While Vladimir Janda was the first to recognize Upper Crossed Syndrome (UCS) and Lower Crossed Syndrome (LCS), few studies have validated the specific pattern of muscle imbalance and postural abnormalities associated with these common muscle imbalance syndromes.

Janda's Upper Crossed Syndrome Janda’s Upper Crossed Syndrome

 

Matthias Treff, a Masters student in Engineering at Virginia Polytechnic recently wrote his thesis, “An investigation of musculoskeletal imbalances in the thoracic and cervical regions, with respect to an improved diagnostic approach for Upper Crossed Syndrome.” The purpose of his research was to determine if differences existed in cervical range of motion as well as cervical and shoulder muscle performance between a group of patients with UCS and subjects without symptoms. The study was a case-control design of 17 subjects with UCS (15 females and 2 males) and 17 matched healthy subjects. They were tested for range of motion and isometric strength and endurance of the neck and shoulder muscles using an isokinetic dynamometer. Compared to healthy subjects, statistically significant decreases in active neck range of motion in bending and rotation were found in the UCS patients, but there was no difference in flexion or extension range of motion. Significant weakness in isometric neck flexion and extension was found in the UCS patients compared to healthy subjects, as well as significant isometric weakness of shoulder external rotation and adduction. Strength ratios of shoulder internal/external rotation and abduction/adduction were also significantly lower in the UCS patients. There was no significant difference in muscular endurance between the UCS patients and healthy controls. The author correctly notes that the diagnosis of UCS is often made through observation of posture and movement patterns. Janda did not advocate manual muscle testing because of the limitations of pain and reliability. The subjects in this study were included based on postural observation and pain complaints, rather than an actual diagnosis of UCS from a set of diagnostic criteria:

“Inclusion criteria for this group were: presence of postural deficiencies such as forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae, and constant or frequently occurring neck- and shoulder pain for more than 6 months”

This thesis helped validate the patterns of muscle imbalance with objective measurements of strength and range of motion. Other studies on patients with upper quarter musculoskeletal pain such as chronic neck pain (Jull et al. 1999), cervicogenic headache (Page, 2011), and shoulder impingement (Cools et al. 2003) have identified muscular strength imbalances consistent with Janda’s classification. While this study helped support Janda’s classification of muscle imbalance patterns in patients with symptoms of UCS, further research can help strengthen evidence-led clinical management. Evaluation the strength of the scapular muscles (also included in Janda’s muscle classification of UCS) would be beneficial. Unfortunately, this research did not correlate the objective findings of muscle strength and range of motion with Janda’s movement patterns (cervical flexion, shoulder abduction), which are critical to an appropriate diagnosis of UCS. I’m hopeful that the author considers publication in a peer-reviewed journal to help strengthen its validity in the rehabilitation literature.

Top 25 Ranking!

by Assessment and Treatment of Muscle Imbalance on May 16, 2014

After almost one year, Assessment and Treatment of Muscle Imbalances: The Janda Approach is in the top 25 on Amazon.com.  We’re #19 in Sports Medicine and #24 in Physical Therapy!

“Essential Reading” recommendation by Mike Reinold

May 16, 2014

Mike Reinold, DPT, ATC, SCS, CSCS, head athletic trainer for the Boston Red Sox, has a great blog on orthopedic and sports rehabilitation. In addition to keeping his readers informed of the literature and promoting discussion on current concepts, he has an “Essential Reading List” for the best books in athletic training, physical therapy, and [...]

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Journal of Bodywork Reviews Assessment and Treatment of Muscle Imbalance

May 16, 2014

Download PDF of review here by Philip Maffetone Vladimir Janda, MD, DSc (1923–2002) influenced generations of practitioners spanning many disciplines. This evidence-based book is written by three physical therapists, all of whom worked with Janda. It emphasizes various assessment and treatment procedures based on the existence of muscle imbalance – the combination of abnormal muscle [...]

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Assessment and Treatment of Muscle Imbalance in BottomLine Secrets

May 16, 2014

Bottom Line Secrets, a free e-newsletter, recently featured Dr. Phil Page in an article about simple exercises for muscle imbalance syndromes. He provides simple exercises for knee pain, hip pain, as well as upper back and shoulder pain… Read the entire article below. Source: HealthyWoman / Bottom Line: December, 2010 Body-Balancing Workout for Pain-Free Joints [...]

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Listen to author Clare Frank podcast

May 16, 2014

Dr. Clare Frank, co-author of Assessment and Treatment of Muscle Imbalance: The Janda Approach was recently interviewed for a podcast on PT Talker.com. She discusses Dynamic Neuromuscular Stabilization from the Prague School, as well as the influence Dr. Janda had on her approach. Dynamic Neuromuscular Stabilization (DNS) is a form of rehabilitation based on development kinesiology. DNS [...]

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Janda book reviewed in Orthopedic Physical Therapy Practice

May 16, 2014

The magazine of the Orthopaedic Section of the American Physical Therapy Association (APTA) recently published a review of Assessment and Treatment of Muscle Imbalance: The Janda Approach. In Orthopaedic Physical Therapy Practice, manual physical therapist Michelle Finnergan reviewed the book. She noted that the book “provides a lot of useful information that is different from [...]

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Manual Therapy reviews Janda Textbook

May 16, 2014

Jairus Quensnele DC, a Canadian chiropractor, recently wrote a review of Assessment and Treatment of Muscular Imbalance: The Janda Approach in the journal, Manual Therapy. Here is an excerpt: “The book is filled with helpful diagrams, pictures and algorithms that promote deeper understanding and enable a more pleasant read. The content is quite broad, appropriately [...]

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Journal of Orthopedic and Sports Physical Therapy review

May 16, 2014

The Journal of Orthopedic and Sports Physical Therapy published a review by David M Williams, MPT, PhD, ATC, CSCS, of the University of Iowa of Assessment and Treatment of Muscle Imbalance: The Janda Approach a well-written, comprehensive overview of t…

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Clare Frank on DNS and Janda

May 16, 2014

Assessment and Treatment of Muscle Imbalance: The Janda Approach co-author Clare Frank, DPT is a certified instructor for “Dynamic Neuromuscular Stabilization,” (DNS) a rehabilitation program based in part on Dr. Janda’s teaching and the rest of the Prague School Faculty. She was recently interviewed by Dr. Phillip Snell of myrehabexercise.com about her experiences with Dr. Janda. Dr. Pavel [...]

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