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cutting vegetables, doing paperwork, or working with a laptop, tablet, or smartphone (Image 2). Working down in front of our body is not new, but with the tremendous proliferation of digital devices, the number of hours people spend hunched forward into flexion has increased exponentially. Indeed, it seems that hyperkyphosis of the thoracic spine is becoming more prevalent, and may now be the most common and problematic postural distortion pattern that manual and movement therapists encounter. Like any postural distortion pattern, the longer we assume a rounded-back posture, the more the soft tissues adapt to the distortional pattern. With a rounded thoracic spine, the anterior pectoral musculature ends up shortening and tightening and the posterior spinal extensor musculature ends up lengthening and tightening in response (see "Locked-Short/Locked- Long" on page 77). Further, the anterior fascial/ ligamentous tissue shortens and becomes taut and the posterior fascial/ligamentous tissue lengthens and weakens, thereby losing the tautness or tone to oppose the forward flexion. As the fascial tissue weakens, this increases the burden on the extensor musculature, which becomes further overwhelmed and dysfunctional in its attempt to prevent the forward progression. As we move further into flexion, our center of weight moves anteriorly, increasing the leverage force of gravity, which furthers the force toward a forward-flexed posture. Additionally, staying stuck in a rounded-back posture also allows the buildup of fascial adhesions (often described as "fuzz" by educator Gil Hedley; watch Hedley's "The Fuzz Speech" at www.youtube.com/watch?v=_FtSP-tkSug) that further resist the body from moving back into extension. When this posture is extremely long-standing, for years or decades, even the bones remodel. The anterior aspects of the vertebral bodies narrow in height in response to the increased weight-bearing anterior compression force. All these factors add up to a postural distortional pattern that, once set in motion, tends to become a vicious cycle that feeds on itself, steadily and progressively worsening. So, what begins as a seemingly innocuous voluntary forward posture that we pay little attention to, often transitions into a stubborn, rigid, dysfunctional pattern in which we become stuck. This pattern alters the health of the thoracic spine, and indeed, much of the rest of the upper body. UPPER-CROSSED SYNDROME (UCS) A rounded thoracic spine does not exist in isolation. Rather, it is usually part of a larger dysfunctional pattern that involves the neck, head, shoulder girdles, and arms. This larger pattern is often described as upper-crossed syndrome (UCS) and is so named because a cross (X) can be placed across the upper body. One arm of the cross represents overly facilitated (locked-short) musculature; the other arm represents overly inhibited (locked-long) musculature. The effect of the imbalanced asymmetrical pulls of the musculature results in the characteristic UCS posture, which involves hyperkyphosis of the thoracic spine, hypolordosis of the lower cervical spine, hyperlordosis of the upper cervical spine, forward-head carriage, protraction of the shoulder girdles, and medial/ internal rotation of the arms at the glenohumeral joints (Image 3). Even though each of these postural distortions can be viewed as a separate entity, in reality, each one tends to increase the dysfunction of the others. However, the rounded- back thoracic hyperkyphosis is most fundamentally the root cause of the UCS pattern. 76 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 6 Working down in front of our body tends to promote a hyperflexed (hyperkyphotic) rounded thoracic spine. Reproduced with permission from Joseph E. Muscolino. Artwork by Giovanni Rimasti. Upper-crossed syndrome. Reproduced with permission from Joseph E. Muscolino. Kinesiology: The Skeletal System and Muscle Function, 2nd ed. Artwork by Giovanni Rimasti. Locked-short upper trapezius and levator scapulae Locked-long deep neck flexors Locked-short pectoralis musculature Locked-long abdominals Locked-short iliopsoas Locked-long rhomboids and serratus anterior Locked-short erector spinae Locked-long gluteus maximus