In Parts 1 and 2 of this article series, Paul touched on the history of weight belt use, discussed the inner unit and our body’s ability to stabilize itself using different mechanisms, and Paul demonstrated that the typical reasons people give for using a belt are invalid and may be predisposing them to a future injury. In this final installment, Paul helps you to wean yourself off of the belt, safely!
HOW TO BE BACK STRONG AND BELTLESS!
The worst thing someone could do is discontinue the use of a belt cold turkey! If you have been using a back belt or weight lifting belt for more than a month, chances are very good that your abdominal recruitment patterns have been altered. Your TVA and posterior IO are now likely sitting on the couch, relaxing, favoring use of your rectus abdominis and external obliques as the primary stabilizers of the trunk in concert with the erector spinae muscles.
If you have been using a belt for several months or even years, particularly if you have had or currently experience any low back pain, chances are very good that you have sensory-motor amnesia of the deep abdominal wall. If you remove your belt and go back to your normal Herculean performances in the gym or start packing power tools around the construction site, chances are very good you will be purchasing a new Mercedes for your doctor or orthopedic surgeon, real soon!
When you take the belt off and begin working or lifting, your brain will sequence the muscles as though you were lifting with the belt. When your nervous system recruits the rectus abdominis and erector spinae at greater intensity as learned when wearing the belt, you are likely to have increased compression, torsion and/or sheer in one or more segments of your lumbar spine without the hoop tension provided by the belt.
Additionally, a correlation of my clinical findings among athletes that wear belts and have experienced hamstring injury is supported by research. Lander et al. found that while using weight-belts, there was increased EMG activity of the vastus lateralis and biceps femoris. This is logical when considering the intimate relationship that exists between the biceps femoris and the TVA via the thoracolumbar fascia system as an integral part of what is called the "deep longitudinal system" by Gracovetsky (Figure 14).
Figure 14. The Deep Longitudinal System
Adopted from Gracovetsky and Lee, the Deep Longitudinal System illustrates the working relationship between the TVA as a stabilizer of the pelvis (A), the sacrotuberous ligament (B), the peroneus longus and biceps femoris (C) and the erector spinae musculature (D). In the late swing phase of gait, dorsiflexion of the foot in preparation for heel strike generates tension in the peroneus longus. Vleeming (7) indicates that approximately 18 percent of that force is transferred into the biceps femoris, which works to tension the sacrotuberous ligament, stabilizing the sacrum and ilium at heel strike. The erector spine musculature serve to dissipate kinetic energy through rotary action on the spinal column prior to reaching the cranium. This mechanism may explain the high correlation between biceps femoris injury in lifters using belts and sprinters with TVA dysfunction; theoretically, the biceps may be working to tension the thoracolumbar fascia system to compensate for inadequate action of the TVA.
If the belt user has developed the habit of responding to the exteroception provided by the belt by pushing the abdominal wall outward (which will inhibit the TVA), then it is very likely the brain may up-regulate the recruitment of the biceps femoris in an attempt to stabilize the thoracolumbar fascia. This can be done by the biceps femoris because of its intimate relationship with the thoracolumbar fascia via the sacrotuberous ligament. Having treated numerous biceps femoris injuries in weight lifters and athletes performing in sports requiring explosive movement, I have witnessed a strong correlation between sensory-motor dysfunction of the deep abdominal wall, an inability to stabilize the lumbopelvic region and biceps femoris injury.
Additionally, a study titled, "The effect of industrial back belts and breathing technique on trunk and pelvic coordination during a lifting task," that "phase angles" (relationships) between the pelvis and lumbar spine during the initial phase of lifting tasks were altered among belt users. The researchers concluded "the change in segmental kinematics was similar to that previously reported for patients with a history of low back pain." What this means is that if you stop belt use cold turkey, or even forget your belt one day, not only will your motor sequencing be aberrant, but the relative timing of joint movements will also be faulty. This is a formula for disaster!
