The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health

Bracing and Belting for Performance and The Pelvic Floor

• Christina Prevett

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Having a strong brace is important for lifting heavy weights. It is a critical part of CrossFit, powerlifting and weightlifting. Not to mention just life. We use bracing when we move couches, pick up our kiddos etc.
 
 Weightlifting belts are a performance aid that really helps us to create stiffness through our midline to lift more as well.
 We did an entire video on it on our YouTube channel.

  Knowing HOW to brace and use a weightlifting belt though is super important for our pelvic floors AND our performance. 50% of women pee when they lift heavy weights.

That is a massive number! But there is things we can do about it. We break it all down in this week's podcast episode

If youre interested in learning specifica considerations for returning to bracing postpartum, check out our Barbells after Babies Webinar free. 


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Speaker 1:

Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everyone and welcome back to the Barbell Mamas podcast, christina Previtt. Here and today, we are going to be talking about bracing and belting for a performance and for the pelvic floor.

Speaker 1:

It is super interesting that we now have pretty good research that upwards of 50% of women will pee when they lift heavy. We have seen research in CrossFitters, in power lifters, in weight lifters. It is something that can be really commonly talked about amongst female lifters with each other, but too commonly, individuals are just thinking that this is something that happens in sport and it's something that they are going to just accept, rather than something that we can really do something about and try to improve symptoms. When we know that 50% of women pee when they lift heavy, when we know that 50% of women pee when they lift heavy, it actually fills me with a little bit of anger, because if we were to take that percentage and apply it to something like pain and we said 50% of women had knee pain when they lifted heavy we would never accept that to just be the way that it is or something that is just part of being in the sport of powerlifting or in weightlifting or strength-focused sport. And yet that's kind of the way that we've talked about leaking or peeing on the platform or peeing in competition. And when I see the percentages that are that high, well, yes, that it's something that myself, as a pelvic floor physical therapist, an individual who works with female athletes deals with or works with or works to resolve all the time. 50% is a really high number and it makes me think that this is also something that is a coaching issue. We are doing something when we are coaching these athletes that is potentially predisposing them to leaking on the platform or peeing with heavy movement, and I really, truly believe that this comes down to how we are teaching bracing, and little tweaks that we can make to the way that we are teaching females and males really how to brace may be a little bit more advantageous for performance and also just hugely decrease the likelihood of individuals peeing on the platform. What do I mean by this?

Speaker 1:

Oftentimes, when we are taught how to brace at the very beginning of our lifting career, we are told to inhale nice and big and then bear down into our bellies to create this rigid belly and rigid core that allows us to lift more weight. When we are doing this, this is a technique called Valsalva, and a Valsalva is, when we are holding our breath, taking up as much space as possible in our chest cavity, and what that does is it increases the amount of work that the muscles in our core, our pelvic floor and our back are doing to make our core nice and solid and rigid, and that allows us to lift more weights. We will naturally stop breathing, inhaling, exhaling when we are at about 80% of our one rep max. Sometimes that is transiently or it can be on purpose, and throughout the entire movement of the lift. This is because our body has created this mechanism to keep us safe. Right, it keeps us safe in that it allows us to generate more force against an object, whether it's, you know, trying to get a car off us if we're pinned, or we're trying to lift a heavy deadlift, and that allows us to be a little bit stronger than if we didn't have this mechanism. And that means that we want to incorporate Valsalva, if strength and getting stronger is an important goal. And so the idea of never, ever, performing a Valsalva, which is sometimes the advice that female lifters can get, is just misguided, and it's a really important part of performance. But the way that we are teaching this can change.

Speaker 1:

So, before we get into how we teach the brace, let's talk about the circumstances in which individuals are peeing. The movements the barbell movements that are the biggest culprit for peeing are a squat, a deadlift and a clean, and this makes a lot of sense because it's the three movements in lifting that we are lifting the most absolute amount of weight, right, usually the lifts that are the highest in terms of the amount of weight on the bar are the squat, the deadlift and the clean. We see that individuals tend to lift or leak when they are lifting heavier. So when they are in that one to five rep max category, when they are under fatigue and when they are using a weightlifting belt and the belt is kind of this interesting asterisk where it's is it that they're using the belt incorrectly, potentially, or is it that we tend to use a weightlifting belt when we are at heavier loads? The jury's out.

