Why Do Powerlifters Get Nosebleeds? (And, How To Avoid)

reasons why powerlifters get nosebleeds

Grinding out a difficult lift can cause powerlifters to have nosebleeds. 

Why do powerlifters get nosebleeds? A max effort lift with full-body tension and proper bracing causes intra-thoracic and intra-abdominal pressures, which results in an elevation in blood pressure. The elevated pressure forces blood vessels in the nose to burst and leads to“epistaxis”, or a nose bleed.

The sight of blood coming from someone’s nose may be concerning, but in this article, I will not only discuss the mechanisms behind nosebleeds while powerlifting, but also 4 ways to prevent it, if it’s bad, what to do if it happens to you and more.

4 Reasons Why Powerlifters Get Nose Bleeds

The 4 reasons why powerlifters get nosebleeds are: 

1. Valsalva Maneuver

valsalva maneuver is used by lifters to increase trunk stability and generate tension

The valsalva maneuver is used by lifters to increase trunk stability and generate tension. It is the act of exhaling forcefully against a closed glottis (holding your breath).

To learn more about this technique check out our step-by-step guides on Proper Breathing Technique For Squats and Proper Breathing Technique For Deadlifts.

This technique increases intra-abdominal and intra-thoracic pressure, and temporarily increases blood pressure; especially, during a max-effort attempt. This acute elevation in blood pressure increases the strain on the blood vessels of the nasal cavity and can result in them bursting, leading to a nosebleed.

A study looking at the Influence of Breathing Technique on Arterial Blood Pressure During Heavy Weight Lifting showed that a group of athletes with an average resting blood pressure of 127/80, temporarily increased their average blood pressure to 311/284 during a max-effort leg press.

The difference between the leg press in the study and powerlifting is that powerlifting requires more full-body tension to complete the lift because there is nothing holding us in position; whereas with the leg press, we are supported.  Therefore, powerlifting would likely generate a higher blood pressure reading than that of the leg press.

Although the blood pressure values may seem daunting, the Valsalva Maneuver has been proven to be a safe technique for most individuals, apart from those with a high risk of heart disease. 

If you’re interested in more differences between the leg press and squat, check out my article on Leg Press vs Squat

Want to get advice on programming, technique, or competing? Speak with one of our coaches.

2. Powerlifting Gear

wearing compressive gear in powerlifting can cause nosebleeds
Equipped powerlifting can be a cause of nosebleeds

There are two types of gear that can cause nosebleeds in powerlifting:

Compressive Gear 

Powerlifters sometimes use compressive gear like belts, knee wraps, and squat suits to help them generate more rigidity and trunk stability while lifting.

The increased pressure on the intra-thoracic and intra-abdominal cavities caused by bracing against a belt coupled with other compression gear that restricts blood flow, causes a rise in blood pressure. The result of which increases pressure of the blood vessels in the nasal cavity and could cause them to burst if they are pushed beyond their limits.

Need some belt recommendations?  Check out my article on the Best Powerlifting Belts.

Smelling Salts (Ammonia)

Some lifters use smelling salts to “get hyped-up” before a max-effort lift and can cause nosebleeds. 

The smelling salts work by irritating the lining of the nasal cavity, which triggers a breathing reflex to try and clear the nasal passage of the inhaled substance. This process makes the lifter become more alert.

Smelling salts do have the potential to deteriorate the nasal membranes over time, which would increase the risk of nosebleeds while lifting. The deteriorating effects of ammonia only occur over time with frequent, heavy doses.

Interested in powerlifting gear? Check out our Top Recommendations for Competition Gear

3. Lifestyle Factors

Having a high resting blood pressure, known as “Hypertension” significantly increases our risk of nosebleeds while lifting.

With hypertension, we would already have an elevated resting blood pressure; therefore, a higher baseline of pressure. This is important because during a max-effort lift we know that we will naturally increase blood pressure further by bracing properly and exerting force against the barbell.

The range at which we could increase our blood pressure without pushing the limits of the smaller vessels of the nose, would be less for someone with hypertension because of a higher baseline of pressure.

Those with normal blood pressures would have more “wiggle-room” to increase pressure because they are starting from a lower baseline pressure.

This is also one of the factors that I discussed on Why Lifters Pass Out From Deadlifts.

4. Environmental Factors

The environment we train in and/or compete in can put us at a higher risk of a nosebleed because of the impact on the nasal cavity. 

Dry air and high-altitudes can cause the nasal lining to dry out and become irritated.

The lack of moisture in the nasal cavity increases the risk of nosebleeds by creating tears in the nasal lining when the tissues are being stressed, as they would be while lifting maximal loads.

Is Getting Nose Bleeds While Lifting Bad?

Nose bleeds caused by lifting are not common, and the majority of lifters will not experience them. However, if you are one of the lucky few, then don’t panic. Most of the time, nosebleeds are not a medical emergency and they will resolve on their own.

