Valsalva Maneuver

Posted on 14 Dec 2008 02:12

By Ground Up Strength, Eric Troy

What is the Valsalva Maneuver?

The valsalva maneuver was named for Antonio Valsalva, an 18th century physician. Used as a way to evaluate the cardiovascular system, it is often done, both consciously and unconsciously, by those engaged in vigorous movement; especially where those movements encounter resistance, as with strength training. Described simply, the valsalva maneuver is a forced expiration against a closed glottis.

The “KIA” in karate can be compared to the modified vasalva maneuver, which is the technique most lifters use. Any unconscious grunt under exertion likewise can be compared to this technique. It is NOT holding ones breath and completely holding one’s breath during heavy weight lifting, in this writer’s opinion, should never be recommended. Instead we use this "modified" technique in which the glottis is partially closed in order to maintain more pressure during the most difficult portion of the lift. Some air is allowed to escape in a controlled way. Your breath should be allowed to release quickly just upon passing the 'sticking point' of the lift.

The vasalva maneuver helps to increase intra-thoracic and intra-abdominal pressure. With resistance training it is this intra-abdominal pressure we are concerned with. This increase in pressure results in decreased venous return and reduced cardiac output. The heart rate speeds up and vasoconstriction increases so that blood pressure is maintained. If intense and prolonged enough you may become lightheaded or even faint due to lack of oxygen in the brain. Also, when the pressure is released, blood pressure can sky rocket due to the vasoconstriction and high cardiac output.

Intra-abdominal Pressure

This intra-abdominal pressure has been referred to as a “fluid ball”, which is a rigid compartment of fluid in the lower torso. This increase the rigidity of the torso and helps to support the vertebral column. Basically similar to the effect of a weight belt but naturally produced in the body…much to our benefit. Although, many authoritative sources claim that the using the valsalva is necessary to bring this about, including such books as Essentials of Strength Training and Conditioning, according to Stuart McGill, this “fluid ball” is a natural and automatic response of the body under heavy load. The valsalva just helps to increase this pressure. And indeed this claim is borne out by a great deal of clinical data.

Clinically, the VM is considered to have four phases.

1) A temporary rise in mean arterial blood pressure as a result of the increased intra-thoracic pressure

2a) A fall in atrial filling pressure leading to a decrease in mean arterial blood pressure. b) An increase in sympathetic activation which increases peripheral vascular resistance so mean arterial blood pressure rises a small amount once again and heart rate increases a bit.

3) The strain is released and mean arterial blood pressure falls suddenly as the intra-thoracic pressure falls.

4) The increased sympathetic tone and systemic vascular resistance is persistent so there is an overshoot in mean arterial blood pressure. This results in reflexive slowing of the heart rate (bradycardia) and both blood pressure and heart rate return to normal.1

If you’ve ever experienced an exertional headache, for instance, during squatting, this may be one cause of it. But it is important to note that resistance exercise causes acute increases in blood pressure regardless if someone holds his/her breath during a lift. This is temporary and, according to research, has no long term effect on resting blood pressure. Also, this transitory increase in blood pressure becomes blunted in trained individuals compared to untrained ones [1]. The valsalva maneuver does not change this and some of the dire warnings against the maneuver are a bit unfounded.

Contrary to popular belief, higher peak blood pressures are associated with submaximal high volume lifting more than with maximal lifting. During the last few reps of high volume sets the pressure reaches it's peak, regardless of valsalva maneuver use although the valsalva is associated with even higher peaks. However, the valsalva is really not necessary for such submaximal training and would be difficult since oxygen deprivation and the need to breath in a regular way is contrary to its performance. It is exactly for this reason that most trainers teach trainees to breathe in during the eccentric and out during the concentric as a simple way to maintain breathing during the kind of resistance training most people engage in, which entails lighter weights and moderate to high volume.

I should point out, that although huge increases in blood pressure have been recorded during resistance training and even more during the valsalva maneuver there is nothing to indicate a negative effect on resting blood pressure. Basically things quickly normalize and return to baseline. And indeed, resistance training seems to lead to lower blood pressure than that of sedentary individuals, especially in men.

So obviously the maneuver should be used with caution. High volume and lack of normalization of blood pressure…which can take minutes, can lead to some very serious consequences. The good thing is that the valsalva is not necessary for higher volume lifting at lesser intensities. Indeed, it is not necessary at all since increased intra-abdominal pressure is an automatic response in heavy lifting. The valsalva is very useful for increasing that pressure, but it is not true that you need it to create pressure in the first place.2 However, the conclusion of one study by Haykowsky, et al. suggested that cerebral arterial stress was actually lower when the valsalva maneuver was used during resistance training than when resistance training was performed without the maneuver. According to the study this was due to a "canceling out" affect of the rise in systolic blood pressure being accompanied by increased intrathoracic pressure. These authors revealed similar results for left ventricle wall stress in that brief Valsalva maneuver was not associated with an alteration in LV wall stress or LV systolic function in healthy young men. The resistance exercises used, however, were the biceps curl and the leg press, respectively. [2] [3]

So, you do not hold your breath during an entire lift. You can release your breath in a controlled way. Hold the tongue against the glottis and exhale slowly. Or, you can hold your breath until you are past your sticking point and then do a controlled release. The valsalva maneuver is about abdominal bracing and it not just the act of holding your breath. During lighter is not necessary at all.

