Upper Crossed Syndrome: How Pilates Can Help Today’s Office

Worker With a Common Dilemma

Mila Zenarosa Sharaf 11 September 2014

CTTC, Indianapolis, Indiana

Abstract:

Today, with the proliferation of laptops, tablets and smart phones enabling us to

be more mobile, it is becoming more common for us to be hunched over with our

necks hanging down towards our small screens. Margaux is seemingly suffering

from such a phenomenon. Some daily adjustments addressing her mechanics

should help build her body awareness. But the true corrective involves

rebalancing key muscles via Pilates. She is very interested in Reformer work

first, so her plan will take her stepwise through a reformer repertoire to stretch

and strengthen her upper body. We will also focus on stretching and

strengthening so she can realign her back and pelvis to a more neutral position.

Table of Contents: Anatomical illustration 4

Background 4

Medical Restrictions 6

Fitness Level 7

Goal 7

Assessment / Recommendation 7

Program Framework 8

BASI Program 10

Conclusion 12

Bibliography 13

Background:

Margaux is a 44 yo female working full time in an office setting. Her situation is

relatively typical of an office worker today. She spends several minutes getting

ready in the morning, leaning over a bathroom sink. She has a 45-minute

commute in the car, at least 6 to 8 hours in front of her laptop, and then another

45 minute commute home. She seals the deal with another 2 hours online in the

evening tying up lose ends, answering personal emails or watching some show

via online streaming. She works out about 1 hour 3 times a week but still feels

beaten down by the daily grind. Her aches and pains have driven her to try 3

mattresses and toppers in the last several years; she has gone through at least 4

different pillow types, various orthotics, arch supports and shoe styles. She

comes in wishing for some help to pull her up structurally since she is hitting that

time in life where things are taking their toll. Her neck, back and shoulders hurt.

She tries to stay active and exercise and has had physical therapy on her

shoulders but the problems persist. At her initial assessment I noticed a fatigue

type posture, with predominant upper crossed syndrome.

To put Margaux’s syndrome in context, the average American adult spends eight

and a half hours a day in front of a screen, whether it’s on a computer, TV,

mobile phone or other gadget. Users who spend the most time in front of a

screen are in the 45 to 54 age group, dedicating nine and a half hours to this per

day.

The average adult spends 50-70% of their time sitting which may have far

reaching implications. Dr. Emma Wilmot, a research fellow in the Diabetes

Research Group at the University of Leicester in the UK combined the results of

18 studies and included a total of 794,577 participants. The results showed that

sitting for 6 or more hours a day increases your risk of cardiovascular disease

and diabetes significantly.

Today, activities that corrupt our posture and create havoc on our muscle

balance compete with the amount of time we spend sleeping. The Bureau of

Labor Statistics released the results of their time use survey for 2011:

So now that we understand the broader context, let us get back to Margaux.

Medical restrictions:

None

Fitness Level:

She works out regularly so has an intermediate level of fitness. Historically she

has been very athletic but currently she walks, does yoga and hot yoga, has

dabbled in Pilates on the mat in mostly group settings. She was not a huge fan

of Pilates in the past because of the venue and structure, but a close friend

recommended she try again with a more personalized approach to the practice

on the reformer.

Goal:

She wishes to feel vital and free, unencumbered by posture, soreness, and daily

fatigue. She feels slumping also impacts her overall mood.

Assessment/Recommendation:

I did an initial assessment with a roll down for postural assessment. She over

tucked her chin to her chest, seems scrunched in the shoulders, tight through the

thoracic and lumbar spine as well as the hamstrings. Her hips were posteriorly

tilted. She slightly supinates.

I recommend she practice Pilates to correct imbalances, but supplement this with

daily triggers to remind her to stretch and recruit correct muscles for proper

ergonomics. Specifically, she should be in Pilates 3 times a week with daily

stretches and posture check-ins to reinforce habits (stretches, kitchen sink

movements, posture while driving, etc.).

I feel strengthening her abdominals, back extensors, and hamstrings should help

her lengthen vertically, mitigating her hypolordosis. Opening her through the

chest, strengthening her Rhomboids and Serratus should help as well. Also

rebalancing her Upper trapezius and Levator scapulae should alleviate her

shoulder pain and instability.

Below is a general approach, keeping in mind Margaux’s enthusiasm is highly

valued and her feedback to the repertoire will be incorporated to tailor her plan as

she progresses. The approach consists of a BASI program within a broader

framework.

Program Framework

Week 1-10

• Session 1, I will take a baseline picture of Margaux from back, front and

side as a baseline visual for her reference. Additional photos (front, back,

side) taken at weeks 4 and 8 for visual reinforcement of progress

• At regular intervals during the day, she should practice:

o Chest Stretch in Sitting: Extend arms behind you with elbows

straight. Interlock fingers if possible. Gently lift elbows upward. You

should feel a stretch in your chest.

o Shoulder Door Stretches for Pectoralis: Abduct shoulder to 90

degrees or less. Place hand on the door jamb and lean forward.

