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What you’ll hear in this episode:

• What Lower Crossed Syndrome is
• Steps to treat UCS
• About Eric Finger’s Concierge Physical Therapy service

In the second installment of his series on postural abnormalities, Dr. Khris Ramdeen is once again joined by his physical therapist friend Eric Finger. This time, they discuss Lower Crossed Syndrome (LCS). LCS can also be referred to as pelvic crossed syndrome. Finger, MPT, OCS, FAAOMPT, is the founder of Move Empower Concierge Physical Therapy.

LCS is another common postural abnormality caused by muscle strength imbalances in the lower half of the body. It’s most common feature is an arched lower back, technically called an anterior tilt to the pelvis. One of the most common causes of LCS is prolonged sitting because consistently holding a static position encourages an imbalance of over- and underactive muscles in the pelvic region.

If you’re experiencing symptoms of LCS or think you might have it, it is most important that you see a primary care doctor or physical therapist in order to get a proper diagnosis. Though he admits he might be a little biased, Finger recommends seeing and working with a physical therapist since they are musculoskeletal experts and can develop an exercise regime tailored to you.

Listen to this third installment of Apple a Day Doc Talk to hear more about UCS and how Finger and Dr. Ramdeen recommend treating it. If you like what you hear, share it with a friend or maybe your gym buddy! You can find more Apple a Day Doc Talk here!

 

Apple a Day Doc Talk is a Founding Media podcast created in partnership with Dr. Khris Ramdeen.

Host: Dr. Khris Ramdeen

Guests: Eric Finger, Move Empower Concierge Physical Therapy

 

