International Journal of Science and Research (IJSR)

ISSN: 2319-7064
SJIF (2020): 7.803

Prevalence of Lower Crossed Syndrome among

Collegiate Young Females in Kochi
Sushmitha T1, Angel Anna Chacko2, Angela Sarah Jolly3, Akhila Unni4
1
Assistant Professor, College of Physiotherapy, Medical Trust Institute of Medical Sciences, Irumpanam, Kochi-682309
sushmitha.sushmi66[at]yahoo.com
2
Undergraduate Student, College of Physiotherapy, Medical Trust Institute of Medical Sciences, Irumpanam, Kochi-682309
angelannachacko2[at]gmail.com
3
Undergraduate Student, College of Physiotherapy, Medical Trust Institute of Medical Sciences, Irumpanam, Kochi-682309
angelasarahjolly[at]gmail.com
4
Undergraduate Student, College of Physiotherapy, Medical Trust Institute of Medical Sciences, Irumpanam, Kochi-682309.
unnikrishan73409[at]gmail.com

Abstract: Background: Lower crossed syndrome is a musculoskeletal imbalance characterized by specific patterns of muscle weakness
and tightness that crosses between the dorsal and the ventral sides of the body. This postural imbalance among young individuals can
lead to Low Back Pain in future. Hence, this study aims to find out the prevalence of the lower crossed syndrome in young female
college students of Medical Trust Institute of Medical Science, Ernakulam. Method: In the following study, 33 students were selected
according to the inclusion criteria. Length of bilateral Iliopsoas muscle was measured by Modified Thomas test using Universal
Goniometer. Length of spinal extensor muscle was checked by non-elastic measuring tape. Strength of abdominal muscle and bilateral
Gluteus maximus muscle were evaluated according to MRC grading of manual muscle testing. Results: The study results showed that 9
out of 33 female volunteers have Lower Crossed Syndrome. Conclusion: The study concluded that 27.27% of young collegiate females
have lower crossed syndrome. The rest of the participants were found to have weakness or tightness of atleast one of the muscle groups.

Keywords: Lower crossed syndrome, Abdominals, Gluteus Maximus, Iliopsoas, Spinal extensors, Low Back Pain

1. Introduction Phasic or dynamic muscles (Abdominals). Pathology

affecting both types of muscles can lead to LCS. (3)
The frequent imbalance between postural and phasic
muscles in and around the pelvis causes postural distortion The researcher noticed that due to prolonged sitting all day,
and painful movement patterns. There are thirty-three with time, hip flexors become tight. Thus, the brain will
muscles attached to the pelvis and the most common eventually start to inhibit opposite gluteus muscles. These
imbalance or pattern of muscle dysfunction is the Lower imbalances will lead to lumbar lordosis because of anterior
Crossed Syndrome or Pelvic Crossed Syndrome as pelvic tilt and hip flexion contracture, and the over activity
documented first by Vladamir Janda and Jull. (1) of the hip flexors compensating for the weak abdominals. (4)

The lower cross syndrome is a neuromuscular condition in The hip extension would be limited due to tightened psoas
which there are tight thoracic lumbar extensors and hip and inhibited gluteus maximus. So, contralateral lumbar
flexors, while the abdominals and gluteus maximums are erector spinae and ipsilateral hamstring would have to be
weak. The pattern of imbalance creates joint dysfunction at overactive. (5, 6)
L4-L5 and L5-S1 segments, sacroiliac and hip joint. (2)
People with such threatening combinations of biomechanical
muscle imbalances frequently complains of low back pain
due to the excessive stress it places on the lower back
structures and if left unchecked and untreated, it can lead to
chronic low back pain in later stages. (7)

Studies have reviewed that as in adults, the prevalence of

low back pain in childhood increases with age and have
shown higher prevalence by 20 years of age. (8, 9) Also, there
are studies which identify the features associated with low
back pain as well as risk factors and its development. (10, 11,
12)

There is literature evidence which suggests that females are

There are mainly two types of muscles present in our body: more prone to develop the lower cross syndrome than males.
Postural or static muscles (iliopsoas, quadratus lumborum, (5) Hence, this study was designed to find out the prevalence
erector spinae group, rotators of the back, multifidus) and of lower crossed syndrome among collegiate young females

Volume 11 Issue 1, January 2022

www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: SR22119155806 DOI: 10.21275/SR22119155806 1202
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2020): 7.803
of age group 18-23 years which in the long term may lead to strength, all the volunteers performed warm up exercises
low back pain. under supervision.

