I have a client whose ESGs are very (perhaps overly) developed and tend to become hypertonic whenever an exercise is performed where the ESGs are only synergists, at best. She has a high level of functional fitness, good reaction time and neuro-muscular activation in complex exercises; she has achieved great improvements in overall posture since we began our work together, as she then presented with a "lower crossed"(Chek)/"condition 1"(Egoscue) posture. We just can't seem to get those ESGs to calm down! I think she'd have even more hip extension/glute power, although these are not bad as it is. The main issue is that the ESGs do fatigue and give her pain, and become inflamed (according to her, they "grow") no matter what the exercise or regression. Thanks.

ANSWER:

This is a common dysfunction that was quite common years ago, but over time from people sitting more and moving less, we typically see the opposite. Over the years, clients that I see that have this distortion are athletes, pregnant women, men or women with visceral inflammation, as well as most that have a dysfunctional inner unit.

I want to first clarify something before I provide you with any further information. A lower cross syndrome is taught in the CHEK certification, but it is not a CHEK term. It is actually a term that was coined by Vladimir Janda out of Prague.

My first question to you, as well as any practitioner that is questioning “why” their client is not progressing is, have you fully assessed your client? Have you done a ROM, length tension comparison, static and dynamic posture assessment, SIJ assessment and so forth? If you are just going by looks, well as “they”say, “you can’t judge a book by its cover!” To simplify it, when assessing your client, any muscle that shows up as short, you put into their stretching program. As well, any muscle that shows up as lengthened, you put into their exercise program. This is a simplified approach, as there are instances when a lengthened/taught muscle needs to be strengthened and a short muscle does not need to be stretched. Sometimes when there is an instability, the body over recruits’ muscles in order to create more stability. So in the end, if you stretch it, you could make things worse. This is common in people that have lots of visceral inflammation, which inhibits the inner unit, pulls the lumbar spine in extension, anteriorly rotates the pelvis, and creates a lower cross syndrome.

Most of the time when someone has a lower cross syndrome, the typical muscles that are short and long are:

Short: psoas, RF, adductors, TFL, sartorious, multifidus, ES, lats, QLO
Long: glutes, hams, lower ab, EO, IO, TVA

Common Injuries: LBP, SIJ, knees and ankles, hamstring, degeneration

Some of the major things that contribute to this are:
1. Improper exercise program development
2. Pattern overload
3. Repetitive movement patterns
4. Poor ergonomics
5. Visceral inflammation
6. Lumbar spine instability
7. Deep longitudinal subsystem dysfunction
8. Improper stretching of the already lengthened muscles

Some of the things you need to look into are:
1. Fully assessing your client so you know what is short, long, what their skill level is, how they recruit under load and while moving. This will allow you to develop and individualized program, as well as providing you with the necessary tools in order to teach them how to create inner unit to outer unit synergy with movement.

2. All their foundational nutrition and lifestyle principles: thoughts, hydration, moving, sleeping, and eating (quality and quantity). Any dysfunction or inflammation in any of their organs, will shut down the inner unit (secondary to Hilton’s Law), thus creating lower cross syndrome.

3. Most women that have this distortion have inflammation in not only their viscera, but also their female organs. This will shut off their inner unit, creating a lower cross. My recommendation is to find a Functional Medicine practitioner, naturopath, etc that does saliva testing. This will allow you to refer her out for adrenal and hormonal testing.

4. Instability in the SIJ from a faulty deep longitudinal subsystem will create lengthened or taught biceps femoris, instability in the SIJ, excessive extension in the lumbar spine, increased shearing, compression and torsion = pain!

5. Does she have children? Did she have a cesarean section? If not and it was vaginal, did she have an episiotomy? If so, this creates what is called Heart Bottom Syndrome. Thus, the inner unit (mostly pelvic floor) gets shut off, thus inhibiting the glute max and causes over recruitment of the glute medius to stabilize the SIJ and low back (by a process called irradation). So if the scar does not get worked out by soft tissue work and you restore visceroptosis, eliminating her lower cross will not happen.

6. According to Vladimir Janda, the most common muscle that facilitates a lower cross syndrome is the psoas. This can become short from sitting too much, over recruiting it from improper exercise technique, but also from inflammation in the organs, visceroptosis, leaky gut syndrome and according to Healing Touch and Chinese Medicine, issues with the stomach.

The glutes are a phasic or fast twitch muscle that can only be recruited by explosive movements. Your goal initially is to assess her, clean up her nutrition and lifestyle principles, get some soft tissue work if needed and work her through the stability-strength and power paradigm. Initially correcting her posture by recruiting more slow twitch fibers, then working through the paradigm in order to get her glutes to contract (sumo squats, box step ups with kick, sprints, etc).

Some resources that can help are:
1. How to Eat, Move and Be Healthy by Paul Chek
2. Better Butt, Better Back audio program by Paul Chek
3. Books: Symptoms of Visceral Disease by Pottenger, Healing Touch Therapy by Dr. John Thie, Between Heaven and Earth by Harriet Beinfield, and Muscles Testing and Function by Florence Kendall.

Good luck!