Valsalva Induced Retinopathy (Vitreous Hemorrhage)

Although trainees are often warned of the risk of eye hemorrhage (vitreous hemorrhage), this is not a common finding associated with the valsalva maneuver and is much less likely when the modified valsalva is employed. Holding one's breath completely during lifting, as discussed above, especially during high volume lifting, would be an excessive use of the valsalva and their may certainly be a risk of valsalva induced retinopathy such as vitreous bleeding. There are no controlled studies to indicate this risk because, of course, intentionally causing such eye injury would not be ethical. However, several case studies can be found describing eye injuries of this sort due to the valsalva maneuver. It should be noted, that not all of these are associated with heavy weight lifting. Prolonged vomiting, blowing up balloons, etc. are more likely to cause such a problem than the controlled use of modified valsalva during weight training. The risk is up to you, however.

How to Perform the Valsalva Maneuver

Boris of Squat Rx does a great job of explaining and demonstrating breathing maneuvers and also show just exactly what a “sticking point” is. But to define it clearly: its is the point in a lift that is most strenuous (really a region rather than one point).

Boris’s breathing technique here is second to none. I use much the same technique myself with very heavy loads. Although I tend to verbalize more, which can be a good way to go since a deep grunt is a handy way to control breath release.

So to summarize: Immediately before you push or pull take a deep breath into the abdomen then tense your midsection, pushing down and out. As you start the lift it is fine to let air escape. But it escapes under pressure. Once you've passed the sticking point, you can exhale fully if you want. I will usually inhale as I lower again. But some individuals may need to experiment, according to the lift, with with when they should inhale perform the maneuver. During deadlifts, especially, many people find it easier to do it at the bottom while setting up for the next lift.

Myth: The Valsalva is Necessary to Maintain Core Stability

The needs of a heavy lift has nothing to do with the needs of most athletic activities. Most athletes have a need for continued stability under dynamic conditions while also maintaining a steady supply of oxygen. The valsalva has become synonymous with core stability in the minds of many trainees. Since this entails restricted breathing this presents a conundrum.

Likewise, one cannot compare playing in a Soccer match to doing higher volume resistance training, where breathing can be regulated and controlled. Resistance training usually consists of discrete skills performed repetitively. These skills are also closed skills. A Soccer match, on the other hand, is much more unpredictable, highly dynamic, and completely non-conducive to a controlled breathing pattern. Some find that they are unable to both breathe deeply and maintain a stable core.

Athletes are often instructed to "breathe naturally". The word naturally is meaningless in and of itself but this instruction can be narrowed down to mean "to breathe without affectation or specific intent". While for some athletes this could be correct, for others it could be inefficient and even injurious depending on their habitual breathing patterns. So how does one breathe deeply while maintaining a strong and stable core?

The answer lies in proper diaphragmatic breathing and developing what McGill calls an "athletic diaphragm" which allows continuous breathing without sacrificing control of the torso, which tends to happen when breathing becomes labored and shifts to a high chest pattern. There is a good way to begin practicing this:

  • After a period of vigorous exercise when your breathing is somewhat heavy but not strained perform a timed front plank while maintaining your breathing solely in the diaphragm. The plank position makes it necessary to both use diaphragmatic breathing and to contract the core musculature. Doing the exercise while fatigued creates the proper environment.

The supine bridge position with hips extended can also be used to practice belly breathing as it forces the breath into the "belly".

Valsalva's Test and Spinal Pain

The valsalva maneuver is a common test used to evaluate the presence of spinal injuries or lesions. As it increases intraabdominal pressure it also increases intrathecal pressure. Intrathecal refers to anything happening inside the spinal canal. The result of this increase in intrathecal pressure during the valsalva can cause pain secondary to a herniated disc or other lesion that is occupying space in the spinal canal. If you have back pain and experience an increase in this pain upon performing the valsalva maneuver or if you are asymptomatic but experience back pain as a result of the maneuver stop and seek professional medical advice.

Remember that whether you use the maneuver or not is up to you. It is not strictly necessary in order to perform a proper abdominal brace so don't feel obligated to do it just because other lifters do. The purpose of this article is to provide some information to help you decide for yourself how and when to use it in your training, not to tell you what to do.

Remember that how you breathe during resistance training has very little relation to how you breathe in an open environment.

1. Marcardle, William D.; Katch, Frank I.; Katch, Victor L. Exercise Physiology: Energy, Nutrition, and Human Performance.4th ed. Baltimore: Williams & Wilkins, 1996. 220-222, 276-277.
2. HAYKOWSKY, MARK J.; EVES, NEIL D.; R. WARBURTON, DARREN E.; FINDLAY, MAX J. Resistance Exercise, the Valsalva Maneuver, and Cerebrovascular Transmural Pressure. Medicine & Science in Sports & Exercise: January 2003 - Volume 35 - Issue 1 - pp 65-68
3. Haykowsky, Mark J.; Taylor, Dylan; Teo, Koon; Quinney, Arthur; Humen, Dennis. Left Ventricular Wall Stress During Leg-Press Exercise Performed With a Brief Valsalva Maneuver. CHEST January 2001 vol. 119 no. 1 150-154

This page created 14 Dec 2008 02:12
Last updated 17 Jul 2016 00:21

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