Creating Rock Solid Shoulders

At PT-Health, we specialise in holistic health, and a big part of that involves getting people out of pain or preventing the pain in the first place.

I’m not talking about pain that comes from falling over and breaking a bone. I’m talking about pain that appears from nowhere. When you ask yourself ‘how did I do that?’ and you can’t name a specific incident.

Common areas for this to occur is the low back, knees, neck and shoulders. 

What we’re going to do here, is show you the most common problem we see, show you how to identify it in yourself, then show you how to fix it.

We’re going to be looking at an Upper Cross Syndrome (‘Upper X’ for short).

What’s An Upper Cross Syndrome?

An Upper X concerns the postural position of the head, spine and shoulders. It makes sense to first show you what an ideal position of the head and shoulder is when standing.

From a side view, if you were to draw a vertical line up from your Lateral Malleolus (ankle bone), that line should go straight through the middle of your shoulder and up through your ear (like the first image on the right).

That’s the best position you can be in with regard to muscle balance and joints being in the safest place.

An Upper X looks like the second photo. The shoulders are in front of the line, the ear is usually even further in front and the Thoracic spine (upper back) looks like Quasi Modo’s.

There are a few things wrong with this position. 

The first being appearance. It’s much less attractive being in an Upper X position than the ideal posture.

From a practical point of view, the more the spine is in flexion (bent forward), the less you can rotate to each side. To add to that, being flexed and rotated is the most unsafe position your spine can be in. It has herniated disc and severe back pain written all over it.

As well as looks and practicalities, an Upper X syndrome can also lead to pain. The neck extensors (muscles that lift the head up) have a constant battle against gravity to keep your head up which can lead to tension headaches and neck pain.

Over a period of years, the body eventually gets tired of having to hold your head up (as opposed to it sitting balanced on top of the spine) and starts to add tissue to the vertebrae at the back for support. This is called a Dowager’s Hump.

For the shoulder joint, being in this forward position makes it much more likely to suffer from many different shoulder problems given the shoulder joint’s complexity.

You’re more likely to suffer from an impingement syndrome, which essentially means it hurts to lift your arm past horizontal. Due to the nature of the position and the reasons why your shoulder is in this forward position (which we’ll discuss shortly) the shoulder is MUCH more unstable than it should be. Any sudden impact in the wrong direction could dislocate the shoulder without much resistance.

The simplest and most common thing is just a general aching of the shoulders when in this position.

What Causes An Upper X?

So given the huge number of downsides of an Upper X Syndrome compared to an ideal posture, we now need to understand why most people are in this position.

It starts with how our lifestyles have changed in the recent past.

Our bodies are designed for hunting and gathering. We should be out in the fields chasing things, climbing things and carrying them back to camp.

Instead, we wake up, sit down on our way to work, spend most of our time sitting at work, sit some more on our way home, sit eating our dinner and then most likely sit in the evening in front of the TV.

Don’t worry, I’m not going to be saying you should sell your car, quit your job and throw out the TV. I do almost exactly the same (I’m sat down as I type this).

All this sitting leads to consequences that show up as muscle imbalances.

When we sit, certain muscles are getting shorter and stronger because they’re being used to hold us in a sitting position, whilst other muscles get longer and weaker because they don’t need to work at all.

Specifically, the neck extensors, the pectoral muscles, the upper abdominal muscles and the latissimus muscles (back of the neck, chest, 6-pack and big, triangle back muscles) are getting shorter and stronger.

Meanwhile, the neck flexors and the upper back muscles are getting longer and weaker.

Think of the muscles as strings. Each of those strings has a certain amount of tension based on how thick the string is. The thicker the string, the more tension it holds.

The neck flexor string and the neck extensor string directly oppose each other. When they’re equally as thick strings, the neck is in it’s ideal position. However, when the neck extensor string becomes thicker than the flexor string, that string starts to pull harder in it’s own direction.

The same thing applies to the upper back string (which is made up of lots of different strings) verses the pectoral, abdominal and latissimus strings. When the latter three become thicker strings, they start to dominate and pull the shoulder and the spine in their direction, forwards.

What makes all these issues worse, especially for young males, is what muscles get the most attention in the gym. For guys, it tends to be those exact muscle groups, the abs, the chest and the lats (mirror muscles, as they’re commonly known). This compounds the problem even more.

How Do We Fix An Upper X?

The way we fix this issue (and fix the Upper X itself) is by rebalancing the strings. We simply need to relax some of the tension in the tighter strings by stretching them, and we need to build some tension in the loose strings by strengthening them.

To save you the trouble of having to research pec stretches, ab stretches, upper back exercises etc. we’ve done a simple, yet VERY effective exercise program you can do at home every few days to help combat the Upper X Syndrome.

For it to be effective, you must stick to the times and reps given. There are images of all the stretches and exercises in the membership area of CleanPlan.


Sub Occipital Stretch 30 second hold

Swiss Ball Pec Stretch 30 second hold each side

Swiss Ball Lat Stretch 30 second hold

Middle Back & Ab Stretch 30 second hold


Prone Cobra 3 minute hold total

Wall Angels 50 reps total

For the exercises, you may struggle to reach the 3 minutes and 50 reps in one go so start off with something like three sets of one minute and five sets of 10 reps with a 15 second rest between sets.

Your aim is to build up to a three minute hold and 50 reps with no rest.

How To Fix An Upper X In Everyday Life

An hour in the gym a few times a week is still going to struggle to balance out the hours and hours of sitting each day. To run alongside the program above, here are some practical tips to help avoid an Upper X syndrome-

There’s much more science behind the fixing of Upper X Syndromes than we have time to explain here. Stretching the tight strings and strengthening the loose strings is the main gist of it.

It’s not necessary for you to know every single detail. Plus, I don’t want to break the two rules of success-

  1. Never reveal everything you know…

Jokes aside, you can now-

  1. Check whether you have an Upper X Syndrome
  2. Know the potential downsides if you don’t do anything about it
  3. Understand the mechanics of an Upper X
  4. Have a ready made program to fix the problem