Breathe, brace, hold your breath... which one??

​Bracing is a strategy used in many aspects of life. Definitely by those who do heavy lifting in the gym whether it be CrossFit, power lifting, or traditional strength training; but also, in everyday life when lifting something from the floor, or moving a heavy object. When I say bracing, I mean the tension and pressure created through the abdomen upon lifting. This is generated by core musculature and influenced by bracing and breathing strategies. Do you hold your breath when you lift, breathe out with the greatest effort, or allow yourself to breathe however feels comfortable? 
 
Unbeknownst to many, the strategy being used can largely impact the pelvic floor; and it may be important to evaluate this if you experience stress incontinence, have a prolapse or suspected prolapse, are currently pregnant, or are recovering from labor and delivery. Depending on the strategy, the pressure changes within the abdomen and therefore through the pelvic floor. So, what do these strategies look like?
 
Strategies that reduce pressure through the pelvic floor include breathing in and out throughout the movement or breathing out during the most difficult aspect of the movement. If relating this to a full balloon under pressure, releasing some of this pressure through the opening of the balloon can reduce pressure throughout the balloon, creating a better tolerance to load. If this breath is held, pressure may escape elsewhere – commonly through the path of least resistance. Sometimes this is the pelvic floor, which can lead to leakage or affect a current prolapse. This can also be a diastasis or separation through abdominal muscles. 
 
Strategies that can increase pressure through the pelvic floor include Valsalva or wearing a weightlifting belt. We’ve talked about increasing pressure through the pelvic floor, and how this can sometimes have a negative impact; but is this always bad? This isn’t bad in and of itself. It’s a matter of whether the pelvic floor is strong enough! These strategies can be great for increasing effectiveness and strength through a lift and allowing for one to lift heavier! However, if one’s pelvic floor is not ready for this increased pressure, the previous strategies are likely a better place to start.
 
A Valsalva maneuver involves taking a deep breath in and then sealing escape routes including the nose and mouth; this is done by keeping the mouth closed as well as closing the glottis, so air doesn’t escape through the nose. Because the escape routes are closed, pressure increases throughout the abdomen and pelvic floor. You might imagine a balloon that does not allow air out through the top. However, when imaging this balloon as the abdomen, upon bracing and breath holding you want to draw your abdomen in vs. pushing it out. Pushing out can send the pressure down toward your pelvic floor and focus it here rather than distributing it more evenly through the abdomen and pelvic cavity. 
 
Wearing a weightlifting belt creates the most pressure through the pelvic floor, but again, this is not inherently a bad thing! It’s important to remember that when wearing a belt, pushing out against the belt is going to create the most pressure distributed toward the pelvic floor. Instead, we want to think about drawing in away from the belt as if assisting it in keeping everything sinched in. This will reduce pressure through the pelvic floor and create better efficiency in bracing over all! 
 
Who knew such a small thing like bracing can influence the pelvic floor so much?! It seems simple but can have a great impact; but because of that simplicity and impact, we can also make small changes that will make a large difference in pelvic floor symptoms when lifting or working out! 
 
If you or someone you know has trouble with leakage, pressure, or pain when lifting; or they are working to get back into the gym and to those activities, we encourage you to work with someone who has experience in pelvic floor training! 
 
Cheers! 
 
Elle Carlson, PT, DPT