Upper/lower crossed syndrome & Key movement patterns

Question 1

Skeletal muscles that have higher predominance of Type I fibers (myoglobin) and are resistance to fatigue are what kind of muscles

Answer 1

Postural muscles

Note: they shorten and tighten when chronically stressed and/or injured

Question 2

Skeletal muscles that have higher predominance of Type II fibers (myoglobin and glycogen) and used for quick movements and short bursts of activity

Answer 2

Phasic muscles or arms and legs

Note: They have a tendency to lengthen and weaken when chronically stressed and/or injured

Question 3

What are the 4 postural trunk muscles

Answer 3

1. Cervical and lumbar erectors
2. Quadratics lumborum
3. Scalenes muscles
4. Sternocleidomastoid m

Question 4

What are the 4 postural shoulder girdle muscles

Answer 4

1. Pec major and minor
2. Levator scapula
3. Upper trapezius
4. Bicep brachii

Question 5

What are the 2 phasic trunk muscles

Answer 5

1. Mid thoracic erectors

2. Longus capitus and colli

Question 6

What are the 4 phasic shoulder girdle muscles

Answer 6

1. Rhomboids
2. Middle trapezius
3. Lower trapezius
4. Triceps brachii

Question 7

Reciprocal inhibition

Answer 7

When a muscle contracts, its direct antagonist relaxes to an equal extent allowing smooth movement.

Question 8

Why do key movement patterns (KMP)?

Answer 8

Observe AROM and you can see/palpate altered firing patterns within synergistic groups of muscles

Question 9

Upper crossed syndrome is associated with short ______ and long ________

Answer 9

• Short tight postural muscles

- Long weak/inhibited phasic muscles

Question 10

Upper crossed syndrome: postural/tight muscles (6)

Answer 10

Cervical erectors
Upper traps
Levator
Pectorals
SCM
Scalenes
Upper extremity flexors

Question 10

Upper crossed syndrome phasic/weak/inhibited muscles (5)

Answer 10

Mid-thoracic erectors
Mid- and lower-traps
Rhomboids
Serratus anterior
Deep neck flexors — longus capitus and colli
Upper extremity extensors

Question 11

What will you see in a lateral postural evaluation for someone with upper crossed syndrome?

Answer 11

• Anterior head carriage
• Forward and rounded shoulders
• Internally rotated humerus
• Thoracic hyperkyphosis
• Protruding abdomen

Question 12

What muscles are overactive/inhibited in anterior head carriage?

Answer 12

Overactive SCM

Inhibited deep neck flexors

Question 13

What muscles are overactive/inhibited in forward and rounded shoulders?

Answer 13

Tight pectoralis major/minor

Inhibited rhomboid, serratus anterior

Question 14

What muscles are overactive/inhibited in internally rotated humerus?

Answer 14

Tight pectoralis major/minor

Inhibited serratus anterior

Question 15

What muscles are overactive/inhibited in thoracic hyperkyphosis

Answer 15

Facilitated T/L erectors

Inhibited gluts

Question 16

What muscles are overactive/inhibited in protruding abdomen

Answer 16

Facilitated poses

Inhibited gluts

Question 17

What are functional movement pattern evaluations for upper crossed syndrome?

Answer 17

Neck flexion
Trunk flexion
Shoulder abduction
Lowering from push-up with a plus

Question 18

What muscles are inhibited or tight in lower crossed syndrome?

Answer 18

Inhibited: Glut. Max, abdominals, (glut. Med)

Tight: spots, rectus femoris, lumbar erectors, TFL, QL

Question 19

What will you see in a lateral postural evaluation for someone with lower crossed syndrome?

Answer 19

PELVIS: A/P tilt, torsion, hiking, lateral shift

GLUT MAX: flattened upper-outer quadrant, sagging fold

ADDUCTORS: distal “notch” ipsilateral hip dysfunction

HAMSTRINGS: overactivity in distal 1/3 = inhibited glut

CALF: soleus hypertrophy

LUMBAR ERECTORS: should be > TL erectors

Question 20

What are some key functional movement patterns to evaluate lower crossed syndrome?

Answer 20

Hip extension
Hip abduction
Trunk flexion

Question 21

Do you perform key movement patterns (KMPs) on acute patients?

Answer 21

No

Question 22

What do you evaluate before doing KMPs?

Answer 22

Posture and gait

Question 23

How do you perform KMPs in general (4)?

Answer 23

1. Expose area
2. Give minimal verbal cues
3. Pt performs 3+ trials
4. Observe both sides for comparison

Question 24

List 4 positive findings for hip extension

Answer 24

- deviations in lumbar spine - recruitment of upper back musculature - inability to maint knee extension - decreased hip extension

Question 25

List 5 positive findings for hip abduction

Answer 25

``` Cephalad shift of the pelvis – overactive QL Hip flexion – overactive TFL or psoas Hip ER/extension – overactive piriformis Limited abduction – tight adductors Pelvic rotation – overactive TFL ```

Question 26

In hip abduction, what does a cephalad shift of pelvis suggest?

Answer 26

Overactive QL

Question 27

In hip abduction, what does hip flexion suggest?

Answer 27

Overactive TFL or psoas

Question 28

In hip abduction, what does hip ER/extension suggest?

Answer 28

Overactive piriformis

Question 29

In hip abduction, what does limited abduction capability suggest?

Answer 29

Tight adductors

Question 30

In hip abduction, what does pelvic rotation suggest?

Answer 30

Overactive TFL

Question 31

In hip abduction, what does faulty patterns suggest?

Answer 31

Inhibited gluteus medius contraction

Question 32

What are positive findings for the first part of the trunk curl-up?

Answer 32

Trunk flexion versus hip flexion. WEAK ABS and OVERACTIVE ILIOPSOAS, the flexion movement of trunk is minimal and the movement will be mostly hip flexion. Tsk Tsk Also, the back may stay straight and pelvis tilt anteriorly +/- Heel pressure means iliopsoas is dominating

Question 33

In shoulder abduction, what are abnormal patterns?

Answer 33

``` Early scapular movement (prior to 60˚) Late scapular movement (after 90˚) Winging Contralateral side bending of the trunk Bilateral assymetry ```

Question 34

In shoulder abduction, what might early scapula motion mean? (Movement prior to 60˚ abduction)

Answer 34

Short/tight - lateral scapula mm: teres, infraspinatus - Overactive upper trap Long/weak - medial scapula mm: rhomboids - lower trap

Question 35

In shoulder abduction, what does late scapula motion mean? (Movement after 90˚ abduction)

Answer 35

Reverse. Short/tight - medial scapula mm: rhomboids - lower trap Long/weak - lateral scapula mm: teres, infraspinatus - upper trap

Question 36

What muscles coordinate to allow upward scapular rotation? What what oppose the motion?

Answer 36

Upper trap Lower trap Serratus anterior Opposers: Rhomboids Levator scapula

Question 37

If upper trap and lower trap are not balanced or if serratus anterior m has portions that are shortened or weak, what will happen to scapular motion?

Answer 37

It’ll be atypical/aberrant because scapula isn’t adequately stabilized

Question 38

What are abnormal patterns for neck flexion?

Answer 38

Chin protrusion Shaking Chin deviation