Question
How does the Valsalva maneuver function in strength training, and what are its associated risks and benefits?
Answer
The Valsalva maneuver, defined as a forceful exhalation against a closed glottis, is commonly used in strength training to increase intra-abdominal pressure (IAP), thereby stabilizing the trunk and spine during heavy lifts. This bracing technique allows athletes to lift heavier loads more safely by enhancing spinal stability and paraspinal muscle engagement. However, the maneuver also carries risks, particularly if breath-holding is prolonged or performed at high intensities. Potential side effects include transient increases in blood pressure, risk of pre-syncope or syncope, increased intraocular pressure (which may contribute to glaucoma risk), and, in rare cases, more serious complications such as spontaneous spinal epidural hematoma. For most healthy individuals, these risks are low and transient, but athletes with cardiovascular or ocular conditions should be counseled on alternative breathing strategies.
One common alternative is exhaling through the sticking point of a lift, which involves breathing out during the most challenging phase of the movement rather than holding the breath. This method reduces the spike in blood pressure and intra-abdominal pressure, making it safer for those at risk. Another strategy is "bracing with an open glottis," where the athlete maintains core engagement and trunk stability while allowing a small, controlled exhalation, thus avoiding complete breath-holding. These techniques can be practiced and refined to maintain adequate spinal support while minimizing health risks. The choice of strategy should be individualized based on the athlete’s health status, the load being lifted, and the specific demands of the sport or exercise.
This Ask the Expert is an edited excerpt from the course, 'Strength Athletes and Pelvic Floor Physical Therapy', presented by Brianna Durand, PT, DPT, PPSC.
