If you walk into any gym with a penchant for resistance training, you’ll see some common lifting equipment. In this instance I’m not talking about barbells, kettlebells, and dumbbells; although I’d hope they’re all there too. I’m talking common wearable lifting gear like weightlifting shoes, knee sleeves, weightlifting belts, lifting straps, and wrist wraps. Of all of these different wearables, the weightlifting belt and its purpose/utility may be the least understood.
Common Beliefs Regarding Weightlifting Belts
Some common beliefs regarding the use of weightlifting belts during resistance training include:
- “A weightlifting belt will protect your back from injury”
- “If you have low back pain, a weightlifting belt will decrease your pain by ‘shielding your back’”
- “A weightlifting belt should be worn for all exercises”
- “A weightlifting belt should be worn for all sets of compound exercises”
- “A weightlifting belt makes your trunk (‘core’) muscles weak, over time”
In the next section, we’ll explore the available research and anecdote to see which of these beliefs are substantiated and which are not.
Weightlifting Belts and Lumbar Spine Stiffness
Cholewicki et al. looked at the effects of increased intra-abdominal pressure and an abdominal belt on trunk stiffness during a “quick release task.”
The quick release task involved a participant's placement into a semi-sitting/kneeling jig that restricted motion at the hips and below, leaving the trunk free to move in all directions. An isometric load of 35% MVIC was then applied to their mid/lower thoracic spine to create a flexion, extension, or side bend moment about the lumbar spine, via a magnetic quick release system. The researcher would then release the load (without warning), while measurements of trunk stiffness and muscle excitation were taken.
They assessed the results of five different conditions for each quick release task, including non-belted conditions at 0%, 40%, and 80% of maximum intra-abdominal pressure; in addition to belted conditions at 0% and 80% of intra-abdominal pressure. The authors did point out that it was impossible to NOT generate intra-abdominal pressure and that the mean intra-abdominal pressures for each group were actually 14.1% (0%), 42.8% (40%), and 71.3% (80%) for each condition.
The authors found that both the abdominal belt and intra-abdominal pressure increased trunk stiffness in all directions, although the values were non-statistically significant for resisting extension. They found that non-belted 40% and 80% intra-abdominal pressure increased trunk stiffness by 21% and 42% when resisting flexion. They found that the belt, at 0% and 80% intra-abdominal pressure, increased trunk stiffness by 29% and 41%. These two factors were additive, meaning that the belted condition at 80% intra-abdominal pressure increased trunk stiffness into flexion by 83%. For lateral flexion, the belted condition at 80% intra-abdominal pressure increased trunk stiffness by 86%.
Muscle excitation, via EMG, increased in all tested muscles with increasing intra-abdominal pressure. These include rectus abdominis, external oblique, internal oblique, latissimus dorsi, thoracic erector spinae, and lumbar erector spinae. The belt had no effect on muscle EMG when resisting flexion, except for a statistically significant decrease in lumbar erector spinae excitation at 80% intra-abdominal pressure.
Voluntarily increasing intra-abdominal pressure and wearing a weightlifting belt can increase trunk stiffness, independently, with an additive effect when used in combination. Increased intra-abdominal pressure led to increased EMG excitation of all trunk musculature, although the belt decreased spinal erector EMG values.
Weightlifting Belts and Spinal Compression
Kingma et al. performed an investigation with 9 experienced lifters to determine the effects of a weightlifting belt on spinal compression forces when lifting a 75% bodyweight barbell from floor to hips (they didn’t specify ‘deadlift’).
Their results demonstrated an 18% and 44% increase in peak intra-abdominal pressure when inhaling and wearing a belt, compared to a non-belted inhale and belted exhale, respectively. They also demonstrated an approximately 10% reduction in spinal compression forces when both inhaling and wearing a belt (lifter’s Valsalva maneuver), compared to both a non-belted inhale and a belted exhale.
