When it comes to muscle and joint pain, many people ask if their posture has anything to do with it and whether they should get it fixed like using a posture corrector, corrective exercise, or even get “adjusted.” Or they may ask themselves if they need to be sitting or standing straighter. The obsession with maintaining a “perfect posture” is not new. Some historical evidence indicates that some of the roots came from the European military in the Early Modern Period that eventually permeated throughout the world, including Maoist China.

While there are many types of postures, this series outlines some of the most common ones that you may see online.


Upper Cross Syndrome

women sitting kyphosis

Photo: Nick Ng

The characteristics of upper cross syndrome consist of protracted shoulders and (sometimes) the head, which may exaggerate the curvature of the upper spine. The idea proposes that “tight” or “shortened” muscles in the chest and upper trapezius and “weak” or “lengthened” muscles in the shoulder stabilizers, neck extensors,  and other neck muscles are the cause this posture.

Along with lower cross syndrome, the idea behind upper cross syndrome was proposed and popularized by Dr. Vladimir Janda (1928-2002) in the 1970s. As popular as it is today, what does the scientific research actually say about the relationship between crossed syndromes, pain, and movement?

Details: upper cross syndrome


Forward Head Posture

young woman writing with forward head posture slouching

Photo: Nick Ng

Forward head posture is the excessive protraction of the head in relation to the shoulder girdle. While this has been nicknamed “text neck” or “nerd neck,” which further led to many manual therapists and posture correction companies to sell their services and products in the 2010s.

Details: forward head posture

Cervical Lordosis

man looking at smartphone cervical lordosis

Photo: Nick Ng

The lack of a natural neck curve is often blamed for causing chronic neck pain, causing many people to likely seek treatment to increase the lordotic curve. Like forward head posture, years of research in the relationship between posture and neck pain found very little association between the two.

Details on cervical lordosis.


bruce lee practices sticky hands with Grandmaster Ip man wing chun

Bruce Lee and Grandmaster Ip Man practicing Wing Tsun sticky hands in “upper cross syndrome” posture.
Photo: Uploaded by שילוני on Wiki Commons https://commons.wikimedia.org/wiki/File:Lee_and_yip_chi_sau.jpg

Kyphosis exists in nearly everyone’s upper spine in various degrees, but too much outward curve—sometimes called a “hunchback” or “dowager’s hump”—can reduce movement range of motion and increase the risk of some joint disorders and diseases. However, kyphosis cannot be just lumped under one umbrella term and assume nearly all treatments and causes are the same. Research has shown that kyphosis is more than just about posture.

Details: kyphosis


Rounded Shoulders

Ben Cormack upper cross syndrome

Photo: Nick Ng

Rounded shoulders are caused by the anterior tilting of the scapulae, along with possible increase in scapular internal rotation. This is usually coupled with tight pectoral muscles and can gradually lead to increased tightness in the soft tissue structures anterior to the shoulder joint. It is common to see individuals with rounded shoulders with their arms turned inwards as the shoulder joints assume an internally rotated and adducted position.

Details: rounded shoulders


Lower Cross Syndrome

young woman with lower cross syndrome

Photo: Nick Ng

Lower cross syndrome is another type of “Janda’s postural syndromes” that also follows the same logic as the upper cross syndrome. Many print and online depictions of lower cross syndrome tend to show a sideway view of someone with an “X” drawn in the middle of the abdominal and pelvic region to show which muscles in the lower back and hips are “tight” and which ones are “weak.” The aim is identify these areas to bring the pelvis and spine as close to “neutral” position as possible. However, this hypothesis was never validated.

Details: lower cross syndrome



young man with excessive lordosis and anterior pelvic tilt

Photo: Nick Ng

Lordosis in the concave curvature of the spine, and it often refers to the lumbar spine. Colloquially called “swayback,” it can also refer to the neck curvature—known as cervical lordosis—which is related to forward head posture and upper cross syndrome.

Details: lordosis


Anterior Pelvic Tilt

young woman with lower cross syndrome

Image: Nick Ng

In the anterior pelvic tilt, the pelvis is rotated forward in the sagittal plane, causing an increase of the lumbar spine curvature. This position tilts the gluteal muscles upward, exaggerating its round appearance for some people. Sometimes the pelvic tilt decreases the upper spine curvature, making the person appear to have a flatter upper back.

Details: anterior pelvic tilt


Posterior Pelvic Tilt

woman with posterior pelvic tilt

Image: Nick Ng

The posterior pelvic tilt is where the pelvis is rotated back in the sagittal plane, causing a reduction in the curvature of the lumbar spine and buttocks. Sometimes the pelvic tilt exaggerates the upper spine curvature, making the person appear more hunchback.

Details: posterior pelvic tilt


Q Angle

q angle knee measurement

Photo: Penny Goldberg

The Q-angle may be thought of as the “posture of the knees.” A closer look at whether Q angles affect knee pain and hip pain or not.

Details: Q-angle



young man scoliosis

Photo: Nick Ng

Scoliosis is an abnormal curvature of the spine, which occurs in all three dimensions. It may originate in the structure of the bones, or it may be created by the muscles. It may present as a single or double curve. While many people attribute scoliosis to back and hip pain, scientific evidence finds that it is more than just the spinal posture alone.

Details: Scoliosis


Foot Pronation

foot pronation flat foot man

Photo: Penny Goldberg

Foot pronation, specifically overpronation, has long been considered a risk factor for foot injury. But what does the scientific evidence actually say compared to what you see in advertising and hear what some clinicians say?

Details: foot pronation

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