Monday, January 6, 2014

A Brief Introduction to Janda's Lower Cross Syndrome

It's a beautiful negative 15 degrees outside today so I figured, what better to do than crank up the heat and work on my writing. My goal for this weeks posts was to introduce readers to the two most common postural distortions that you are likely to encountered as an athlete or coach. Earlier in the week we discussed upper cross syndrome, a condition that causes athletes to walk through the door face first, rather than standing upright like us homo sapiens are supposed to do.

Hopefully now we all have a solid grasp on how posture affects performance and injury and we can address another prevalent distortion, this time focusing in on the lower body. Lower crossed syndrome (LCS) is also a concept defined by Dr. Vladimir Janda. Like Upper Cross, LCS refers to a series of muscles or muscle groups that are either too tight or too weak relative to their antagonist group, and that imbalance pulls the body into unfavorable positions.

Lower Cross Syndrome

LCS is a combination of four factors (much like Upper Cross). It is a combination of weak abdominals and glutes as well as overly tight hip flexors and low back extensors. When uncorrected this combination of factors often leads to the pelvis sitting in what is called an anterior tilt. Imagine the pelvis as a bowl and when the contents of the bowl spill out the front that position is an anterior tilt. When the contents spill out the back that is a posterior tilt. This will be important later on. 

Let's address the problems individually and how we can fix them. Like last time we will start with tight areas and move from there to weak areas.

Tight lower back: This tension in the lower back is mostly a result of tension in the hip flexors pulling the pelvis (and therefore lower back) into compromised positions, as well as a lack of strength in the trunk musculature and glutes to maintain neutral spine. Stretching of the lower back is something I tend to avoid with my clients. In my experience and reading the lower back should have minimal range of motion and tightness there will dissipate by working on the rest of the areas in this article as well as mobility of the mid/upper back (ie thoracic spine)

Tight hip flexors: The hip flexors exert a downward pull on the pelvis, tipping it forward into an anterior tilt position. This inhibits the force producing capacity of the glutes (ie performance) and can lead to lower back pain. 

Anterior Tilt

Fix: Stretching the hip flexors feels great but in my experience most people are doing it wrong. We just covered how the hip flexors are located in front of the pelvis and they tilt it downwards, meaning that when the pelvis is tilted down and forward the hip flexors are all in a shortened (ie. not stretched) position. In order to stretch the hip flexors the pelvis needs to go into a posterior tilt direction in order to lengthen the muscles we want to stretch.

Emphasis on posterior tilt via gluteal contraction and abdominal bracing
Excessive low back arch. Zero hip flexor stretch occurring 

Some people may be thinking "Wait, I do that second one all the time and I totally get a stretch out of it. I can feel it" What you are most likely feeling if your stretch looks like that second picture is actually not a stretch at all. That aggressive leaning forward causes the head of the femur to push up against the anterior capsule of the hip, giving you the "Stretch" sensation at the front of your leg, close to where the hip flexors are. Best case scenario you are wasting your time. Worst case you are creating instability at the hip that over time can lead to pain. 

Some people will do the hip flexor stretches perfectly and find no improvements in posture, performance or pain relief. The reason for that is that this postural distortion is a four part problem. When the glutes and abdominals don't properly stabilize the pelvis the hip flexors (especially the psoas) try to "pick up the slack" and become tight to provide a sort of false stability. This reactive tension can't simply be stretched out of and requires strengthening the posterior tilting muscles.

Weak abdominals: Talking about core strength is opening a big can of worms and I don't want this piece to get too long [1] so I will try to keep this brief. The ability to resist extension is one of the primary actions of the abdominal muscles along with the obliques and the inner unit core musculature. When the trunk cannot resist extension lower back pain often follows. Try this exercise out to fix things up

I know that planks have been beaten to death by a lot of coaches and trainers and maybe you think they are too easy. And maybe they are for you. But pay close attention to his spinal position when he engages the plank. The glutes fire hard and cause a slight posterior tilt and the head pulls back into the double chin position that I mentioned in the last post. If you can do this perfectly for 30 seconds then start worrying about making it more advanced. 

Weak Glutes: The gluteus maximus is responsible for hip extension and posterior tilting of the pelvis. When it is not functioning properly the hamstrings and quads take over the movement and lead to incomplete hip extension, decreased force output and diminished work capacity, as well as increased likelihood of hamstring strains, lower back pain and a host of knee injuries.
Fix: Start by working the glutes directly with basic body weight exercises and be sure to focus on achieving a good squeeze during full body movements. There are a million glute exercises out there. Choose whichever you like, just make sure you are getting full extension with each rep. Squats and deadlifts are classic staples but single leg variations work effectively as well. I personally have found most success with walking lunge variation because the locomotive aspect of the lift forces you to get full hip extension to go into the next step. 

I hope that the last two articles have given you a good look at common movement impairments and help you and your clients achiever perfect posture and performance while avoiding pain and the nagging injuries that hold back progress.

[1] A piece solely devoted to core strength will be coming soon 

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