In terms of muscular excitation, the authors found reduced iliocostalis mm. EMG in the belted/inhale condition versus both the non-belted/inhale condition (lumbar extensor mm. only) and belted/exhale condition (lumbar and thoracic extensor mm.) This can be interpreted in so far that:
"At a given weight, the belted/inhale condition is more efficient for the spinal extensors than the non-belted inhale and belted/exhale conditions because the same load is moved with reduced requirement for mm. excitation.”
The authors asserted that while the intra-abdominal pressure increased in a statistically significant amount, which increased the stiffness of the trunk, the belt itself was the catalyst for the reduction in spinal compression forces.
The authors rationalized this conclusion because:
- The net compression force remained similar between the three conditions, despite decreased spinal compression in the belted/inhale condition
- In the belted/inhale condition, there was decreased spinal extensor excitation and subsequently a 30 Nm decrease in extensor moment (per their model)
- The increased intra-abdominal pressure could have only provided a 2-5 Nm increase in spinal extensor moment (per their model)
- Other variables were accounted for
As such, the authors affirmed that the increased intra-abdominal pressure seen in belted lifting DOES serve to increase trunk stiffness, but it’s the belt’s own passive stiffness (when properly inhaled/braced against) that supplies an extension moment which leads to a decreased need for spinal extensor excitation at a given load and subsequently a reduction in spinal compression.
It is important to note that these lifters were lifting 75% of their body weight rather than the 100-300% bodyweight seen in training and competition. As the load a lifter moves increases toward larger percentages of their bodyweight and % 1RM; the significance of an extensor moment provided by the belt, muscle excitation, and intra abdominal pressure’s effect likely all change. This is important to note, because the 10% reduction in spinal compression force found in this study when lifting 75% bodyweight, is likely much smaller, if even significant, at typical training loads for most lifters who utilize a belt.
Wearing a tight and stiff weightlifting belt when inhaling before lifting increases intra-abdominal pressure. It also reduced spinal erector EMG values for a given load. In this study it also reduced spine compression by about 10% (lifting 75% bodyweight), but we must exercise caution in assuming this also happens at heavier training loads.
Weightlifting Belts, Intra-abdominal Pressure, Intra-muscular Pressure, and Trunk EMG
Miyamoto et al investigated the effects of a lifting belt on intra-abdominal pressure, intra-muscular pressure in the erector spinae muscles, and EMG activity of the trunk muscles during both a standing Valsalva Maneuver (Exp. #1) and three maximum isometric activities (Exp. #2). They compared each belted activity to the same activity, non-belted.
Experiment #1: Weightlifting Belts and Standing Valsalva
In experiment #1, resting intra-abdominal pressure (IAP), peak IAP, and the maximum increase in IAP were statistically similar between the belted and unbelted conditions. They did find a statistically significant effect of increased peak and maximum intramuscular pressures of the erector spinae (IMP-ES) musculature during the belted Valsalva maneuver compared to the unbelted condition. Additionally, they found increased EMG excitation of the rectus abdominis musculature in the belted Valsalva maneuver condition. No differences were found in EMG excitation of the external obliques or the erector spinae, when comparing belted vs. unbelted conditions.
It is worth noting that the peak IAP after full inspiration with Valsalva in the belted condition, while not statistically significant, was 20% higher than the peak IAP after full inspiration with Valsalva in the non-belted condition. Furthermore they state in their discussion that they “do not intend to state that the increase in IAP is always nonsignificant by wearing abdominal belts in all kinds of lifting styles” and that their small sample size (n=7) may not include sufficient statistical power to adequately assess the statistical significance of all variables tested.
Experiment #2: Weightlifting Belts with Isometric Activities
In experiment #2, the “arm lift” activity roughly represented a max effort bicep curl at 90 degrees of elbow flexion, The “leg lift” activity roughly represented the position in the last 25% of the concentric phase of a squat, while the “torso lift” activity roughly represented the position of an isometric Jefferson curl from knee height. In this experiment, the participants were not cued to hold their breath during each maximum isometric pull but the authors report that each participant did nonetheless, in both conditions.
