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Mid-Back Pain - Upper Crossed Syndrome

Updated: Jul 8, 2023

Most people are familiar with low back pain during pregnancy and beyond, however mid-back pain, between the shoulders in the bra-strap region, can be particularly bothersome, especially when compounded by postural changes.

Upper Crossed syndrome is typically described as rounded shoulders, an anterior head carriage (jaw and neck jutting forward) and slumping in the upper to mid-back (see diagram). It is caused primarily by weak lower stabilisers of the scapulae, weak deep neck flexors, tight (and sore) upper trapezius muscles and tight pectorals. The shoulder girdle can also be affected in combination with upper crossed syndrome, as the shoulder and neck are closely related in function.


Upper crossed syndrome mid-back pain

So, what causes it? It is very common due to sedentary lifestyle with lots of sitting, slumped over a phone or computer, however postural changes that occur during pregnancy in the belly/low back region, have a knock-on effect higher up in the mid-back. As breasts get bigger and therefore heavier, this adds to the rounding of the shoulders as the body tries to compensate for the extra loads being carried at the front of the body. Postural changes do not automatically revert back after birth; lifting and carrying baby, car seats (another blog post about lugging around these here!), sitting in less-than optimal positions whilst feeding baby for example, can compound the problem further.

During the recovery from birth and the postpartum period as your body starts to strengthen and change once again, it is important to be mindful of how these groups of muscles work in harmony to keep you upright and mobile.

  • Simple rehab exercises to strengthen the weak muscle groups in a safe, gentle and holistic way once you have been given the all clear by your healthcare practitioner.

  • Soft-tissue work such as massage and stretching of the tight muscle groups can be extremely beneficial at alleviating pain and optimising function.

  • Being aware of safe-lifting of baby by minimising twisting, lifting from the knees rather than the back, can help prevent strains.

  • Optimal breastfeeding or infant feeding positions which avoid slumping over, bringing baby to you and using props such as pillows or more laid-back feeding positions (biological or nurturing breastfeeding) can alleviate mid-back pain and help prevent future problems in this region.

  • As baby gets older and heavier, trying to alternate sides if they are carried on the hip, to avoid asymmetrical loading of the spine. Using a baby carrier that loads the spine evenly and distributes weight through the hips as well as the shoulders.

  • Seeking support from a manual therapist such as a chiropractor, osteopath or physiotherapist and massage therapist to help rebalance these postural muscle groups.

Taking care of your posture benefits everybody, at any stage in life and goes a long way to prevent injury and optimise function, especially when running around after little people or just running around.


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