7 AW-A9 783 EFFECTS OF A BELT ON INTA-ASOOMINAL PRESSURE OWING 1/1

IWISET LIFTINO(U) RMY RESEARCH INST OF ENVIRONMENTAL

IEDICINE MUTCK "A E A NHtHAN ET AL. MAR U9
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11. TITLE (Include Security Classification)
Effects of a belt on intra-abdominal pressure during weight lifting
12. PERSONAL AUTHOR(S)
Everett A. Harman, Richard M. Rosenstein, Peter N. Frykman and George A. Nigro
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FIELD GROUP SUB-GROUP Respiratory Mechanics, Force Plate, Ground Reaction Forces,
Safety
I Esophogeal Trandsucer, Support,
19. ABSTRACT (Continue on reverse if necessary and identify by block number)
Intra-abdominal pressure (lAP) has been widely hypothesized to reduce potentially injurious b
compressive forces on spinal discs during lifting. To investigate the effects of a standard
lifting belt on lAP and lifting mechanics, lAP and vertical ground reaction force (GRF) were
monitored by computer using a catheter transducer and force plate while 9 subjects aged
28.2+6.6 yrs. dead-lifted a barbell both with and without a lifting belt at 90% of maximum.
Both-IAP and GRF rose sharply from the time force was first exerted on the bar until shortly
after it left the floor, after which force usually plateaued while IAP either plateaued or
declined. lAP rose significantly (p(.05) earlier with than without the belt. When the belt Ak
was worn, but not without it, lAP rose significantly earlier than did GRF. For both condi- 0
tions, lAP reached plateau significantly sooner than did GRF. Variables significantly higher
with than without a belt included peak TAP, area under the TAP vs. time curve from start of
TAP rise to lift-off, peak rate of lAP increase after start of IAP plateau, and average
pressure from lift-off to lift completion. In contrast, average rate of IAP increase before

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 01011

SCIENTIFIC PAPER

Title: Effects of a belt on intra-abdominal pressure during weight lifting

Running head: Weight lifting belt and intra-abdoninal pressure

* Authors: Everett A. Harman, Richard M. Rosenstein, Peter N. Frykman

and George A. Nigro

Study site: Exercise Physiology Division

U.S. Army Research Institute of Environmental Medicine
Natick, MA 01760

Corresponding author:

Everett Harman
Exercise Physiology Division
USARIEM

Natick, MA 01760
Phone: 617-651-46888

d.~~ ~Q ODR461- r - - -
Effects of a belt on intra-abdominal pressure during weight lifting

Accession For
NTIS GRA&I
I)TIC TAB E
LUnanounced E
mill Justification.

0"PCE By
Distribution/_
Availability Codes
Dist
Avail and/or
Special
 2

ABSTRACT

Intra-abdominal pressure (IAP) has been widely hypothesized to reduce

potentially injurious compressive forces on spinal discs during lifting. To
investigate the

mechanics, IAP and

effects

vertical
of a standard

ground reaction
lifting

force
belt on IAP and lifting

(GRF) were monitored by

!
computer using a catheter transducer and force plate while 9 subjects aged

28.2 6.6 yrs. dead-lifted a barbell both with and without a lifting belt at
90% of maximum. Both IAP and GRF rose sharply from the time force was first
exerted on the bar until shortly after it left the floor, after which force
usually plateaued while IAP either plateaued or declined. IAP rose
significantly (p(.05) earlier with than without the belt. When the belt was
worn, but not without it, IAP rose significantly earlier than did GRF. For
both conditions, IAP reached plateau significantly sooner than did GRF.

Variables significantly higher with than without a belt included peak IAP,
area under the IAP vs. time curve from start of IAP rise to lift-off, peak
rate of IAP increase after start of IAP plateau, and average pressure from
lift-off to lift completion. In contrast, average rate of IAP increase before

start of IAW plateau was significantly lower with the belt. Correlations
provide additional information about relationships between variables. Results
suggest the use of a lifting belt increases IAP, which may reduce disc
compressive force and improve lifting safety. ; ulr 1-'

/I
RESPIRATORY MECHANICS FORCE PLATE, GROUND REACTION FORCES, ESOPHOGEAL
TRANSDUCER, SUPPORT, WAETY

11111111 l~ ll lli ll~l~ il~ ll ll~i lillI

 3

INTRODUCTION

Most disc compressive force during lifting has been attributed to tension
in the erector spinae muscles which serves to oppose spinal flexion and

accelerate the upper body and load (1,2,5,13). Although there has been some
dissenting opinion (8,11), it has been widely hypothesized that intra-

abdominal pressure (IAP) during lifting reduces the spinal compressive forces

by creating a rigid body compartment which aids in resisting spinal flexion,

lessening tension in the erector spinae muscles necessary to effect a lift

(3,4,12,13,14). Intra-abdominal pressure has been estimated to reduce spinal

disc compressive forces by up to 40% (6,9,12,14).

