If youโre a lifter who loves to push themselves and โtrain their guts out,โ just make sure that you always take that phrase poetically rather than literally because the literal result is a hernia, which can wreak havoc and cause major setbacks to your lifting pursuits.
In order to avoid getting a hernia while lifting weights, you need to know the basics of how and why hernias occur, know how to use the Valsalva maneuver during heavier lifts, when to wear a weightlifting belt, and learn how to get bigger and stronger without always lifting heavy.
In this article, Iโll break down the details that every lifter needs to know when it comes to preventing hernias from occurring. Prevention is better than any cure, and the healthiest, most successful lifters are the ones who educate themselves as much as they can when it comes to avoiding lifting-related issues.
Quick note: My name is Jim Wittstrom, Iโm a physiotherapist in Calgary, Alberta, Canada. While I diagnose and treat hernias with my own clients, just remember, Iโm not your physiotherapist. So if you believe you have a hernia, then contact a medical professional who can serve you best!
Table of Contents
1. Learn the Basics of What Hernias Are and Why They Occur
The first step that needs to occur for hernia prevention involves having a basic understanding of what hernias are (known as the pathology) along with how and why they occur (known as the pathophysiology).
Itโs essential to understand each of these features. Through understanding the nature of what hernias are and how they occur, the steps you will need to take to prevent or minimize them will become much more intuitive and meaningful.
The overall result, therefore, will likely be a safer and less hernia-prone pursuit of lifting.
What Exactly Is a Hernia?
A hernia or herniation refers to an abnormal opening within a tissue wall through which an organ either bulges or pokes through.
There are many different locations in the body where a herniation can occur.
However, the type that is arguably most commonly known by both lifters and the general population (and will thus be the focus within this article) is the inguinal hernia.
This is the infamous type of condition where an individual with such a hernia may see a bulge in or around their groin area (around the front crease of their hip). Itโs also the one that most lifters often refer to when wanting to do all they can to prevent a hernia from occurring.
Hernias can be symptomatic (meaning they cause noticeable pain and potentially create a visible bulge) or be symptomatic (meaning they do not cause pain and potentially donโt create a visible bulge).
While itโs kind of scary to think of your abdominal wall having a small tear in it, the current medical consensus is that inguinal hernias typically only need surgical intervention (repair) if they are painful.1
These hernias often produce their respective pain with coughing, sneezing, or other intense abdominal contractions such as during bowel movements.
Why Do Hernias Occur?
While hernias result from an abnormal opening in a wall of tissue (such as a tear), which allows another organ or structure to poke through, the reasons for their occurrence can be due to a variety of reasons.
Some of these reasons can be due to factors influenced by the individualโs activities (such as sports). Others can be outside of their own control, such as genetic predispositions, which have shown to be a strong factor in the risk of sustaining hernias.
Itโs worth mentioning that currently, there is no medical consensus about whether or not heavy lifting can be a direct cause for inguinal hernias.
In the case of suffering this type of hernia from heavy lifting or improper lifting technique, the theory is that the high pressure that the abdominal contents (in this case, the small intestine, which sits within the abdominal cavity) can exert is enough to push through the abdominal wall.
The abdominal wall is the tissue structure that otherwise keeps the small intestine where it needs to be.
Itโs important to note that the excessively high outward pressure of the abdominal contents onto the abdominal wall with a heavy tends to occur with improper breath control and improper muscle activation of the abdominal muscles.
What is clear when it comes to inguinal hernias is that many individuals (lifters and non-lifters alike) can often have an inguinal hernia without even knowing it (this would be the form of an asymptomatic hernia that also has no visible outward bulge and does not produce any subsequent pain).
In that regard, all lifters need to know how to have proper technique and breath control when lifting to ensure that they do not make the herniation any worse.
This is due to the fact that high amounts of abdominal pressure (such as during a heavy lift that requires internal abdominal bracing) over a weak or torn area of the abdominal wall can make the tear or bulge much more extensive.
2. Know When and How to Properly Use the Valsalva Maneuver
A second line of defense in preventing a lifting-induced hernia from occurring can involve using a technique known as the Valsalva maneuver.
This technique should be performed when attempting heavier lifts. Itโs important to note that this technique may need to be avoided if you already have a symptomatic hernia or a hernia that you are aware of. While the Valsalva can offer benefits to protecting abdominal contents, it has the potential to cause further issues in pre-existing cases.
While there can be individual considerations that need to be taken into account when performing the Valsalva maneuver, when executed correctly, it is a powerful tool that keeps lifters safe and can prevent hernias (among other injuries) from occurring.
It is considered an advanced breathing technique. As such, it should only be learned, attempted, and implemented once the lifter has developed technical proficiency with their compound lifts (squats, deadlifts, etc.) at moderate to moderately heavy loads.
