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Lower Crossed Syndrome - 6 Steps To Fix Anterior Pelvic Tilt and Swayback Posture PDF
Lower Crossed Syndrome - 6 Steps To Fix Anterior Pelvic Tilt and Swayback Posture PDF
DARWINIAN MEDICINE
A N E VO LU T I O N A R Y A P P R OAC H TO H E A LT H A N D D I S E A S E
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As sitting for prolonged periods of time can lead to shortening of the hip exors, increased
tension on the lower back, and glute atrophy, it’s no surprise that LCS is so common in our
society today. The problem develops over time, and suddenly a daily activity, like tying the
shoes, causes pain.
As I noted in my article on UCS, it’s important to be aware of and able to correct muscle
imbalance patterns, as they set the stage for poor exercise technique, compensation patterns,
injuries, lower back pain, impaired physical performance, and in some cases, disorders such as
osteoarthritis and degenerative joint disease. Moreover, poor posture generally isn’t
aesthetically appealing. Exercises and mobility drills aimed at treating UCS and LCS may
improve your physical appearance, as they will help you achieve a better posture.
So, what does this mean exactly? It means that there is a weakening and lengthening of the
abdominals and gluteals and a tightening and shortening of the hip exors and lower back
muscles. LCS involves reciprocal inhibition, a process where muscles on one side of a joint are
relaxing to accommodate contraction on the other side of that joint.
Causes
Prolonged sitting, particularly with bad posture
Physical inactivity
Regular performance of sports and activities that involve an uneven stimulation of the
muscles that are involved in LCS
Poor exercise technique (e.g., lumbar hyperextension in the deadlift, press, and squat).
Imbalanced strength training (e.g., a lot more lower back and/or hip exor training than
glute and/or abdominal training)
Genetic predispositions
The development of LCS initiates a vicious cycle. Because the gluteals and abdominals are
weak, their function is compromised, and other muscles such as the hamstrings and lower
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back muscles are recruited to assist them in performing activities such as walking, running,
and squatting. This leads to overuse and tightness of the hamstrings and lower back muscles,
and a further weakening of the abdominals and gluteals.
These signs and symptoms, in combination with a screening that reveals sti hip exors, poor
glute and abdominal strength, and compensation patterns, are good indicators of LCS.
I think most trainers will agree that one of the keys to being a good coach is to understand that
all exercises, mobility drills, etc. should be included only if they serve a purpose. This is
especially important when training clients with muscle imbalance patterns, as poor exercise
technique and selection only will worsen the problem.
I’ve tried various approaches for dealing with LCS. After a lot of trial and error (there’s only so
much you can learn from reading science and theory on the subject), I’ve discovered certain
patterns regarding what works and what doesn’t. While there isn’t one standard approach that
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works for everyone, there are certain general principles that everyone should adhere to. These
principles serve as the foundation for the step-by-step protocol in this article.
Hip exor stretches are often considered essential for the treatment of LCS. However, I’ve
found that it’s generally more important to strengthen the muscles that produce Posterior
Pelvic Tilt (PPT) and ingrain good movement patterns.
I want to emphasise that there are a range of spinal alignments that are considered “normal”,
and although a lot can be done through strength training, some people will naturally have a
more anteriorly tilted pelvic alignment. Also, it’s important to note that xing LCS requires
persistency and e ort. Simply doing some light pull throughs at the gym every now and then
is not going to get you very far. If you don’t have the will or knowledge to attack this problem
on your own and/or are severely a ected by LCS, then I recommend that you seek out an
experienced coach or therapist that can help you treat this condition.
People with LCS often have no idea that their low back sway, bulging abdomen, and/or back
pain are actually manifestations of a muscle imbalance pattern that to a great extent can be
treated. Moreover, individuals with LCS typically have no idea how to posteriorly tilt their pelvis.
For these people, step 1 is to learn how to get the pelvis into a neutral position and posterior
tilt. The lying pelvic tilt is a great exercise for achieving this, as “push the lower back into the
ground” is an easy cue for most people to understand.
Instructions: Lie on the oor and push the lower back into the ground, then anteriorly tilt the
pelvis (curve the lower back) before repeating the exercise.