High intra-abdominal pressures have been recorded during weightlifting

(7,9). Both olympic and power lifters have used lifting belts for many years,
yet virtually no research has been reported which examines the efficacy of

belts for increasing intra-abdominal pressure, reducing injury or improving

lifting capacity. One abstract (10) showed higher mean intra-abdominal
pressure during the squat weightlifting exercise with than without a belt,

with no statistical evaluation reported. Magnitude of intra-abdominal pressure

has been found to correlate positively with amount of weight lifted (7). The
present experiment was undertaken to determine if wearing a belt during
lifting increases intra-abdominal pressure, possibly reducing spinal disc

compressive force for a given weight lifted or allowing more weight to be

lifted at a given disc compressive force. High speed computerized data

collection was used in order to obtain more information about pressure changes

during lifting than was obtained during any previous experimentation.

S-
 VXMWRU WWI . .

METHODOLOGY

Exercise examined
The dead-lift was chosen since it is recognized as an exercise that places

considerable stress on the lower back muscles. It also simulates the lifting

of heavy objects in a work environment. The dead lift is effected by gripping

with both hands a barbell resting on the floor and raising the weight until

the body is upright with the barbell suspended from the arms. To standardize

the lift, subjects were instructed to begin with straight back and bent knees,
and to avoid rounding the back or prematurely straightening the knees.

Apparatus

Subjects lifted Olympic style barbells and weight plates while standing on

a model LG6-1-1 AMTI (Newton MA) .6 meter by 1.2 meter force plate. The plates

at either end of the bar rested on surfaces adjacent to and level with the top

of the force plate. A switch (model PE-30, Tapeswitch Corporation, Farmingdale

NY) transmitted a voltage signal when the barbell was lifted off the ground. A

hand-held switch allowed the experimenter to signal again when the subject had

reached the endpoint of the lift. Intra-abdominal pressure was measured using

a Millar model SPC 350 Mikro-Tip catheter pressure transducer (Millar

Instruments, Houston, TX) inserted nasally. The transducer is optically

isolated and incorporates a strain gauge pressure sensor with frequency

response flat to 10 kHz. A control unit (model TCB 500) produces, according to

switch position, either calibration voltages corresponding to 2.667 and 13.333

kilopascals (kPa) or a .15 volt per 10 kPa (.2 volt per 100 m.Hg) signal
reflecting pressure at the catheter tip. Voltage signals from the pressure
transducer control unit, force plate and event marking switches were fed into
. . • S * .4

an Infotek (Anaheim CA) AD200 analogue-to-digital converter board mounted in a

Hewlett-Packard (Lexington MA) 310 microcomputer. Signals from each channel

i
were sampled at 200 Hz. Processed data was transferred to a VAX 780 ma infram ~'S

computer for statistical analysis using MOKP (Los Angeles, CA) programs.
ExperimentalI procedure

The experiment was conducted in accordance wit~h the pol icy statment of

the American Col lege of Sport~s Medicine (MIEDICINE AN

Th sampelzrceddaIaease voransfere SCIENCE
jcswere8 tho ad IN SPORTS 10: ix-
v7marinfrdee
xa1978) and U.S. Army regulataion AR 70-25 on use of volunteers in research, I'.
ofncompeo ttieicigl nlisuing
exprDece (Los Anelepsicll
CA)iv
prgrms
which require t(hat humn subjct give free and inforlmd voluntary consent

nth exprietgascndced in O accordancethewiths dy

polices
storatment ofs
before partici pation.

ol lected on the subjct's age, height nd weight . Instructions were given on

catheter insertion andliftg procedures. Each subject's 1 repetition maximum

(be) lifting capcity in the dead lift was determined. escriptive statistics
on subject age, height, body
m s and
1 RM lift are shown in table 1. The Ir

lift averaged 1.85 t ims body weight .

