Do Lax Abdominal Muscles Usually Cause Back Pain?

I was examined by a general surgeon for repair of a very large broad-based umbilical hernia. During the examination, the surgeon inquired whether I had back pain (I have rather severe back arthritis). He stated that the lax abdominal muscles, which allowed the hernia to occur, most likely contributed to the back situation and recommended an abdominoplasty, both for a more complete hernia repair and to stabilize (not eliminate) my back issues.

The plastic surgeon to which I was referred agrees with the assessment, as does my primary care physician. Is this a common scenario and, if so, why is the abdominoplasty portion of the recommended procedure not covered by insurance?

Doctor Answers 13

Lax Abdominal Muscles can be associated with Back Pain

Our bodies appear to function best when they are in balance. For every muscle group that bends or lifts there is an opposing group of muscles which straightens or pulls down. Any weakening of this balance will take its toll. The spine is acted upon by several muscles groups but it has been shown that weakened, exercised, damaged or separated abdominal muscles are associated with back pain.

Rather than delve into a lengthy and never to be resolved discussion about whose responsibility it is to pay for poor life long habits, aging, bad luck or a combination of all of these, let's just for a second close our eyes and try and consider the bill to insurers if every American with a flabby and or separated abdominal muscles, for whatever reason, came in demanding a tummy tuck. (I am NOT saying this is the case here). 

Since insurance companies tell you on the front end what they will pay for and the much longer list of what they will not pay for, there is NO chance that any of them will pay for a Cosmetic Surgery procedure EVEN IF it could improve your back symptoms. In their manuals, across the way from BACK PAIN they may have: Advil (etc), massage, chiropractors and after demonstration of repeated failure of such "treatments", back surgery (ONLY after specific criteria are met). A Tummy Tuck is NOT one of the options.

Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Abdominoplasty can address the lax abdomen, but not back pain

Back pain is a complex issue with many causes.

Loose abdominal muscles can cause back pain by allowing the lower back to curve forward-a condition called lumbar lordosis. This causes back pain because the curvature of the vertebrae compresses the nerves which causes pain.

When the abdominal muscles tighten they can help reduce the lumbar lordosis and could help back pain. However if there are primary problems in the spine such as a herniated disc or arthritis, the abdominoplasty won't help.

The abdominolasty is not a recognized, approved procedure for correction of back pain recognized by the medical insurance companies-so they do not cover it.

Generally, abdominoplasty is done primarily for cosmetic reasons.

Lower back pain and insurance coverage for repair of a diastasis recti

The   abdominal wall forms a cinch around the lower abdomen giving some support to the lower back.  Clinically I see many patients who report that their back pain is improved following an abdominoplasty.  There is really no way to tell if an insurance company would consider this medically necessary.   You could always call your insurance company and speak with a claims representative and ask if there is a coverage for this problems.  In today's world you just do not know for sure.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Relief of back pain with tummy tuck: insurance coverage

An preliminary report published in 1990 suggested that Wide Abdominal Rectus Plication (aka the WARP abdominoplasty technique) produced some back pain relief in 24/25 patients treated.

However, this has not been substantiated and should not be the primary reason you seek abdominoplasty.

Furthermore, most insurance companies do not accept this as in indication for benefits coverage.

If i can explain. Your spine depends on a delicate balance between your stomach muscles and back muscles. When your stomach muscles are weak you may have an abnormal posture which creates excessive back discomfort.

Think about how it feels on your back when you have been sitting "Indian-style" for a while.

This is the reason orthopedic surgeons and spine surgeons will often prescribe a course of physical therapy to strengthen your abodminal muscles. It is also why Pilates and Yoga core strengthening exercises can improve minor back pain. I perform Pilates after a long week of surgery and I find dramatic relief from back strain.

The muscle rearrangement that occurs with abdominoplasty can enable you to use these stomach muscles in a more normal fashion and improve back pain but it should not be the sole reason you seek surgery.

In fact, in the early postoperative period, you may experience a greater degree of back pain you feel due to excessive bending forward from your tendency ot releive the pull felt by tightening the skin.

I hope this helps!

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Lax abdominal wall might contribute to back pain but the science behind this claim is weak.

Patients with back pain commonly report that their backs feel better after an abdominoplasty.  This is subjective and there is very little in the literature to explain why this might be so.  There has been published a paper comparing MRI scans of the back before and after abdominplasty but the science is still weak and incomplete.  I would never promise a patient improvement in back pain with an abdominoplasty.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Abdomen muscles and back pain

Having a large hernia or diastasis can definitely affect your posture and contribute to back pain. Repair of the defect may improve your symptoms. However, many times this is not a "tummy tuck," but rather an abdominal wall repair. Your plastic surgeon may remove skin and fat while he's there to improve the look of your abdomen, but reviewing what is and is not covered by insurance is very important.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Back pain caused by lax abdominal muscles

Your posture and comfort of your back is dependent on muscles around your spine and in your abdomen. If you have a significant hernia this may displace the muscles and can cause an imbalance in your pelvis. Your best bet is to be evaluated by a back surgeon as well as a general surgeon who can determine if you are a candidate for a hernia repair and if this will help your back pain. It is possible to perform a tummy tuck at the same setting as a hernia repair.

To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

Back pain and abdominal weakness

Back pain can be due to many different things.  Tightening the core through exercise may improve symptoms for some patients.  Surgical tightening may not improve your symptoms.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Weak abdominal muscles do cause back pain

You doctors are very correct in that weakness in the abdominal or sit-up muscles do cause back pain in some, though not all individuals. Imagine if you will, that the curvature of your spine is balanced between the muscle of the back and the muscle of the abdomen. If the abdomen is weak the spine assumes a curve forward or a sway back configuration placing more stress on the discs and joints within the spine. Particularly with arthritis, postural backache can result or in some disc narrowing or collapse, and disc herniation can occur.

Strengthening the abdomen can reduce postural backache and strain or perhaps delay disc problems. It is an important part of any physical therapy program for back pain.

Insurance coverage for abdominoplasty depends solely on what your carrier chooses to cover, and "medical necessity", a term they use to limit care choice will influence what is available under your particular plan or contract. There may be an appeal process available if you feel you have been wrongly denied coverage. Your company benefits officer can sometimes help you understand your present coverage. Our experience in Chicago, where I practice, is that insurance plans do not deem abdominoplasty as a medical necessity.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Laxity of abdominal muscles may cause back pain

Although there are many other causes for back pain, laxity of the abdominal musculature can be a significant element in back pain due to imbalance of muscle forces.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon
4.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.