# Upper Crossed Syndrome in the Workplace: A Narrative Review with Clinical Recommendations for Non-Pharmacologic Management

## TL;DR

Upper crossed syndrome, a posture-related musculoskeletal disorder common in office workers, causes neck and shoulder pain and can be managed with non-drug treatments like stretching and ergonomic improvements.

## Contribution

This paper provides clinical recommendations for non-pharmacologic management of upper crossed syndrome and highlights its public health impact.

## Key findings

- Upper crossed syndrome is prevalent among office workers and contributes to high rates of neck and shoulder pain.
- Early diagnosis and non-invasive treatments like stretching and ergonomic adjustments can reduce symptoms and prevent complications.
- Improving workplace ergonomics and increasing provider awareness can lead to a healthier and more productive workforce.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Upper crossed syndrome, a musculoskeletal disorder characterized by a forward head posture, rounded shoulders, and scapular dyskinesis, is a major global contributor to neck pain, rated at 2450 individuals per 100,000, with shoulder pain incidence at 37.8 per 1000 individuals per year.This syndrome is particularly common among office workers who spend long periods working on computers, leading to high rates of absenteeism, reduced productivity, and disability.

Upper crossed syndrome, a musculoskeletal disorder characterized by a forward head posture, rounded shoulders, and scapular dyskinesis, is a major global contributor to neck pain, rated at 2450 individuals per 100,000, with shoulder pain incidence at 37.8 per 1000 individuals per year.

This syndrome is particularly common among office workers who spend long periods working on computers, leading to high rates of absenteeism, reduced productivity, and disability.

Public health significance—Why is this work of significance to public health?
Upper crossed syndrome is particularly prevalent among working-age adults, including young adults, whose symptoms may be exacerbated by a forward head posture during cell phone use.Left untreated, upper crossed syndrome can lead to more serious health problems, including cervicogenic headaches, thoracic outlet syndrome, and subacromial impingement syndrome.

Upper crossed syndrome is particularly prevalent among working-age adults, including young adults, whose symptoms may be exacerbated by a forward head posture during cell phone use.

Left untreated, upper crossed syndrome can lead to more serious health problems, including cervicogenic headaches, thoracic outlet syndrome, and subacromial impingement syndrome.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health?
Provider education regarding the symptoms of upper crossed syndrome can lead to an earlier diagnosis, when the condition is easily treatable by non-invasive methods such as stretching and corrective exercises.Improvements in workplace design to address poor ergonomics underlying upper crossed syndrome, combined with simple stretching exercises, could significantly reduce incidence, leading to a healthier and more productive workforce.

Provider education regarding the symptoms of upper crossed syndrome can lead to an earlier diagnosis, when the condition is easily treatable by non-invasive methods such as stretching and corrective exercises.

Improvements in workplace design to address poor ergonomics underlying upper crossed syndrome, combined with simple stretching exercises, could significantly reduce incidence, leading to a healthier and more productive workforce.

Problem Statement: Upper crossed syndrome (UCS), as first described by Janda, refers to a group of muscle imbalances in which tightness in the upper trapezius and levator scapulae dorsally cross with tightness in the pectoralis major and minor muscles, and weakness of deep cervical flexors cross ventrally with weakness of the middle and lower trapezius. Postural alterations from this dysfunction, including forward head, rounded shoulders, and scapular dyskinesis, contribute to upper-back and shoulder pain, particularly among office workers who spend long periods of the workday on a computer. Upper crossed syndrome is a significant contributor to both neck pain and shoulder pain among computer users, which have been rated at 55–69%, and 15–52%, respectively. Despite its prevalence, knowledge about UCS and its treatment remains spotty among primary care physicians. In addition, improvements in workstation ergonomics along with hourly work breaks may be considered as primary prevention strategies for UCS. Objectives: This narrative review examines and synthesizes evidence about the epidemiology and diagnosis of UCS, along with clinical recommendations for physiotherapeutic approaches to treatment. Ergonomic measures in the workplace, including changes in the design of computer workstations so that both the keyboard and monitor are at the proper heights to minimize the risk of long-term musculoskeletal disorders, are also critical. Methods: The first author, a Doctor of Behavioral Health, performed the initial literature search, which was reviewed by the second author, a PhD in sports injury epidemiology. The third author, a chiropractor and practice owner, provided clinical recommendations for stretching and strengthening exercises, which were also described in the literature. Discussion: While easily treatable when caught early, UCS may become resistant to noninvasive approaches over time, and more severe pathologies of the neck and shoulder, including impingement, thoracic outlet syndrome, and cervicogenic headaches may result. Because there is no specific ICD code for UCS, it is important for physicians to recognize the early signs, consider them in the context of workplace-related injuries, and understand physiotherapeutic strategies for symptom resolution.