One of my favorite sayings by physical therapist Kelly Starrett is that “athletes need to work from trunk to sleeve.” What does this mean exactly? Well, it means that when athletes are working to improve their performance, they have to work from the torso to the extremities. You have heard us talk about all of these syndromes that quarterbacks can present with during their throwing motion. These include lateral leaning, trailing leg, snapping leg, over extension, and over striding. What would you say if I were to tell you that there’s one common denominator that plays a role in causing all of these syndromes? Well, there is! It’s a physical therapy term that we call “lower crossed syndrome” and it affects nearly 80% of the athletes we see. Today, we will do a DEEP dive into what this is, how it affects the throwing motion, and steps players can take to try and fix it.

What is this?

Lower crossed syndrome is a misalignment of the pelvis in relation to the spine that causes stiffness in certain muscles on the body, and weakness in others. As you can see in the picture above, if the pelvis sits like it is tilted forward, then the abdominals and glutes are put in a position where they are weak. If the pelvis is tilted forward, then we also see lumbar extensors and hip flexors also get very tight or present with tone. This over extended position is a detrimental position for nearly every athlete, especially rotational athletes. Have you ever wondered why you have a pinching on the front of the hip when you squat or low back pain when you squat? Yep, this could definitely be the reason why. What about constant, nagging hamstring pulls? Missing high on throws? Yep, this could most definitely be the culprit. Let’s dive into why this affects the throwing motion in a very negative manner.

Lower Crossed Syndrome and Loading Phase

Here is what we want you to do. Visually picture the issues that are listed above and now think about how it is going to affect a QB during his loading phase of throwing. During the loading phase of throwing, we are essentially wanting the quarterback to get to a common position at the end of the loading phase so they have a chance at being successful during the acceleration phase of the motion. We talked a lot about this in last week’s blog post so I have attached it below if you have not seen it.

In order to get to a proper loading phase, we can essentially cut the body into three portions when talking about how the body is moving. We would like to see the upper torso moving to the right, the lower torso staying very stable and neutral, and the hips rotating to the left. This is for a right handed quarterback. The opposite would be true for a left handed quarterback. This means that the QB must have some pre-requisite qualities in order to get into this position. Here are those qualities:

1. Full thoracic rotation
2. 90 degrees of shoulder external rotation
3. 90 degrees of horizontal abduction
4. The ability to stabilize lower torso

In the picture above, you can see that Baker Mayfield does this with ease as his hips are rotated to the left, lower torso stable, and upper torso rotated to the right. He does this in a very balanced position with his weight still loaded on the right foot and ready to drive into the acceleration phase. The picture below is a picture of Cam Newton. We have never screened Cam Newton, but I bet if we did, he would present with a lot of the impairments that we see during lower crossed syndrome. Here is why I say that. During his loading phase, his rib cage flares and you can see that he is in a slightly over extended position in his spine. This is a classic presentation that we see for guys that are big and strong like Cam Newton, but tight in areas where they don’t want to be because it causes issues during the throwing motion. This is going to cause a lot of compensations of how this athlete tries to create power during the acceleration phase of the motion. When a QB starts in an over extended position in his spine at the end of the loading phase, whether it be due to stiffness in the upper spine, shoulder, or hips, there will be compensations created in the acceleration phase to try and create power. This over extension causes a distinct disconnect between the lower body and upper body.

Lower Crossed Syndrome and the Acceleration Phase

That was how lower crossed syndrome affects the loading phase of the motion. The position that the QB starts from before he accelerates forward will dictate how successful and efficient the throw is. Please read that sentence again. Our quarterbacks often hear us say “if you enter the tunnel well, you will exit well.” This is exactly what we are talking about.

So let’s now go to the acceleration phase of the motion and talk about the pre-requisite qualities that are needed to be successful at this portion of the motion.

1. Full shoulder elevation
2. Full hip internal rotation
3. Full hip extension
4. The ability to stabilize the trunk with the hip extended and arm overhead

There’s more than this, but these are most important in regards to what we are talking about in this post. So now, we have added a picture of Baker Mayfield during his acceleration phase of the motion. Please notice that during his motion he has the following qualities that tell us that he is able to use his hips and create power from the ground up while also maintaining the properties necessary in order to have max accuracy and efficiency.

