Sitting for long periods of time in our daily lives has lead to a shortening of our hip flexor muscles over time. Even athletes who do not spend much of their day sitting can have trouble with their lower back if they perform an exercise incorrectly over time or overwork certain areas of their body. If pain in your lower back and hips is slowing you down, perhaps you are suffering from Lower Crossed Syndrome (LCS). LCS occurs when weak abdominal and gluteal muscles are combined with tight iliopsoas and erector spinae muscles, forming a cross when a person is standing sideways. This can sometimes lead to having a forward head posture and flat gluteals or even protruding gluteals and a protruding abdomen. How do you know if you have LCS? There are two simple, at-home tests you can perform.
Testing for LCS
First, stand with your back against the wall with your heels touching the wall. Try to flatten your lower back to the wall without letting your pelvis or shoulders leave the wall. Then, without moving your back, raise your arms above your head to touch the wall. If you cannot touch the wall with your arms while maintaining your posture, you may have LCS.
Second, sit on a table or other flat surface with your feet touching the floor. Raise your knee to your chest and hold it there with your hands and slowly roll onto your back on the table, leaving your other foot on the floor. If you are unable to lay in this position without having your hanging leg hang in a horizontal position, you may have LCS.
How to Treat LCS
Treating LCS is a two-stage process. First, you must loosen the tight iliopsoas and erector spinae muscles, then you can strengthen the abdominals and gluteals. Treating LCS is best done under the direction of a physical therapist who can test for underlying conditions and recommend a customized stretching and strengthening program.
Loosen the Tight Cross
The first priority in treating LCS is to loosen the tight part of the cross. This serves two purposes. First, it alleviates pain and discomfort associated with LCS. Second, it allows the body to be receptive to strengthening the weak part of the cross. If you were to jump into strengthening exercises, you are more likely to exacerbate your injury, rather than treat it. A physical therapist will recommend foam rolling exercises for the iliopsoas muscles, floor exercises designed to stretch the lumbar spine, pelvis, and hip joint, and standing stretches for the upper spine if there is a forward head position.
Strengthen the Weak Cross
Strengthening the weak abdominals and gluteals is often not as simple as planking and performing squats, although these exercises may play a role in your recovery. Instead, the deep stabilization muscles need attention if LCS is going to be treated effectively. One exercise that can strengthen both the glutes and the deep abdominals is the hip raise. Lay on your back with your feet flat on the ground. Raise your toes slightly, making sure the majority of the pressure is in the heels. Raise your hips until your knees, hips, and mid-back form a straight line, taking care to not hyper-extend the hips. Hold for 2-3 seconds and lower the hips, repeating for 12-15 reps.
Once you have addressed both parts of the cross, you will find your posture becomes more neutral, your exercise technique will become better, and your overall athletic performance will improve. For more information on how to treat LCS, or if you suspect you have LCS, contact your physiotherapist today.