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Lower Crossed Syndrome Cheat Sheet (DRAFT) by

Presentation, Management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Muscles can be postural or phasic
Postural (Thora­col­umbar ext, iliopsoas, rec fem) muscles are more likely to be tight
Phasic (Deep abdominal muscles and gluteals) respond by becoming weakner


- GT pain syndrome
- ITB syndrome
- PF
- Balance, gait, propri­oce­ption issues
Can all be associated with LCS


- Subtype A: Tight, short hip flexors - excessive hip and knee flexion + hyperl­ordosis in Lx
- Subtype B: Flat/h­anging gluteals - strong hip flexors and spinal erectors, anterior pellvic tilt, knee hypere­xte­nsion, lumbar hypolo­rdosis , upper tx hyperk­yphosis + AHC


Postural exam reveals: Anterior pelvic tilt
Lx hyperl­ordosis
Lateral lumbar shift
Lateral leg rotation
Knee hypere­xte­nsion
- Gluteal weakness causing Trende­len­berg, assess the single leg squat /pelvic drop/knee buckli­ng/foot pronat­ion­/lumbar hyperl­ordosis
- +ve Thomas Test, +ve Wall angel
- Gluteal weakness causes hypera­ctivity in the hamstrings and piriformis
- TTP in QL, TFL and Gastro­soleus
- Joint dysfun­ction of L4/L5 & L5/S1, SI and hip joints


- Does not require imaging unless suspected structural pathology


- Sherri­ngton's law - one muscle is hypert­onic, its anatag­onist relaxes - hypertonic muscles must be lengthened before streng­thening
- Stretching and myofascial release of: Thorac­olumbar extensors, iliopsoas, rectus femoris, QL, TFL, hamstr­ings, piriformis
- Myofascial release of gluteals (Home exercise - foam roller of thigh and hip muscles)
- SMT of lumbop­elvic joints
- Streng­thening of abdominal and gluts - dead bug, posterior lunge, clam, side bridging, board stability
- Ergonomic advice