Posture pain, “tech neck,” and upper and lower crossed syndrome

By Dr. Jeremiah Carlson, chiropractic physician · Jacksonville, FL · Reviewed Nov 2026

Upper crossed syndrome

Picture an “X” across the upper body. On one line, muscles tend to get tight: the upper trapezius and levator scapulae (top of the shoulders and back of the neck) and the pecs (chest). On the other line, muscles tend to get weak: the deep neck flexors (front of the neck) and the lower trapezius and serratus anterior (between and around the shoulder blades).

• Forward head posture, or “tech neck”
• Rounded shoulders and shoulder blades that wing or ride up
• A stiff, rounded upper back
• Often comes with neck pain, tension headaches, and tightness at the base of the skull

Lower crossed syndrome

The same “X” idea at the hips. Tight: the hip flexors (front of the hip) and the low-back muscles. Weak: the abdominals and the glutes.

• Anterior pelvic tilt: the pelvis tips forward and the low back arches more
• Belly pushed forward, tight hips after sitting
• Often comes with low back pain and hip tightness

How we assess it

• Standing posture from the front and side
• Movement tests, such as how you raise your arms, bend, squat, and extend your hip
• Muscle length checks (chest, hip flexors) and strength and endurance checks (deep neck flexors, glutes, core)
• Joint motion of the neck, upper back, and low back, plus a standard neurological screen

How we treat it

• Chiropractic adjustments or gentle mobilization for stiff joints, especially the upper back and neck
• Soft-tissue work on the tight side of the “X”, which may include Graston, cupping, or dry needling
• Chiropractic physiotherapy: corrective exercise to stretch what’s tight, strengthen what’s weak, then retrain how you sit, stand, and lift
• Workstation and habit changes so the results last

What the evidence says, honestly

Janda’s crossed syndromes are a widely taught way to describe common muscle-imbalance patterns, and they help us pick exercises. They are not a formal diagnosis, and there isn’t strong trial evidence that these patterns cause pain or that correcting them is the reason people improve. Research also hasn’t shown one “perfect” posture. What is better supported: exercise and manual therapy for neck pain (JOSPT guideline), and staying active and exercising for low back pain (ACP). We use the model as a roadmap, track whether your pain and function improve, and change course if they don’t.

Quick workstation setup (based on OSHA guidance)

• Top of the monitor at or slightly below eye level, about an arm’s length away
• Elbows near your sides, wrists straight, keyboard and mouse close
• Feet supported, with a backrest supporting the low back
• Get up and move every 30–45 minutes

How we approach it at our clinic

1. Talk and exam. Dr. Carlson takes your history and checks posture, range of motion, reflexes, strength, sensation, and orthopedic tests.
2. Imaging only if it’s needed. We don’t take X-rays in our office. If your exam shows you need X-rays, an MRI, or a medical specialist, we refer you out and help coordinate it.
3. A plan in plain English: what we found, what we recommend, how often, and how we’ll measure progress.
4. Care that fits you, which may include chiropractic adjustments (manipulation or gentler mobilization), chiropractic physiotherapy (corrective exercise), home exercises, lifestyle and workstation advice, and, when appropriate, acupuncture, dry needling, Graston, cupping, laser therapy, or massage therapy.

Questions people ask

Sources

• Page, Frank & Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach (Human Kinetics, 2010)
• Neck Pain Clinical Practice Guideline (Blanpied et al., JOSPT 2017)
• American College of Physicians low back pain guideline (Qaseem et al., Ann Intern Med, 2017)
• OSHA eTool: Computer Workstations