2. Need of Study Length of bilateral Iliopsoas muscle was measured by

Modified Thomas test using Universal Goniometer. Length
Lower crossed syndrome in young population increases the of spinal extensor muscle was checked by non-elastic
incidence of mechanical low back pain as abnormal motor measuring tape. Strength of abdominal muscle and bilateral
recruitment of muscles lead to muscle tightness and gluteus maximus muscle were evaluated according to MRC
weakness. Therefore, clinical identification and prevention grading of manual muscle testing. The subjects were asked
of occurrence of lower crossed syndrome among young to assume the testing position and then different tests for
individuals is important to prevent future pathology. checking the muscle tightness and muscle strength of the
Females were chosen as analysis suggests that females are required muscles were performed. Data was collected on the
more prone to develop lower crossed syndrome than male of basis of these tests. The collected data was then subjected
an equivalent age bracket. for data analysis.

Aims and Objectives Measurement of iliopsoas muscle length:

To find out prevalence of lower cross syndrome in young The volunteer was instructed to lie in supine with half of the
females of age between 18-23 years thigh out of the couch while the therapist was standing by
the tested table. Lumbar spine was checked for excessive
3. Methodology lordosis. The volunteers were instructed and demonstrated to
pull (flex) and hold the non-tested hip in flexed position,
Study design bringing the knee close to the chest to flatten out the lumbar
Cross-sectional study spine and to stabilize the pelvis and the knee of the tested leg
was allowed to extend so that the two-joint rectus femoris
Study setting does not limit the range. One student researcher measured
The study was conducted at Medical Trust Institute of the length of opposite side iliopsoas with a universal
Medical Sciences, Cochin. goniometer by keeping the fulcrum over greater trochanter,
movable arm kept parallel to the lateral border of femoral
Sample size shaft and stationary arm parallel to the tested table. The test
33 subjects were selected by using convenient sampling was done on both sides. The iliopsoas was considered tight
technique. if hip extension angle was less than 15°.

Inclusion criteria
1) Girls in age group of 18-23yrs.
2) Those who have given their consent for participation in
this study.

Exclusion criteria
1) Girls with back pain due to menstruation or other
gynaecological problem.
2) Those having history of spinal trauma, joint dysfunction
or congenital defects.
3) Those having pain due to any systemic inflammatory
disease. Figure 1: Measurement of iliopsoas tightness (Thomas test)
4) Acute spasm of Para spinal muscles of back or sprain of
any Para vertebral structures like ligament or fascia. Measurement of strength of abdominal muscle:-
5) Un co-operative patients. Abdominal muscle strength was measured by positioning the
volunteers in supine lying with both hip and knee flexed.
Materials used The grading of the test is:
1) Universal goniometer
2) Non elastic measuring tape Grade 5=hands clasped behind the head and scapula clears
3) Stopwatch the table, 20-30 sec hold.
4) Plinth Grade 4=arms crossed over chest and scapula clears the
table, 15-20 sec hold.
4. Procedure Grade 3=arms straight and scapula clears the table, 10-15
sec hold.
In the following study, considering all exclusion criteria, 33 Grade 2=arms extended, towards knees and scapula clears
subjects were selected by doing convenient sampling. After the table, 1-10 sec hold
taking consent from the subjects, procedure was explained to Grade 1=unable to raise more than head off table.
them. Demographic data including age, sex, height, weight
and Body Mass Index (BMI) were collected from 33 healthy Therapist was standing at side of the table at level of
individuals. Prior to the evaluation of muscle length and volunteer’s chest to ascertain scapular clearance from table
during test. A trunk curl up was emphasized until scapula
Volume 11 Issue 1, January 2022
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: SR22119155806 DOI: 10.21275/SR22119155806 1203
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2020): 7.803
clears the table. Instruction was given as “Tuck your chin
and bring your head, shoulders and arms off the table, as in a
sit up”. The muscle is considered to be weak if the grade is 4
or less.

Figure 4: Measurement of spinal extensor length (final

position)

Figure 2: Measurement of abdominal strength Measurement of Gluteus Maximus strength:

