Stop ‘Sucking It In’: Breathing, Core Function, & Pelvic Health
The ‘suck it in’ culture around us is not helpful
I am continuously amazed by the deep underlying societal conditioning, seen in both men and women, to ‘suck it in,’ and I am a warrior for ‘let it go’! Many people think 'sucking it in' is a harmless posture habit, but it can fundamentally change the way we breathe, move, and coordinate pressure throughout the body. Chronic abdominal gripping, sometimes referred to as hourglass syndrome, can contribute to breathing dysfunction, pelvic floor dysfunction, and low back pain.
There is a deeply ingrained cultural emphasis on physique, and our perception of physique is often centered around the abdomen. Maybe you were taught by your caregivers to ‘stand up straight and suck it in,’ or maybe the teacher in your favorite exercise class says this cue to help you engage your abs, or maybe you just want to fit into your jeans from last year, so you have to ‘suck it in’ to get them on and keep them on. There is also a possibility that you simply suck it in without even realizing it. Unraveling and unlearning the messages we have been told or shown, particularly about our bodies, takes time. I, too, am part of this group of people learning how to let it go, which is why I am passionate about this work. As a pelvic floor physical therapist, I frequently help clients identify and overcome these subconscious movement and breathing patterns.
What I see in my clinical practice
Repetitive 'suck it in' habits can create a pattern of chronic abdominal gripping, also known as hourglass syndrome. In my clinical practice, I see underlying abdominal gripping inover 60% of clients I work with, and it is often subconscious. Signs and symptoms can include poor rib cage expansion and decreased diaphragm movement with breathing, low back pain, tight pelvic floor muscles, and a potential horizontal crease in the upper abdominal skin. In clients with this, I often see concurrent bowel, bladder, and/or sexual dysfunction as well as back pain and pelvic organ prolapse. These symptoms are commonly associated with impaired core and pelvic floor coordination. The diaphragm becomes less efficient, forcing our accessory neck muscles to work harder (which, by the way, can keep our nervous system in more of a ‘fight or flight’ state). Our obliques can become overactive, while our deepest core stabilizer, the transverse abdominis, takes a backseat, leading to back pain and trunk pressure management issues.
My treatment philosophy
Teaching my clients how to relax their abdomen is a foundational skill that must be established in the first few physical therapy visits before we can make progress with any other symptoms related to their abdomen, low back, or pelvic floor. If we do not address abdominal gripping, then most other interventions, such as manual therapy, including internal muscle release, and therapeutic exercises, will not have a lasting effect or improve physical outcomes. Addressing abdominal gripping is often a key component of pelvic floor physical therapy and rehabilitation for chronic low back pain.
There are better cues for ab engagement
The goal is not to stop using your abdominal muscles altogether. Rather, it is learning how to engage them with better coordination and pressure management. There are so many other, more effective cues to coach people on how to engage their abdominals, such as ‘draw the belly button back and up towards the spine’ or ‘exhale as you draw the abdominals in and up and make the sound “Haa” by constricting the vocal cords’, among many others. ‘Suck it in’ often causes people to lift their diaphragm, which simultaneously lifts the pelvic floor and disrupts the natural coordination between breathing and pressure management. Using an exhale is an important part of abdominal contraction, just as inhalation helps facilitate abdominal relaxation when we have good rib cage and diaphragm movement.
Basic strategies for healing abdominal gripping
Building awareness. Become mindful of your abdomen and breathing throughout your day, and ask yourself, “Am I gripping my belly?” Building awareness of how often you are doing this is key. Only then can we begin to unlearn this often subconscious, unhelpful pattern of sucking it in.
Practicing relaxation. Consciously, soften your abdomen multiple times per day. Offer yourself compassion when you notice you’re contracting it again, and again, and relax again, and again. Unraveling deep patterns of conditioning takes time, so be patient with yourself.
Restoring breathing mechanics. You can do this by practicing ‘360° breathing’, also known as diaphragmatic breathing. Diaphragmatic breathing and ‘belly breathing’ are often used interchangeably, yet ‘belly breathing’ puts an emphasis only on the front of the abdomen rising and falling. This means we leave out engaging the sides and the back of the ribs, which together make up more than half of the area where our diaphragm attaches. It is important to engage our minds in this practice and focus on the parts of the body we want to expand, including the sides and back of the ribs. The visualization of our body parts dramatically changes how our body responds during an activity like this. Practicing diaphragmatic breathing can help improve rib cage mobility, core function, pressure management, and pelvic floor health.
The following exercises can help reduce abdominal gripping, improve diaphragmatic breathing, and restore healthy core and pelvic floor coordination.
Specific exercises:
Elevate the feet and lower legs in a chair, while lying on your back and practicing ‘360° breathing’. This relaxes the abdomen and hip flexor muscles, which connect to the diaphragm, allowing your diaphragm to move more effectively while you practice breathing.
Lying on your side with a bolster or rolled blanket under your ribcage. Then, with the arm overhead or not, breathe into the side of your ribcage facing the ceiling for 2-4 minutes. Repeat on the other side.
As you come into a child’s pose, place yoga blocks between your thighs and your front ribs on either side. As you reach the head towards another block or the floor, the blocks stop the front ribs from moving while you breathe and facilitates the back ribs to expand more effectively, allowing you to stretch your lower back and use your diaphragm more efficiently.
Key takeaways:
Chronic "sucking it in" can become an unconscious pattern called hourglass syndrome.
Abdominal gripping can affect breathing mechanics, pelvic floor function, and abdominopelvic coordination as well as top-to-bottom pressure management.
Symptoms may include back pain, tight pelvic floor muscles, bowel/bladder dysfunction, and restricted rib movement.
Healing starts with awareness, abdominal relaxation, and the restoration of diaphragmatic movement.
Abdominal gripping is a common but often overlooked contributor to pelvic floor dysfunction, chronic low back pain, and breathing pattern disorders.
