PT on the Net Research

Upper Crossed Syndrome and Beyond


HELP! I'm having a few on-going symptoms that I initially assumed were part of upper cross syndrome but am now wondering if something more is happening. My head pulls laterally to the right, and there is a great deal of tightness above and behind my right collarbone. It is painful to depress my right scapula, though I can retract without too much trouble. Shoulder abduction with a flexed elbow is also uncomfortable (my upper trap tends to spasm, and there is a distinct pulling behind my right arm - almost deep to my tricep), though shoulder flexion seems OK. Internal rotation is restricted (as in a throwing motion). Even typing this has caused tightness above and behind my right collarbone, so I keep thinking that elbow flexion must be related since, again, shoulder flexion with a straight arm seems to be OK. I've been told by both a chiropractor and a PT that my first rib is elevated and that my right humerus seems to pull forward of the joint, though they offered no particular explanation as to the root cause.

Treating the symptoms seems to always be short lived and though I've tried to do the stretches for SCM, levator, upper trap., the results are also short lived. I've been trying to strengthen my rhomboids and mid/lower traps, but it almost feels as though I can't get my right shoulder and scapula in the right position to properly execute the movement. I'm a fairly flexible person and even SMR on the foam roller is not particularly uncomfortable in any location.

I'm willing to do whatever I need to at this point, either by way of corrective exercise or perhaps seeing a practitioner with a better eye for this kind of problem. Any ideas would be greatly appreciated.


This could be a number of things. You will need to get help assessing this condition. A skilled physical therapist should be capable of performing the assessments, particularly if they have O.C.S. behind their name, which is an American Physical Therapy Association signifier for "Orthopedic Certified Specialist." Look for the following:

Include alar ligament integrity test to rule out upper cervical instability (do you have any spasm or unusual symptoms in the face, head or neck? Examples would be spasm when swallowing or biting the tongue).

Your symptoms present such an overlay that there could be many problems at once. The symptoms also lend themselves to frank internal derangement of the shoulder causing compensatory stress in the craniocervical unit, which is common when people keep using a shoulder with an undiagnosed derangement. If you live near any Level 3 or 4 CHEK practitioners, they should be able to assist you.