As a fitness professional, it’s critical that you’re able to see and address lower cross syndrome in clients. This posture issue also goes by the term lower crossed syndrome. If unnoticed, clients will push through with exercises that make the issues worse over time, they can end up in debilitating lower back pain as one example.

When assessing clients, it’s important that you look for the key characteristics, including weak gluteal muscles (specifically the gluteus maximus) and abdominals (rectus abdominis). You’ll also be on the lookout for tight hip flexor and lower back muscles. The combination of a tight muscle and opposing weak muscles is known as a muscle imbalance. It often contributes to an anteriorly rotated pelvis (aka anterior pelvic tilt), excessive lumbar lordosis, and a hunchback appearance. 

If you discover lower crossed syndrome in a client, it’s time to change their program. Here’s what you need to know to assess and address this condition in any client.

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What Causes Lower Crossed Syndrome?

Although identifying the exact cause of lower cross syndrome is complex and multifactorial, posture and sedentary lifestyle are the primary contributors. Long periods of slouch sitting reduces the time of muscular activation of the abdominal and core musculature. Consequently, these muscles grow more prone to inhibition than innervation. Simply put, they become weak muscles that don’t activate. 

In addition to losses in strength, the hip flexor muscles (rectus abdominis and iliopsoas specifically) shorten and stiffen. This combination— weak abdominals, weak glutes, and tight hip flexors—results in an abnormal resting pelvic position and muscle imbalance. 

To illustrate, imagine the pelvis is a bowl of cereal secured to a surface by elastic bands. As the bands shorten in front of the bowl, the bowl tilts forward. This increase in anterior tension causes posterior tension to increase in the hamstrings. 



In addition to poor posture and sedentary behavior, there is another cause for an anterior pelvic tilt- natural biomechanics of the human body. The flexor muscles of the body operate at a mechanical advantage and are prone to hyperactivity. These muscles include the biceps, hamstrings, pectorals, latissimus dorsi, and hip flexors. Thus, these muscles need to be stretched to avoid pain and reduce injury risk.

On the other hand, the extensor muscles work at a mechanical disadvantage and are prone to inhibition. These muscles include the quadriceps, triceps, spinal erectors, deltoids, and glutes. The extensor muscles need to be regularly strengthened. 

With this information in mind, it is clear to see how lower crossed syndrome is so prevalent. When clients aren’t stretching and strengthening in the right ways, lower crossed syndrome is easy to develop.

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How to Assess Lower Crossed Syndrome

A static standing and seated posture test is an excellent place to begin when assessing for lower crossed syndrome. Have the client stand against the wall and watch the lower back, upper back, and head closely. If a fist can be placed between the wall and the lower back, then the client has lordosis or excessive low back curvature. 

Note, however, that weak muscles of the abdominals and a tight hip flexor complex do not always cause this. Many people, myself included, have had natural lordosis since birth. However, it is something to make note of. 

Next, take note of the relationship between the upper back and the head. Does the client have a forward head? Does the client push the head backward to make contact with the wall, separating the upper back and wall? If so, make a note.  

To assess hip flexor length, a Thomas test can be used. If you do this test and find that the patient has tight hip flexors, check the box. In addition, testing the strength and activation ability of the gluteal muscles and the abdominal muscles will give you enough information to diagnose your client as someone with lower crossed syndrome. 

How to “Correct”Lower Crossed Syndrome

Although I do not like the word “correct”, the following three steps will help clients suffering from lower crossed syndrome. These steps are also valuable for nearly any client, especially those who sit much of the day for work.

Create Better Posture

If posture is poor, everything else will be lacking as well. No amount of programming and “corrective exercises” will help if posture is not improved.

To create better posture, coach clients to: 

  • Keep the rib cage over the pelvis in the seated and standing positions 
  • Contract the lower abdominal muscles and don’t “spill the cereal.” 
  • Contract the glutes and walk with confidence. “Walk like an influencer, not a weasel.” 

Create Consistency with Training

Tissue does not change overnight. As a trainer, you know one of the most challenging conversations to have with clients involves why they’re not getting results. It takes time and consistency to see results, so use this as an opportunity to remind clients of this key aspect of healing and goal achievement.

Focus on Strengthening

Remember to focus your program on strengthening the abdominals, spinal erectors, glutes, and upper back muscles.

Include Stretching

Stretching is just as important as strengthening, so build this into your program, especially for the hip flexors. 

Ultimately, no strength training will produce results without consistent training and impeccable posture. I have worked with thousands of young athletes. On three specific occasions, I pleaded with the athletes, who were baseball players, to maintain better posture and lose the heavy backpack. I was trying to change the environment the athletes were living in. Unfortunately, the warnings were not headed, and all three athletes tore up their shoulders. As a trainer, you have to guide and teach.

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Don’t Ignore Lower Crossed Syndrome

If you have clients suffering from lower crossed syndrome, don’t ignore the signs. Instead, properly assess their bodies and posture and implement the strategies suggested to help them heal and see results. 

Ultimately, however, these strategies will help nearly all of your clients. Think about it, how many of your clients have tight hips? How many have or continue to avoid doing extra glute and lower back work? Keep this in mind when working with all clients, not just those suffering from lower crossed syndrome, to help clients look and feel their best.

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