Speaker 1:

And what happens is that when individuals are peeing on the platform, a lot of individuals who were taking some of these surveys that we have research on were saying that it was causing them to lose concentration. They were worried about peeing on the platform when they were going for their lift, they were afraid of being embarrassed, and so some communities have started to nor normalize maybe that's the right word this this problem, by saying if you ain't peeing, you ain't PRing, or it's just something that we deal with in powerlifting, no sweat. And that can be wonderful because it can try to take the embarrassment factor out of it. Um, but it definitely. We definitely want to make sure that we don't normalize it to the point of feeling like there's nothing that we can do about it, because there is a lot that we can do about it, because there is a lot that we can do to try and help in these situations and circumstances.

Speaker 1:

And then if I have a client who's coming in and you know, as I am talking to her, she's saying that yeah, I'm leaking when I'm deadlifting and at this certain weight threshold and this is what's going on threshold and this is what's going on. How would I approach a session like that is starting with bracing. When we are thinking about bracing, we do not want to be bearing down All of the other parts of that explanation that I said earlier, where we inhale nice and big and then close our glottis, which is what helps us to inhale, exhale or opens to allow us to inhale, exhale. We're going to close that off and we're going to tighten up all the muscles by bearing down to create this big increase in pressure and force in our belly that allows us to lift more weights.

Speaker 1:

When we are thinking about this bear down, what can happen is that, if we think about our core as this box, we have our chest wall diaphragm. At the top we have all of our ab muscles at the front, we have our back muscles, our erectors and some of our stabilizing muscles in the back and then we have our pelvic floor at the bottom. When we say, bear down, if you are listening in your car or you're listening to the video or audio or watching the video version of this podcast, I want you to really think about just bearing down into your pelvic floor. Especially for me as somebody who's had two vaginal deliveries, it really gives me this ick feeling when I do that, because I feel more movement down there. I don't really feel that supported and it would definitely, for me at least, be a weak link within that box.

Speaker 1:

And if you have a weak link if you think about, for example, if you have an actual box and you get one side of it wet and it loses integrity and then you put weight in it, we're more likely to have that fall through of weight in the box or that opening up of the box happen in that weak side and that can be putting extra pressure on the pelvic floor until it gets to that point where it can no longer close under the force that's being generated when we are bracing that way and we can leak as a result. It's not something that is bad. It is a signal that, one, the pelvic floor is our weak point across our core canister potentially, or two, we're setting ourselves up for a disadvantage in respect to our pelvic floor health because we are putting too much pressure on that side of the box and not evenly distributing the force across all sides of that container. And what do we do about it then? Then what is the result? What are the things that we are going to do instead? The way that we advocate at the Barbell Mamas for teaching bracing, and how, in my courses within the Institute of Clinical Excellence, we teach other clinicians to teach bracing, is to inhale nice and big and then think about tensing your core as if somebody was going to give you a punch to the stomach. If I am working with a mom, I'm also going to say, you know, as if your toddler was about to jump on your belly. Instantly, what happens is that your rib cage tucks over your pelvis and all of these muscles around our middle tensen. That is going to give you a solid foundation and it's going to distribute that pressure or that activation across all sides of the wall evenly. That is an important part. When we are talking about bracing, we want all of the sides of the canister to have an equal amount of pressure in order for us to transfer weight up on the barbell and feel stronger.

Speaker 1:

If one side is working too hard or less hard, then symptoms could potentially creep up, and that is going to have two, two ways that this can go awry when it comes to pelvic floor health. One is if we're bearing down and then our pelvic floor becomes a weak point and then we are leaking because we just can't withstand or have the strength to close our sphincters so that we don't pee and poop when we don't want to pee and poop when we are doing a brace or lifting a heavy weight or squatting or deadlifting. The flip side of that is that individuals can be so concerned about not leaking that they tighten their pelvic floor muscles and do the tightest kegel that they can, even when they're lifting at 20%, and that can make our pelvic floor be working too hard. And then we can have other issues like pain with intercourse or pain with penetration or you know other syndromes or symptoms of hypertonicity or too tightness. The best way to think about that is that if we are doing a squat that is at 20% and we're contracting our pelvic floor at 100%. Now there's this mismatch between one side of the canister. In our first example it was a weakness issue and on the second example it is going to be a too tight or a strength issue, where one side of the canister is working significantly harder than others.

Speaker 1:

How do you know what side of the spectrum you may be on with bracing? If peeing is something that you struggle with under heavy loads, the first is going to be what you're you're thinking about as you're lifting. If you're contracting super, super tight every time you're lifting, more likely than not you're kind of pushing yourself into the too tight category. If you have any pelvic pain also associated with how you're feeling, that can also be a hint that you may be on the too tight side of the spectrum. If you are newly postpartum, if you aren't experiencing any of those pain syndromes, if you are not, you know, kind of thinking about that tight pelvic floor contraction, you may be on the weaker side of the spectrum, and then we would be working on some of that coordination.

