We may have touched on Lower Crossed Syndrome in the past, but it is seen so frequently that is does not hurt to mention it again.
Lower Crossed Syndrome is a common musculoskeletal disorder related to postural imbalances. In this syndrome, the patient will often present with short/strong hip flexors and lower back extensors. Contrarily, they will have lengthened/ weak abdominals and gluteal muscles. These diagonal patterns of imbalance create an imaginary "X" on the patient (hence the name "crossed" syndrome). This syndrome is typically seen in people who sit for long periods of time, allowing the hip flexors to shorten. Additionally, it can be found in athletes who use repetitive movements such as running. Clinically you will see an anterior pelvic tilt, lumbar lordosis, lateral rotation of the lower extremities, genu recurvatum, and alterations in arm/leg swing patterns during gait. The anterior pelvic tilt and lumbar lordosis may create increased compressive forces along L4, L5, and S1. Any compromise of the lumbopelvic muscles may lead to instability throughout the lower extremities, so your patient may present with low back pain, knee pain, or ankle issues. For example, the gluteus maximus is an important eccentric decelerator for hip flexion, internal rotation, and adduction. If the gluteus maximus is weak, it cannot stabilize the tibiofemoral joint properly during dynamic motion. Additionally, the tight hip flexors are placed in a better position for muscle contraction and consequently receive increased neural input. This reciprocal inhibition can lead to further tibiofemoral instability and knee pain.
When treating these patients, postural awareness, lifestyle modification, stretching, and strengthening will be important. Remember to address the shortened muscle prior to intensive strengthening. The patient needs to have adequate muscle length before beginning a strengthening program. Also, always direct your attention to the cause of the patients symptoms. While they may be having regional symptoms, the true cause may be either proximal or distal to the symptoms.