Lower Crossed Syndrome

Lower Crossed Syndrome Sang mi Yun October 23 rd 2017 Costa Mesa 2016

Abstract Lower-Crossed Syndrome (LCS) is also referred to as distal or pelvic crossed syndrome. In LCS, tightness of the thoracolumbar extensors on the dorsal side crosses with tightness of the iliopsoas and rectus femoris. Weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius. This pattern of imbalance creates joint dysfunction, particularly at the L4-L5 and L5-S1 segments, SI joint, and hip joint. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension. BASI Pilates Block System provides a program that can fix bad posture and improve week muscles, so LCS can be fixed and prevented. 2

Table of Contents Abstract 2 Anatomical description.4 Case study..9 BASI Block System..10 Conclusion 11 Bibliography 12 3

Definition The Unterkreuz syndrome is also known as pelvic crossed syndrome, lower crossed syndrome or distal crossed syndrome. The lower crossed syndrome (LCS) is the result of muscle strength imbalances in the lower segment. These imbalances can occur when muscles are constantly shortened or lengthened in relation to each other. The lower crossed syndrome is characterized by specific patterns of muscle weakness and tightness that cross between the dorsal and the ventral sides of the body. In LCS there is overactivity and hence tightness of hip flexors and lumbar extensors. Along with this there is underactivity and weakness of the deep abdominal muscles on the ventral side and of the gluteus maximus and medius on the dorsal side. The hamstrings are frequently found to be tight in this syndrome as well. This imbalance results in an anterior tilt of the pelvis, increased flexion of the hips, and a compensatory hyperlordosis in the lumbar spine. 4

Clinically Relevant Anatomy The pelvic crossed syndrome involves weakness of the trunk muscles; Rectus abdominus, Obliques internus abdominis, Obliques externus abdominis and transversus abdominis; along with the weakness of the gluteal muscles: Gluteus maximus, Gluteus medius and Gluteus minimus. These muscles are inhibited and substituted by activation of the superficial muscles. There is co-existing over activity and tightness of the thoracolumbar extensors: Erector spinae, Multifidus, Quadratus lumborum and Lattisimus dorsi; and that of the hip flexors: Iliopsoas and Tensor fasciae latae. The hamstrings compensate for anterior pelvic tilt or an inhibited gluteus maximus. 5

Tight Muscles Hip flexor group: tensor fascia latae, psoas major, psoas minor, iliacus, Sartorius, rectus femmoris, adductors complex Latissimus dorsi 6

Erector Spine Weak Muscle Abdominal muscle 7

Gluteus Muscle Main Causes of Lower Crossed Syndrome -bad posture -sitting too much -wrong and bad postures of sports and training -pregnant -high heel How to fix -strengthen abdominal and gluteus muscle -stretch hip flexor and trunk extensor 8

Case Study Sang mi Yun, 36 years old I have been doing Pilates over 1 year at BASI Pilates in Costa Mesa, CA. I stared with my journey in Sep., 2016 and I only had 20 private sessions experience of Pilates at that time. The reason why I started Pilates, because I had pain on my lower back and pelvis after I gave a birth to my daughter. At the beginning, my posture of exercise was really poor. I even could not roll-up and all exercise based on rounded back posture like roll-over, roll-like-a-ball, open-leg-rocker, etc. My back was very tight and abdominal was too weak to do those exercises. Also, my pelvis tilted forward, so my spine was hyper lordosis and my belly is pooched forward. It was typical Lower Crossed Syndrome. I am still struggling with it, but it is getting better because of whole body exercise of BASI Pilates Block System. I have been doing Pilates over 1 year with well programed BASI Block System that fixed my problems. I always start with 2 times roll-down which can stretch my tight back and I do warm up on the mat and then start with foot work/ abdominal work like hundred and coordination on Reformer/ hip work/ spinal articulation like semi-circle or short spine on the reformer/ stretch like kneeling lunge or full lunge on the reformer/ full body work/arm work/ foot work like single leg skating/ lateral flexion like side over on the box/ back extension and then I end with 2 times roll down. I usually focus Abdominal work for strengthening my week muscle, Stretches for stretching tight Hip flexor and hamstring and spinal articulation for stretching my tight back. 9

Reformer Exercise with BASI Block System Warm Up: Abdominal & oblique strengthening, pelvic stabilization, warm up the spine -Pelvic Curl -Spine Twist Supine -Chest lift -Chest loft with Rotation Foot work: Hamstring & quadriceps strengthening, pelvic stability -Parallel heels, Parallel toes, V position toes, Open V heels, Open V toes, Calf raises, prances (ends with calf stretches), Single leg heel, Single leg toes Abdominal Work: strengthening weak abdominal muscle -Hundred -Coordination Hip Work: strengthening hip adductor, pelvic lumbar stabilization -Extended Frog -Extended Frog Reverse -Down Circle & Up Circle Spinal Articulation: Great exercise for articulating tight spine, strengthening hamstring -Semi-Circle Stretches: Stretch tight hamstrings and hip flexors -Kneeling lunge Full body Integration: Strengthening abdominal muscle, Trunk Stabilization, Shoulder stabilization, hamstring Stretch for up stretch1 & Elephant -Reverse knee Stretch -Down Stretch -Up Stretch1 -Elephant Arm Work: Shoulder extensor & flexor strengthening, Strengthening Abdominal for Trunk Stabilization -Arms kneeling Series: chest Expansion, Up Circle, Down Circle, Triceps, Biceps Leg Work: Strengthen Gluteus Medius & Hip Adductor, Pelvic lumbar stabilization -Single leg Skating -Side Split Lateral Flexion/Rotation: Strengthen Abdominal & Oblique, Stretch Oblique muscle -Side over on Box 10

Back Extension: Back extensor strength, shoulder extensor strength -Pulling Straps 1&2 ends with Rest Position on the Box to stretch the spine and back extensors Conclusion I programed Fundamental to Intermediate Reformer workout based on BASI Block System. I often use this program when I work out alone at studio for my daily work out because it is well balanced whole body work out which is focused my tight or weak muscles. Sometimes I put some Advanced work like Balance Control Front and Balance Control back prep to strengthen my upper body. Cadillac and Wunda Chair are really good apparatus as well so, I often use those apparatus for my exercise. I do Cat Stretch, Standing Pike and Jack Knife on Wunda Chair to strengthen Abdominal and stretch my back. Also, I do Roll up with Roll up bar, Monkey Original, and Tower on Cadillac for same reason. I have been doing exercise at least twice a week or more, every week with BASI Block System and BASI System Equipment. Now, I can have stronger abdominal and gluteus muscles and more flexible back and hip flexor muscles so, I feel easier to do every exercise that based on rounded position than before. I will keep doing work out based on BASI Block System to get a more solid and healthy body and teaching my clients to give them well balanced healthy body, as well. 11

Bibliography Books Isacowitz, R. (2014). Pilates (2 nd ed). Human Kinetics. Isacowitz. R., Clippinger, k. (2011). Pilates anatomy. Human kinetics. Biel, A. (2014). Trail guide to the body (5 th ed.). Books of Discovery Websites http://www.muscleimbalancesyndromes.com/janda-syndromes/lower-crossedsyndrome https://www.physio-pedia.com/lower_crossed_syndrome Pictures www.google.com 12