Annual Fitness Post: Injury Prevention with Breathing Technique

Over the last several years I've pretty much covered every meaningful piece of advice on how to get in shape.  
http://missiontotransition.blogspot.ca/2013/01/annual-fitness-advice-post-using-social.html
http://missiontotransition.blogspot.com/2012/01/no-nonsense-fitness-guide.html.

http://missiontotransition.blogspot.com/2010/10/nutrition-rant-simple-vs-complex-carbs.html

http://missiontotransition.blogspot.com/2010/06/i-was-planning-on-attacking-some-recent.html

http://missiontotransition.blogspot.com/2010/07/health-and-nutrition-part-2.html

http://missiontotransition.blogspot.com/2010/07/health-and-nutrition-part-3-hopefully.html

This year I'm going to cover how to prevent injury.  I'd say that this is probably the most difficult lesson for former competitive athletes to learn because the most significant way to prevent injury involves not exerting yourself 100% when you aren't feeling 100%...Probably common sense for most people.  Anyhow, lets git our lern on.

Broken Record:
Before I begin, I just want to repeat the most fundamental lessons for success in fitness:
(a) The work out/physical activity you actually enjoy and will do regularly is better than the perfect physical activity that you hate and will quit after a few weeks.

(b)  If your primary goal is weight-loss, calories in vs calories out is your first guiding principle of how to eat.  Obviously, don't be dumbass about it and eat small meals of nutritionless food, but by and large, calories in must be fewer than calories out or you simply won't lose weight.  That's science!

(c)  Medium-high intensity activities generally yield better fitness and health results than low intensity activities.

(d)  Leverage the effects of social pressure:  If you aren't naturally motivated to exercise, you'll probably have a better chance of sticking to an activity if it's a social activity.  Also, publicly announcing your goals and/or having a friend check up periodically on your progress increases your likelihood of success.

(e)  Resistance exercises:  (i)  Over the last decade, there's been a growing body of quality evidence showing that resistance/strength programs outcompete endurance exercises in terms of combating the effects of aging.  (ii)  If you want to incorporate strength exercises (i.e., weight training) and you've never really done it before, please, please, please hire a professional personal trainer to get you started. Make sure that the person actually weight trains themselves (and has done so for at least 5 years) and isn't some yoga or aerobics instructor who took a weekend certification course.  A simple heuristic to find out if they are knowledgeable about weighlifting is to ask them: "Do you even?".  If they reply with "do I even what?" or "I don't understand the question" find another trainer.

(f)  Don't waste your money on supplements.  99% of them don't have any good evidence to support their efficacy.  If you insist on supplements, the only ones I'd recommend are protein powder and creatine.  Possibly pre-workout powder if you need an energy boost but a coffee does the same thing, has the same active ingredient, and is cheaper.

I Enjoy Preventing Injury Because:
Now that we've got that out of the way, lets get down to the important matter of preventing injury.  At the very real risk of stating the obvious, it's important to avoid injury because:
(a)  injuries hurt and make me cry

(b)  injuries keep you away from your activity of choice thereby causing you to lose (i) your precious gains and (ii) your momentum which in turn sends you back to you pre-activity sedentary state from which you must one more time begin the difficult task of overcoming the inertia of inactivity.

(c)  injuries cause further injuries.  Often in protecting your injured body part, you'll compensate in a way that causes you to injure another body part.

By far, one of the most common area that gets injured is your back.  So, if there's a way to minimize back injury, maybe we should check it aus...

Correct Breathing
Ok, if you aren't going to include weight lifting into your fitness plan, then this section isn't too relevant to your needs.  But it may be, so read it anyway.  I spent time writing the damn thing!

Fact: 99% of fitness trainers teach incorrect breathing technique for weightlifting (source: Ami's Journal of Test Tubes, Beakers, and Scientifical Facts).  Let me qualify that: it depends on the type of lift (and some will say the amount of weight in relation to your max).  But lets not get caught up in distinctions, this is a fitness post!  Everything I teach you will make you lose 20 lbs in 2 weeks and cure cancer!

The valsalva maneuver.   That's what I'm talkin' 'bout!  Instead of 'splaining it, I'm going to illustrate. Nay! You're going to illustrate it! Good teachers explain, great teachers make you figure it out your own damn self (or something like that).

Drop something on the floor right now.  Slowly bend over and reach down to pick it up. Wait! Stop! While doing this, I want you to focus on the sensation in your lower back. When your torso gets to about perpendicular with the floor, I want you to exhale.  Now, pick up the dropped object and return to your erect position (heh heh heh....he said "erect position").

Now I want you to try to duplicate the exact same motion but this time before initiating your movement inhale deeply and hold your breath.  Without releasing the air in your belly and chest, bend over and pick up the fallen object and focus on how it feels in your lower back. Don't release your breath until you are almost fully erect again (heh heh heh...he said "fully erect").

What were the results?  In the second case, your lower back should have felt more support and less strain that in the first.

Here's another experiment to illustrate the principle:   Hold yourself in push-up/plank position. Now exhale all the air from your lungs.  What happens to the stability of your core?  Does it sag?

Repeat but this time, while in push up position, inhale and fill yourself with air and hold it. What happens to the stability of your core?  Is it more stable?

Doing this carefully controlled experiment should reveal to you the one secret the fitness industry doesn't want you to know! You should only breath in, and never exhale!  This will make you appear more buff and saving you 1000s of dollars on expensive steroids supplements!

Ok, I kid.  Here's the real lesson: When you are doing strength exercises that require a stable core (mainly: squat, deadlift, bench press, military press, shoulder press, any olympic and power lift), before you initiate the movement, you should breath IN and fill your belly and torso with air and HOLD your breath during the main exertion of force, releasing it only once the most difficult part of the movement has been completed (you can let a little air out through pursed lips during exertion).

