Lower Crossed Syndrome: The Hidden Culprit Behind Low Back and Hip Pain (and Maybe Your Knee pain, too)
Dr. Tyler Wright
If you’ve ever finished a workout with more low back soreness than glute fatigue—or you’ve had recurring hip or low back pain despite stretching and strengthening—it’s time to talk about something deeper: Lower Crossed Syndrome.
This post breaks it down in a format we all understand: Who, What, When, Where, Why, and How. By the end, you’ll know whether this sneaky muscular imbalance is keeping you from feeling and performing your best.
Who Does Lower Crossed Syndrome Affect?
Lower Crossed Syndrome (LCS) can affect just about anyone—but especially:
- Desk workers who sit for hours with poor posture
- Parents constantly bending and lifting with less-than-ideal form
- Athletes—from cyclists and runners to lifters—who overtrain certain muscle groups
- Weekend warriors who push their bodies hard but skip mobility or core work
- Active people who look fit but have poor postural control under load
What is Lower Crossed Syndrome?
LCS is a postural imbalance first described by Dr. Vladimir Janda, characterized by a pattern of muscle inhibition and tightness across the pelvis:
- Tight/Overactive:
- Hip flexors (iliopsoas, rectus femoris)
- Lumbar extensors (erector spinae)
- Weak/Underactive:
- Abdominals (especially deep core stabilizers)
- Glutes (primarily glute max)
These opposing imbalances create an exaggerated anterior pelvic tilt, increased lumbar curve (lordosis), and altered spinal and hip mechanics. It’s a classic case of muscles pulling the pelvis in opposite directions—hence the "crossed" name.
When Does Lower Crossed Syndrome Show Up?
You’ll notice LCS not during a sprint or heavy lift, but in the aftermath—when your body is compensating for poor movement patterns.
- After standing too long and feeling a dull ache in your low back
- During deadlifts when the tension goes to your spine instead of your glutes
- When your hip pinches or your back arches excessively during squats
- When core workouts just don’t seem to click, despite effort
Where Does It Hurt?
This is where things get interesting. LCS doesn’t just cause one issue—it sets the stage for a bunch of common musculoskeletal conditions.
Common Injuries or Symptoms Linked to Lower Crossed Syndrome:
- Chronic low back pain
- Especially from erector strain or facet joint irritation
- SI joint dysfunction
- One side of the pelvis gets overloaded due to glute underuse
- Hip impingement or labrum stress
- From repetitive anterior pelvic tilt and poor glute activation
- Anterior hip pain
- Misdiagnosed as tight hip flexors but actually due to dysfunction
- Hamstring strains
- Often from compensating for weak glutes during hip extension
- Piriformis syndrome
- A tiny stabilizer overworked because the glutes are sleeping
- Patellofemoral or knee pain
- Related to altered mechanics at the hip causing downstream stress
Why Does Lower Crossed Syndrome Occur?
Blame modern life. Or at least the way we move through it.
- Sitting for hours on end, which shortens hip flexors and turns off the glutes
- Poor postural awareness, especially when lifting or standing
- Repetitive quad-dominant workouts (running, biking, squats) with no posterior chain balance
- Old injuries, especially to the back or hips, that led to compensation patterns
- No real core engagement—not just planks, but coordinated, functional bracing
Over time, your body adapts—but not always in the right way. LCS is one of those adaptations that feels “normal” until it breaks down under load.
How Do We Fix It? We test, never guess.
At Ascent Health & Performance, we take a holistic, active approach to restoring functional movement and reducing pain.
Step-by-Step Breakdown:
1.Movement Assessment
- Identify postural and movement faults, not just symptoms
- Use functional screens to test pelvic control and muscle coordination
2.Manual Therapy
- Active Release Technique, cupping, spinal adjustments, and soft tissue mobilization to reduce tone in overactive areas (hip flexors, erectors)
3.Neuromuscular Re-education
- Teach your core and glutes to fire again—this is the real rehab magic
- Examples: Deadbugs, Side Planks, Glute Bridges with Band
4.Progressive Strength Loading
- Functional lifts like:
- Goblet squats
- Split squats
- Single-leg Romanian deadlifts
- Pallof presses
- All geared toward restoring balance between mobility and stability
5.Shockwave Therapy (Optional)
- We use the PiezoWave2 focused shockwave for chronic trigger points in hip flexors, erectors, or glutes
- Can accelerate healing in stubborn tissue and help break long-standing patterns
Final Thoughts: It's Not Just About Pain-It's About Performance
Pain is often the last thing to show up and the first thing to disappear during recovery. But that doesn’t mean the problem is fixed. Lower Crossed Syndrome is about restoring optimal function so you can lift, play, and move without fear or compensation.
Let’s Fix the Foundation.
Think you’ve got low back or hip pain that just won’t quit? Book an appointment at Ascent Health & Performance in Anchorage—we’ll get to the root of it, not just the symptoms.