Transcript:
this is a founding media podcast
welcome to the apple today doc talk podcast a show that combines concepts of fitness with medicine to focus on primary prevention and disease management I’m your host Dr khris Ramdeen we are continuing our series discussing postural abnormalities of sitting down with physical therapist Eric finger to discuss with these abnormalities look like what can be done to prevent that and what to do when you have them if you missed our first conversation about upper crossed syndrome make sure you go back and take a listen this week Eric and I discuss lower crossed syndrome
this is actually part two of a three part series that we’re talking about postural abnormalities with the help of our physical therapist here Eric is actually an entrepreneur and started a company called move empower cons here’s P. T. he’s a mobile physical therapist so you killed your house or your business where he co Hey yeah yeah no longer do you need to sit in traffic on N. mopac I’ll come to you right Eric’s gonna do the the hard part and drive through autstin traffic for you right okay and then Eric what why did you become a P. T. what got you into it wow yeah I you know I was a athlete you know as a use and do I want to kind of continue that and always had an interest in medicine and kind of stable I saw that physical therapy as a way to kind of combine those two injured my knee in college she had to go through physical therapy and how does your journey what would happen as planes and pick up basketball and tore a ligament yeah no fun but yes I went through that myself and kind of kind of really solidified that yeah this is the choice for me and suction great Kelly the relying in Canada Eric is a midwesterner began his formal education at the university of Kansas how do you like Kansas I like India L. during basketball season so actually he likes basketball when he was a varsity swim ease on the varsity swim team right and how is that how do you do there it did all righty Jose but flyer there and I remember coming to college swimming and from high school it was just night and day I was like oh we’re gonna train that long and that many hours yeah that was great as the shape of my life and I met some great folks that’s good time perfect and then when he was there he earned his bachelor of science in exercise science and then completed graduate training at Texas Tech University health sciences center in two thousand two then you graduated you went on to this pretty extensive postgraduate training tell me a little bit about which is
yeah so you know I get and got in his you know about four years into the career I was kind of like I need something I need I just so I went back and studied and with physical therapy we you can sit for board exams actually just exam to kind of show competence and such and so we did that and was great really helped kind of refine my skills and then again was needing something else and went back and did some special specialty training in manual therapy in writing some of that training you got your certification and the E. P. T. A. came a board certified orthopedic specialist and fellow of the American academy of orthopedic manual physical therapy and I thought that was really neat because less than ten percent of the therapist in the K. exactly yeah yeah yeah it’s it’s kind of a nice distinction that you know kind of separate you from the herd and suction not that I’m doing it for a bunch of letters after my name is that it’s a nice way to build a nice good good skill set that helps me out you know to treat everyone that comes through my head that I said I come in contact with
what kind of insights do you think that that certification equipped you with the American academy of orthopedic manual physical therapy yeah yes so manual therapy is obviously deals with the hands and such and we had training in thrust techniques so what you would see like a chiropractor doing so okay many appealing joints we’re doing a lot of soft tissue work meaning so we’re doing some massage work we’re doing building a good knowledge of you know how joints work how how muscles how they affect the joints just give me a really good broad scope to be able to work with a lot of different people because there’s one thing I’ve learned in my practice is that not one patient is the same as having a lot of tools in the toolbox is is great that’s great and the couple other hobbies you compete in triathlons yes Sir and then your favorites escape from Alcatraz an Ironman seventy point three you have done one half iron and then the escape from Alcatraz a couple years back which was pretty fun yeah on the same system and and you got three kids yeah how do your kids like you traveling around town yeah they they’re enjoying it yeah yeah my yeah oldest is trying to help me with my social media really I’ve never had a twelve year old I guess at the start paying very helpful yeah that it’s great
all right so let’s talk a little bit about lower crossed syndrome if you can tell us a little bit about what is it what what exactly is it lower crossed syndrome is kind of a situation where the the hips the pelvis in the low back adopt this dysfunctional posture what you get is a is a kind of an asymmetry on the imbalance of the muscles in the front of those joints of the you know the lower trunk and in the in the in the back for the rear yeah so those set you up for kind of presenting with you know a a posture that can be overtime kind and hard on the body yeah in it when you have that can the pelvis kinda tilts forward yeah does it exactly so that kinda looks like that’s exactly right where you you’ll get a kind of an increase curve in the low back kind of a it leads to issues up in the and as you go up in the spine into the mid back kind of a increased curvature there and even a protruding sometimes even kind of the head protruding to so not only does it affect things locally down at the trunk but it can affect things all the way up and down the chain to be honest and I’m really glad we’re talking about this too because again you know Eric and I we work out together sometimes and go to the pretty big jams and see this very very frequently and when the hell this is tilt forward like that like you said you