Episode #38: The Valsalva Maneuver Explained | How to Breathe While Lifting
ONE OF THE MOST COMMON QUESTIONS RESISTANCE TRAINEES HAVE IS “HOW TO BREATHE WHILE LIFTING.” THE ANSWER IS VERY SIMPLE; YOU SHOULD PERFORM THE VALSALVA MANEUVER WHEN YOU RESISTANCE TRAIN WITH BARBELLS OR ANY OTHER KIND OF RESISTANCE TRAINING. THE PROBLEM IS, PEOPLE BELIEVE THE VALSALVA MANEUVER IS DANGEROUS OR THEY PERFORM IT WRONG.
HERE AT PROGRESSIVE REHAB & STRENGTH WE FIRMLY BELIEVE THAT THE VALSALVA MANEUVER IS NASA:
Necessary
Automatic
Safe
Adaptable
In this episode of the PRS Podcast, PRS Clinical Coaches Drs. John Petrizzo, Rori Alter, and Alyssa Haveson discuss the physiology of the Valsalva Maneuver and how it’s safe for nearly all types of people regardless of age, injury, and medical history.
IN THIS EPISODE THEY DISCUSS:
The physiological mechanism of the Valsalva Maneuver and its importance in stabilizing blood pressure and protecting the blood vessels throughout the body and brain from bursting an aneurysm.
How 100% of people automatically perform this maneuver whether or not they believe they do and whether or not they’ve been warned against it
Why the Valsalva Maneuver does not increase your risk for a stroke during exercise and is actually protective against it.
How the Valsalva Maneuver adapts with you over time while in the same way your bones, muscles, ligaments, tendons, neurological and cardiovascular systems adapt to resistance training and get stronger over time.
So if you’re confused about this maneuver, its safety, and how to properly execute it, check out this episode on the PRS Podcast!
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:04] All right. So welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, clinical coach here at Progressive Rehab & Strength, with my lovely co-host, Dr. Alyssa Haveson, and Dr. John Petrizzo, who are both clinical coaches here at Progressive Rehab & Strength. And we have a very important episode for you guys today. This is going to be all about the Valsalva Maneuver. So if you're new here, Dr. John is a clinical coach at Progressive Rehab & Strength, a physical therapist at a local clinic, and a professor in exercise science at Adelphi University. He has published multiple papers in peer-reviewed journals and is very knowledgeable about all things exercise, science, the human body, and physical therapy. Et cetera. Et cetera, as well as strength training. So we will talk about the Valsalva Maneuver today because it is a very important piece of strength training, barbell training, and life. And I have a saying that I like to use the Valsalva Maneuver, which is the breathing mechanism we use when performing a heavy movement of any type against an external load. And it's something that we do automatically. And saying that I like to use is that the Valsalva Maneuver is NASA necessary, automatic, safe, and adaptable. So a common misconception about the Valsalva Maneuver is that you shouldn't hold your breath or utilize it when you're doing something heavy or exercising with a heavy load because it's dangerous for your brain and your heart. So you can have an aneurysm or a stroke, especially in the older population or the ill or sick population. So, John, why don't you share exactly what the Valsalva is and the mechanism of the Valsalva maneuver? Then we can kind of dive into the safety and effectiveness of it and why it's necessary, adaptive, necessary, automatic, safe, and adaptable.
Dr. John Petrizzo, PT, CSCS, SSC: [00:02:27] Sure. So and first thing I'll say is that I agree with you. When you hear the word maneuver, right, you think that it's like something special that you're doing right, that you have to make yourself do, when in reality, I look at it like a reflex. You know, it's something that even if you're trying not to do it, you're still going to do it to some extent. Whenever you're exerting yourself like you, like you said, um, that's the.
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:59] Automatic component of it, Right?
Dr. John Petrizzo, PT, CSCS, SSC: [00:03:01] Exactly. So, the Valsalva Maneuver is something. I mean, we certainly associate it with resistance training because this is the world we deal with, right? But it's something that's been around really for hundreds of years. Valsalva was an Italian physician who originally created this technique because he thought that by holding your breath and increasing intracranial pressure, you would be able to dislodge. Fluids and different sorts of substances from inside the skull through the ear canal. So his hypothesis was incorrect, but that's where it came from. And over time, it's been used in various medical procedures. Right. And it's something that's been done medically for a variety of things for a long time. But as you said, any time we're exerting ourselves, we will utilize this strategy to help us make our force production more efficient. So we'll talk all about that as we go. But classically, when you look at the Valsalva Maneuver. It's thought to occur in four different phases. And the important thing to stress here is the difference between, you know, how it may be used in medicine versus how we use it from a resistance training standpoint. The second phase of the Valsalva Maneuver classically lasts from 50 to 20 seconds of continuous strain. Right. Um. And what we see when we are holding our breath for that long a period while we're trying to exert force is that in phase four of the, you know, classic valsalva maneuver, we get an overshoot of blood pressure during the recovery phase, right? So we get this high spike in blood pressure.