These qualities are as followed:

1. Full hip extension (notice the direction of the foot at the release point of the ball)
2. Full hip internal rotation (once again, notice the direction of the foot)
3. Rib Cage down in a neutral trunk position
4. Arm Fully overhead with the ball being released at the highest point

Notice that there’s no lean to the left to try and create power, no foot that is pointing to the right, no over extension in the spine, his plant leg has some knee bend, and he essentially does not stride at all in his motion. This is about as good as it gets. Now let’s look back at Cam Newton to see how he enters the acceleration phase.

So you can see hear that Cam is over extended like crazy as he accelerates forward. This is most likely due to one or more problems that we listed above when it comes to lower crossed syndrome. This is NOT GOOD for the throwing motion as Cam now has learned several compensations to try and create power because of the disconnect between the upper and lower body. His compensation is to essentially throw his torso forward during the acceleration phase through trunk flexion because he generate power from his hips. Now Cam is a big, strong dude so he can get away with this, but this means at the expense of accuracy on his throws because this is not efficient at all. You can see that he often misses high on his throws and this is why! He’s not efficient with his release point of the ball which constantly changes the trajectory of the ball when it comes out of his hand.

The problem here is that there’s no amount of work on the field that is going to correct this. This is going to be corrected by mindful work of reversing this lower crossed syndrome and unlocking the capability to use the hips when throwing. The moral to this story is that if you present with lower crossed syndrome, you will never be able to access your glutes to produce power in throws. You will also ALWAYS have decreased accuracy because the stiffness in the hips will ALWAYS cause over extension of the spine because of where the hip flexors connect in the spine, therefore causing you to change the trunk position and trajectory of throws. It’s a lose, lose for players that have lower crossed syndrome. Guess what though? You probably have this. We always did as players. Below are some more pictures of guys that have similar problems. This happens at every level!

Lower Crossed Syndrome and This Very Common QB Teaching

There’s several common QB teachings that drive us crazy, but there’s one that directly relates to lower crossed syndrome.

This is dragging the foot or leaving the hip in extension during the deceleration phase and the follow through of the motion. This seems to be the common teaching now and here’s why this is wrong in relation to lower crossed syndrome. The first reason is that this is generally taught because the QB has had some balance problems in controlling the position of the body after the release point of the football. Either the QB falls to the left because he leans that way or falls forward because the foot swings around too much. Well, what is the reason for the QB falling off balance during the motion? This is the exact question that I would ask the coach. The reason is going to be that they present with one of these compensations that was talked above previously because of the inability to properly produce force during the acceleration phase. Whether is be the lateral lean, over striding, or locking the plant leg, these are all problems that will cause a ton of balance problems in the deceleration phase and follow through. Not only is the QB going to continue to have these problems, but now by dragging the foot, this is going to put an early braking system on faulty movement which is going to cause decreased power on throws, but also predispose the shoulder and elbow to pain because that area now has to work harder to produce power. The second reason that coaches are said to use this is that it keeps constant contact to the ground which allows the force to be translated through the body, almost like a batter hitting a ball. The first thing that I would say to that is that these are very different movements and there is a distinct difference between hitting an object vs throwing an object. The next thing I would say is that when a QB tries to go into hip extension without having proper range of motion, then that power is lost anyways.

A QB literally can not use his glutes as well and the power that is trying to be translated is now lost because the over extended spine can’t translate that force. I see a lot of QB’s that keep the drive foot into hip extension and their foot even comes up off the ground because their tight hip flexors pulls it off the ground. Here is an example of what I’m talking about below. In essence, coaches are compensating the compensation. This puts an extremely low ceiling on players as they might have more control during their motion, but a lot less power generation on throws for maybe a little more accuracy. Let’s put stitches on the wound to and increase range of motion instead of putting a band aid on it by dragging the foot after the release point.

Well, What Do We Do?

Many of you are asking this question after reading to this point. The first thing you need to do is look at our youtube channel in depth to see how to reverse the symptoms of “lower crossed syndrome”. We have a ton of videos on mobility exercises and strengthening exercises to reverse this problem. You can also reach out to us to have us take you through our QB Performance Screen where we can tease out all your impairments that are playing a role in decreased performance while throwing the football. Hundreds of repetitions throwing the football is not going to help. It’s actually going to make things worse. There needs to be an objective measurement done in order to see where you stand right now as a mover. From there, you can get individualized exercises to improve the dysfunctions you have to become a better thrower. We look forward to hearing from a lot of you! A good email to reach us is at [email protected] or by text/call at 812-343-4226.

-Drew Kiel PT, DPT, CSCS