Lower cross syndrome (LCS) occurs when there is an imbalance in the strength of the muscles around the pelvis. This can result from sitting for prolonged periods.

The condition can affect a person’s posture and movement, as well as causing pain or discomfort. Treatment can involve strength training and stretching.

In this article, we look at LCS in more detail, including what it is, the common symptoms, and the treatment options.

A person doing exercises to help improve lower cross syndrome.Share on Pinterest
Image credit: Peter Muller/Getty Images

LCS gets its name from the cross pattern of affected muscle groups.

According to the National Academy of Sports Medicine (NASM), LCS is one of the most common compensatory patterns in the body. In other words, the body adds a new movement in an attempt to make up for a lack of movement or strength in one area of the body.

In this case, weakened muscles include the abdominal muscles and the gluteus maximus, which is the largest muscle in the buttocks. People with LCS typically also have tightened hip flexors and lumbar erector spinae — the group of muscles running from the base of the skull to the hip.

In many people with LCS, the tightened muscles pull the pelvis out of its normal alignment.

The abdominals and gluteus maximus typically offer a counterpull and keep the pelvis in line. However, weakness in these muscles allows the additional pull from the hip flexors and lumbar erector spinae to change the person’s posture and movement patterns.

To compensate for these issues, the person’s lower back arches, and their pelvis tilts forward.

Other people may notice different changes in their posture, depending on the affected muscles.

The most common cause of LCS is a sedentary lifestyle. Sitting for prolonged periods can cause an imbalance between the muscles to develop.

Another potential cause is overtraining certain parts of the body while undertraining others. For instance, if a person strengthens their hip flexors and back without focusing on their glutes and abdominals, this could lead to an imbalance.

Several muscle groups can potentially cause LCS when they become weakened or tight.

Muscles that can become weakened include the:

  • gluteus medius, which is on the outer surface of a person’s pelvis
  • transversus abdominis, which is on either side of the abdominal wall
  • gluteus maximus, which is in the buttocks
  • posterior tibialis, which is in the lower leg
  • internal oblique, which is on either side of the abdominal wall
  • anterior tibialis, which is on the outside of the tibia bone

Muscle groups that can become tight and contribute to LCS include the:

  • erector spinae, which is a group of muscles that run the length of the spine
  • latissimus dorsi, which are a pair of muscles covering the lower back
  • adductor complex, which is around the thigh
  • hip flexor complex, which comprises hip muscles
  • soleus, which is a broad muscle in the lower calf
  • gastrocnemius, which is the chief muscle in the calf

LCS can affect both posture and movement.

A person may not be able to stretch fully or correctly. Doing so may also cause aches and pains in the body.

According to the American College of Osteopathic Family Physicians, LCS can cause two types of posture: type A and type B.

Both postures feature:

  • Hyperkyphosis: This is the curvature of the spine that causes the top of a person’s back to appear more rounded.
  • Hyperlordosis: This is a condition where there is excessive curvature of the lower back.

Type A posture

Illustration by Diego Sabogal

Type A posture occurs due to the pelvis tilting backward.

It causes the buttocks to lift and protrude outward while the pelvic region tucks under the body. The lower back also arches inward.

Features of the type A posture include:

  • Thoracic hyperkyphosis: Hyperkyphosis is the exaggerated rounding of a person’s upper back. In this case, it has occurred on the thoracic region of the spine.
  • Lumbar hyperlordisis: Hyperlordosis is the curvature of the spine. In the type A posture, it is affecting the lower back. This causes the lower spine to arch inward.
  • Anterior pelvic tilt: This means the pelvis tilts backward.
  • Slight hip and knee flexion: In the type A posture, the hips and knees are bent.

Type B posture

Illustration by Diego Sabogal

Type B posture occurs due to an arch in the upper back near the shoulders.

The arch forms a bulge in the upper back and forces the neck to tilt forward and appear outstretched.

Features of the type B posture include:

  • Head protraction: The head protraction is the result of the misalignment of the spine.
  • Thoracic hyperkyphosis: Similarly to type A posture, the upper back is rounded.
  • Lumbar hypolordosis: The lower spine arches inward, in the same way as it does in type A posture.
  • Knee recurvatum: This means that the knees bend backward.

If the pain is severe, a doctor may recommend taking over-the-counter pain relievers.

They may also suggest applying heat or cold packs to the affected area.

A person should avoid taking medications for extended periods and talk to a doctor before taking drugs to treat lower back pain, particularly if they are taking other medications.

The goal of treatment is to correct the person’s posture through retraining the muscle groups responsible for the imbalance. Once a person corrects the imbalance, their posture and movement should return to normal.

A person can talk to a physical therapist, certified personal trainer, or another healthcare provider about an exact exercise program to follow to help treat LCS.

A therapist or trainer can create an effective program for the person. They can also demonstrate proper form and provide general guidance throughout the process.

Physical therapy and exercises

Physical therapy involves a variety of steps:

1. Relaxing the muscles

Firstly, a person should relax the muscles.

To do this, they can use a foam roller and slowly roll parts of the body, such as the quads and inner thighs, over it. Once a person finds a tender spot, they should hold the position for 30 seconds.

2. Lengthening and static stretching

The next step is to strengthen and lengthen the muscles.

At this stage, a person should get into a static stretch and hold the position for 30 seconds.

One example includes the iliopsoas stretch:

Iliopsoas Stretch

To perform the iliopsoas stretch:

  1. Begin in a kneeling position with the back in line with the buttocks and knees.
  2. Place one leg in front with the knee bent, the foot resting flat on the ground, and the toes facing forward.
  3. Lean forward slightly into a lunge position until there is a gentle stretch in the hip flexor.
  4. Hold the stretch for 15–30 seconds and then repeat using the other leg

3. Activating and strengthening the muscles

At this stage, a person needs to perform a strengthening exercise with little or no external resistance. The NASM state that a person should hold these positions for 2 seconds and perform 10–15 repetitions for 1–2 sets.

The following are examples of some stretches that a person can perform:


To perform bridge:

  1. Lie flat on the back with the knees bent and the feet flat on the floor. Keep the heels a few inches away from the buttocks. Extend the arms out straight toward the feet.
  2. Keeping the shoulders on the floor, lift the pelvis into the air, forming a straight line with the knees, pelvis, and shoulders.
  3. Hold the position for a couple of seconds before lowering the body. Perform 10–15 repetitions.

Learn more about the bridge stretch here.

Hip extensions

To perform this move, a person should take the following steps:

  1. Start on all fours with the hands under the shoulders, the knees under the hips, and the neck in line with the spine.
  2. Stretch out the right arm and left leg, resting the hand and foot against the ground.
  3. Once balanced, raise the outstretched right arm and left leg until they are both parallel with the back.
  4. A person should hold this before returning to the starting position and carrying out repetitions.

4. Integrating

At this point, integrated movement patterns can help the brain understand how to move the muscles. A person should follow the exercises that the physical therapist advises.

A person should talk to a doctor if they have persistent lower back pain. It could be the result of LCS or one of several other underlying conditions that can potentially cause pain in the lower back.

It is also a good idea to talk to a doctor before starting any new exercise program, particularly one that aims to help correct a person’s posture.

LCS occurs when muscle imbalances cause posture and movement abnormalities.

A person may experience pain in the lower back and noticeable differences in how they stand, sit, or move around.

The most effective treatments aim to fix the imbalance by strengthening some muscles and stretching or relaxing others.

A person should work with a certified fitness professional or physical therapist to develop a suitable treatment program to meet their needs.