Hold for 10-15 seconds and repeat 3-4 times.

• While driving, she should adjust her seat so she is within arms distance,

not over reaching forward, sitting erect, shoulders down with Scapulae

tucked in pockets (right to left bottom pocket, left to right bottom pocket)

• Margaux’s BASI program for Weeks 1-10

• Margaux’s feedback of how she is feeling, making any adjustments

needed

Week 11-20

• Margaux’s BASI Program for Weeks 11-20

• Additional photos (front, back, side) taken at weeks 12, 16, 20

• Continued daily stretches and postural adjustments made while driving the

car

Margaux's BASI Program: Reformer  

1-3 4-10 11-20

Warm Up: • Pelvic Curl • Spine Twist

Supine • Chest Lift • Chest Lift with

Rotation • Single Leg Lifts

• Pelvic Curl • Roll-up • Spine Twist

Supine • Double Leg

Stretch • Single Leg Stretch • Criss Cross

• Pelvic Curl • Roll-up • Spine Twist

Supine • Double Leg

Stretch • Single Leg Stretch • Criss Cross

Footwork • 3 reds • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel

and toes

• 3 reds • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel

and toes

• 3 reds/1 blue • Parallel heels • Parallel toes • V position toes • Open V heels • Open V toes • Calf raises • Prances • Prehensile • Single leg heel

and toes

Abdominal • Hundred Prep • Coordination

• Hundred • Coordination • Short Box Series:

Round Back, Flat

• Hundred • Coordination • Short Box Series:

Round Back, Flat

Back, Twist, • Teaser Prep

Back, Twist, • Teaser Prep

Hip • Frog • Extended Frog • Extended Frog

Reverse • Down Circles/Up

Circles

• Frog • Extended Frog • Extended Frog

Reverse • Down Circles/Up

Circles

• Frog • Extended Frog • Extended Frog

Reverse • Down Circles/Up

Circles

Spinal Articulation

• Bottom Lift • Bottom Lift with

Extension • Short Spine

Stretches • Hamstring

Stretch Series:

Standing lunge

• Hamstring Stretch

Series: Kneeling

Lunge

• Hamstring Stretch

Series: Full Lunge

Full Body Integration 1

• Up Stretch Series:

Up Stretch 1,

Elephant • Down Stretch

• Up Stretch Series:

Elephant, Up

Stretch 1, Up

Stretch 2, Long

Stretch • Down Stretch

Arms • Arms Supine

Series:

Extension,

Adduction,

Up/Down Circles

• Arms Sitting

Series: Chest

Expansion,

Biceps,

Rhomboids, • Arms Kneeling

Series: Up/Down

• Arms Sitting

Series: Chest

Expansion,

Biceps,

Rhomboids, • Arms Kneeling

Series: Up/Down

Circles, Triceps • Shoulder Push • Shoulder Push

Single Arm

Circles, Triceps • Shoulder Push • Shoulder Push

Single Arm

Legs • Long Box Series:

Hamstring Curl

Lateral

Flexion/ Rotation

• Mermaid • Short Box Series:

Side Over Box

(modification of

arms crossed

across chest, not

raised overhead)

• Short Box Series:

Side Over Box

(modification of

arms crossed

across chest, not

raised overhead)

Back Extension

• Breaststroke

Prep

• Long Box Series:

Pulling Straps 1,

Pulling Straps 2

• Long Box Series:

Pulling Straps 1,

Pulling Straps 2,

Breaststroke

Close • Roll Down • Roll Down • Roll Down

Conclusion:

Margaux’s ailments are common in today’s society. Created and reinforced by

improper ergonomics from activities pervasive in our daily living. Since she is

active and interested in her physical health, a solid regimen of Pilates and

changes in some basic habits should help her improve her body awareness,

recruit the proper muscles and ultimately improve her posture and muscle

balance. Helping her understand what has happened over time and caused the

imbalance will help her understand how good form will undo it. It will be

important for her to feel and see the benefits from her hard work, since this will

help anchor the discipline for the rest of her life.

Bibliography:

1) Modification of Darwin cartoon on a T-shirt,

http://www.kleargear.com/1409.html

2) Reproduction of Upper crossed Syndrome of Vladimir Janda,M.D, by Erik

Dalton, PhD,

http://erikdalton.com/dalton-dirty-dozen/  

3) Council for Research Excellence (CRE) and Ball State University’s Center

for Media Design (CMD), Nielsen-funded

4) Emma Wilmot, M.D., Diabetes Research Group, University of Leicester,

UK, Diabetologia, October 2012

5) The Bureau of Labor Statistics, American Time Use Survey - 2011

Results, Table 1. Time spent in primary activities  

6) http://www.crossfitinvictus.com  

7) Pilates Anatomy, Rael Isacowitz and Karen Clippinger, 2001  

8) BASI Study Guide, Comprehensive Course