Lower Cross Syndrome: Does It Cause Lower Back Pain?

What Is Lower Cross Syndrome?

Lower cross syndrome or LCS means an imbalance in your trunk muscles. The imbalance caused by weakening or tightening muscles in your lower body that connects from the erector spinae (extensor muscle in your back) to your pelvic, and leg muscles.  These weak and tight muscles constantly affect the function of each other.

Many people who suffer from chronic lower back pain may not relate muscle imbalance to their back pain.  As a matter of fact, the chance of most chronic lower back pain has a deep relationship with the lower cross syndrome.

You may often hear your physical therapist, personal trainer or friends mention they have anterior pelvic tilt.   The anterior pelvic tilt is basically the position of the pelvic tilt forward that cause by tight and week muscles.

What Cause Lower Cross Syndrome?

There are a few factors that cause the lower cross syndrome, but the top cause of LCS is our sedentary lifestyle. There is a study that shows that sitting is actually a disease called Sitting Disease, We spend more time in front of our computers, and you will be surprised how much this lifestyle cause you to see your pain specialist or pain management doctor.

“Sitting is the new smoking” is a term used to describe the damage it causes from prolonged sitting.

It will lead to many health issues such as a higher chance of death, increase waistline due to increase calorie conservation, lower back pain, decrease stamina, increase tightness, and pulled back muscles.

Why is lower cross syndrome more common now?


The lower cross syndrome is more common because we spend more time sitting, lack of exercise, poor posture in sitting & standing, inactive, and overweight.  As we mentioned above that our sedentary lifestyle increases the chance of imbalance in our trunk muscles to offset the balance our body needs in order to be pain-free.

Another reason we see LCS more common is because of poor ergonomics in our workspace.  Do you know that sitting toward the edge of your chair increases the curvature of your lower back, and increases hip flexor tightness? A shorter person with a higher chair will face this problem too, but they may also present with plantar fasciitis.

Overweight will also increase the curvature of your lumbar spine, and increase your chance of LCS.

What are the weak muscles in the lower cross syndrome?

  • Gluteus maximus
  • Gluteus medius
  • Gluteus Minimus
  • Hamstring
  • Abdominal – transversus abdominus, Internal oblique

Why do muscles become weak in LCS?

  • Gluteus muscles weakening because the sitting position will lengthen your gluteus muscles, and become inactive mode, less active muscles over time will lose its strength and become weaker and cause an imbalance in your trunk muscle.
  • Hamstring muscle becomes weak because the same as gluteus muscle that sitting position will lengthen your hamstring,
  • Abdominal muscle such as the transversus abdominus and internal oblique lengthen and inactive from prolong sitting

What are the tight muscles in the lower cross syndrome

  • Hip flexors such as psoas, iliacus, rectus femoris, TFL
  • Adductor complex
  • Latissimus dorsi
  • Erector spinae
  • Gastrocnemius

Why do muscles become tight in LCS?

  • Hip flexor tightening (shortening) from sitting position naturally decreases the length of the muscle fibers, and if the muscle fibers are in decrease length during prolong sitting, your hip flexor loses flexibility.
  • The erector spinae and latissimus dorsi muscles get tight because flexion muscle in your hip flexors and abdominal becomes weak, unable to maintain flexion position, this will cause an imbalance in extensor muscles in your back.

Lower cross syndrome“62MD23” by sportEX journals is licensed under CC BY-ND 2.0

What causes anterior pelvic tilt?

Anterior pelvic tile is another term for your pelvic is tilting forward.  You will notice your posture from the side view will be an increase in lumbar curvature, and your butt will stick out more prominent.  Anterior pelvic tilt posture is more obvious in skinny person vs overweight because of the excessive mass in your trunk will mislead you.


In the picture above, we see the tight (facilitated) muscles erector spinae and rectus femoris pull pelvic in a forward or anterior position.  If your gluteus maximus, medium, minimus, and abdominal muscles are not weak (inhibited), it will maintain your pelvic in a neutral position.  But because the muscle is weak, it causes an imbalance in your trunk muscle, and we now have an anterior pelvic tilt posture.

What is the simplest way to check if you have anterior pelvic tilt?

Usually, a train profession such as a medical doctor, chiropractor, and physical therapist can check wheater you have anterior pelvic tilt by checking the position of your ASIS and PSIS.  Your ASIS and PSIS normally aligned when you compare both positions.  If ASIS is below PSIS, you most likely have an anterior pelvic tilt.

Anterior superior iliac spine (ASIS) is the pointy bone below your abdominal muscle on both sides.

