How many of you does this sound like? Patient presents with chronic low back pain with symptoms going down the back of leg, front of thigh and knee pain. Patient also has difficulty standing upright for extended periods of time and resorts to hunching over with feet planted to give relief. The most common retorts to this presentation is “It is arthritis, old age or IT’S MY SCIATICA!” Although these symptoms due mimic sciatica, the more complete diagnosis is LOWER CROSSED SYNDROME (LCS). LCS is a muscular imbalance syndrome often brought on by prolonged sitting, poor posture, repetitive movements and a lack of core/spinal strength. This syndrome commonly affects the lower kinetic chain consisting of the lumbar spine, pelvis/hip, knee and ankle.
As you can see in the picture above, LCS is characterized by weak abdominals (core strength) and gluteus maximus (butt muscles) and overtightened lumbar extensors and hip flexors. This detrimental combination often leads to a pattern of imbalance and joint dysfunction at L4-5, L5-S1, the SI joint and hip joint. Does it make sense that these are the areas most often diagnosed as problems on Xrays and MRIs?
Lower crossed syndrome most commonly develops from poor postures or from sitting for extended periods of time. Constant seated positions cause the small muscles supporting the lumbar spine to continually maintain the body’s seated posture. While holding the body upright, the flexed position of the the pelvis shortens the muscles of the hip flexors. When shortened/flexed for too long, the muscles adapt and shorten in a guarded position leading to muscles tightness/spasm.
We often hear patients insist their problem is not in their back, but a pain in the hips or front of the thighs, so why are you concentrating on my low back? Tightness in the butt (piriformis), side of leg (tensor fascia lata) and inside of leg (hip adductors) are all symptoms stemming from a muscular imbalance of the low back and core muscles.
If the gluteus maximus muscles are weak, the hamstrings, lumbar stabilizers (erector spinae) and piriformis muscle (hip muscle) are recruited to assist in physical activities such as walking and standing. If these muscles become overactive, this can lead to muscle tightness, spasm and pain. If these muscle conditions go untreated, this leads to spinal and hip degenerative changes which ultimately lead to muscle strength, flexibility and range of motion to be significantly decreased with pain in the lower back and hip. Degenerative changes and muscular adaptations cause pain and leave the body susceptible to spinal/disc injuries and re-exacerbations of previous conditions affecting the lower kinetic chain.
Please consult the doctors if lower crossed syndrome accurately describes the pains you are experiencing. Understand though, there must be a commitment to exercising and stretching at home to ensure a complete recovery. Muscular imbalances are conditions that may require weeks or months to fully heal from, so do not get discouraged if symptom reduction is not over-night. Patients must realize the body heals at different rates depending on the age, nutrition and daily habits of individuals. Please email me with any questions at firstname.lastname@example.org or call 732-920-8188.
Yours in health,
Dr. Christopher Yanchus, DC