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A rigid thoracic spine that is stuck in flexion places a greater demand on the lumber spine to extend. Reproduced with permission from Joseph E. Muscolino. Artwork by Giovanni Rimasti. Lower-crossed syndrome and the thoracic spine. Reproduced with permission from Joseph E. Muscolino. Artwork by Giovanni Rimasti. Lower-Crossed Syndrome and the Thoracic Spine Rounded-back thoracic hyperkyphosis is often caused by and accompanied by a general rounding of the entire spine, including the lumbar region (see Image 2). In these cases, the lumbar spine reverses its lordosis to become kyphotic and the thoracic spine continues this kyphosis, resulting in rounded posture of the entire thoracolumbar spine. However, even a hyperlordotic lumbar spine can result in a rounded hyperkyphotic thoracic posture (see accompanying image). Lumbar hyperlordosis is a prominent feature of the postural distortional pattern known as lower-crossed syndrome (LCS; Image 3). The hallmark feature of LCS is an excessively anteriorly tilted pelvis, which then results in a hyperlordotic (in other words, hyperextended) lumbar spine. With LCS, because the lumbar spine is hyperextended, the center of weight of the trunk moves posteriorly. As a compensation to bring the trunk's center of gravity back anteriorly, the thoracic spine must increase its flexion (kyphosis), thereby resulting in an excessively rounded thoracic spine (with all of its sequelae described in this article). EFFECT ON THORACIC OUTLET SYNDROME If this were not enough, UCS also increases the likelihood of all three myofascial forms of thoracic outlet syndrome: pectoralis minor syndrome, costoclavicular syndrome, and anterior scalene syndrome. Pectoralis minor syndrome is due to the locked-short pectoralis minor; costoclavicular syndrome is due to the collapsed posture of the clavicle against the first rib; and the anterior scalene syndrome is due to the adaptive shortening of the scalene musculature. EFFECT ON BREATHING UCS even inhibits our ability to breathe. This is easy to demonstrate. Flex your thoracic spine, protract your shoulder girdles, medially rotate your arms, and try to take in a deep breath. It is difficult, correct? Now, open up your body by extending your thoracic spine, retracting your shoulder girdles, and laterally rotating your arms. Take in a deep breath, and notice how much more easily you can breathe deeply. A flexed, protracted, medially rotated posture inhibits the ability of the thoracic cavity to expand, limiting our ability to intake air, as well as oxygenate our blood and all the tissues of our body. EFFECT ON THE LUMBAR SPINE Effects of a rounded thoracic spine can even be felt inferiorly at the lumbar spine. By early middle age, a hyperkyphotic thoracic spine tends to become rigid, thereby limiting thoracic extension and other ranges of motion. This places a greater demand on the lumbar spine to extend (Image 6), resulting in increased compression force on the lumbar facet joints, likely causing facet irritation, osteoarthritic degenerative changes (and possible foraminal encroachment and nerve impingement), joint dysfunction, and low-back pain. Low-back pain often then results in protective spasming of the nearby paraspinal extensor musculature, causing further joint dysfunction and low-back