The authors found that isometric lifting capacity (peak force), peak IAP, and maximum increase in IAP were statistically similar between the belted and unbelted conditions.
Conversely, peak IMP-ES and maximum increase in IMP-ES were both found to be greater and of statistical significance in the belted condition for both the “leg lift” and “torso lift.” For the “arm lift,” only the peak IMP-ES was greater. Additionally, the EMG excitation of the rectus abdominis was significantly greater during the “leg lift” in the belted condition. External oblique and erector spinae EMG values were of non-significant difference.
In regard to the assessment of intra-abdominal pressure, it is unfortunate that the authors did not include a third group in this experiment to assess the difference between a maximum isometric lift without a belt, a maximum isometric lift with a belt, and a maximum isometric lift with a belt and Valsalva after full inspiration. Given that the italicized condition is the most commonly utilized strategy by lifters, this experiment leaves some data to be desired.
While the participants held their breath in both conditions, which would likely result in a Valsalva maneuver (i.e. exerting pressure against a close airway), full inspiration or close-to-full inspiration prior to a Valsalva maneuver/breath hold is likely to produce the most pressure against the belt, the most intra-abdominal pressure, and potentially different results than a Valsalva/breath hold without intentional near-maximal inspiration.
The final aspect of this study worth mentioning lies in reference to a survey they provided to a group of weightlifters regarding the perception of lifting belts. The authors’ survey found that: “the majority of lifters perceived enhanced stability and stiffness in their backs when they used the belts during lifting.”
Wearing a weightlifting belt raises the intra-muscular pressure of the erector spinae muscles and increases perceived “stability and stiffness” during lifting. The increased intra-muscular pressure in the spinal erectors may serve as the catalyst for the decreased EMG values found in other studies.
Weightlifting Belts and Back Pain Prevention
Ammendolia et al performed a systematic review of the available literature to determine the effectiveness of a lumbar/abdominal belt for prevention of back pain. In their discussion, they stated:
“Based on this review, the evidence for the effectiveness of back belt use in preventing the incidence or reducing lost time for occupational low back pain among material handlers is conflicting and limited in both quantity and quality.”
"In general, the majority of the evidence presented in this review, and the evidence presented in earlier reviews of the topic, indicates that individual workers presenting with no prior history of LBP are unlikely to benefit from the use of a back belt."
They did acknowledge that there is some research pointing toward potential benefits of utilizing a back belt in workers with a previous history of low back pain, but that the results remain conflicting.
There is no conclusive evidence to support back belt use to prevent or reduce lost time from occupational low back pain.
The Valsalva Maneuver, Intra-abdominal Pressure, and Safety Considerations
Aforementioned thus far is that the common utilization of a lifting belt during exercise includes:
- a deep inspiration
- a Valsalva maneuver (exerting pressure against a closed airway/glottis)
- the performance of one full repetition
- an exhalation
This process is then repeated for each repetition until the set is over.
As such, the physiology and safety of the Valsalva maneuver during exercise should be briefly discussed.
Sullivan’s article, titled The Valsalva and Stroke: Time for Everyone to Take a Deep Breath, extensively breaks down the physiology of the Valsalva, the benefits of the Valsalva, potential mechanism of injury from the Valsalva (chiefly hemorrhagic stroke due to a ruptured aneurysm), and how it all actually shakes out in practice.
I would highly recommend reading this article if you are a coach/clinician because it overviews the safety of the Valsalva, for almost all populations, through both a physiological and epidemiological lens. Additionally, it provides a practical view upon the dangers of our legal system and how coaches/clinicians can protect themselves from litigation due to factors associated with this largely unavoidable maneuver.
It’s important to further underscore this last point, as he does with five citations:
"Another critical point emerges from the physiological data. Multiple authors have observed that, notwithstanding any physiologic effects the Valsalva may have, it is an everyday occurrence and is virtually unavoidable under heavy loading, even when the lifter is instructed not to do it."
