What Causes Hourglass Syndrome?

Medically Reviewed on 12/9/2021

3 primary causes of hourglass syndrome

Hourglass syndrome (Stomach Gripping)
The 3 primary causes of hourglass syndrome include poor habits, nonideal childhood development, and defensive patterns.

The 3 primary causes of hourglass syndrome include:

  1. Poor habits or social anxiety
    • Many wish for a flat abdomen. However, holding it in for a long time is not a good idea.
    • When this is continued for a long duration, it can “rewire” the brain from the natural pattern of adjustment to this changed form.
  2. Nonideal development during childhood
    • In about 30 percent of infants, the stomach gripping or hourglass syndrome is a typical compensation procedure in response to poor muscle development, which can persist into adulthood.
  3. Defensive patterns
    • Stomach gripping can develop as a feature of muscle protection post an injury and may persist long after the pain has been cured.
    • After an accident, injured tissues heal but muscles learn.
    • They promptly develop a habit of protecting even after recovery.

What is hourglass syndrome?

Hourglass syndrome is a disorder in which people suck in their abdomen habitually.

  • There is an activation of the upper abdominal muscles because of the pulling of the diaphragm toward the opposite direction that inflates the lungs.
  • Thus, sucking in the abdomen pulls the diaphragm inward and consequently pulls the lower ribs inward too.
  • Doing this, for an extended period results in a smaller waist, an up-turned belly button, and a horizontal crease located across or over the belly button.

This happens because of the abdominal muscle imbalance, leaving the upper muscles in constant constriction. However, it causes the lower back and abdominal muscles to go lax, consequently pulling the abdomen in an upward direction.

3 consequences of the hourglass syndrome

  1. Lower back pain 
    • The diaphragm is a critical stabilizer of the lower back. So, when it is not working accurately the lower back is left weak.
    • This implies that the other muscles need to work more efficiently to make up for the dysfunction of the diaphragm, especially the extensors of the lower back. 
    • This consistent overworking of the muscles can prompt tightness and pain.
  2. Neck pain
    • If in case the diaphragm does not descend normally as expected, not only will the stabilization be affected but also breathing. This can cause a huge strain on the neck.
    • The center of the diaphragm ought to descend downward, extending the abdomen and expanding the lungs. In the hourglass disorder, this normal pattern of motion is disturbed, and, mostly when inhaling, the chest and shoulders lift instead of compensating.
    • This puts a great deal of stress on the muscles of the neck and is a key cause of migraines and neck pain.
  3. Acid reflux
    • Alongside its breathing and balancing functions, the diaphragm additionally works as a sphincter, assisting to prevent the stomach contents from going back up into the throat (esophagus).
    • If the diaphragm is damaged, it can increase the risk of acid reflux.

How is hourglass syndrome treated?

The treatment for hourglass syndrome is mainly physiotherapy. The main objective for physiotherapists is to induce the right activation of the diaphragm and release the strain in the overloaded muscles of the abdomen and back.

At the point when a person stretches the abdomen, they inhale for 15 seconds in the "cobra" or "seal" position. Also, to stretch the back muscles, the "child's posture" is ideal.


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Medically Reviewed on 12/9/2021
Image Source: iStock Images

Dunn HW. The hourglass syndrome. Nurs Clin North Am. 1970 Jun;5(2):351-7. https://pubmed.ncbi.nlm.nih.gov/5199257/

FYZIOklinika physiotherapy. Hourglass Syndrome. http://www.fyziopedia.org/articles/303-hourglass-syndrome