kinda have to shift your shoulders back so you can stand up straight this creates a huge lumbar curvature yeah basically a big curve in the spine and why is that bad one yeah that’s that’s a great question so when you when we increase I mean there’s that let’s let’s start there folks need to know that a natural curve down there is what’s called a lower data curve is is good we want that’s healthy that this bein has about three different curves but they’re they’re only supposed to be so much each and when you go to much or have a hyper curve down that low back it puts increased compression on the sensitive parts of the spine not just the the joints the bony parts but even the the ligaments and even the the desks which are the kind of the gel like supportive pieces between each of the spine bones you start doing that over time and add maybe loader activities bad mechanics with sports or lifting you can start having issues excellent and when you say adding the load you you mean above that curvature pushing down on to it where now all the pressures being basically held right there in the over extension of land lumbar lower coming kind of the the path of least resistance of the body and the body is very smart and it’s going to find that and that part of the body that that low back is going to take the brunt of it can you do that enough you start what kind of wearing out wearing out or kind of overdoing on the sensitive structures that we just talked about right yeah and that
this is why I wanted to stress this point is because again hi my top priority is safety and I just want our audience to be aware of these pots this postural abnormalities in particular because doing these types of exercise trying to get you know gains by by by lifting or pushing load straight over your head when you have this big lumbar basically increased extension in the lumbar curvature that can be dangerous yeah yeah can be I think over time yet yeah deleterious to to the structures and such what you what you notice with this is that your the the muscles that tend to become tied to are those lower back extensor muscles yeah extensors think of that the kind of the long band like muscles you can see in the mirror those become pretty darn tight the the muscles in front of the body the what we call the hip flexors preference and that’s pretty common become ultimately tied and then those are in balance by weakness in the the lower abdominals and them one of the most important muscles the bodies for me is the gladius that includes so it’s that imbalance that just sets folks up and it’s really under worked area the groups you know you see
yeah a couple of things that make me cringe a little bit when I’m in the gym and I see people moving in certain ways this is something as basic as just getting to the gym you know starting out and doing hamstring stretches mmhm so when you have any details or lower cross syndrome right why can that be that Everton doing with a hamstring stretches right right so if the hamstrings the hamstrings can develop tightness through there but there’s you know putting putting this hamstrings on stretch might alleviate some of the tightness that you’re writing but you’re not getting to the crux of the issue right and so the the there’s the A. P. tilt your pelvis is stilted forward basically pulling on that hamstring at the back of your legs right and so it feels tight not because it’s you know actually tight but because it’s being hold tight with the rotation rotation and then now you’re stretching them out even more making the AP tilt worse yanking your problem or so something is simple you know as in in seemingly benign right hamstring stretch can make things worse things worse yeah so that’s why we want you to kind of look in the mirror seared first and foremost here doctor but if you do think you know that Hey maybe this looks a little bit like I have a pretty big curve you know in my lumbar spine or my pelvis is tilted forward that I should probably go check this out and and try to strengthen like you said your core your lower ABS yeah yeah this maximus and try to straighten that pelvis back out and then another thing I I Tennessee you know in the chin is people going from the hamstring stretch they might go to the leg press machine and that doesn’t really have a lot of glute engagement and sell yeah yeah I think yeah it there’s after so many exercise you can go out there but I think trying to get the best exercise you know about the best exercise exercise get the most bang for your Buck is is important I’m gonna take a step back in Yemen thing think how did we get there in the first place and we talked about the tightness we talked about the postural abnormalities but why did this why this weakness suddenly appeared and I think what folks need to know is that as we get the body’s pretty dense hard as this tendency that when you have muscles that get tied on one side it’s antagonise or the opposite guy tends to shut off if you will kind of goes on vacation give us an example of a agonist and antagonist sure so pretty simple one would be the agonist the biceps and antagonise the triceps going the opposite directions now okay I hope that makes sense for folks in the with the lower crossed syndrome the agonist would be maybe this hip flexors writer real tight and then it’s antagonistic the opposite is that gluteus maxims such right in the hip flexors are basically bringing your knees up towards your chest right got it yeah your knees to your chest and the and the glue it’s our extend hip so they they helped propel you they’re very key with you no one like its stance or walking going up and down stairs the surgeon imbalance in terms of tightness and shortening on the front the flex our movement bring your knees to your chest races you know kicking your leg backwards right now having that strength there yeah I think folks might be wonderful how do I get this why do those glued shut off that in someone trying to kill us to Quinn the term but gluteal amnesia yeah and what that’s coming from is that the glued shut down but a lot of it’s from extended periods of sitting or not and that we that the vehicle is when we’re doing I saw a stat the other day that average American sitting for over seven hours a day