THE FORMULA FOR FREEDOM FROM BELTS
To begin, you must assess your TVA strength and function as described below in "Find the Weakness and Kill It!" Once you have achieved the ability to recruit your deep abdominal wall and you have restored normal lower abdominal coordination, it is then safe to begin weaning yourself off the belt.
After performing the test procedures described below and correcting any deficits, start by only wearing your belt with lifts of greater than 80 percent intensity (eight rep max or heavier). For some of you, this may mean only performing your warm-up sets without the belt. For those of you that don’t normally lift at higher than 75 percent maximum intensity (12 reps), you may want to begin by only performing your warm-up sets without the belt. The next step would be to take the belt off during your first working set, and so on. After two weeks of training, while continuing to use the abdominal retraining techniques described below, remove the belt for all exercises at an additional five percent intensity or two reps closer to your maximum. Continue this progression for four to eight weeks. If your beltless performances match your previous lifts with a belt, you may safely drop the belt forever.
Please note: If you have any pain in the region of the back from T7-S3, it is very important not to try weaning yourself off the belt without professional guidance. Consult a qualified physical therapist that understands strength training. Pain in any spinal segment between T7 and S3 or anywhere in the lumbopelvic region can inhibit the transversus abdominis and pelvic floor musculature, leaving you susceptible to injury.
Find the Weakness and Kill It!
A chain is only as strong as its weakest link, and your body is no different. The first step toward developing a belt free body and toward reestablishing function of your own natural lumbar corset is to test it. Using a blood pressure cuff, you can test the TVA for proper function (Figure 13). If your TVA function is normal, you should be able to reduce the pressure in the BP cuff by 10 mmHg without any movement of your spine, without flexing your hips or pressing your shoulders into the floor. You can safely consider that for each 1 mmHg less than 10 mmHg you de-pressurize the cuff, you have a 10 percent loss of function. For example, if you could only reduce the BP cuff pressure 5 mmHg, you are probably about 50 percent deficient in TVA function.
Should you find your level of function is less than 100 percent, I strongly recommend you follow the exercise progressions described in Table 1. For those of you who need to condition for improved neuromuscular isolation of the muscle as dictated by your test results, the test becomes the exercise. As indicated in Table 1, you should progress until you can de-pressurize the cuff by 10 mmHg for 100 seconds without rest.
TABLE 1. TRANSVERSUS ABDOMINIS CONDITIONING
-10 mm Hg
-10 mm Hg
-10 mm Hg
=/> 100 s.
Some of you, particularly females, may have a hard time getting your TVA to fire. This is likely to be the case for anyone with a history of back pain, anyone currently experiencing back pain or anyone who has given birth to one or more children. To jump start the TVA, I use the "4 Point TVA Exercise" demonstrated in Figure 15 A-B. The 4 Point TVA Exercise works very well because when you are on all four points, gravity is pulling your viscera downward into your abdominal wall, stretching the deep abdominal wall muscles. The stretch excites the spindle cells of the muscle, increasing awareness of the deep abdominal wall in the sensory-motor cortex. This aids in recruiting the muscle when afflicted with sensory motor amnesia.
Figure 15. The 4 Point TVA Exercise
- Positioned on your hands and knees with neutral spinal alignment, inhale deeply. Be sure to use a diaphragmatic breathing pattern. This means that as you inhale, your umbilicus should move away from your spine and your belly should relax and expand.
- To exercise the TVA, as you exhale through pursed lips, draw the umbilicus toward the spine. Draw the umbilicus as close to your spine as possible, holding the TVA contraction for 10 seconds. If you need to breathe during the ten-second contraction, try to hold the umbilicus inward toward the spine while you do so. Always preface each contraction with a diaphragmatic breath, repeating the cycle as described here. Ten repetitions, holding each for 10 seconds would constitute one set. Work up to three sets with one minute rest between them.