The volunteer was asked to lie in prone position with knee
Measurement of length of spinal extensors muscle:- flexed to 90 degree. Student researcher was in standing
The volunteers were instructed to stand erect with the position on the tested side at the level of pelvis. Pelvis was
cervical, thoracic, and lumbar spine in 0° of lateral flexion stabilized by applying downward pressure at the low back
and rotation. Spinous process of C7 and S1 vertebrae was by one hand of the therapist. The volunteers were instructed
marked and distance between two processes was measured to extend the hip maintaining the knee flexion at 90°. The
by a tape measure. The pelvis was then stabilized by keeping test was done on both sides. The strength of gluteus
the student researcher’s hand over PSIS to prevent anterior maximus was graded according to MRC grading.
tilt of the pelvis. Instruction was given to the volunteers to
bend forward gradually while keeping the arm relaxed The gradings of this test are:
maintaining equal load on both feet. The motion was Grade 5= Complete hip extension and holds end flexion
stopped when resistance to additional flexion is experienced against maximum resistance.
by the volunteer and the student researcher feels the pelvis Grade 4= Complete hip extension is possible and can be
start to tip anteriorly. Then the distance between the two held against heavy to moderate resistance.
spinous processes were again measured. The difference Grade 3= Completes full hip extension and holds end
between the first and second measurement indicates the position but takes no resistance.
amount of thoracic and lumbar flexion. The muscle was Grade 2= Completes full range of hip extension in side
considered tight when the measurement is less than 10cm. lying position.
Grade 1= Palpable contraction of gluteus maximus will be
seen as narrowing of the gluteal crease. No visible joint
movement.

The muscle is considered to be weak if the grade is 4 or less.

Figure 3: Measurement of spinal extensor length (initial

position) Figure 5: Measurement of gluteus maximus strength

5. Results and Statistical Analysis

Table 1: Demographic summary
Variables Mean & SD
Age (years) 19.52 ± 1.7
Height (cm) 155 ± 6.23
Weight (kg) 49.98 ± 10.46
BMI (Kg/m2) 20.08 ± 3.76

Volume 11 Issue 1, January 2022

www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: SR22119155806 DOI: 10.21275/SR22119155806 1204
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2020): 7.803
weakness, 79% of subjects had left gluteus maximus
weakness and 81% of subjects had abdominal muscle
weakness. Similarly, 55% of subjects had right and left
iliopsoas muscle tightness and 61% of subjects had spinal
extensor tightness.

Studies have proved that weakness and tightness of certain

muscles cause low back pain which leads to the lower
crossed syndrome. (1, 6, 7) Low back pain could be a universal
downside and lower crossed syndrome is one among the
threatening combos of biomechanical muscle imbalance
because of excessive stress it places on the structures of
Graph 1: Prevalence of Lower Crossed Syndrome lower back.

Graph 1 shows that 27.7% participants had lower crossed Physiotherapy for this condition is aimed at stretching the
syndrome tight muscles and strengthening the weak muscles to restore
balance. Core muscle strengthening can be given to the
Table 2: Frequency distribution of muscle length abdominal muscles. Strengthening and resistance exercises
can be given to the gluteus and stretching can be given to the
Muscles Normal Tight spinal extensors and iliopsoas muscles as preventive
Right Iliopsoas (n=33) 15 (45%) 18 (55%) treatment for Lower Crossed Syndrome.
Left Iliopsoas (n=33) 15 (45%) 18 (55%)
Spinal extensors (n=33) 13 (39%) 20 (61%)
Table 2: shows frequency distribution of right iliopsoas, left 7. Conclusion
iliopsoas and spinal extensor muscle length
The study concluded that 27.27% of young collegiate
Table 3: Frequency distribution of muscle strength females have lower crossed syndrome. Among the total
Muscles MMT grade participants, each student has a muscle imbalance in at least
2 3 4 5 one muscle which has been evaluated. So, allsubjects
Right gluteus maximus (n=33) 0 (0%) 5 (15%) 20 (61%) 8 (24%) included in this study are at risk of having lower crossed
Left gluteus maximus (n=33) 0 (0%) 5 (15%) 21 (64%) 7 (21%) syndrome
Abdominals (n=33) 0 (0%) 16 (48%) 11 (33%) 6 (19%)
Table 3: shows frequency distribution of right gluteus 8. Future Scope
maximus, left gluteus maximus and abdominal muscle
strength. In this study we have included only 30 young collegiate
females. Future studies are needed to be done with including
6. Discussion both males and females with larger sample size

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Author Profile
Sushmitha T, Assistant Professor, College of
Physiotherapy, Medical Trust Institute of Medical
Sciences, Irumpanam, Kochi-682309. Mail ID:
sushmitha.sushmi66[at]yahoo.com

Angel Anna Chacko, Undergraduate Student, College

of Physiotherapy, Medical Trust Institute of Medical
Sciences, Irumpanam, Kochi-682309. Mail ID:
angelannachacko2[at]gmail.com

Angela Sarah Jolly, Undergraduate Student, College

of Physiotherapy, Medical Trust Institute of Medical
Sciences Irumpanam, Kochi-682309. Mail ID:
angelasarahjolly[at]gmail.com

Volume 11 Issue 1, January 2022

www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: SR22119155806 DOI: 10.21275/SR22119155806 1206