you know be it at work or in traffic that can lead to those muscle shutting down and this imbalance that we’re that we’re discussing kind of take over so when I when I when I see folks going back to your question I digress going back to your question about what’s the exercise I think we got it we gotta get back to you instead of doing going to the hip to the you know doing some big power squad if those muscles aren’t even turned on and say this could turn in their they’re probably not gonna participate they should in a normal healthy body but they’re not they’re gonna let the other guys who are dominating being the quads hamstrings and you’re not gonna turn a month so I think the important part is maybe taking a step back and really you know maybe just starting an exercise laying down on your yoga mat doing like what I call the bridge yeah where you’re on your back with your knees bent lift your pelvis up holding it in down to turn that muscle on and then you know once it’s turned on quote unquote then go over and begin those kind of bigger exercises you’re gonna get you’re gonna get more bang for your Buck right and that’s it that’s a really great exercise Eric especially if you’re just trying to just isolate the glutes laying on a yoga mat on your back on your back and then pushing through your heels down into the floor to squeeze your buttock and not act like not using the whole base your foot or your toes and swinging up get a note from the yoga mat it’s got to be a slow deliberative process where yeah you squeeze yeah but Oct the glue and he got it think of the force going through your heels yeah you can just isolate that that those muscles think of
yeah exactly yeah connect brain with muscle on that and you’ll totally get your bio neural connection exact yes yes so like like K. you’d said think about pushing from the right area for me with the heels and then also thinking okay I want to unlock my butt to do this job and squeeze it has you looked up right and you will you will activate where you need to say yeah excellent excellent how can hop over complicate such an exercise but it’s it’s it’s body smart you know and it is going to go from point a to point B. in the easiest way possible right and it’s like you said that muscles been turned off yeah and it has to do all this work to re engage it yeah why it why do it why not just swing your way up there one of the other reasons why we don’t want you swinging up like that is because you can hurt yourself whenever you using momentum in an exerciser you have to stop at just the right place or if you go a little too far you’re gonna put too much of a curve in your back and get it yourself yeah most said yeah I think momentum swing and you know when I when I’m working with patients I think if it anytime I’m gonna catch months it’s using momentum yeah Hey you’re cheating there yeah yeah you’re not only could you and yourself but also you’re not recruiting the muscles while regulating maybe gravity helped out here or start records other mode yes yeah yeah and then when you go slowly you kinda go up get that squeeze and release slowly getting the most out of that E. centric contraction right so what’s the E. centric contraction with some scientific so when we think of it let’s go to the bicep curl round holding that that dumbbell under hand we’re gonna bring it up is you sh as you bring it up that’s concentric now when we get short URL shortening thanks and then when we when you bring it back out to the starting position that’s the key centric or lengthening while under tension while under god that resistance the cable the barbell dumbbell whatever it is and your flex fuel trying to flex your bicep but it’s being lengthened you’re a sickly letting go but you want to have control slow controller that only phase you don’t want to just drop it use momentum exact and then lose that whole half of the contracts yeah
yeah it’s a great a great way to strengthened by the way too right here and this and that and then one other thing one other exercise I notice not really exercise but movements in the gym that you’d want to avoid if you were if you were to have this is like you said those flex our movements maybe something as simple as sit ups you know doing ab curls you don’t necessarily want to engage that it will source complex which flexes you’re hindering your knee up to your chest because that’s gonna pull your pelvis it’s going to make the postural abnormalities more pronounced yeah it’s actually gonna pull it down more agreed yeah I think if you and tell you have that tightness mmhm the levy added once you get the proper link then I thinking go back to some of those exercise but I think you’re just feeding into that over activity if you if you’re doing exercises like you mentioned or even I was thinking just the one of the call the Roman chair we are doing that you know we bring in the knees to do lab work at work and such might not be the best one to do at that time right or with you know if you’re if you’re dealing with this so basically right what are you saying is that used to basically suspending yourself in the air with your hands and following your knees up to your chest divided flexor Korean razor ads but when you bring your knees up it’s not all lab work right you happy likely engaging your flexors and so you wanna try to avoid anything like that that’s gonna make your problem worse you want to try to work the other side like the groups yet yeah and