Once you have performed the 4 Point TVA Exercise every day for a week, retest yourself with the BP cuff. While you are working on your deep abdominal wall, you can also be working on your lower abdominal strength and coordination.
LOWER ABDOMINAL COORDINATION TESTING
Belt use has been shown to alter the natural recruitment patterns of the abdominal wall, favoring the rectus abdominis, erector spinae and potentially disrupting recruitment sequences in the legs. It is therefore no surprise that belt users frequently present with aberrant coordination in the abdominal wall when assessed clinically.
It is very common for belt users to have reduced ability to control sacral base inclination or pelvic tilt. This is another common challenge I must work through with back pain patients. Inability to control sacral base inclination can cause instability of the sacroiliac joints, particularly during forward bending activities. Clinically, I have found inability to control sacral base inclination is also commonly related to such spinal pathology as spondylolistheses, spondylolysis, spinal instability and disc herniation.
To test yourself, lay on your back and place your hands under your spine (palms down). When your fingertips are just behind your umbilicus (L3), flex your hips to 90 degrees and keep your knees fully relaxed (see Figure 16). From this position, roll your pelvis posteriorly until you can feel the spinous process of your spine pressing on your fingers. Now, while holding the pressure on your fingers with your spine, begin lowering your feet to the floor, always keeping the knees fully bent. If you have normal lower abdominal coordination, you should be able to slowly lower your feet to the floor and bring your legs back to the point of 90 degrees hip flexion without the pressure of your spinous processes at the L3 level ever coming off your fingers.
Figure 16. Lower Abdominal Coordination Testing
If you are unable to hold consistent pressure while lowering and raising the legs as described, it is very likely that you have facilitated hip flexors. A very simple approach to correcting the problem is to stretch your hip flexors and repeat the test. If your test is now normal, it is an indication that you should stretch your hip flexors to reestablish normal recruitment pathways before doing any heavy lifting. If you stretch your hip flexors and you are still unable to pass the test, then it is likely you have developed a faulty motor engram (recruitment pattern). Restoration of normal motor control in the lower abdominal region is complex and beyond the scope of this article.
THE WORLD’S GREATEST WEIGHT BELT!
Once you have passed the lower abdominal coordination test and can decompress the BP cuff for 100 seconds or longer at 10 mmHg less than where the needle started, it is time to integrate your deep abdominal wall into your general movement schema and gym exercises.
It is well documented that coordinative patterns of the abdominal wall are task specific. For example, one may have normal abdominal wall function during a squat pattern but not a push pattern. Additionally, loss of abdominal wall coordination is easier to prevent than to restore. This should give those of you considering use of a weight belt adequate reason NOT TO!
What is a good idea, is to use what I call "the worlds greatest weight belt". It is simply a piece of kite string. Place the kite string around your waist at the belly button level. Exhale and draw your belly button in slightly, just enough to notice that it has moved toward your spine and that you now have more definition along the oblique line. With the string snug around your belly now, tie the string in a knot.
As you perform your exercises in the gym, you should always inhale and draw your umbilicus off the string prior to exerting any force. This teaches the brain to activate the TVA first. If you are lifting any significant load, you will cross the stabilization threshold, at which time you will go from segmental to gross stabilization. This will be identified as visually observable activation of the external oblique and rectus abdominis. When the load is heavy enough, you will notice that no matter how hard you try, you cannot keep the string lose around your torso. If you progressively reduce the weight, you will eventually cross back under the stabilization threshold, which will be identified by your ability to perform the lift and keep the string lose.
It is very important to perform enough low intensity lifting to train the brain to always recruit the deep abdominal wall before recruiting the outer unit, or outer muscles which function as gross stabilizers.