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When you manage to perform the lying pelvic tilt and understand how to control the
alignment of your pelvis, performing the standing pelvic tilt is the natural next step.
Instructions: Stand with your feet shoulder width apart. Squeeze the glutes (this triggers you
to posteriorly tilt the pelvis), hold the contraction for some time, relax, and then repeat the
exercise.
The pull through is an excellent exercise for learning the hip hinge pattern. The movement
pattern in the pull through closely resembles that of the deadlift, kettlebell swing, and other
hip dominant exercises. However, there’s one key di erence. In the pull through, the band or
cable is attached behind you, thereby “forcing” you into a posterior weight shift.
Instructions: Concentrate on keeping the chest high (without overarching the lower back),
pushing the hips back (rather than bending the knees and entering into a quad-dominant
squat), and nishing the movement by squeezing the glutes.
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I’ve found that the cable pull through and a modi ed version of the plank are among the most
e ective exercises for treating LCS. PPT hip thrusts, american deadlifts, and other exercises
that strengthen the PPT movement pattern and weak muscle groups (especially glutes and
abdominals) are also great additions.
Instructions for the modi ed plank: Perform a regular plank, but this time focus on squeezing
the glutes all you can.
Instructions for the cable pull through: Concentrate on keeping the chest high (without
overarching the lower back), pushing the hips back (rather than bending the knees and
entering into a quad-dominant squat), and nishing the movement by squeezing the glutes.
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As many lifters tend to round their backs when doing hip dominant exercises, “arch!” is often a
good cue for getting people into a better movement pattern. However, when coaching
someone who possesses APT, this cue typically does more harm than good as the lifter ends
up with an exaggerated lumbar curve.
While many inexperienced lifters (even those with no apparent postural problems) have a
tendency to overextend their backs when locking out the deadlift, people with LCS often
display excessive back arch during the entire lift. This position is generally considered more
damaging than the more commonly seen spinal exion.
People with LCS typically also overextend their lumbar spine during presses, pulldowns, and a
wide range of other exercises. In combination with quad dominant lifting, poor glute
involvement, and forward knee drift (e.g., in the squat), this poor alignment strengthens muscle
groups that are already strong and increases the risk of injuries.
While some experienced lifters prefer a rounded (upper) back position in exercises such as the
deadlift, the general recommendation is to keep the spine in neutral. The best strategy for
achieving this position varies from person to person. For someone with a normal
(neutral/slight APT) or posteriorly tilted pelvis, it is often useful to think about arching the back
or perhaps even better, pulling the chest tall. For someone with excessive APT, getting the
chest up is still important, but focusing on arching the back may be a mistake, as this can
quickly lead to overextension of the lumbar spine.
As for the position of the neck/head, tucking the chin and maintaining a neutral neck position
is always a safe tip, That being said, many of the strongest deadlifters and squatters in the
world look straight ahead during the lift. Some coaches argue that you’re strongest when
lifting with a neutral neck position, but if there really is an advantage to this position, then it’s
probably quite small.
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Besides the focus on spinal alignment, my two top tips for a perfect deadlift and squat are to
spread the oor apart (push against the outside of your heels like you’re literally trying to pull
the oor apart beneath you) and drive through the heels. It’s also important to remember that
the bar should travel in a vertical line over the mid-foot.
It’s not just during lower body exercises that the alignment of the pelvis and spine is important.
Squeezing the glutes and posteriorly tilting the pelvis during exercises such as the press,
push-up, chin-up, pushdown, and bicep curl is a good general recommendation. While it’s not
a requirement, posteriorly tilting the pelvis during these types of exercises stabilizes the spine
and even gives you some static glute training. Also, when performing hip dominant exercises
such as the deadlift, hip thrust, and box squat, a good tip is to nish the concentric part of the
lift by squeezing the glutes.
Resistance training
Incorporate step 1, 2, and 3 into your warm-up routine prior to strength training sessions.
Spend 10-20 minutes on step 4 every workout by focusing speci cally on exercises that
target the muscles that produce PPT. If you’re training the lower body one day, simply
perform these movements as part of your workout. If not, include the pull through, plank,
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and other exercises that strengthen the PPT movement pattern at the end of your
training session. Also, remember to squeeze the glutes during exercises such as the
press, push-up, etc. (step 5).