how do you work the corner that the the ads yeah right as the dollar’s complex without trying without engaging too much flex our movement how how would you sure sure so the the abdominals that I tend to try to turn on here I started again I’m gonna go way back to basics and have someone down on the down on the mat with their nests bent and we’re gonna work on really trying just activate the deep the deepest of the core muscles when I call the transfer so dominance think of it as a kind of a a a the muscle that kinda envelopes your lower trunk and like where a Cumber bun would sit on someone yeah hi yeah and we’re gonna start there believe it or not and I’m gonna spend you know ten minutes they’re really talent you know educating folks on how to turn that on because we’re gonna incorporate that in with other exercises if we can get that muscle turned on we’re gonna have better why is that so important to me to take a step back is because it ask intimate connection with the spine it’s a stabilizer of this mine increases their intrude on the pressure and and gives it some sturdiness so once we get that turned on you’re not gonna have that curve you know that we’re worried about with the lower crossed syndrome and we can really take that turn that muscle on and then take it to other exercises so starting on the mat I particularly like to to I’m just a marching exercise believe or not lying on your back to engage the lower of dominoes but by activating that that trains are Saddam S. up front first you really have to think about it when you’re doing your core right I know P. sale that engage your ABS in his raps but you have to learn the difference and we keep saying the term my owner connection but yeah there is a muscle nerve yeah link that you want to establish and learn what the differences like when you’re talking about transfers of Saddam is you want to learn what it feels like the exact likes that yeah that you don’t mistakenly think that you’re doing ab work when you doing hip flexor work yeah exactly now it’s it’s you nailed it right there it’s it’s I’ll I’ll even you know to kind of highlight that even bring myself over when I’m doing a plane can be a by a mere just to make sure that my rump isn’t too high or I’m arching kind of playing at like what maybe some with lower cross syndrome might look like you price folks probably seen some of the plank in their low back has a you know kind of a curvature yeah couple watered so
excellent and some of the injuries you get or tend to see in in patients with lower cross syndrome would be what would you share with the spine you know we are talked about how that kind of sets the spine up and kind of compressive so it’s already the the spine sorry under a little stress kind of closed down add to that may be a powerful golf swing you know weakness of the lower abdominals you can see some sprains of the low back kind of you can call ready John is a little background yeah yeah yeah and then first I think we mention the hamstring complex strain just because of that pulling that’s going on in the hamstring behind the lake because of that A. P. tilt into pelvic tilt and then you can also get some interior knee pain with this pain in the front of the knee just because of the Mel Lyman of yours yeah the tightness I don’t not only is the the hip flexor that so as muscle type but the one of the quads particularly the rectus it’s a big muscle one your longest muscles in the quadriceps that connects to your knee cap to your pelvis is too tight well it connects to the knee cap so you’re gonna have some abnormal pull down there and it can aggravate even though the the knee and such so yeah it’s it’s not just localized to the trunk for sure okay and and you mentioned sitting being a really big problem it’s a big part of all day the other anything else any other activities or movement patterns that can promote this or help you know make this happen I think activities that that where you’re where you’re in positions of extension too much so extension maybe someone who stands you know stands for long long periods works on concrete or someone that can kind of develop if they don’t have that hip strength that can be an issue from an exercise you know someone at the gym who might be doing exercises maybe that promote hyperextension and such can they can they can that would be something that could maybe promote this if they’re not balancing themselves on the on the opposite side instead of a city for me
how big of a part of your practice would you say that lower crossed syndrome is I think the spine in general anything that is hatch the spine is probably going to be a you know typically probably about sixty to seventy percent of what I see yeah and I’m including that the neck too but yeah it’s it’s you know back pain is low back probably some component yes at exactly you know Jennifer and then let’s say you know we’re talking about looking in the mirror maybe a picture you have a really big curve you know basically any increased lumbar extension or you know maybe someone else’s reckon recognize that maybe your physician has let’s say they haven’t gone to a doctor yet they they think they might have it maybe they’re having some pain some of that hamstring type symptoms where do you where do you recommend they go who should they consult with you can you know if if you’re if you’re curious about it you’re not having any you know like you said pain isn’t too bad numbness or tingling I think I mean my biased obviously is is starting again just starting a call with physical therapist this is a consultation Hey this is what I’m noticing this is what I’m feeling right you know what what what do you think of that and is it you know and I think any therapist would be happy to discuss that with you because that’s what that’s what we’re trying to do is really were kind of muscular skeletal specialist axle see that and you know and guide you on whether or not you know physical therapy would be a good option for you and if and if not you know help direct you to the right practitioners kind of find out what’s going on perfect perfect and then begin Eric’s companies move them power concierge PT and you can visit is a link in the show notes and I just want to thank you thanks for coming back I do know that another episode we’re gonna do yeah my pleasure three soon create an angle distortion yeah I’m looking forward to it and thank you founding media for hosting us thanks so much guys we’ll see you next time thank you again Eric I appreciate your time if you would like to learn more about the services we put a link in the show notes the apple with a doctor podcast team includes me doctor Randy producer Mariah Gossett an audio engineer Jake Wallace thank you everyone at founding media for your support if you’re enjoying this podcast maybe leave us a review on iTunes it helps other people find the show you can follow me on Instagram at Ramstein N. D. spelled R. A. M. D. E. N. M. D. or check out the link to my YouTube channel and website in the show notes thanks for listening