To best condition your body, it is important to focus first on learning to activate the abdominal wall while performing what I call "Primal Patterns." Primal Patterns are the movement patterns most likely to have been necessary for our developmental survival as dictated by the selective pressures of nature. The Primal Patterns are:
- Gait (walk, run and sprint)
All these patterns, to be true Primal Patterns, must be performed from a standing position. If this is not possible, then you will need the help of an exercise or rehabilitation professional to assist you in learning how to correctly perform the sequencing and development of the movements.
Once you have implemented the training techniques described here, you will be free from training with the belt and have full confidence that your body now works correctly. If you have any orthopedic problems at all, it would be wise to consult a skilled rehabilitation professional that understands the science of corrective exercise to aid you in your quest to be "BACK STRONG AND BELTLESS!"
In this article, I discussed several legitimate considerations regarding chronic use of corsets, back belts and weight lifting belts. Available research clearly demonstrates that belts are unable to stabilize the spine at a segmental level, therefore only stabilizing the torso. Gross stabilization, as provided by belts, may allow you to lift more weight than you could without the belt, indicating a stabilizer dysfunction within your body. The increased weight being lifted as afforded to the lifter by the belt will likely serve to traumatize the spine due to increased levels of compression, torsion and sheer, increasing the potential for a serious injury.
Caution should be exercised by those using belts to increase "proprioception," as a belt is clearly a form of "exteroceptive stimuli." When the belt is removed, is likely to have accomplished little in improving proprioception, leaving the lifter with an increased risk of injury secondary to belt usage. My clinical treatment of workers and athletes with spine injuries has shown that chronic use of weight lifting belts and back belts is highly correlated with sensory-motor amnesia of the deep abdominal. Finally, weaning yourself off a belt must be done carefully and in concert with evaluation and treatment of any stabilizer deficit found in the torso.
- Abreu B.C. Physical Disabilities Manual. (pp 137) New York: Raven Press, 1981.
- Acta Physiol Scand 1992, 144, 409-418.
- Aruin S.A., Latash M.L. Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res (1995) 103:323-332.
- Axelsson P., Johnsson R., Stromqvist B. Effect of lumbar orthosis on intervertebral mobioity. A roentgen sterophotogrammetric analysis.
- Bauer J.A., Fry A., Carter C. The Use of Lumbar Supporting Weight Belts While Performing Squats: Erector Spinae Electromyographic Activity.
- Bogduk N., Towmey L.T. Clinical Anatomy of the Lumbar Spine (2nd. Ed.).
- Bogkuk, N. Clinical Anatomy of the Lumbar Spine and Sacrum 3rd. ED.
- Bourne N.D., Reilly T. Effect of a weightlifting belt on spinal shrinkage.
- Br J Sports Med 1991 Dec;25(4): 209-12.
- Brownstein B., Bronner S. Functional Movement – In Orthopedic And Sports Physical Therapy New York, London, Edinburgh, Melbourne, San Francisco, Tokyo: Churchill Livingstone, 1997.
- Charles C Thomas, 1951.
- Chek P. Advanced Program Design (Correspondence Course) Encinitas, CA: C.H.E.K Institute, 1998.
- Chek P. Core Conditioning Volume 1 Part 1 – The Gym Instructor Series
- Chek P. Corrective and High-performance Exercise Kinesiology Certification Manual – Level II (four year internship program course manual) Encinitas, CA: C.H.E.K Institute.
- Chek P. Equal But Not the Same – Considerations for Training Females (correspondence course) Encinitas, CA: C.H.E.K Institute.
- Chek P. Scientific Back Training.
- Chek P. Scientific Core Conditioning.
- Cholewicki J., Juluru K., McGill S. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. Journal of Biomechanics 32 (1999) 13-17.
- Cholewicki J., Juluru K., Radebold A., Panjabi M.M., Magill S.M. Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure. Eur Spine J 1999;8(5): 388-95.
- Cholewicki, J., Juluru, K., McGill, S. Intra-abdominal Pressure Mechanism for Stabilizing the Lumbar Spine. Journal of Biomechanics 32 (1999) 13-17.