Weโve written about how to use the Valsalva maneuver in other articles:
What Is the Valsalva Maneuver?
The Valsalva maneuver is a breathing technique that increases pressure throughout the abdominal cavity, resulting in increased activation of the core musculature and increased rigidity of the spinal column.
Itโs essentially an internal bracing technique.
As a weightlifter or powerlifter, having a rigid torso and spinal column throughout a heavy resistance exercise (such as a squat or deadlift) yields significant benefits for both safety and performance.
With all four of your limbs linking back to the central area (core) of your body, an unbraced core cannot effectively transfer power to other regions of the body, nor can it maintain the ability to resist unwanted movements.
The inability to effectively transfer power will rob you of serious strength and performance gains with your lifts.
At the same time, the ability to resist unwanted movements can result in unsuccessful lifts, or worse, physical injury. This becomes a major issue for both risking herniations of your spinal discs as well as herniations of your abdominal contents.
If youโre familiar with lifting heavier loads that feel like they take a decent amount of effort to complete, such as on your squats and deadlifts, youโve likely realized the tendency and ability for that weight to pull you out of position throughout the movement.
Generally speaking, the heavier the load is for you, the harder it becomes to control with optimal form. As a result, the heavier you go, the smaller the movement deviation needs to be before you wind up becoming unsuccessful at completing the lift.
In that regard, increasing rigidity through your midsection and spinal column prevents instability (either micro or macro) from occurring during your lift.
The issue with unwanted movements while under heavier loads is that more stress, strain, and shear occurring through your body (particularly your torso) can theoretically be transferred to the abdominal wall as you try to correct your positional deviation.
With the relatively thin abdominal wall being the only structure holding the small intestine back, you want to avoid as much necessary force on this wall of tissue as possible.
By using the Valsalva maneuver, youโre essentially turning the midsection of your body into a strong pillar, which will have a much higher propensity to resist unwanted movement while moving weight with a high load.
How to Perform the Valsalva Maneuver
Performing the Valsalva maneuver is relatively straightforward to do.
Itโs simply the same technique you would do when bearing down during a bowel movement (this โbearing downโ increases pressure within your abdominal cavity, forcing the bowel movement to occur).
Itโs essential to know that your stomach shouldnโt be pushing directly outwards when you do this. If this is happening, youโre doing it wrong. The goal is to prevent the stomach (and thus, the abdominal wall) from bowing or bending outwards, which signifies that more significant amounts of stress are being placed upon this wall of tissue.
Note: If you experience pain in or around your groin when performing this technique, it could be a sign that you have an inguinal hernia, even if itโs not outwardly visible. If this is the case, a medical evaluation is warranted, and avoiding the Valsalva, for the time being, may be necessary to ensure youโre not making the condition any worse.
When performing the Valsalva maneuver, youโll notice that you essentially canโt breathe if youโre trying to maintain the maximal amount of intra-abdominal pressure.
This is due to the closure of your glottis, preventing air from leaving your trachea. The closure of the glottis essentially acts like a plug or valve for keeping high pressure within the โcanisterโ (i.e., the torso).
This is where the Valsalva can go wrong for lifters if theyโre not proficient with it or if they use it incorrectly. It can go wrong since youโre essentially holding your breath whenever you perform this technique.
And if you hold your breath for too long while trying to move and maintain a heavy load, itโs easy to become lightheaded, dizzy, or pass out entirely.
As a result, you need to know how to implement this breath control technique on each of your heavier lifts. Thereโs no point in trying to protect your guts from a hernia during a heavy lift if it leaves you passing out and splitting your head open on the gym floor.
When to Perform the Valsalva Maneuver
The Valsalva maneuver isnโt always required for lifting.
Lifting at submaximal loads of around 65% or less tends not to require as much intra-abdominal pressure and torso rigidity.
Under these lighter loads, a regular breathing pattern should suffice (typically involving a breathing pattern where you exhale during the challenging portion of the lift).
3. Know When and How to Properly Wear and Use a Weightlifting Belt
Thereโs no point in wearing a weightlifting belt if you donโt know how to effectively perform the Valsalva maneuver, so make sure you can do so before using a weightlifting or powerlifting belt.
This is because a weightlifting belt achieves its maximal effect when the maneuver is correctly performed, and the lifter has reasonable control over their abdominal musculature.
While itโs not uncommon to come across a โto belt or not to belt?โ debate in the world of lifting, the general consensus is that a belt, when used appropriately and properly, can help to ensure better safety and performance for the lifter.
Itโs important to know that a belt may not help with certain hernias, such as an inguinal hernia, however, there are many established lifters who say that they feel much better or experience less hernia-related pain when wearing a belt.
As such, considering the use of a weightlifting belt can potentially be an appropriate adjunct in your training.
When Should You Wear a Weightlifting Belt?
