Hourglass syndrome

Do you keep exercising your abdominal muscles since you started doing sports in your childhood, or you started just now? If yes, it is good to know about the risks of incorrect exercising, which you can unknowingly do while training or when trying to keep a correct body posture. The problem is also arising during incorrect strength exercising or when trying to keep ideal figure. Complications may start already in childhood during incorrect exercising. We will focus mainly on the hourglass syndrome.

CLHourglass syndrome external cropHOW DOES HOURGLASS SYNDROME LOOK LIKE?

You can notice this syndrome from the front, if you focus your view on the abdomen. There is no balanced activation of all muscles of the abdomen, but there is a prevailing increased muscle tension of the upper part of the abdominal wall - especially the rectus abdominis muscle (abs).


Hourglass syndrome can form thanks to incorrect exercising rooted since childhood and inducing coactivation of the muscles on the front and back side of the trunk.

The main risk of hourglass syndrome is incorrect execution of crunches. That is usually accompanied by incorrect breathing, during which the chest is too high and the abdominal muscles are activated sooner than the diaphragm. That results in increased involvement of the core muscles in the back. We are getting to uneven burdening of the abdominal muscles. It leads to increased activation of the upper fibres of the rectus abdominis muscles, but the transverse abdominis muscle fibres along with the lower fibres of the rectus abdominis muscles are excluded from their function. Most recent studies proved that the abdominal muscles and diaphragm are automatically and functionally connected, and there is no doubt that they affect each other during incorrect burdening.

This wrong stereotype is usually involved into common habits. unbalanced muscle activity results in non-centered posture, and it brings many negative consequences - for example acute or chronic overloading. All that is disallowing a quality coordinated stabilization of the lumbar spine.


Further manifestations of this syndrome are the so called inverse functions of diaphragm, which cause the lower ribs to shrink inwardly and the sternum bone is pushed during activation downwards.

This activation is further affecting the upper ribs, which widens the rib cage thanks to the breathing muscles. Especially the activity in the upper part of the abdominal muscles causes the chest to not expand. That consequently leads to insufficient function of the diaphragm which also plays a stabilizing function in the trunk.

We can see by patients with chronically painful back, disabled hypertonic rectus abdominis muscle which is able to function only in its upper part, and the lower part is usually weakened and nonfunctional. During functional examination of the stability it is manifested by pain in the groin area. By physically active youth is the stereotypical movement can be hardly affected. It has the most significant effect on the lumbar spine and pelvis - which can have a fatal consequences on the general body posture, painful conditions and further injuries.


The main goal for physiotherapist is to induce the correct activation of the diaphragm and release the tension in the overloaded muscles of the abdomen and back. It is important to approach each patient individual during activation of the diaphragm. When you stretch the abdominal muscles in the whole range, breathe at least for 15 seconds in the “cobra” or “seal” position. And for stretching the back muscles the “child’s pose” is ideal.

Stretching the rectus abdominis muscle

  • Lay on your stomach
  • Bend your elbows and rest your hands on the ground closer to your shoulders
  • With inhale lift up your trunk - in first stage lift your trunk only by your back muscles, in the second stage involve your arms in the lifting
  • Stretch out your head upwards
  • Press your shoulders down
  • Keep your arms stretched
  • Keep your legs stretched and rested
  • Breathe freely in this position
  • With exhale return back to the default position on your stomach.

Stretching the back muscles (latissimus dorsi)

  • Sit down on your heels
  • Stretch your arms as much as you can in front yourself, and place your hands, forearms on the ground
  • Rest your forehead on the ground
  • Breathe freely
  • With exhale return back to the default position

Recommended article about correct activation of the diaphragm:

Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience in private practice and physiotherapeutic field, FYZIOklinika

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