More on Holding Your Breath

Sep 21st, 2013

Category: Fitness

More on Holding Your Breath

Carrie Jerk

Carrie holding her breath while locking out a jerk.

I wrote an article a while back describing the Valsalva Maneuver and why it is a good idea to use it when lifting weights. Briefly, the Valsalva Maneuver is the process of taking in a big breath and holding it when you need to perform a strenuous task, such as lifting a heavy weight. This helps to make your torso more rigid, which helps you hold your spine in position, and results in increased efficiency for the transmission of force and decreased chances of spinal injury. One often-voiced concern is that holding your breath is dangerous and could lead to an aneurysm, or a stroke, and perhaps even kill you. Surprisingly, people who should know better still voice these concerns.

Dr. Jonathan Sullivan, an emergency room doctor and Starting Strength Coach, recently wrote a very detailed article about the Valsalva Maneuver and the risk of the cerebrovascular accidents over at It provides an in-depth analysis of the anatomy, forces at work, and literature regarding the Valslava and its potential to cause unwanted things, such as death.  The good news is that holding your breath while lifting will not cause you to suffer a stroke any more than anything else will. So, hold your breath, turn red, and know that you properly engaging your trunk musculature to help with the lifting of heavier weights more safely.

The articles clocks in at 15 pages with 2 pages of endnote references. While not a light read, it is a valuable contribution for coaches and athletes who train with barbells. Also, while lengthy, it is hardly a dry, academic piece. Here’s a sample:

In short, based on a generous reading of Bursik and Conway’s data and using conservative assumptions that favor their position, a lifter from the general population training three hours a week with 15% of that time under Valsalva will, on average, sustain one SAH in seventy thousand life-years.

And yet, our calculations assumed that the risk is the same for all of us – which it is not, since, as we’ve already seen, the majority of intracranial hemorrhages occur in those unfortunate individuals with a pre-existing lesion. When we take that 1-6% congenital aneurysm rate into consideration, we start to get into stroke-free lifter life spans that invite consideration of sub-light-speed interstellar travel. Moreover, my analysis of the data cited by Bursik and Conway accepts their assumption that the 32 reported cases can be extrapolated to 1287 actual cases. We assumed that their number under-represents the actual hemorrhage rate by 100%, that all such hemorrhages occurred in the context of Valsalva, and that all of these strokes could therefore have been prevented.

But we shouldn’t accept any of these assumptions.

Because they’re all bullshit.

The extrapolation of the 32 cases to 1287 assumes that the 100 hospitals surveyed by the NEISS for this data are truly representative of the admission rate for weight-training-associated SAH across the US. Given the extremely small incidence of such strokes, this relationship cannot possibly be demonstrated. The contention that the 1287 figure actually under-represents incidence is based on their further assumption that many cases of hemorrhagic stroke are never evaluated in the ER.

Really? Where else would they go? The chiropractor? Coach’s office? The In-And-Out Burger? Let’s get real: If you have an acute subarachnoid hemorrhage in America, you will end up in one of two places: the ER or the Eternal Care Unit.

For those wishing to read the rest of the piece, you can do so at: