Valsalva Breath Holding in Lifting: Is It Safe for Women? The Pros, the Cons, and What Your Pelvic Floor Might Say
In the world of strength training, few techniques are as powerful—or as misunderstood—as the Valsalva manoeuvre. This breath-holding technique is frequently used in resistance training to create intra-abdominal pressure (IAP) and support the spine under load.
But while it's hailed by some experts as a vital performance tool, others warn that in women—especially those postpartum or with pelvic floor dysfunction—it can backfire.
So, what’s the truth? Let’s explore both sides.
💪 The Positives: Support, Strength, and Spinal Stability
with insights from Dr. Christina Prevett, Barbell Mamas
Dr. Christina Prevett, a pelvic health physio and strength coach, has been leading the charge in helping women lift safely and powerfully. Her take? The Valsalva breath hold is not the enemy—it’s an advanced strategy that works when used intentionally.
“The Valsalva creates intra-abdominal pressure that supports the spine under heavy load. Avoiding it in high-level lifting can actually increase injury risk because you lose core integrity.” — Dr. Christina Prevett
Rather than bracing with brute force, Dr. Prevett teaches cues that create tension without downward pressure:
🫁 “Inhale, hold, and draw your collarbone down.”
🥊 “Inhale, hold, and visualise being punched in the belly.”
These cues activate the deep core and—when executed well—often recruit the pelvic floor reflexively. That’s because as the diaphragm descends on inhale, intra-abdominal pressure increases, and in a coordinated system, the pelvic floor lengthens and then responds with a subtle upward lift.
This is supported anecdotally by many coaches and lifters who describe a sense of pelvic containment or lift during a well-executed brace.
⚠️ The Negatives: When Pressure Misfires
But this strategy isn’t universally appropriate. Experts like Michelle Lyons, Antony Lo, and many pelvic health physiotherapists caution against its blanket use—especially in women who haven’t rebuilt their functional canister post-birth or injury.
“We have to earn our pressure strategies. If we add high intra-abdominal pressure to a system with weak or unresponsive pelvic floors, we risk descent, leakage, or even prolapse.” — Michelle Lyons
“It’s not about fear-mongering, but matching the breath strategy to the task.” — Antony Lo
🔻 In those with poor core-pelvic floor coordination, the pressure created by the Valsalva can:
Push downward, toward the perineum
Cause or worsen symptoms of prolapse or incontinence
Be held in the belly or chest, bypassing the functional bracing mechanism
Create habits of breath-holding under stress, even in daily movement
This is especially common postpartum or in women returning to lifting without adequate breath, alignment, or pelvic floor rehab.
🔬 Science Says: What Kari Bø’s Research Reveals
If you’ve been around the pelvic health world, you’ll know the name Professor Kari Bø. Her groundbreaking research has changed how we understand pelvic floor loading and breath mechanics.
In one of her foundational studies, Bø measured intra-abdominal pressure during various exercises and found that:
Valsalva manoeuvre generated some of the highest IAP levels—exceeding those found in coughing or jumping (Bø et al., 2006).
A study comparing elite female powerlifters to controls revealed that:
Some powerlifters showed decreased levator ani function, even without symptoms of incontinence.
Others displayed excellent pelvic floor control, suggesting that individual variability matters (Bø et al., 2013).
Later reviews concluded that:
Women engaging in heavy resistance training should be screened individually for pelvic floor risk factors, and intra-abdominal pressure strategies should be tailored to their function, not fear (Bø & Nygaard, 2020).
This supports what many practitioners—myself included—have long observed: strength doesn’t equal safety if pressure is misdirected or mismanaged.
⚖️ The Middle Ground: Co-ordination First, Pressure Second
The solution isn’t to fear the Valsalva. It’s to build up to it—like any other skill.
Before using Valsalva in lifting, ask yourself (or your clients):
✅ Can I feel my pelvic floor rise, not descend, when I brace?
✅ Can I control where the pressure goes in my body?
✅ Am I leaking, straining, or holding my breath without control?
✅ Have I rebuilt my breathing mechanics, core strength, and alignment first?
Breath strategies like Hypopressives, 360° DNS-based breathing, or exhale-on-effort are great alternatives in rehab and early strength phases.
🧠 Want to Know How Your Breath and Core Are Really Working?
I’ve created a quick Pelvic Floor & Breath Self-Check questionaire you can download to explore how your body is responding to load and pressure:
👉 Download the Self-Check Here
💬 Ready to Train Smarter, Not Just Harder?
If you’ve ever wondered whether your breath is supporting or sabotaging your pelvic floor during exercise, my Pelvic Floor MOT is the place to start. For just £48, I’ll review your breath, posture, and pelvic floor strategy via video analysis and personalised feedback.
🔎 This isn’t just a check-up—it’s a game-changer.
💌 Book yours here or drop me a message.
📚 References
Bø, K., Berghmans, B., Mørkved, S., & Van Kampen, M. (2006). Evidence-based physical therapy for the pelvic floor. Elsevier Health Sciences.
Bø, K., Frawley, H. C., Haylen, B. T., Abramov, Y., Almeida, F. G., Berghmans, B., ... & Dumoulin, C. (2013). An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourology and Urodynamics, 36(2), 221–244.
Bø, K., & Nygaard, I. (2020). Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Medicine, 50(3), 471–484
