The Valsalva Maneuver: The Forgotten Technique That Can Save You From Back Pain (And Make You Stronger)

Most fitness tips do not provide instant gratification. As much as people hate it, fitness — as a method of seeing results — is an endurance event. It takes a lot of reps and sets, sometimes across a span of years, to change your body. And while no workout will instantly slash fat or make you more muscular, there are a few techniques that — like magic — can have an immediate impact on how well you train and feel. The Valsalva maneuver is one of those techniques.

When you learn about training, almost everything focuses on the usual suspects:

  • How much weight you’ll use
  • The reps and sets
  • The exercise selection
  • And maybe even what you’ll wear to the gym

All of these are important. But all of these cover what you do. Notice that they all avoid how to do it.

Correct form is important, but so is how you breathe when you lift — and, in particular, learning to master what’s called the valsalva maneuver.

If this sounds crazy, well, you’re not alone. Most people think the idea of “learning how to breathe” is like telling someone to learn how to blink. It’s instinctual and doesn’t require a manual.

And that’s where your lesson begins. Breathing is automatic, but how you breathe while you’re sitting at a desk is not the same thing as how you should breathe with 300 pounds on your back (or while you’re holding any amount of weight, for that matter).

In fact, the way you breathe on different exercises can make all the difference between a hurt back and feels-great back, or not seeing progress versus hitting a new PR.

Interested? Here’s how learning the valsalva maneuver technique will change your entire training experience.

The Soda Can Test: How to Know Your Spine is Safe

You might know the squat is one of the best exercises for developing strength and building muscle. You also probably think of it as a way to end up with a hurt lower back. That alone means a lot of people avoid squats — when in reality it’s not the exercise that’s the problem; it’s how you’ve been taught to do the movement.

“Everybody tells you to inhale on the way down, and exhale on the way up,” says Mark Rippetoe, owner of the Wichita Falls Athletic Club and author of Starting Strength: Basic Barbell Training. “That is complete and utter bullshit. If you do that, you will hurt yourself.”

Now, Rippetoe isn’t suggesting you shouldn’t breathe. What he’s saying is that the typical breathing cue is incomplete and leaves out some vital details.

What Rippetoe knows is that the Valsalva maneuver is what allows you to push, pull, squat, or deadlift any amount of weight without stressing your spine. And it’s not just beneficial from a safety standpoint. Learn to do the Valsalva maneuver well, and the amount of weight you can use on any exercise will increase.

“When you Valsalva, you’re protecting your spine,” says Dr. Belisa Vranich, clinical psychologist and author of Breathe: The Simple, Revolutionary 14-Day Program to Improve your Mental and Physical Health. “Most people don’t understand that you have to take a big breath in to be able to protect your spine [when you lift].”

When you inhale deeply, you create what’s called intra-abdominal pressure. The term describes forces within your abdominal cavity, or the area surrounded by the muscles on the side of your abs (your obliques), your pelvic floor (on the bottom), diaphragm (on top), rectus abdominus (the area known as the six-pack), and several back muscles.

When you have a heavy load on your back, this pressure is your friend. To understand why, think of a can of soda. When it’s pressurized and sealed, it’s very strong. You can stack several bricks on top of it and it won’t budge. But if you open the can and let that pressure escape, the weight would crumple the can underneath.

WIthin your abdomen, the pressure you create with a deep inhalation helps keep your spine rigid and stable. “Air is support to the back,” Rippetoe says. So the way you should lift when you squat is to inhale deeply and brace your torso, hold that breath (and bracing) on the way down, then either continue to hold it on the way up or exhale through pursed lips when you hit the most challenging part of the lift.

Before you try the Valsalva maneuver, there’s something you should know: in order for it to work for you, you first have to master an even more fundamental skill.

Are You Breathing Well? (Here’s How to Find Out)

Consider this breathing 101. Because you know how to breathe, it will be quick. But understanding your anatomy will help make it clear how your breathing patterns might be incorrect, and how the way you’re used to breathing might limit the effectiveness of the Valsalva maneuver.

