Uncovering The Layers Of “The Layer Syndrome”

Dr. Vladimir Janda in 1979 introduced the crossed syndromes namely, upper crossed syndrome, lower crossed syndrome and layer syndrome.

The layer syndrome which is also known as “stratification syndrome” is said to occur when both upper and lower crossed syndromes are involved. It results from the typical imbalances in the body’s musculature mainly in the upper quarter and the lower quarter, during which there is an alternating pattern of hypertonicity and hypotonicity in the muscles.

This syndrome is most commonly seen in older adults. The prognosis is poor due to long-standing dysfunction.

Characteristics:

Upper Quarter-

-Tightness or facilitation (hypertonic) in the upper trapezius, sternocleidomastoid, levator scapulae and pectorals.

-Weakness or inhibition (hypotonic) in the deep cervical flexors, lower trapezius, weak scapular stabilizers.

-Postural changes will be seen as forward head, shrugged and protracted shoulders, winged scapulae.

Lower Quarter-

-Tightness of the trunk extensor muscles, hip flexors.

-Weakness of the abdominals and hip extensors.

-Postural changes occur as anterior pelvic tilt, increased lumbar lordosis and a mild flexed hip.

Assessment-

The Janda Approach mentions some movement evaluation tests for the layer syndrome.

The tests are as follows:

1. Cervical Flexion- The patient is asked to lift their head and look down at their feet in the supine position. The sternocleidomastoid muscle is tight if the chin comes up first, also indicating the weakness of the deep cervical flexors.

2. Hip Extension- Ask the patient to lie down in the prone position with their neck in the neutral position. Then ask the patient to lift their one leg. If the spinal muscles are tight and the abdominals are weak, there will be delayed activation of gluteus maximus.

3. Hip Abduction- Patient to lie down in the side-lying position. Now, ask the patient to abduct their top leg against your resistance. The less pressure from the patient indicates weak core muscles.

4. Trunk Curl-up- From the supine position, ask the patient to bend his knees to 90 degrees and place their heels in the clinician’s hands. The patient is then asked to curl up until their scapula leave the floor while keeping the pressure on the heels. If the clinician finds the pressure getting lessened up early on, there is definite facilitation of the hip flexors.

5. Push-up- If there is the winging of the scapulae or there is an excessive elevation of shoulders, this indicates the weakness in scapular stabilizers.

Treatment-

The treatment mainly includes:

a) The stretching of tight muscles- Levator scapulae stretch, Pectoralis stretch, Iliopsoas stretch, Rectus femoris stretch, Quadratus lumborum stretch

b) Retraining of the inhibited muscles- Lower trapezius retraining, Abdominals retraining, Gluteus maximus retraining.

c) Postural Retraining

Jyoti Pathak

BPT, IPH

References-

· Janda Syndromes- The Janda Approach

· Evaluation & Management of the Crossed Syndromes- acofp

· The Janda Approach to Pain Management & Body Mechanics- nydnrehab