That being said, it does become a medical emergency if you experience any of the following:

  • Non-stop bleeding for more than 20 minutes
  • Significant blood loss (leading to fatigue, confusion, light-headedness)
  • Headache or mental confusion
  • Tasting blood even with the head tipped forward

If you experience any of these symptoms you should seek medical attention.

If medical attention is required, there are two procedures that the medical professional may use to help stop the bleeding:

1. Cautery

With this procedure, the doctor will spray a local anesthetic, locate the vessel that is bleeding, and use a chemical to cauterize (burn) the area to seal it.

2. Nasal Packing

This procedure is most often used when cautery fails or the doctor is unable to locate the source of the bleed.

The medical professional will pack the area with gauze or nasal sponges to maintain pressure on the wound, and leave the packing in for 24-48 hours. This normally requires being admitted for monitoring, until the situation has been resolved.

4 Ways to Avoid Getting Nose Bleeds While Powerlifting

4 ways you can prevent getting nosebleeds from powerlifting

The 4 ways you can prevent getting nosebleeds from powerlifting are: 

1. Program Design

Having a coach who is knowledgeable, and provides you with a well-written program can help prevent frequent nosebleeds while powerlifting.

A good program should be mainly focused on increasing work capacity, improving technique, and “peaking” (or maxing-out) only when appropriate.

Maxing out too often can increase the risk of nosebleeds because we would be putting too much stress on the blood vessels of the nose too frequently, and they may not be able to fully repair.

2. Stay Hydrated

Prioritizing water intake can help prevent nose bleeds by maintaining adequate moisture in the nasal cavity and preventing nasal tissues from drying out and becoming more susceptible to bleeds.

3. Lifestyle Modifications

Lowering blood pressure through exercise and nutritional interventions could help to decrease the risk of nosebleeds, by reducing the baseline from which it rises.

Herkner et al., (2000) tells us that even without lifting, patients with chronic high blood pressure had significantly more episodes of epistaxis (nose bleeds), compared with patients with epistaxis and no chronic high blood pressure.

Decreasing our resting blood pressure to a normal or “low-risk” range (120/80 mmHg) can give us the “wiggle-room” to increase blood pressure while lifting, and minimize the chances of a nosebleed.

4. Supplementation

Proper supplementation of vitamins and minerals that control coagulation of the blood, can minimize nosebleeds by ensuring that our bodies are maintaining an appropriate blood plasma density.

Vitamins deficiencies that can be responsible for lack of coagulation are: vitamin K, vitamin C, some of the B vitamins and iron to name a few. If we are deficient, nosebleeds can become more medically significant because of the potential to lose too much blood.

What To Do If You Have a Nose Bleed While Lifting

Finish the lift first!

But seriously, if you’re lifting and your nose starts to bleed you want to:

  • Use your thumb and index finger to pinch the soft part of your nose
  • Sit tall and tilt your head forward (NOT back)
  • Grab tissue or a towel to catch the blood
  • Optional: apply ice to the bridge of your nose to constrict blood vessels
  • Avoid strenuous lifting to promote recovery
  • Avoid blowing your nose until the wound has fully healed

Remember to keep track of the amount of blood lost, and how long it has been bleeding for, in case it does become of medical concern.

Can Anyone Get a Nose Bleed while Lifting or Just Powerlifters?

Any lifter, recreational or competitive, has the potential to get a nose bleed when lifting max-effort loads. This is because the same principles of blood pressure apply regardless of whether we compete or not.

Are Certain Lifts Worse Than Others For Causing Nosebleeds?

Performing a certain lift does not directly relate to having a nosebleed; however, there does seem to be a higher risk of a nosebleed occurring during the squat and deadlift.

This is because the squat and deadlift require maximal contractions of large musculature to move challenging weights. Because these lifts involve stronger musculature, we can usually lift heavier weights with these lifts, which requires increased intra-thoracic and intra-abdominal pressures to keep the weight from breaking down our technique.

A study by Palatini et al., focusing on the blood pressure changes that occur with heavy resistance training, tells us that these pronounced increases in intra-thoracic and intra-abdominal pressures are a major determinant of blood pressure elevation.

The more pressure required to maintain the technique and lift the weight, the more chance there is for a nosebleed.

Final Thoughts

Nosebleeds in Powerlifting are a rare occurrence, and the reasons why Powerlifters get nosebleeds are almost all related to the same mechanism: Blood Pressure.

It should be noted that the use of the valsalva maneuver and powerlifting gear are not inherently bad, but when coupled with hypertension it could increase the risk of a nosebleed.

If you are someone who deals with nosebleeds while lifting, you may want to adjust your program, focus on lowering your resting blood pressure, and maybe chat with a professional if this is becoming a regular occurrence.

Related Article: Does Weightlifting Cause Acne?