Dr. John Petrizzo, PT, CSCS, SSC: [00:05:17] And that tends to be what everybody cites, you know, from an exercise standpoint as to why we need to avoid this. Right. They say you shouldn't hold your breath when you're exercising. It will increase your blood pressure, and increasing your blood pressure is dangerous, right? Well, in reality, when we're talking about lifting, we're talking about holding your breath during the exertional portion of your repetitions. Right. And even the heaviest, you know, hardest repetitions that you're going to do, they may feel like they take 20 seconds, but in reality, they only take a few seconds to do. Right. So, we're never really getting to that point where we're holding our breath for a prolonged period where we would even expect to see that phase four high spike in blood pressure that we would traditionally see with the Valsalva maneuver, the way it's used in a lot of the literature on it. Okay. Um, you know, the way that we teach the Valsalva maneuver and the way that a lot of strength coaches teach the Valsalva maneuver is before your rep. You take a big breath, hold it during your rep, and then you're breathing between your reps, right? So, in reality, you're only holding your breath for a handful of seconds, um, even under the greatest amount of strain. So, so when you.
Dr. Rori Alter, PT, PRSCC, SSC: [00:06:41] Think of I just want to clarify, I just want to reiterate how the valsalva maneuver or a component of the Valsalva maneuver is performed in barbell training. So like you said, it's you take a big hold, take the breath in before you do the rep, hold it while doing the rep, and then exhale between the reps. But I want to be a bit more specific because I think many people still don't understand that concept. So what you do is you take a bit before you start any rep, you take a big breath in, and you shut your mouth. You then execute the rep, come to a complete stop at the finish of the movement, and exhale. And then you take another big breath in before you start the next rep. And I think that's kind of where a lot of people are. People get confused about the Valsalva Maneuver in many different ways and areas. But that's one element that people get confused about: they start to confuse where they take their breath and exhale. So it's the breathing in and the breathing out that happens when you're not moving. And they happen between reps. Okay. You can go on now.
Dr. John Petrizzo, PT, CSCS, SSC: [00:07:56] Yeah. No, I think that that's an important thing to stress about because we're not telling you. You have to hold your breath for your whole set. Right? We don't want you to hold your breath for a prolonged period. We just want you to hold your breath during the portion of the repetition where you're exerting yourself, where you're moving, right? Essentially, right. When you're not moving in between the reps is where you're going to breathe. So that in and of itself, you know, should mitigate a significant portion of people's concern about the Valsalva Maneuver. You know, we're not talking about prolonged breath holding by any stretch of the imagination, you know, Um, but still, and you know, I deal with this all the time with my students because, you know, I teach in an exercise science program. And what do all the exercise organizations say, you know, don't hold your breath? Well, during your resistance training. Right? The American College of Sports Medicine, we can go on and on. You know, I teach a course that's a preparation course for the Cscs exam, which the National Strength and Conditioning Association gives. So you would think of the National Strength and Conditioning Association. Right. They're very pro-resistance training. Right. They're going to talk about, you know, the structural exercises like squats and deadlifts and cleans and things like that to a much greater degree than maybe the American College of Sports Medicine, which is much more kind of like general population, you know, health and fitness based rather than performance and even.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:26] The mechanics of the movements. Wrong. Yeah.
Dr. John Petrizzo, PT, CSCS, SSC: [00:09:29] There are many problems with their material, but they still talk about breathing. They, they say, instruct athletes to exhale through the sticking point and inhale during the less stressful phase of the repetition. Then on the flip side, they also say that for experienced and well-resistance-trained athletes performing structural exercises, you can use the Valsalva Maneuver. So they kind of like. Right. It doesn't make sense. Right. Anybody that is critically analyzing their materials, just say, wait. On the one hand, you're saying don't hold your breath. It's dangerous. But if you've experienced when you're lifting heavy weights, well, then start doing it right, Which which, if we're concerned again about safety and like you talked about previously, adaptability, um, it doesn't make a lot of sense. Why would we want to start using this thing that supposedly is potentially dangerous once we're already lifting very heavy weights? Why not start the first time you lift, learn how to use it, and then adapt to that stress over time? You know, kind of like you you mentioned previously, I don't want to, you know, kind of get ahead of myself too much here.