The posterior superior iliac spine (PSIS) is the bony projection of the posterior iliac in your back.

Lower Cross Syndrome Exercises

Now we know what causes the lower cross syndrome, it will be easy to find a solution to prevent the lower cross syndrome.  Below are some exercise helps to strengthen the weak muscle in your trunk.

  1. Plank

  2. Bridge

  3. Squat

  4. Pelvic Tilt

Stretches For Lower Cross Syndrome

Exercise is great for weak muscles, stretching is great for tight muscle. If we strengthening weak muscle and not stretching the tight muscle, we may have a posterior pelvic tilt posture instead.  Below are some stretch for tight muscles in your trunk.

  1. Psoas (hip flexor) stretch

    • Psoas muscle is one of the major hip flexors
    • psoas stretch will lessen the resistance of the hip extensor muscles when your hip is in hip extension during vertical jump.
    • Here are the steps for Psoas stretch
      • Get down to lunge position with the back knee on the floor
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      • Make sure your forward knee line up with your ankle
      • Tighten your buttock (gluteus) muscle
      • Drive your hip forward
      • Hold in position for 30 seconds
      • repeat the above steps on the other side
  2. Cat Cow Stretch

    • Inhale/breath in
    • You’re on your ground with both hands and knees on the ground
    • take a deep breath in, arch your lower back upward, with your head looking up, drop your belly closer to the ground. hold for 10–20 seconds.
    • Exhale/breath out
    • you breathe out, slowly arch your upper back upward to the sky, tug your tailbone in, your neck and head should flex and look down on the ground. hold in this position for 10–20 seconds
  3. Quad stretch

    • Quad muscle is one of the main hip flexors
    • Quad stretch will lessen the resistance during hip extension
    • Here are the steps for Quad Stretch
      • Stand on your feets
      • Bend your left foot and use your left hand to bring your left foot toward your left buttock
      • Make sure your left knee is pointing straight down toward the floor and keep your both knee close together
      • Gently pull your foot closer to your buttock
      • You should feel the stretch on the front thigh
      • Hold in position for 30 seconds
      • You can gently hold on to a chair or a wall to keep your balance
      • Repeat the above steps on the other side
  4. Calf stretch

    • Plantar flexes of the foot flex of the knee
    • Calf stretch will help improve and maintain the flexibility of calf muscle and Achilles tendon
    • Here are the steps for Seated Towel Straight Leg Calf Stretch
      • You will need a towel
      • Sit on the floor with both legs out straight
      • Use a towel at the ball of your foot or at the arches of your foot
      • Gently  pull your foot toward yourself while you maintain a straight leg
      • You should feel stretch on the back of your knee
      • Hold in position for 30 seconds
      • Repeat the above steps on the other side
  5. Adductor stretch

    • Adductor muscles make up the inner thigh muscle which adducts and flexes the thigh
    • Adductor stretch will lessen the resistance of the hip in extension and abduction motion
    • Here are the steps for Adductor Stretch
      • Sit on the floor with both knees apart, bend your knee and bring the bottoms of your feet together.
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      • Maintain a straight back and keep your chest up
      • Use both hands to grab your feet
      • Bend forward at your hip
      • Gently pull at your feet to assist
      • You should feel the stretch on your inner thigh
      • Hold in position for 30 seconds

How Does LCS cause lower back pain?

LCS is not just a poor posture, it can cause lower back pain if you left unattended.  If you’re active, exercise regularly, and stretch regularly, you’re less prone to LCS and lower back pain.  But we are sitting more than we expected. A study shows we sit an average of 15 hours every day or 80,000 hours over a lifetime.

Pain medication and muscle relaxants may bring a temporary solution for your pain, but the pain will return after the medication wears off.  Going for physical therapy or chiropractic treatments will help improve your condition, but there is so much they can do for you.  You still need to put in hard work to release those tight muscles and strengthen those weak muscles.


If you have lower back pain due to LCS or anterior pelvic tilt, you can reverse it by simply stretching, postural exercise, pelvic tilt exercise, and strength training exercise.  Anterior pelvic tilt or LCS can be reversible, but it takes patience and consistency in order to work.

Some conditions that are related to LCS such as lumbar herniated disc, sciatic, knee injury, hip injury, and ankle sprain.  These medical conditions might be the cause of LCS or vice versa, because of these issues, you end up having LCS along the way.

If you suspect you have LCS or anterior pelvic tilt, you can try the stretches and exercises above and see if your lower back pain improves.  If not, see your doctor for medical advice.


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  3. Unlock Your Hip Flexors Review
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