Speaker 1:

There is this kind of semantics or naming issue that can become a bit problematic when we're talking about bracing. You're noticing that I'm saying bracing and not Valsalva, and Valsalva is this bear down positioning. And if you're listening to this and you do CrossFit or weightlifting or powerlifting, you realize that that is not how it feels to brace really hard. But it's what's guiding a lot of our decisions when it comes to what is okay and what isn't okay with bracing. And so I've kind of moved away from using the term Valsalva and really talk about how to appropriately brace for our performance and for our pelvic floor. And so, if you are experiencing leaking with bracing, we do not want to avoid Valsalva altogether. We want to encourage your body to be ready for Valsalva, and so ways that we start to do that is one we can figure out.

Speaker 1:

Is there anything in how you are moving and how you are bracing that we can tweak from a technique perspective that may reduce the odds of you leaking? An example is avoiding that bear down and relearning some of that bracing strategy. Another one is if you tend to be a person, for example, who arches or is very kind of you, have a very curved low back, by pinning or working on pinning your rib cage down over your pelvis to stay in this neutral position, it can help get all the sides of the core canister connecting and working at the same amount of intensity and that can help with symptoms. And so working on your technique is going to be super helpful If we kind of do all those tweaks and you're still experiencing symptoms. The next thing we want to know is when did those symptoms come on? Is it as soon as you squat over 40% of your Wonder at Max, or is it only when you're over 85 or 90%? If it's only on those heavier percentages, then we're gonna back off below that threshold, make sure your technique is perfect. Then we're gonna accumulate repetitions just below those symptom thresholds, get your body a bit stronger and then push into those symptoms. If you are in prep for competition, this may not be something we're doing in this moment and we are just trying to manage symptoms as best we can. And then, when you're in your off season, we'll be able to really dive into some of the reasons why you're leaking with these movements and really work on it. And so that is number two we'll kind of accumulate sub threshold.

Speaker 1:

And then the third thing that we can do is manipulate breathing for the time being, until your body is ready for Valsalva. What we call with this is an exhale on exertion. Our breath and our pelvic floor are intricately connected, and so when we exhale, our pelvic floor contracts, and when we inhale, it relaxes, and it relaxes only to a certain amount. We're not peeing every time we inhale, but by using our exhale, that exhale on exertion on the hardest part of the movement, we can try and kick our pelvic floor into gear a little bit and allow us to get some extra recruitment, and this is where a lot of people get the advice of blow as you go or exhale on exertion and avoid bracing altogether, but this is a strategy that we use temporarily to help recruit all the muscles that we need to recruit, get our symptoms down and then push back into bracing as our body is ready for it. What is also really interesting for our CrossFit athletes, though, is that, by being able to switch our breath strategy from holding our breath to exhaling on exertion, this is something that is really helpful when we're differentiating between what you are doing as strength-based training in CrossFit and what you are doing in conditioning, because we expose in CrossFit, we have some heavy, heck heavy weight, and that you know. You can have a 225 deadlift in a conditioning circuit and if you can figure out how to really stay strong through your core when you are exhaling on exertion and when you are holding your breath. Using that exhale on exertion during conditioning is going to keep your heart rate a little bit lower and it is going to help you avoid hitting those red line intensities when you are in your conditioning circuits, and that can be a huge performance advantage of being able to leverage these things back and forth and therefore be able to use them to your advantage from a performance perspective.

Speaker 1:

When we think the next part is about adding in this weightlifting belt, when we think about weightlifting belts, these are different types of material. For powerlifters, they tend to use leather belts that are very thick and rigid. Their organizations have specific brands of belts that they utilize versus in crossfit and weightlifting. There are certain specifications for the belt, but there isn't specific brands that you have to use and our crossfitters and weightlifters. We tend to use a lot more of these cloth belts. If you're watching the video version, I have one of the belts that I use in my training in the gym very commonly and it's a cloth belt.

Speaker 1:

When athletes are asking me about what belt they should be using. My first filter is based on your sport, so what is the rules in your competitive league when it comes to weightlifting belts? We want to make sure we're staying close to that. First and foremost, I am very pro-belt, and it is because belts are a performance aid number one. We know that we have an increase in how much our muscles are working by about 10% when we use weightlifting belts, and we know that the effort that we feel, based on our one to 10 scale of rate of perceived exertion, is lower when we are using a weightlifting belt at the same weight as if we are lifting it without it. So effort goes down, muscle activation goes up and therefore we are definitely pro weightlifting belts when used appropriately, and so we are going to make sure that we are again using them at the right time.