With the above information as a starter, the “classic” Valsalva maneuver utilized in medical practice, sustained for 30-35 seconds, is described with an emphasis on the four distinct phases and its associated effects. These effects include changes in intra-abdominal/thoracic pressure, blood pressure, heart rate, stroke volume, intracranial pressure, and cerebral perfusion pressure. A brief description of the Valsalva maneuver that is utilized under load during resistance training is then provided. It essentially leads to dramatic, but brief, increases in intra-abdominal/thoracic pressure, blood pressure, and intracranial pressure. He notes that these increases also occur during resistance training without the performance of a Valsalva, although not as markedly.
In terms of safety, Sullivan puts forth that based upon the evidence we have -- an individual who has an undiagnosed cerebral aneurysm (1-6% of the population), especially if on the larger size, does have an increased risk of subsequent subarachnoid hemorrhagic stroke (SAH), full stop. With that being said, he expands upon the fact that this increased risk likely resides in the aneurysm itself and not the Valsalva maneuver.
This was underscored by multiple papers, including one by Matsuda et al that described the circumstances during subarachnoid hemorrhagic stroke for 513 patients. They found that 2.7% of these patients were engaged in sporting/exercising at the time of rupture.
"This made exercise one of the most infrequent associations with SAH, behind eating and drinking (4.7%), shopping (6%), housework (7.6%), sleeping (8%), or [using the bathroom] (12.7%). The big winner, at about 14%, was “chatting/watching television/staying home.” In other words, you were more likely to pop your cork just sitting in front of the tube than while working out."
In his conclusion, he states:
"People with known aneurysms or other intracranial lesions, known retinal disorders, a family history of aneurysm or SAH, or a history of polycystic kidney disease should not lift, Valsalva or no Valsalva, unless and until cleared by a physician."
While not mentioned in the above sentence, this same mandate should apply to anyone with a history of stable or unstable cardiovascular disease. Using the Physical Activity Readiness Questionnaire (PAR-Q) or a similar screening tool, in addition to old-fashioned clinical reasoning, is an excellent place to start, regarding pre-exercise referral to a physician.
- Screen your clients for risk factors, make appropriate referrals as needed, and follow any physician recommendations
- Recognize that heavy lifting will inherently lead to a Valsalva, even if coached to avoid it
- Appreciate that an undiagnosed cerebral aneurysm is rare, unlikely to be diagnosed (unless it does rupture), and more often ruptured during non-athletic endeavors like relaxing at home, using the bathroom, or sleeping
- Read the Sullivan article and adhere to his advice regarding liability insurance and a signed documentation of explicit assumption of risk, by the client
You can now consider yourself ‘woke’ to the Valsalva maneuver and its utilization during resistance training with or without a lifting belt.
Tying the Evidence Together
Pulling all this information together, some conclusions can be drawn based upon the current available evidence.
Weightlifting belts increase intra-abdominal pressure, when properly braced against with the use of an inhale and Valsalva maneuver.
Weightlifting belts, when properly braced against, increases the stiffness of the trunk segment during tasks that resist an external flexion moment (i.e. squats, deadlifts, etc.). Trunk stiffness is improved further as the percentage of maximum intra-abdominal pressure increases.
Weightlifting belts, when properly braced against, increases the muscle excitation of the trunk musculature, except for the spinal erectors. The increased muscle excitation may be more a result of the increased intra-abdominal pressure, than the belt itself. The decreased spinal erector excitation may be due to the increased intra-muscular pressure created in the spinal erectors with the use of a belt. This can be viewed as increased efficiency of the spinal erectors at a given load, with belt utilization.
There is no research to suggest that weightlifting belts leads to trunk/"core" weakness over time. Given that the world’s strongest lifters of all disciplines tend to use a lifting belt during much/all of their training and competition, we think the anecdotal evidence speaks for itself.
