Nuances of the Valsalva manoeuvre and bracing with regard to resistance training performance and its effects on the pelvic floor

Abstract

There is a great deal of confusion about the use of the Valsalva manoeuvre (VM), and its potential to harm or benefit the pelvic floor when performing resistance training (RT). The VM is completed when expiratory pressure is exerted on a closed or partially closed glottis. This creates a haemodynamic response that corresponds to an increase in blood pressure and then heart rate. For the RT athlete, the VM is a term used to describe bracing of the abdominal musculature to increase trunk stiffness and lumbar stability by intensifying intra-abdominal pressure. This gives individuals a performance advantage during RT. Within pelvic health, the VM is used to assess pelvic floor dysfunction (PFD), and in particular, pelvic organ prolapse. Emerging literature demonstrates that rates of PFD are high in resistance-trained female athletes, and therefore, it has been suggested that avoidance of the VM helps to reduce pelvic floor complaints in this population. However, this is unrealistic given that an involuntary, transient VM occurs at loads greater than 80% of an individual’s one repetition maximum, and removal of the VM would potentially reduce performance in RT athletes. Physiotherapists need to use their evaluation and management skills to improve the symptoms of individuals who participate in RT and experience PFD. This clinical commentary reviews the physiology of the VM, explores rates of PFD in resistance-trained female athletes, and makes recommendations for the evaluation and treatment of these individuals. Unique considerations for the pregnant female participating in RT are also discussed.