Speaker 1:

But one of the questions that I get asked most commonly is one how do you use a weightlifting belt? And two, what is the best weightlifting belt to be using? And so that first, for the best weightlifting belt, the first one is going to be well, what does your organization allow? That's going to obviously dictate a lot of our decisions. And then the second thing is that we really want the belt to be the same width all the way around. When you're thinking about what a weightlifting belt is doing, it is providing extra compression across every side of your core canister in order for you to have something to push against, and it helps you to get that recruitment of those muscles because of that sensation or pressure that you are feeling. If you have a thin part of your belt at the front and a wide part at the back, which is what we tend to see now, you're getting this uneven amount of pressure on one side of the core canister as compared to the others, and the way that force is being distributed around that core canister is different, and so we want to make sure that we are picking a belt that is equal all the way around.

Speaker 1:

Ideally, the size or width of this weightlifting belt is going to be from the bottom of your rib cage to the top of your hip. So if you are a shorter athlete listening to this, you know I have some athletes who are 4'11", 5'5", 5'1". The typical weightlifting belts that we see advertised and we see a majority of athletes using are usually about three to four inches thick, and that can really push into a person's rib cage, even if you aren't a shorter athlete, but you have a really short torso, and so there are different brands that will get really really much smaller inch in diameter or width so that you can not feel like your ribs are being bruised. I had an athlete with a really short torso and she ended up with a two inch belt all the way across because it felt a lot better for her and anytime she would try and use a typical three inch belt, she would feel like her ribs were being bruised or that it was really actually painful and uncomfortable and cutting into her stomach, which was distracting her when she was squatting and dead lifting. And so we found us a thinner belt, or less width was down on the belt, and and that was really helpful for her.

Speaker 1:

When we are thinking about using the belt, we see a lot of athletes will pee when they are using a belt, and so why is this? There's a couple of things. One is that, again, we can be taught incorrectly how to leverage a weightlifting belt. Individuals are taught I want you to inhale nice and big and then push out against the weightlifting belt. When we are doing that, I want you to think about you have a balloon and you are pushing in the middle of it. When you are pushing in the middle of it, that air has to go somewhere, and if we're thinking about that air being in our bellies, it can't go up because our rib cage is there, and so all of that air has to be pushed downwards and it causes an increase in pressure on our pelvic floor. And so we can make it that when we are using a weight lifting belt, that we are more likely to have symptoms where we are peeing.

Speaker 1:

Our bracing strategy should not change when we are using a belt versus when we are not. In what other situation would we completely change our technique when we are exposing ourselves to the heaviest load in our training session? We would never do that, and so we want to be mindful of that when we are using a belt. And so when I am coaching my athletes through using a weightlifting belt, here is what I will tell them I want you to put on your weightlifting belt when you have not done that big inhale, so you're going to be exhaled and you're going to tighten it so that you can still breathe, but you're feeling it around your middle when you haven't breathed, taking that big inhale. I should be able to stick a finger underneath the belt and it should be tight, but I shouldn't feel like a Chinese finger trap, like I just can't get my finger outside of your belt. From there you're going to take a big inhale and tighten up your core muscles, as if I was going to give you a punch to the stomach or your toddler was about to jump on your belly or your dog, whatever it may be. If you haven't had kiddos and you're listening to this, when you do that, you are going to feel that big inhale is going to put pressure against the edges of the belt and then you're going to tighten up your core and that's going to put even more feelings of this hug of the belt around your middle and that is going to give you that feeling of support that is going to help you from a performance perspective in the big movements, the squat, the deadlift and the clean and jerk. And so those are ways that we can leverage the weightlifting belt.

Speaker 1:

And the next question is well, when do I start using a weightlifting belt? And I will typically advocate that we are not using our weightlifting belts until we are done with all of our warmup sets. What do I mean by that? We are going to use them for our working sets within our session if we feel like we need it. You should not. If you have a 225 pound squat, you should not feel like you need to use a weightlifting belt at 135 pounds. We want to teach our core and have a strong bracing strategy without the belt and then use the weightlifting belt as a performance aid.

Speaker 1:

Where we go wrong is trying to create artificial support through our midline by using a belt instead of putting in the work to feel strong and supported in our brace at sub max weights. This can be if you are leaking. I see this a lot in athletes who have had back injuries, for example, where they really heavily start to rely on their back, either out of fear of re-injury or because their body isn't back to its baseline level of strength. Though we are getting back into load, we want to make sure that we are able to create that force and generate that nice, strong brace without the belt before we start using a weightlifting belt, and this is something that we talk about a lot in our free webinar. If you are a person who is trying to return to bracing and barbell specifically after babies. We have a free webinar on our resources section of our website barbells after babies that you can take a look at for free, and we go through not only bracing and belting like we have today, but also specific pelvic floor considerations and returning to lifting postpartum. So if you're interested, I will put the link to that webinar in the show notes in the description for this episode, and I encourage you to take a look.

Speaker 1:

When we think about bracing and belting after baby, using a belt as an artificial support is definitely something that I see very commonly, and another question that I get asked by athletes all the time is when can I start returning to hard bracing or bell salving and when can I start using a weightlifting belt? In the study that I talked about in our heavy lifting during pregnancy podcast episode, I'll put a link to that episode as well. We asked our athletes, who took the survey, when they got back to these things postpartum. What we saw was that individuals started returning to harder bracing strategies where they held their breath between four and five months postpartum and they started returning to weightlifting belts between five and a half and six and a half months postpartum. That is an average, and some people were faster and some people were later, but it gives us kind of a timeline for us to be thinking about our postpartum recovery and what we can expect with respect to body readiness to get back to harder bracing strategies.

Speaker 1:

The one thing that I do see a lot is that we get athletes who are six, eight, 10 weeks postpartum who start using weightlifting belts and they haven't put in enough time on the foundations of returning to strength in their midline and pelvic floor after having a baby and they are using that belt as an artificial support. We want to make sure that we put in the time and the reps and, yes, the barbell isn't going to feel that heavy on our quads or our hamstrings or our muscles in our legs, but it's going to be our core or pelvic floor which is our limiting factor postpartum and that is okay, that is our expectation and that is our recovery from a very big life-changing, body-altering time in our life during pregnancy and then an injury. When it comes to rehab postpartum, after delivery whether that was a vaginal delivery or a C-section delivery that was a vaginal delivery or a C-section delivery you want to make sure that we are not undercutting and using the belt as an artificial support and not putting in the time to get our core stronger right. If you are working at 40% of your pre-pregnancy one rep max and you are using a weightlifting belt, it is because your core does not feel strong enough. Your legs can absolutely handle that load and it means that we probably shouldn't be using the weightlifting belt just yet and we should be really focusing on getting that strength, reestablishing our strength and our bracing. And what you will notice is, as you put more time under the barbell, as you get into your rehab program, where we start to really load up the back and load up the core, our strength and support that we feel in our brace will start to go up, and it is going to be almost directly proportional to how much core rehab we have done, how much our core strength has come back after our pregnancy and after our delivery. And so you want to make sure that you are taking the time to do that and laying those foundations, because it is going to set you up for so much success down the road and it's going to make you feel like your path to rehab is going to be much more linear, with less hiccups and things coming down the pipeline and allowing you to really fully get back to all of those movements as symptom managed or, hopefully, as symptom free as possible.

Speaker 1:

All right, let's kind of bring this full circle. When we talk about bracing, whether you have had children or not, whether you're postpartum or not, we really want to focus on technique first, and one of the biggest ways that we can clear up any pelvic floor symptoms is to make sure that we are bracing and are bracing appropriately for a pelvic floor, and that our technique is going to set us up for success by allowing as much clear force transfer and equal distribution of that muscle force across every side of our core canister. When we are adding in a weightlifting belt, we want to ensure that it is the proper weightlifting belt for our sport, that it is even in terms of how it is giving us that support across all sides of that canister, and that we are not changing our bracing strategy when we add in a weightlifting belt and we are using it in our working sets only and not as an external crutch to create support that we should be able to create within our own bodies first. That we should be able to create within our own bodies first. After baby, our body needs to be ready again to do that hard brace after our rehab process is at a level that our body is ready for that increase in pressure on the pelvic floor and allow us to do so in a way that is symptom managed and then ditto with the weightlifting belt. Our body needs to be ready for that type of increase in force and increase in pressure in our bellies in order for us to lift as much weight as possible.

Speaker 1:

All right, if you have any more questions about bracing and belting, we have a ton of resources that we have been slowly putting together on our YouTube channel. So if you could like and subscribe to YouTube, we would really love that, because we are putting a lot of work over on that platform to try and create as much educational resources as we possibly can to remove any barriers to heavy lifting for our females who have had kids or not. If you have any other thoughts or any requests for this podcast, please let us know. Otherwise we will see you all next time. Bye now.

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