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About Eirik
Eirik Garnas is the creator and owner of Darwinian-Medicine.com. His longstanding
interest in nutrition, medicine, and health, topics he has spent a signi cant amount of
time reading up on, was spurred by his desire to enhance his athletic performance and physique
and overcome various health problems that had come to dominate many aspects of his life. Eirik is
formally trained as a nutritionist and holds a bachelor's degree in Public Nutrition and a master's
degree in Clinical Nutrition. Additionally, he is a science writer, health coach, and personal trainer
schooled at the Norwegian School of Sport Sciences. During the years he's been working in the
health/ tness sphere, Eirik has gone through several structured courses in order to improve his
coaching skills and worked with a number of clients, both via the web and in real life (See client
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testimonials). Over the past decade, Eirik has also written for a variety of health and tness
magazines and websites. You can read more about Eirik here and contact him here.
Comments
Nice work Eirik, full of easy actionable hips. As coaches we can easy recognize LCS but
how does the individual know when they have full blown LCS? How can they diagnose
themselves? I had poor posture for years and I didn’t know.
Reply
Reply
Eirik says
DECEMBER 20, 2015 AT 3:54 AM
Hi Shane!
My advice for someone who’s trying to determine whether they have LCS or not is to
go through the lists of causes and signs and symptoms I’ve presented in this article.
For example, make a set of questions based on the list of signs and symptoms (e.g., Is
my pelvic anteriorly tilted? Am I incapable of properly activating my glutes when I’m
doing squats and deadlift?). If the answer to several of these questions is yes, then
chances are LCS is an issue.
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Reply
Alison says
DECEMBER 24, 2015 AT 5:50 AM
Excellent article Eirik, thanks for the tips & wishing you all the best for the Holidays!
Reply
Eirik says
JANUARY 2, 2016 AT 9:56 AM
Reply
Eirik thank you for this article. I su er from LCS and it’s been an issue for 4 years now…There
are so many terms for this condition, anterior pelvic tilt, piriformis syndrome, sciatica, etc.
Noe the sciatic pain due to the LCS has become unbearable and now my job is in the line.
I’ve taken all kinds of pain meds and the doctors say nothing. Physical therapy doesn’t
work, and nothing seems to help. Thank you for this article. Please send all of the articles
that you have on this condition.
Reply
Eirik says
AUGUST 23, 2016 AT 7:25 AM
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Hi Sequoia,
I understand you’re confused regarding the terminology. Anterior pelvic tilt and lower
crossed syndrome tend to go hand in hand, but they are not the same thing.
Usually, anterior pelvic tilt develops as a result of the muscular imbalances present in
LCS. In other words, APT can be said to be a symptom of LCS. Not all cases of APT
develops as a result of muscular imbalances, but many, if not most, do.
I do o er online coaching so if you need someone who can help you treat this
condition then send me an e-mail through the contact form here on the blog.
Reply
Hi Eirik,
I can’t thank you enough for this article and I’m so glad I found it. I was diagnosed with
Lower Crossed Syndrome by a Chiropractor nearly 6 years ago and have su ered for a long
time. It has a ected every aspect of my life and has kept me from doing many of the things
I love to do. Unfortunately, none of the dozen or so Chiropractors I’ve seen over the last 6
years have given me much help on correcting the problem. Even searching on line hasn’t
produced much info that was helpful…until a week or so when I found your article. I’ve been
following your exercises and have noticed an improvement in my posture already. I haven’t
been able to stand straight for years and it is nally starting to change. I wish you were
local where I live (Palm Springs, CA) because I would hire you to train me, but, I will keep
doing your recommendations and hopefully soon I will feel “normal” again!
Thanks,
Mark
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Reply
Eirik says
AUGUST 23, 2016 AT 7:18 AM
That’s great, Mark. Just keep doing the exercises and I’m sure you’ll notice further
improvements over the coming weeks.
Master the hip hinge pattern and the pelvic tilt movement, and then move on to PPT
planks, pull-throughs, etc. Go heavy, but not so heavy that your form is compromised.
