Hour Glass Syndrome: Why Females Have Lower Belly Pooch
The dreaded hourglass syndrome is the culprit of lower belly pooch that so many women have. Hourglass syndrome is not synonymous with an hourglass figure. When women have an hourglass figure, it is referring to proportionate curves that are attractive to the eye.
Hourglass Syndrome on the other hand, is when women have overdeveloped upper abdominal muscles, and an underdeveloped lower abdomen. This syndrome is caused from doing thousands of sit-ups, or repetitive trunk flexion exercises to strengthen the upper abdominals.
This causes “fake core strength.” The upper abdominals look ripped, but the core musculature is weak, leaving the lower back and pelvis prone to injury. The core musculature does not just include the abdominals, it also includes the diaphragm, the obliques, the pelvic floor musculature, and the transversus abdominis. These muscles are responsible for supporting the structure of the body upright against gravity.
Many patients recognize the importance of the strong core strength. However, what the majority of them don’t understand is that if they aren’t engaging each of these muscle groups they are actually causing the hourglass syndrome, which leads to postural compromise and can be injurious to the lower back.
How to Detect Hourglass Syndrome:
With the patient seated, have them expose their abdomen. Look at the patient’s abdominal muscles and watch how they breathe. With Hourglass Syndrome, the upper abdominal muscles will be defined, and the lower abdominal muscle won’t be. The lower stomach area will have the “pooching out” effect. As the patient breaths in and out, they will have the defined abdominal tone of the upper abdominals with evident pooching of the lower abdomen.
How Does Hourglass Syndrome Develop?
Hourglass Syndrome develops from a prolonged abnormality of muscle tone within the abdominal wall. The uneven muscle activation arises due to reciprocal inhibition. Reciprocal inhibition means that as one muscle is activated, another muscle is relaxed. Hourglass Syndrome is an extreme example in which over activation of the upper abdominals leads to under activation of the lower abdominals.
Postural Collapse due to Hourglass Syndrome:
Abnormal firing of the abdominal musculature leads to inefficient intra-abdominal pressure in which patients are breathing with less efficiency. Because the lower abdominals are weak, the patient has poor load stabilization of the lumbar spine. As they lift heavy items, the patient is left unprotected. Repetitive heavy loads with weak stabilization may lead to spinal injury.
Educate your patients, especially the females, about Hourglass Syndrome. They will love you for it. Not only have your women patients been trying to lose the lower belly “pooch” and lost hope, they have no idea how it is predisposing them to back and pelvic dysfunction.
The majority of Hourglass Syndrome patients engage in activities to strengthen their core. They are the type of people in the gym doing sit up after sit up. They are looking for a better way to train, but without your guidance, they continue to utilize old, out-date abdominal strengthening techniques.
Core Control Exercises to Offset Hourglass Syndrome:
Core Plank:
This exercise is great at engaging the entire abdominal muscle group, including the lower abdominals and the deep transversus abdominis. Have patients perform this exercise to the point of postural collapse. As they lose form, have them relax then re-start if they have the stamina to do more than one Core Plank. 
Common mistakes while performing this exercise include raising the gluteals and arching the lower back, or drooping the pelvis towards the floor.
Wall Posture:
Wall Posture is a very effective exercise that many of your patients will benefit from, including patients with Hourglass Syndrome. The most important thing while performing this exercise is to maintain proper posture and match pelvic movements with deep, diaphragmatic breaths.
The patient will tuck their pelvis, flattening their lumbar spine against the wall, and then arch their lower back creating a space between the lumbar spine and the wall. As they perform these movements, they keep their upper back against the wall and their legs straight.
Patients with weak core activation will commonly compensate by bending their knees to make the pelvic movement happen. Cue your patients to keep their legs straight.