As a very general rule, if you have sound lifting mechanics for compound lifts such as the deadlift and the squat, youโll want to consider wearing a belt when lifting loads around and above 70-75% of your one-repetition maximum (1RM).
This is not a hard and fast rule, mind you, and every established lifter will tend to belt up at different percentages.
When it comes to using a belt specifically for protection from hernias, most lifters find that 70-75% of their one-repetition maximum is when intra-abdominal pressure really starts to build as a means to increase rigidity in the torso throughout the lift.
If you suspect that you may have a hernia, or you know that you have one, you will need to pay particular attention to at which percentage of your maximal lift that you really feel abdominal pressure build when not belted-up.
Belting up may help eliminate or reduce any discomfort; however, if it doesnโt, you may want to get further medical insight.
If you donโt suspect that you have any herniation and feel otherwise healthy, you likely have a bit more variety in terms of which load(s) you feel you should belt up.
However, itโs important to remember that since wearing a belt also helps add rigidity to the spine, a belt shouldnโt only be worn simply to protect against an inguinal hernia. Increased spinal and torso stability will also help prevent spinal disc herniations as well.
How to Wear a Weightlifting Belt
While there are different types of lifting belts (such as belts made specifically for Olympic weightlifting, made specifically for powerlifting, etc.) and different styles of belts (such as a 3 vs 4 inch width belts, womenโs powerlifting belts, lever vs prong belts, and 10mm vs 13mm thick belts), they all tend to follow the same principles when it comes to wearing them for optimal safety and performance benefit.
As a general rule, the belt should sit right above the top of your hip bones and only be tightened up right before the lift. You want the belt to be tight enough that you feel your abdominal muscles press firmly into the belt even before performing the Valsalva maneuver (as if you were bearing down while having a bowel movement).
When specifically referring to hernias, this essentially allows the belt to act as a reinforcement to the abdominal wall, preventing any outward bulging of abdominal contents during the strenuous portion of the lift.
Since this excessive outward bulging of the abdominal wall can no longer occur with the belt securely in place, the abdominal contents (i.e., the small intestine) can no longer push through the thin abdominal lining, since the belt is reinforcing the wall itself.
4. Know How to Get Bigger and Stronger Without Going Heavy
While the risk of weightlifting-induced hernias can oftentimes be greatly reduced with the above measures, there are times where heavier lifting may not be ideal for a given lifter (due to hernias or otherwise).
While heavy lifting is a great pursuit and one that yields all sorts of physical and mental rewards, it needs to be respected in order to ensure the longevity of your muscles, tendons, bones, joints, and intestines.
This is important because not every lifter (especially those who are new to any form of weightlifting) has the confidence or the technical proficiency to complete their lifts under heavy loads or go through high volumes of heavy lifting.
Other lifters may have predispositions to hernias or have per existing hernias they need to be mindful of. If you happen to fall into any of those preceding categories, you need to understand that there are still plenty of ways to train effectively without necessarily going heavy, or at least going heavy as often.
Even the most accomplished and proficient lifters donโt lift heavy every training session year-round, so follow in their footsteps when it comes to exploring alternative ways to challenge your body without simultaneously beating it into the ground.
By avoiding heavier loads that require higher levels of intra-abdominal pressure (including the use of the Valsalva maneuver), youโll lessen the likelihood of sustaining a hernia or making a pre-existing herniation worse.
How to Get Bigger and Stronger Without Lifting Heavy.
The last couple of decades have seen substantial growth from some great scientific research when it comes to training methodologies that have been shown to improve muscular size and strength without the use of more traditionally heavy loads.
This is good news for lifters who want to avoid using higher intra-abdominal pressures during their training and lifting, including those who have had prior run-ins with hernias or wish to prevent smaller ones from getting any worse.
Two very established ways to continue to improve your muscular size and strength are through the use of either tempo-based training and blood flow restriction training.
Both are great training options for physically exerting and challenging the muscles while simultaneously maintaining ideal mechanics and lower intra-abdominal pressures.
Tempo-Based Training
Tempo training can be done with any of your lifts. It should especially be considered with lifts that predispose any lifter to high amounts of intra-abdominal pressure, such as squats and deadlifts.
Youโll get bigger, get stronger and develop some extra mental fortitude from pushing through a deceptively fatiguing style of training, so donโt scoff at the thought of training with lighter loads.
Tempo-based training involves lifting these lighter loads at a much slower speed (tempo) than what many dedicated lifters tend to train at traditionally.
Donโt be fooled, however. While it involves lifting at lighter loads, itโs incredibly challenging, and youโll need to set your ego aside when performing this training technique. It produces a lot of fatigue but also some significant gains in muscle size and strength.
The concept of moving moderate weight very slowly is quite analogous to riding a bike. The slower you go, the harder it becomes to not fall off. With lifting, the slower you go, the more fatiguing and intense the exercise becomes.