- Ciriello V.M., Snook S.H. The effect of back belts on lumbar muscle fatigue.
- Cresswell A.G., Grundstrom H., Thorstensson A. Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man.
- Dart R.A. The Double-Spiral Arangement Of The Voluntary Musculature In The Human Body. Surgeons’ Hall Journal Vol. 10, No. 2. Oct. 1946 – March 1947.
- DonTigny R.L. Function of the Lumbosacroiliac Complex as a Self-Compensating Force-Couple with a Variable-Dependent Transverse Axis: A Theoretical Analysis. Journal of Manual and Manipulative Therapy Vol. 2:3, 87-93.
- Drechsler A. The Weightlifting Encyclopedia: A Guide To World Class. Whitestone, New York: Performance A is A Communications, 1998.
- Ed by: Vleeming A., Mooney V., Snijders C.J., Dorman T.A. and Stoeckart R. Movement, Stability & Low Back Pain – The Essential Role of the Pelivs. New York, Edinburgh, London, Madrid, Melbourne, San Francisco and Tokyo:
- Fortin J.D. Weight Lifting (Ch. 45, p. 496) In: Watkins R.G., The Spine In Sports St. Louis: Mosby, 1996.
Gill K.P., Callaghan M.J. The Measurement of Lumbar Proprioception in Individuals With and Without Back Pain. Spine Vol. 23, No. 3, pp 371-77.
- Gracovetsky, S. The Spinal Engine. Wien, New York: Springer-Verlag, 1988.
- Hanna T. Somatics: Reawakening the Mind's Control of Movement, Flexibility, and Health. Cambridge, Massachusetts: Perseus Books, 1988.
- Hodges P. Richardson C., Jull G. Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiother Res Int 1996;1(1):30-40.
- Hodges P. W., Richardson C.A. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res (1997) 114:362-370.
- Hodges P.W., Richardson C.A. Contraction of the Abdominal Muscles Associated With Movement of the Lower Limb. Physical Therapy. Vol. 77 No. 2 February, 1997.
- Hodgson E.A. Occupational back belt use: a literature review. AAOHN J 1996 Sep;44(9): 438-43.
- In: Korr I.M. (Ed.) The Neurobiologic Mechanisms in Manipulative Therapy.
- Janda V. Muscles, Central Nervous Motor Regulation and Back Pain. (27-41)
- Kegel A.H. Progressive Resistance Exercise In The Functional Restoration Of The Perineal Muscles. American Journal of Obstetrics and Gynecology August, 1948.
- Keith A. Menders Of The Maimed – The Anatomical & Physiological Principles Underlying The Treatment Of Injuries To Muscles, Nerves, Bones & Joints. Robert E. Kreiger Publishing Co, 1975.
- Lahad A., Malter A.D., Berg A.O., Deyo R.A. The effectiveness of four interventions for the prevention of low back pain. JAMA 1994;272:1286-91.
- Lander J.E., Hundley J.R., Somonton R.L. The effectiveness of weight-belts during multiple repetitions of the squat exercise. Medcine and Science In Sports and Exercise 1992 May;24(5):603-9.
- Lander J.E., Simonton R.L., Giacobbe J.K.F. The effectiveness of weight-belts during the squat exercise. Medicine and Science in Sports and Exercise Vol. 22, No. 1 Feb. 1990 pp 117-26.
- Lee D. The Pelvic Girdle (2nd. Ed.) – An Approach to the Examination and Treatment of the Lumbo-Pelvic-Hip Region. Edinburgh, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 1999.
- Lovett, R. Lateral Curvature of the Spine and Round Shoulders Philadelphia: P. Blakiston’s Son & Co., 1912.
- Majkowski G.R., Jovag B.W., Taylor B.T., Taylor M.S., Allison S.C., Stetts D.M., Clayton R.L. The Effect of Back Belt Use on Isometric Lifting Force and Fatigue of the Lumbar Paraspinal Muscles. Spine Vol. 23, No. 19, pp 2104-2109, 1998.