To summarize the technique (video below):
1. Using your diaphragm (not your chest), inhale deeply before the non-exertion phase of the movement.   E.g., in a squat it will be when you are standing upright before you go down; with bench press and military press it will be when the bar is overhead before you lower it.

2.  Hold your breath and tighten your abs as though someone is going to punch you in the stomach as you lower the bar.  This stabilizes your core.

3.  When you exert force to begin the upward movement, keep holding your breath for the first part of the movement (the most difficult part) and then, near the top of the movement, release your breath.  Note: some people say to release a little bit of air through pursed lips during the main exertion.  Figure out what works for you.

4. Repeat.

Here are a couple of videos illustrating how to use this breathing technique (called the valsalva maneuver in fancy talk) with the most common lifts:

Nerd Note: There are actually 2 types of valsalva maneuvers: (a) the most common one is the one you do during the descent of an airplane when you plug your nose and try to equalize your sinus and ear pressure; (b) the weightlifting one is called the gloittial version because you close your windpipe (with your gloittus) to create pressure in your abdominal and thoracic cavities.

Some good general points, despite his committing the naturalistic fallacy:

The Squat:

The Deadlift: 

The Down-Side and Fine-Print:

First of all, at your next training session where you're doing squats, your zumba weightlifting instructor will tell you to exhale when you exert force in the lift.  Then you're going to say, "but I read on the internets that you should use the glottial valsalva maneuver during the most difficult part of the lift."  At this point you should tell them where on the internets you got the advice.  If they don't immediately recant their position and acknowledge their ignorance in the face of my superior epistemic position, then the correct response is to say "do you even lift?" and walk away.

Apart from conflicts with your pillates weightlifting instructor there are a couple of other risks you should be aware of when using the valsalva maneuver.  While the risks might lead some uninformed fools to conclude that the valsalva maneuver shouldn't ever be used, these nervous nellies aren't taking into account several important distinctions.  Before I address the distinctions, here's a quick list of some of the possible risks incurred by using the valsalva maneuver: 

1.  The valsalva maneuver creates A LOT of internal pressure.  If you have any kind of abdominal hernia you'll probably want to avoid it.  You'll want to avoid it if you really have to go to the bathroom too...

2.  The valsalva maneuver reduces blood-flow to the brain so there's a risk of feinting if you're prone to it.  Also, the reduced blood-flow to your brain means you should avoid attempting complex cognitive operations like doing calculus while holding your breath and lifting heavy weights. 

3. The valsalva maneuver can cause valsalva retinopathy which appears as preretinal hemorrhage (bleeding in front of the retina).  I'm not sure if this is a downside cuz it's a cool story to tell your bros. 

4.  Your blood pressure goes up and your heart rate goes down because of the increased internal pressure.  If you have a history of heart conditions, you might want to avoid doing it.  Consult a qualified homeopath first...I kid:  talk to a real freakin' doctor, damn it! 

The Fine-Print:

Are you scurd? Sounds like a lot of risk just to prevent back injuries and to get gains. Actually, it's not.  It's about as risky as pushing hard while on the toilet when you're constipated (where you've been using the valsalva maneuver for years!). The possibility of negative effects occurs only if you're lifting really really heavy weight which, lets be honest, most of you aren't (do you even?).  So long as you're lifting below 350lbs, there's no real risk.  The greater risk is to your back.

One more thing to note is that if you decide to use the valsalva maneuver for heavy weight (as you should), you should avoid doing sets of more than 5 or 6 reps.  Holding and releasing your breath under heavy load for a standard set of 10 reps increases the likelihood of lightheadedness (and the other problems ) although it's still negligible.  If you aren't lifting heavy, then it's not going to be the end of the world if you don't use the valsalva maneuver but I'd recommend it anyway if you want to protect your back. 

Finally, you don't need to use the valsalva maneuver for every type of exercise.  It's primarily used for heavy compound lifts such as squat, deadlift, military press, bench press, and any olympic lift.  For those movements you're much better off using it than not. For other lifts, especially isolation exercises, you're fine using the breathing technique your aerobics instructor taught you.

In sum, the valsalva movement is an effective way to prevent injury to your (2nd) most vulnerable region--your spine.  

Last Word on Injury Prevention

I've got two words for you:  You have to warm up or you will increase your chances of injury.  Did I go over the word limit?  Oops.  

Good warm-up plan:  

1.  Do 10-15 min at med intensity on one of the cardio machines.  If you're training upper-body that day, use the elliptical.     

2.  Start with compound exercises (i.e., exercises that use more than one muscle group) that focus on a large muscle group (chest, back, legs, shoulders).  Finish your workout with isolation exercises (i.e., exercises that isolate one muscle or aspect of a muscle).  For example, if I'm working chesticles I don't start with flys or cable cross-overs because these movements isolate the chest and don't involve any other muscle groups.  I start with bench press because this uses my triceptors, shoulders, and chest.  Similarly, if you're doing legs, don't start with hamstring curls or leg extensions.  You should start with squats or dead lifts or possibly leg press, all of which use a combination of muscles in your legs as well as your torso.

3.  Do as many warm up sets as you need, gradually adding weight, before starting your working sets.  I usually do 3 warm up sets for my first exercise--sometimes fewer, sometimes more depending on how I feel.

4.  If after 3 or 4 warm up sets, your normal working weight feels heavy, back down.  Your body isn't "feeling it" today which means there's a good chance you'll injure yourself if you push it.  Do your working sets with a slightly lighter weight than you'd normally use.

5.  Once you've done your first major compound exercise, you probably will only need 1 warm up set for your next exercise.

Now stop making excuses and go to the gym.