When it comes to size and strength gains, muscles respond rather favorably to being exposed to more extended periods of mechanical tension, and thereโs some good literature to back this up.
Instead of a set of ten squats only taking thirty seconds to complete at a training load of 70%, as an example, a set of ten squats that takes an entire minute to complete at a training load of 50% can produce more fatigue and generate greater metabolic and mechanical stress to the muscle tissue itself.2โ4
Since this training style is performed at a much slower overall pace (taking a much longer time to complete), the load needs to be substantially lighter. While thereโs no hard and fast rule with the exact loads to use for this training style, experimenting with loads around 50% of your maximum lift is a good starting point.
The goal is to sustain around one minute of continual tension (no major rest breaks at the end of each rep). So, if you were looking to do ten squats, each rep would need to take around six seconds to complete. Three seconds going down and three going up would be one such way for this to be achieved.
Taking upwards of ninety seconds to complete a set has also been shown to produce favorable results. Taking a longer duration of time than this to complete an exercise likely means that youโre using a load that is too light, so try to keep it within the sixty to ninety-second timeframe.
Since this training tempo-based training protocol is done with submaximal loads, the extent to which youโll be predisposed to exerting high amounts of intra-abdominal pressure will be much less than when lifting with traditionally higher loads.
If you have a weakness in your abdominal wall or already have an inguinal hernia, youโll be much less predisposed to incurring a hernia or making a pre-existing one any worse. In the long run, your guts will likely thank you.
Blood Flow Restriction Training
Having done my graduate thesis on blood flow restriction training, Iโve been using this methodology with great success on many of my patients and clients who canโt successfully execute heavier lifts (due to injury, poor movement or technique, recovering from hernia surgery, etc.).
I use this intervention for those who still need to improve various aspects of their physical strength but are unable to lift at the radially heavier loads that are otherwise needed to do so.
Blood flow restriction training is a form of training that has been repeatedly shown within the scientific literature to produce gains in muscle size and strength while lifting at loads much lighter than what are otherwise traditionally required.
The training involves wearing restrictive cuffs around the extremities while lifting. These cuffs restrict the extent of venous outflow from the extremities, which essentially creates a massive build-up of metabolic โjunkโ within the blood that the muscles are exposed to throughout the exercise.
When the cuffs are removed, the large influx of metabolites moves out of the extremities and back into general circulation throughout the body. They ultimately make their way to the brain and inundate it, essentially tricking it into thinking that heavy and high-intensity lifting has just taken place (even though it hasnโt).
As a result, the brain mounts a disproportionately favorable hormonal and physiological response that it believes is required to recover from the โheavyโ and โintenseโ lifting that just took place.
While traditional lifting tends to require loads of around 60-70% of an individualโs maximal ability to produce increases in muscle size and strength, blood flow restriction has reliably been shown within the literature to elicit these same responses at only 20-30% of the individualโs one-repetition maximum.5โ8
While thereโs no set training protocol when it comes to how one should train with blood flow restriction, the 30/15/15/15 protocol is most often used in scientific studies and has shown to offer some great results. These numbers refer to how many reps are performed for each set of an exercise.
- The first set consists of 30 reps to build up the metabolic environment that will trick the brain once the cuffs are removed.
- A thirty-second break is taken, and then 15 repetitions are performed.
- Another thirty-second break is taken, and then the process is repeated two more times for a total of four sets.
Significant gains in muscle strength and hypertrophy are often seen around the six-to-eight-week mark.
If youโre a lifter with predispositions to hernias, are battling through a hernia (or other orthopedic issues, such as sore knees, CNS fatigue, etc.), incorporating low-load blood flow restriction into your training regimen could be a great way to keep your strength up without continuing to stress and tax your abdominal contents.
You will experience a surprising amount of fatigue but wonโt have to worry about your guts bulging out into places that they donโt belong.
Final Thoughts
While an inguinal hernia is by no means a career-ending injury for a lifter, your strength pursuits are going to be much more enjoyable and hassle-free if you donโt have to deal with one in the first place.
Thankfully, itโs not rocket science when it comes to keeping yourself as safe as possible with hernia prevention. Whatโs even better, by following the information within this article, youโll be an overall safer (and better) lifter altogether.
About The Author
Jim is a physical therapist, strength & conditioning specialist and former competitive powerlifter. He loves treating lifters and other active individuals in the clinic and working with them in the gym in order to help them move better, feel better and maximize their training potential.
Website: www.strengthresurgence.com
References
1. Fitzgibbons Jr RJ, Forse RA. Groin hernias in adults. N Engl J Med. 2015;372(8):756-763.
3.ย ย ย ย Pereira PEA, Motoyama YL, Esteves GJ, et al. Resistance training with slow speed of movement is better for hypertrophy and muscle strength gains than fast speed of movement. Int J Appl Exerc Physiol. 2016;5(2).