- McGill S.M., Norman R.w., Sharratt M.T. The effect of an abdominal belt on trunk muscle activity and intra-abdominal pressure during squat lifts.
- McGorry R.W., Hsiang S.M. The effect of industrial back belts and breathing technique on trunk and pelvic coordination during a lifting task. Spine 1999 Jun 1;24(11):1124-30.
- Miller R.A., Hardcastle P., Renwick S.E. Lower spinal mobility and external immobilization in the normal and pathologic condition. Orthop Rev 1992 Jun;21(6):753-7.
- Mitchell L.V., Lawler F.H., Bowen D., Mote W., Asundi P., Purswell J. Effectiveness and cost-effectiveness of employer-issued back belts in areas of high risk for back injury. J Occup Med 1994 Jan;36(1):90-94.
- Miyamoto K., Iinuma N., Maeda M., Wada E., Shimizu K. Effects of abdominal belts on intra-abdominal pressure, intra-muscular pressure in the erector spinae muscles and myoelectrical activities of trunk muscles. Clinical Biomechanics, Feb. 1999 14(2): 79-87.
- National Institute for Occupational Safety and Health. Workplace use of back belts: Review and recommendations. Rockville, MD: Department of Health and Human Services (National Institute of Occupational Safety and Health) Publication No. 94-122, 1994
New York and London: Plenum Press, 1978.
- Norris C.M. Functional load abdominal training: part 1. Journal Of Bodywork And Movement Therapies July 1999
- Reyna J.R., Leggett S.H., Kenny K., Holmes B. and Mooney V. The Effect of Lumbar Belts on Isolated Lumbar Muscle Strength and Dynamic Capacity. Spine Vol. 20 No. 1 pp 68-73, 1995.
- Richardson C., Jull G., Hodges P. and Hides J. Therapeutic Exercise For Spinal Segmental Stabilization In Low Back Pain – Scientific Basis And Clinical Approach. London, New York, Philidelphia, Sydney, Toronto: Churchill Livingstone,1999.
- Richardson C.A., Jull G.A. Muscle control – pain control. What exercises would you prescribe? Manual Therapy(1995) 1, 2-10.
Smith E.B., Rasmussen A.A., Lechner D.E., Gossman M.R., Quintana J.B. The effects of lumbosacral support belts and abdominal muscle strength on functional lifting ability in healthy women. Spine 1996 Feb 1;21(3):356-66.
- Spine 1992 Jun;17(6): 678-81.
- Spine 1995 Jun 1;20(11):1271-8; discussion 1278.
- Steadman’s Medical Electronic Dictionary. Baltimore, MD: Williams & Wilkins, 1996.
- Steindler, A. Post-Graduate Lectures on Orthopedic Diagnosis and Indications
- Teoriya I Praktika Fizicheskii Kultury 3:15-17, 1987.
- Thomas J.S., Lavender S.A., Corcos D.M., Andersson G.B. Effect of lifting belts on trunk muscle activation during a suddenly applied load. Hum Factors 1999 Dec;41(4): 670-6.
- Waddell, G. The Back Pain Revolution. New York: Churchill Livingstone, 1998.
- Webster, D. The Iron Game. Scotland: John Geddes Printers Irvine, 1976.
- White, A. and Panjabi, M. Clinical Biomechanics of the Spine 2nd. ED. J.B. Lippincott Co., 1990.
- Wirhed, R. Athletic Ability & the Anatomy of Motion. Wolfe Medical Publications Ltd., 1984.
- Zatsiorskii V.M., Sazanov V.P. A Waist-Corset For Decreasing The Risk Of Injury To The Spine When Lifting Weights And Doing Strength Exercises.
- Ziglar Z. How To Stay Motivated. (tape series) . Carrollton, TX: The Zig Ziglar Corp.