Unfortunately, most health practitioners, PTs, etc. know little to nothing about LCS. So,
I’m not susprised to hear that none of the Chiropractors you’ve seen know how to
address this problem.
I do o er online coaching so if you need someone who can help you treat this
condition then send me an e-mail through the contact form here on the blog.
Reply
Jobin says
OCTOBER 21, 2016 AT 6:55 AM
I liked your article,specially the hip hinge pattern exercise. Can u suggest
abdominal strengthening in LCS, as they often complaint of low back ache,a nd
becomes di cult to teach or else
Reply
Mark.. I have a similar problem. I go to PS for 3 months in the winter starting Jan 1. I
have spent so much time trying to nd someone to help me through this process .
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Kind of frustrating
Reply
Vikram says
JANUARY 18, 2017 AT 6:07 AM
how much time after you start the stretching and strengthening exercises does it take to
cure this imbalance ?.
Reply
Eirik says
JANUARY 18, 2017 AT 11:28 AM
Hi Vikram,
The treatment of LCS is a gradual process. The time it takes to see improvements
di ers from person to person, depending on the severity of the condition, the structure
and intensity of the treatment program, and a variety of other factors.
Reply
Kim says
MARCH 9, 2017 AT 4:18 PM
I have been dealing with pain in my low back, hip exors and piriformis daily for almost 3
years. At times it’s been excruciating and other times it’s just there and I don’t have to give it
much thought. My primary care doctor said that my muscles have learned to be injured
and that it’s a chronic condition that I’ll likely deal with for the rest of my life. I’m only 46 and
it makes me tear up to think that I’ll always have to deal with this.
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Two and half years ago I did 8 weeks of PT, the PT said I had a pelvic tilt with the right side
of my pelvis tilting forward, consequently one leg is shorter than the other. I spent 8 weeks
walking on a treadmill, doing some strength training and relaxing on a TENS with no
improvement and no real understanding of what was needed to x this. I have been to a
chiropractor twice which caused excruciating pain afterward. I’ve done Egoscue, yoga,
various youtube videos that claim to help these issues and am guilty of sporadic weight
training. I am almost ready to try acupuncture even though I don’t believe in it or rol ng
even though it’s really expensive. Walking a lot or hiking makes it worse. Bike riding seems
to make it temporarily better, so I love bike riding.
Throughout all of this I’ve never heard of LCS and this article is kind of blowing my mind.
Based on the common signs and symptoms I believe I have LCS. I’m committing to doing
these exercises starting today and I feel hopeful. Thank you for posting this.
Reply
Eirik says
MARCH 10, 2017 AT 8:13 AM
Hi Kim,
Based on your description of your problem, it sounds to me that you are indeed
su ering from LCS.
LCS is an extremely common condition. Over the years I’ve helped a lot of people
correct this problem. One of the online clients I work with at the moment is also on a
quest to overcome LCS.
If you feel like you need help/coaching, then don’t hesitate to contact me. You can nd
info about my coaching services and a contact form on the page entitled “Work With
Eirik”.
Reply
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Hi Kim,
After reading your post I felt compelled to respond. I am that client Eirik mentioned in
his response to you. Reading your post was like hearing my own words. I have su ered
for 6 years from LCS. It started in my late 40’s and I went from being healthy and
feeling great my whole life to being in almost constant pain/discomfort. I was a
gymnast and have lifted weights, running, biking, hiking, swimming…basically very
active my whole life. About 6 & 1/2 years ago a friend who was a yoga instructor
convinced me that yoga was a better way to go. So, I started doing yoga every day and
dropped out most everything else I was doing. Within 6 months, I started to have
sciatica type pain and started noticing bad changes in my body/posture.
