Maybe it was your mom telling you to stand up straighter. Maybe it was a fitness instructor constantly reminding you to pull your belly button toward your spine. Or maybe it was the cultural messaging that a flatter stomach is simply more attractive. For many women, after years of being told to "suck it in" — also referred to as "stomach gripping" — it just becomes a way of life. But physical therapists say the habit can have consequences that go far beyond appearance.
Over time, what starts as a conscious effort can become automatic. "That becomes an unconscious holding pattern," Dr. Caroline Packard, a pelvic floor physical therapist and founder of Connect Pelvic Floor Fitness, told HuffPost. "I call this ab gripping, and I see it all the time clinically in women dealing with pelvic floor symptoms, core dysfunction, back pain, hip pain and breathing restrictions."
What is 'hourglass syndrome'?
Hourglass syndrome isn't a formal medical diagnosis. Rather, it's a term clinicians use to describe a common pattern of abdominal tension. According to Packard, years of pulling the stomach inward can train the body to rely on the outer abdominal muscles for stability instead of the deeper muscles that are designed to support breathing, posture and pressure management.
"Hourglass syndrome is what that looks like on the outside," Packard said. "On the inside, the surface muscles you can grip with are doing too much, and the deeper system that's supposed to coordinate pressure has gotten quieter and quieter."
It's not just your abdominals — this habit can cause issues with your breathing, pelvic floor and your back. Melissa Brandon, a pelvic floor physical therapist and founder of Homebody Wellness, told HuffPost that the pattern is surprisingly common and often goes unnoticed. "In my clinical practice, I see underlying abdominal gripping in at least 75% of clients I work with, and it is often subconscious," she said.
How stomach gripping affects your body
Brandon explains that chronic abdominal tension changes how the body manages pressure. "Many people think 'sucking it in' is a harmless posture habit, but chronic abdominal gripping can fundamentally change the way we breathe, move and coordinate pressure throughout the body," she said.
Normally, the diaphragm moves downward during inhalation as the rib cage expands and the pelvic floor lengthens in response. But when the upper abs stay tight, breathing becomes more shallow and chest-driven. Brandon said this can increase reliance on the neck and upper chest muscles, making breathing less efficient and more effortful.
Packard adds that the diaphragm and pelvic floor are meant to function as a coordinated system. When one is restricted, the other is affected. "When you grip your upper abs, you restrict the diaphragm from being able to lower and expand," Packard said. "The pelvic floor never gets the input it needs to lengthen."
Over time, this altered pressure system may contribute to urinary leakage, pelvic pressure, prolapse, painful sex and persistent lower back pain. Packard notes that these symptoms are often misinterpreted as weakness. "Here's what surprises people: the pelvic floor in these cases usually isn't weak in the way people imagine. It's tight," Packard explains. "Imagine holding your bicep contracted all day. By the time you actually went to use it, it would be tired and it wouldn't work very well."
Because of this, she cautions that more Kegels are not always helpful. If the pelvic floor is already shortened and overactive, strengthening alone can reinforce the problem. Brandon agrees that the first step is not strengthening. "Stop defaulting to more Kegels," she said. "For many women, the first step isn't strengthening. It's learning how to relax, lengthen and coordinate the system."
Back pain is also a sign of hourglass syndrome. When the body's deeper stabilizing muscles aren't coordinating properly, other muscles often compensate. The lower back, hips and rib cage may take on more work than they were designed to handle. According to Brandon, this can contribute to chronic back pain, tension and difficulties managing pressure through the trunk. "The diaphragm becomes less efficient, forcing our accessory neck muscles to work harder," she explains. "Our obliques can become overactive, while our deepest core stabilizer, the transverse abdominis, takes a back seat, leading to back pain and issues with trunk pressure management."
Signs you've been gripping your stomach too much
Experts say common signs include:
- A visible crease beneath the ribs
- Difficulty fully relaxing the abdomen
- Feeling uncomfortable when you let your stomach soften
- Shallow chest breathing
- Chronic tension in the jaw, ribs, hips or lower back
- Trouble sensing or coordinating the pelvic floor
- A persistent lower-belly pooch that doesn't improve with more abdominal exercises
How to heal from stomach gripping
Both Packard and Brandon emphasize that the first step is awareness of when and how abdominal gripping is happening.
Build awareness in real time
Packard said, "You can't change a pattern you can't feel." Brandon similarly encourages people to regularly check in and ask, "Am I gripping my belly?" The goal is simply noticing the habit without judgment.
Practice relaxing the abdomen, not bracing it
Both experts stress that early work is about learning to soften the belly repeatedly throughout the day, rather than trying to constantly engage it.
Relearn breathing mechanics through 360-degree expansion
Packard recommends diaphragmatic or 360-degree breathing, where the focus includes the sides and back of the rib cage — not just the front — to restore more balanced diaphragm movement.
Pay attention to body position
Packard emphasizes stacking the rib cage over the pelvis and pelvis over the feet to support more efficient pressure management and reduce compensatory gripping.
Improve rib mobility
Gentle side bends, rotations, and breathing into the back and sides of the rib cage can help restore movement in areas that may have become restricted over time.
Focus on coordination before strengthening
Packard notes that for many people, especially those already holding chronic tension, more Kegels are not the first step. The priority is learning how to relax, lengthen, and coordinate the system before adding strength work.
Undo the habit through repetition, not intensity
Brandon emphasizes that unlearning abdominal gripping takes time and consistency, especially since it is often a subconscious pattern.
"One final reframe: the question of whether the pelvic floor is 'tight' or 'weak' is, in my view, the wrong question," Packard said. Instead, she said it's important to ask these questions:
- Where are you holding tension in your body?
- Can you feel your pelvic floor lengthen, like a trampoline descending between your hips, on an inhale?
- Can you feel it lift and squeeze on an exhale?
- Can you do that smoothly, breath after breath, without gripping somewhere else?
- Can you do it while you're moving?
According to Packard, this is the real measure of pelvic floor health. "It's the lens 'suck it in' culture has taught generations of women to ignore. Healing ab gripping isn't about letting yourself go. It's about letting your body work the way it was designed to work."