An image indicates the position of the diaphragm in the midsection, and how it drops downward during an inhalation.

Your diaphragm divides your insides into an upper (thoracic) cavity and a lower (abdominal) cavity. Think of it as the muscle that powers breathing. When you inhale, your diaphragm pushes downward against your abs, drawing air into your lungs and creating more space for them within your body.

“The lungs will fill like a vacuum once the diaphragm drops downwards,” explains Dr. Kathy Dooley, a chiropractor and anatomy instructor based in New York City.

However, a number of things –such as bad posture — can prevent your diaphragm from doing its job effectively.

“When your abs are gripping your diaphragm, it will not let you take a big inhale,” Vranich says. “If you go to take a big inhale, you’ll have to take it with your shoulders because your diaphragm is being squeezed.”

So what should it look like? If your belly moves outward when you breathe in, it’s a sign that your diaphragm is working correctly. It might make you feel self-conscious because it will look like you’re creating a gut, but you’ll feel and perform a lot better.

On a strong inhale, the belly expands outward.
Image by Dave Regone, courtesy Dr. Belisa Vranich

On the flipside, consider what happens when you don’t breathe correctly. The result looks something more like:

An illustration shows how the shoulders rise and fall during "vertical breathing."
Image by Dave Regone, courtesy Dr. Belisa Vranich

This is known as “vertical breathing.” And it achieves the biologically necessary goal of getting you oxygen (because, ya know, you still need to breathe and your body won’t let that not happen). But, it creates a host of other problems.

The muscles in your neck and shoulders tighten up. If you have your massage therapist on speed dial, vertical breathing may be why. This style of breathing doesn’t deliver oxygen as well as a diaphragmatic breath, so you’ll have to inhale more frequently, which can elevate your blood pressure, pulse, and level of anxiety.

Even crazier? Your diaphragm attaches to your spleen, liver, and small intestine, “If you’re breathing up with the chest, you may not be creating the ‘massage’ for your lower organs to encourage your smooth muscle (tissues in the gut) to act like it should,” Dooley says. “You’d be surprised by how much breathing affects your gastric emptying, and how much breathing affects things like IBS (irritable bowel syndrome).”

And then of course, there’s how bad breathing would affect your ability to use the Valsalva maneuver. If you’re breathing “up,” using your chest, shoulders and other muscles to pull air into your body, you can’t create the type of intra-abdominal pressure that will protect your spine when you lift—even if you took in the biggest breath you possibly could.

“If you’re building good intra-abdominal pressure, you don’t necessarily need to raise your chest upwards [when you inhale],” Dooley says, who adds that the reverse is also true: If you’re raising your chest upwards, you’re not building good intra-abdominal pressure.

There’s a simple way to tell whether or not you’re using your diaphragm well:

Look in the mirror and watch yourself breathe. If your chest and shoulders are moving up-and-down in a way that looks like the illustration above, you have some work to do.

How to Breathe Better (And Lift Weights Better Than Ever)

The way to keep those shoulders down and breathe better seems simple: Just learn to breathe with your diaphragm. But that’s much easier said than done. Here are 3 exercises that can do the trick.

Breathing Exercise #1: Diaphragm Extensions
While Vranich teaches several techniques, perhaps the simplest method is an exercise that requires you to lie on your back and just breathe. (Yup, it’s really that simple.)

To perform the move, lie flat on your back and place any light object—it could be a book, a pillow or whatever you have handy—on top of your belly button. Rest your hands at your sides and cast your gaze slightly downward, so you can see the book somewhere in your field of vision.

Inhale deeply into your belly, raising the book as high as you can. When you exhale, watch the book lower. Keep breathing in this manner for a few minutes.

Vranich recommends you don’t worry about your pace of the breath at first, just notice how breathing into your lower body feels. You may find that performing the technique slowly brings a sense of calm.

That’s because slow, controlled breathing initiates a “rest and digest” response from your body called the parasympathetic nervous system. Which is why you may want to try breathing in this manner before bedtime, or even at the end of your workouts (when it can help bring your heart rate and signal to the rest of your body that it’s time to chill).