Before the liftng tornils, the testig apparstus was calibratd by

computer ampling the pressure transducer cont.ro Intr whileit ws set at 0

mtg ad 100 mHg calibration pulses, and the force plate with no mass and

with 200 kg cpton its surface. Factors derived from the calibration were
used to amhematically transform A/D converter output imaninful units of .

pressure and force. s w

A minimum of two days following the RM test, and afterwaming up with

usedto atheatiallytrasfor
A/ conertr ouputto manigfulunisoo
lighter weights, each subject liftaed
e o of his frmteight once while

S
AV
 6

wearing, and again while not wearing a six inch wide weight lifting belt. The

order of the belt and no-belt lifts was randomized. Force, intra-abdominal

pressure and the event marker were monitored throughout the. lifts by the

computer. The event mrker signal stayed high while the weight rested on the

floor. When the weight left the floor (lift-off) the marker signal dropped to

a low level. When the lifter reached the upright position the experimenter's

button push brought the event marker high again. Subjects rested between the

two lifts until they felt fully recovered. Before the lifting bouts, subjects

inserted the catheter pressure transducer into a nostril and down the

esophagus until it descended just below the diaphragm. Position of the

catheter tip was determined by having the subjects sniff repeatedly during

insertion. A change from below to above atmospheric pressure signalled that

the tip had passed below the diaphragm.

RESULTS

Figure 1 is a plot of intra-abdominal pressure and vertical ground-

reaction force data points collected during a typical dead-lift, with times of

bar lift-off and lift completion indicated by vertical dashed lines. Each lift

took 2-3 sec to complete. It can be seen that before lift-off, pressure and

force increased steeply. Force usually platesued shortly after lift-off while

pressure platesued or declined. Various individual curve patterns were

exhibited. Computer processing determined the following times relative to

lift-off for the pressure and force curves: 1) start of rise above baseline 2)

peak rate of increase before start of plateau 3) start of plateau 4) peak 5)

peak rate of increase after start of plateau and 6) lift completion. The event
 * 7

times are listed in table 2, where a negative sign means an event occurred
before lift-off. In general, pressure began to 'rise 1/3 to 1/2 sec before
lift-off, reached its steepest rate of increase about 1/10 sec before lift-
off, plateaued about 1/5 sec after lift-off and peaked 1/4 sec thereafter.
Ground reaction force followed a similar pattern but reached plateau a bit
earlier and peaked somewhat later than did pressure. Pressure rose
significantly (p(.05) earlier with than without the belt. When the belt was
worn, but not without it, pressure rose significantly earlier than did ground
reaction force. For both conditions pressure reached plateau significantly
sooner than did force.
Table 3 shows intra-abdominal pressure magnitude, area under the pressure
versus time curve and pressure rate of change. The mean for peak pressure is
very similar to that previously reported for dead-lifts without a belt (7).
Variables significantly higher with than without a belt included peak
* pressure, area under the pressure versus time curve from start of pressure
rise to lift-off, peak rate of pressure increase after start of the pressure
plateau and average pressure from lift-off to lift completion. Interestingly,
average rate of pressure increase before start of the pressure plateau was
significantly lower with than without the belt. The earlier pressure rise with
the belt cannot fully explain the phenomenon since peak rate of pressure
increase before start of the pressure plateau was also lower with the belt,
though not significantly so, and peak rate is unaffected by total time of
rise. Those variables that did not differ significantly between the belt and
.5 no-belt conditions were area under the pressure versus time curve from lift-
of f to lift completion, peak rate of pressure increase before the start of
pressure plateau and average pressure from start of pressure rise to lift-off.
 -~~~Y - . 'W7 -7,

Of the eight pressure variables, six mans were higher with than without the
belt, though two of the differences didn't reach significance. Clearly, a belt
increases intra-abdominal pressure during weight lifting.
Table 4 shows ground reaction force magnitudes and areas under the force
versus time curves (impulses). There were no significant differences between
the belt and no-belt conditions. Peak force averaged about 11% above body plus
bar weight. During a lift, whenever ground reaction force is above body plus )
bar weight the center of mass of the lifter-bar system accelerates vertically.F
When ground reaction force equals body plus bar weight the center of mass
moves upward at a constant speed. If ground reaction force is less than body
plus bar weight then the center of mass decelerates, as must occur towards the
end of a lift as the weight is brought to a stop.
Table 5 lists some correlations of interest. Peak pressure, which always

occurred after lift-off, correlated well with average pressure after lift-off
and area under the pressure versus time curve after lift-off, indicating that
pressure peaks were reflective of the magnitude of the entire curve and were
not irregular transients. Graphs of both pressure and force versus time show
that peaks did not generally rise much above the level of curve plateaus. Peak
pressure correlated well with peak pre-plateau rate of pressure increase,
indicating that individuals achieving higher peak pressures did so by
generating pressure at a faster rate. This effect was more consistent when the
belt was worn. Peak pre-plateau rates of pressure and force increase

correlated well with each other when the belt wasn't used and only moderately
when the belt was employed, indicating that use of the belt somehow weakened
the association of force and pressure rate of change. On the other hand, the
fact that there was a higher correlation when the belt was worn between area
 .1 9

under the pressure versus time curve after lift-off and peak force shows that
is the belt heightened the association between force and area under the pressure
versus time curve after the weight left the ground. Time at which peak pre-
plateau rate of increase occurred correlated well between force and pressure,

indicating good temporal association of the speeds of pressure and force

ft. augmentation.