A weightlifting belt may provide the psychological benefit of feeling “stiffer” or “tighter” during the set-up and execution of compound lifting exercises.
It is safe to utilize a weightlifting belt and the associated Valsalva maneuver during resistance training, for individuals medically cleared to resistance train without restriction.
Due to the lack of support for a lifting belt’s use in the occupational setting, we think it is reasonable to conclude that they are unlikely to reduce the risk of first-time low back pain during resistance training. Their role in decreasing the risk of recurrent low back pain remains to be elucidated in the research, but we firmly believe they should not be utilized in an attempt to stress-shield the low back during resistance training. Rather, an individual with low back pain should identify a tolerable entry-point to activity and thoughtfully progress from there.
Now that we’ve established what lifting belts do and don’t do, based upon the current research and some anecdote, we can make some recommendations regarding their use.
When to Wear a Weightlifting Belt
In terms of exercise selection, the use of a weightlifting belt should align with the above evidence. Therefore, any compound exercise that may benefit from increased trunk stiffness/intra-abdominal pressure is ideal for utilizing a lifting belt. These primarily include heavy barbell squats, deadlifts, cleans, snatches and their variants for the lower body; and heavy unsupported presses and pulls for the upper body. With that being said, many powerlifters utilize a belt during bench press (technically “supported”) to assist with getting “tight” on the bench, and that’s just fine too.
In general, we recommend incorporating some beltless variations of these lifts into your training program throughout the year to promote variability via a slightly different training stimulus.
In terms of which sets to utilize a lifting belt, a good rule of thumb is to include your last warm-up set (of which we’d recommend 3-5) and all of your working sets.
How to Wear a Weightlifting Belt
To properly utilize a weightlifting belt during resistance training, you:
- Tighten the belt around your abdomen (varying position based upon preference and lift)
- Set up for the specific lift
- Take a deep breath to expand your trunk into the belt
- Brace yourself against the belt with a Valsalva maneuver
- Perform one full repetition (concentric + isometric + eccentric)
- Repeat for each repetition until you’ve completed the set
One note: if you need to unrack the barbell for the lift (i.e. squat/bench press/overhead press), then a partial or full utilization of this technique can be utilized in preparation of unracking the bar.
When it comes down to it, a lifting belt seems to confer both physiological and psychological benefits during resistance training. These benefits are small and will never supersede the benefits of consistent training with appropriate programming.
As such, weightlifting belts should never be considered “absolutely necessary” and the lack of such should not be a barrier to participation in resistance training.
Belted or beltless, happy training.
- Cholewicki, J, Juluru, Krishna, Radebold, Andrea, Panjabi, Manohar M, and McGill, Stuart M. "Lumbar Spine Stability Can Be Augmented with an Abdominal Belt And/or Increased Intra-abdominal Pressure." European Spine Journal 8.5 (1999): 388-95. Web.
- Kingma, I, Faber, G.S, Van Dieen, J.H, Suwarganda, E.K, Bruijnen, T.B, and Peters, R.J. "Effect of a Stiff Lifting Belt on Spine Compression during Lifting." Spine (Philadelphia, Pa. 1976) 31.22 (2006): E833-9. Web.
- Miyamoto, Kei, Iinuma, Nobuki, Maeda, Masato, Wada, Eiji, and Shimizu, Katsuji. "Effects of Abdominal Belts on Intra-abdominal Pressure, Intramuscular Pressure in the Erector Spinae Muscles and Myoelectrical Activities of Trunk Muscles." Clinical Biomechanics (Bristol) 14.2 (1999): 79-87. Web.
- Ammendolia, Carlo, Kerr, Michael S, and Bombardier, Claire. "Back Belt Use for Prevention of Occupational Low Back Pain: A Systematic Review." Journal of Manipulative and Physiological Therapeutics 28.2 (2005): 128-34. Web.
- Sullivan, Jonathan. “The Valsalva & Stroke: Time for Everyone to Take a Deep Breath.” Starting Strength (2013): Web.