Unfortunately, I thought more stretching would help and it took me years (and EIrik) to
teach me that the x required building certain muscles back up in my body. I’ve tried
many things over the years (Chiropractors, including a Neurologist Chiropractor,
Acupuncture, lots of nutritional supplements, massage, special mattress, di erent car,
magnetic pads,meditation, food allergy testing and treatment…pretty much everything
except pain pills and muscle relaxants since I’m not a big fan of medication or western
medicine.) Basically, nothing helped give me more than a few hours of relief at times. I
never gave up, but I wondered if I would ever feel good/normal again. I even took an
early retirement from my profession (Optometrist) and sold my practice last year so
that I could try to get myself better again…the big problem was I couldn’t nd anyone
who knew how to “ x me”. Then, last August I found Eirik’s blog while googling LCS. I
started doing the exercises and started feeling a bit better until I did a cross country
drive for the month of October which set me way back again. Then I had some house
issues that caused me to live in a hotel for the next 3 months. Finally, 5 weeks ago I
started training with Eirik and with his speci c guidance, I am feeling better than I have
in many years. I still have bad days and some pain/discomfort…but, my posture is
getting better and I feel strength in my core for the rst time in a long time. I would
highly recommend you try the online training with Eirik. It’s not easy and it does take
time…but, it is working for me and I am so excited to be nally getting my life back!
Hope this helps.
Best,
Mark
Reply
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Kim says
MARCH 10, 2017 AT 9:29 PM
Thanks for your thoughtful response, Mark. It helps a lot. I’m on the less-
stretching, more muscle-building bandwagon now and am willing to invest the
time it takes to x this. It’s already been a long road. I sent Eirik an email on his
“work with me page” and am looking forward to hearing back from him.
It sounds like you’ve had to give up a lot to be able to work on this. I’m
encouraged by your progress and wish you the best!
Reply
Nish says
JULY 28, 2017 AT 1:37 AM
Hi Eirik,
I developed pretty severe LCS over the course of a few years, and for the last 3 or so I’ve
been working on xing it. I’m into weight lifting/bodybuilding so this was a di cult setback
for my training. I’ve de nitely made a lot of progress and things are much better than they
were before. However, I feel like I’m not quite back to normal. My left side seems to be
good but my right seems to be still having problems (tight adductors, weaker glutes &
abdominals as compared to the other side). Do you have any recommendations for me?
Also, I’m a 3rd year DPT student so I generally have a good understanding of the
terminology etc. My goal is to get back to to progressing in the gym again and regain
normal mechanics/motor patterns for walking and normal functional activities.
Reply
Eirik says
JULY 28, 2017 AT 7:56 AM
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Hi Nish,
It’s very di cult for me to give you any good recommendation without knowing more
about what you’ve been doing so far, how you perform di erent exercises, and what
your posture looks like.
Reply
Very thorough! I’m a golf tness instructor who’s studying physical therapy, and I’m a big
believer in this syndrome and it’s e ect on the general population (unbeknownst to them!).
I’m trying to get the word out about this and your exercises are perfect for helping reverse
this bad trend.
Reply
NC says
SEPTEMBER 19, 2018 AT 5:04 PM
I think I am dealing with this issue right now. I also have bulging disks in L4-L5 and L5-S1
and I am wondering how this 2 issues relate to each other. In my opinion (and I am only
talking from personal experience) the LCS tends to add to the symptoms from the bulging
disk. That means, it makes more pressure over the columns joints and because of the
bulging disk, it causes more pain.
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Any case, I think that the solution for this is the same: start to strengthen the glutes and abs
and stretch the psoas. Is incredible how this syndrome starts to build up so gradually that
you don’t even notice it. I use to be a VERY active person, and now I nd hard to walk more
than 20 minutes.
Reply
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
[…] as a result of the failed leadership of “their king”. These problems are characteristic of the
lower crossed syndrome, which I’ve talked quite a bit about here on the site in the past. Regular
glute training can go […]
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10 Tips That Can Make You Squat Like a Flexible Kid says:
November 24, 2017 at 9:55 am
[…] for example because they su er from a musculoskeletal-related injury or imbalance
syndrome (e.g., lower crossed syndrome or upper crossed syndrome); however, these folks are in
the minority. Most people are capable of […]
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Client Transformation: “The Extra Weight I Was Carrying Literally Started Melting O ” says:
December 17, 2017 at 7:40 am
[…] problems that had plagued him for many years. He’d come across my website and found an
article I’d written about lower crossed syndrome that immediately resonated with him. In
addition to improving his posture and eliminating muscle […]
Reply
Reply
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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1/5/2020 Lower Crossed Syndrome: 6 Steps to Fix Anterior Pelvic Tilt and Swayback Posture
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