh S. Ultrasound measurement of deep abdominal muscle activity in sitting positions with different stability levels in subjects with and without chronic low back pain. Man Ther 2011;16:388-93.  Back to cited text no. 10
Kaneko H, Horie J. Breathing movements of the chest and abdominal wall in healthy subjects. Respir Care 2012;57:1442-51.  Back to cited text no. 11
Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Med Hypotheses 2008;70:1009-13.  Back to cited text no. 12
Lee MH, Chu M. Correlations between craniovertebral angle (CVA) and cardiorespiratory function in young adults. Korean Soc Phys Med 2014;9:107-13. Available from: http://koreascience.or.kr/journal/view.jsp?kj=DGMHBK&py=2014&vnc=v9n1&sp=107. [Last accessed on 2017 Nov 02].  Back to cited text no. 13
Legrand A, Schneider E, Gevenois PA, De Troyer A. Respiratory effects of the scalene and sternomastoid muscles in humans. J Appl Physiol (1985) 2003;94:1467-72.  Back to cited text no. 14


  [Figure 1]

  [Table 1]


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