By Dr. Sarah Crawford, PT, DPT, COMT, CMTPT
Low back pain is one of the most common complaints among adults—and if you’ve ever wondered whether carrying a little extra weight around your midsection could be a contributing factor, you’re not alone. As a physical therapist who specializes in root-cause-based care, I was recently featured in Woman’s World Magazine to share self-care tips for herniated discs and nerve-related back pain. The truth is, abdominal weight can absolutely play a role in back pain—but not always for the reasons you might think.
What Does the Science Say?
The spine is designed to support your body weight and manage mechanical forces as you move through life. When there’s excess mass—particularly centralized around the abdomen—it shifts your center of gravity forward. This forward shift increases the mechanical load on the lumbar spine (lower back), which can lead to:
- Increased lumbar lordosis (arching of the low back)
- Higher compressive forces on the intervertebral discs
- Muscle fatigue in stabilizers like the multifidus and transverse abdominis
- Postural compensation, such as a swayback or anterior pelvic tilt
Over time, this added strain can irritate joints, tighten muscles, and put pressure on nerves—setting the stage for persistent pain, stiffness, or even nerve symptoms like numbness or tingling.
But It’s Not Just About Weight
Here’s the nuance: weight itself isn’t the enemy—especially not when we look at health through a root-cause lens. What matters more is how your body functions, moves, and recovers.
Excess belly fat may correlate with back pain, but it’s not the sole driver. Other factors like poor core strength, prolonged sitting, inadequate movement, inflammation, and even sleep and stress levels all impact how your spine feels.
In fact, in my clinical experience—and as I shared in Woman’s World—I’ve worked with plenty of people in a variety of body types who find relief through targeted therapy that improves movement patterns, reduces inflammation, and builds functional strength.
How Belly Fat Can Interfere With Function
Abdominal weight can act like a counterweight that pulls the pelvis forward. That affects how the deep core muscles—especially the transverse abdominis and pelvic floor—engage. When these muscles aren’t firing well, the body recruits compensators like the erector spinae or hip flexors, leading to muscle imbalances and pain.
What’s more, increased visceral fat (the type that surrounds organs) is linked to chronic inflammation, which can make nerve sensitivity and soft tissue pain more pronounced. This is particularly relevant in cases of disc-related back pain or sciatica, where inflammation worsens nerve irritation.
So, What Can You Do?
If you’re struggling with back pain and you carry more weight in your abdomen, don’t jump straight into weight loss as the only solution. Instead, focus on these foundational steps that help improve spinal health no matter your size:
- Build Core Awareness: Learn to engage your deep abdominal muscles, not just the “six-pack.”
- Improve Posture + Pelvic Control: Small shifts in alignment can reduce load on the spine.
- Incorporate Anti-Inflammatory Habits: Hydration, sleep, nutrition, and stress management matter.
- Prioritize Movement Over Intensity: Walking, Pilates, or gentle strength work go a long way.
- Seek Collaborative Care: A team-based approach (like we use at WAVE Physical Therapy + Pilates) can identify underlying imbalances, not just treat symptoms.
Final Thoughts
Low back pain is complex and multifactorial. While abdominal weight can absolutely influence posture and load-bearing, it’s not a simple matter of weight equals pain. My primary goal here is to focus on helping clients understand the why behind their pain—so they can take action with confidence, not fear. Our goal is never to shame anyone about their body, but to educate on how physics and spinal mechanics affect movement and load acceptance. The way weight is distributed, how forces are absorbed, and how muscles respond all play a role in how your back feels—not just the number on a scale. At the end of the day, we can about how well and easily someone is moving their bodies, beyond that, none of it really matters!
Your body is adaptable, and with the right strategies, you can move better, feel stronger, and get back to living the life you love—regardless of your waistline.
Ready to get to the root of your back pain?
Book a discovery visit with our Cincinnati team at makeawavecincy.com and start feeling better—without the fear.