To start, try using it for a minute or so at the front of a training session to teach (or remind) you of how diaphragmatic breathing feels.

Breathing Exercise #2: The 90-90
As the name suggestions, the “90-90” indicates that you’ll have a 90-degree bend in your hips, and a 90-degree bend in your knees. And you’ll need a Swiss ball for this one. Lie on the floor, place your heels atop the ball, and adjust your feet so that you have those right angles at your hip and knee. Dooley shows you how to set up for the exercise in this video:

Here again, the object is to inhale into your lower abdomen. Rather than just trying to press upward with the belly, think about filling the whole abdomen in every direction. When you inhale, your abs, your obliques, and the muscles in your lower back all should press outward. “What we’re looking for is for the abdomen to fill in 360 [degrees] on the inhale,” Dooley says. “These muscles all around you are muscles of exhalation, therefore they need to expand when you inhale to build proper intra-abdominal pressure.”

Stay in the 90-90 until you feel like you’re getting the hang of breathing with all of those muscles, or for as long as your workout will allow. If you typically don’t have a whole lot of time to train, no worries. Even a minute will be helpful.

Breathing Exercise #3: The Dead Bug (AKA Dying Bug)
This exercise takes the good intra-abdominal pressure you’ve learned, and applies it to moving your arms and legs.

To set up for the move, you’ll lie on your back with your hips and knees bent 90-degrees. (No Swiss ball for your heels this time.)

You can hold your arms straight overhead, or press them against your abdomen to feel the pressure you’re creating. Inhale, then exhale slowly as you lower the heel of your left leg to the floor, lift it back to your starting position, then lowering and raising the heel of your right leg. You’ll do all of this (moving both legs down and back up) on a single exhale, maintaining stiffness in your corew as you move. Once you’ve completed the movement with both legs, inhale and repeat. Perform 5 to 10 reps, where moving your left and right leg is one rep.

“This is a fantastic drill for learning how to build intra-abdominal pressure and build core stiffness but ambulate the limbs,” Dooley says. “It has a lot of carryover into things like squatting and deadlifting because you’re trying to maintain core stiffness and abdominal stability while you’re trying to ambulate the limbs.”

How to Valsalva Maneuver Like a Pro

If you know how to breathe deeply into your lower abdomen, then the first cue of the Valsalva is pretty simple.

“Big breath in,” Rippetoe says. “Before every rep, take a big breath.”

Just as you did when you performed the Supine 90-90, the breath should fill your lower abdomen in every direction. That’s half of the battle. The other half is bracing properly. Here’s where the work you did in the Dying Bug comes into play. You want to engage your abs, your obliques, and the muscles in your back, holding them all stiff as you start your descent downward. Exhale when you reach the top. Then inhale and repeat.

Some Final Things to Note

The Valsalva maneuver is not something you want to hold throughout a set. Exhale after every rep. Then inhale and reset before your next rep.

One of the knocks on the Valsalva is that it elevates your blood pressure, which most of us tend to think is a bad thing. And indeed it is, if the high blood pressure is chronic—i.e. You walk around every day with a systolic/diastolic combo that’s well above 120 over 80. But the blood pressure lift from the Valsalva is temporary—when you perform it, the pressure goes up. When you stop, it returns to baseline.

However, if you have a known risk factor like an intracranial lesion, then yes, you should speak with your doctor before trying the Valsalva maneuver. Same if you have hypertension that you haven’t addressed. As with anything, exercise common sense and communicate with your doctor if you have any concerns.

Some people have suggested that the Valsalva maneuver could potentially cause a stroke. As Dr. Jonathan Sullivan explains, this is extremely unlikely. He explains that type of stroke that could theoretically result “is quite rare…And [the likelihood of it occurring] under the bar? That is exceedingly, incredibly, fantastically rare. Studying such a rare clinical phenomenon in a controlled manner is virtually impossible.”


How Low Should You Squat, Really?

The Truth About the 7-Minute Workout

The Tension Weightlifting Technique: How to Make Every Exercise More Effective

Leave a Reply

Your email address will not be published.