DISCUSSION
The use of a standard lifting belt during dead lift exercise clearly
increases intra-abdominal pressure, probably reducing compressive force on

spinal discs and improving lifting safety. A belt is likely to similarly

V affect IAP during other lifts involving back extension against resistance. The
belt my function by preventing protrusion of the abdomen and possibly by

forcing the abdominal muscles to move inwardly as they bulge during

contraction.
The phenomenon of earlier pressure rise with than without the belt may be
due to the close proximity of thighs and trunk during the bent-knees straight-
back starting position of the lift which tends to push abdominal tissue up
against the belt. It is interesting that while all measures of pressure
* . magnitude and area under the pressure versus time curve were higher with the
belt, the pre-plateau rate of pressure increase was lower. Apparently the
earlier rise of pressure with the belt allowed IAP to rise higher even though
the rate of increase was less.
It should not be concluded that all weight lifting need be performed with
a belt. If a lifter trains with a belt, the abdominal muscles which contribute
to generation of intra-abdominal pressure my not be strengthened as much as
 I.'
10

they would if no belt were used in training. In addition, neuromuscular

control patterns of pressure generating muscles may develop differently when a

belt is used in training. Thus, a lifter accustomed to using a belt who tries O

lifting without one may generate less intra-abdominal pressure than if he had
trained regularly with no belt. Training with a belt may thus not reduce
vulnerability to injury during lifts without a belt. A conservative
recommendation would be that a belt always be employed for maximal or near
maximal lifting and that someone who lifts regularly with a belt should be
extremely cautious about lifting without one. Athletes or workers who want to
train for an activity during which a belt is not worn may be well advised to

do at least some of their training without a belt to both strengthen the deep
abdominal muscles and develop a pattern of muscle recruitment needed to
generate high IAP when a belt is not worn.
 %7-. w7 -7 V Vw-- 17 K7l - W R -7 TV
IV 01

REFERENCES
1. ANDREWS, J.G. On the relationship between resultant joint torques and
muscular activity. Med. Sci. Sports Exerc. 14(5):361-367, 1982.
2. ANDREWS, J.G. Biomechanical measures of muscular effort. Med. Sci.
Sports Exerc. 15(3):199-207, 1983.
3. BARTELINK, DiL. The role of abdominal pressure in relieving the
pressure on the lumbar intervertebral discs. J. Bone Joint Surg.
39B(4) :718-725, 1957.
4. CHAFFIN, D.B. Computerized biomechanical models: development of and use
in studying gross body actions. J. Biomech. 212(4):429-441, 1967.
5. GRACOVETSKY, S., H.F. FARFAN, and LAMY, C. The mechanism of the lumbar
spine. Spine 6(3):249-262, 1981.
6. ORILLNER, S., J. NILSSON, and A. THORSTENSSON. Intra-abdominal pressure
changes during natural movements in man. Acta Physiol. Scand.
103:275-283, 1978.
7. HARMAN, E., P. FRYKMAN, B. CLAGETT and W. KRAEMER. Intra-abdominal and

intra-thoracic pressures during lifting and jumping. Med. Sci. Sports

Exerc., 20(2) 1988.
8. KRAG, M.H., M.H. POPE and L.G. GILBERTSON. Intra-abdominal pressure: A
study of its role in spine biomechanics. Proceedings of the winter
annual meeting of The American society of mechanical engineers, 125-

126, 1984.
9. LANDER, J.E., B.T. BATES and P. DEVITA. Biomechanics of. the squat
exercise using a modified center of mass bar. Med. Sci. Sports Exerc.
18(4) :469-478, 1986.
 12

10. LANDER,~ .E. The effectiveness of weight bolts during squatting.

(Abstract) Medicine and Science in Sports and Exercise 19(2):65,

1g87.
11. MCGILL, S.M. and R.W. NORMAN. Reassessment of the role of intra-
abdominal pressure in spinal compression. Ergonomics 30(11):1665-
1588, 1987.
12. MORRIS, J.M., D.B. LUCAS, and B. BRESLER. Role of the trunk in
stability of the spine. J. Bone Joint Surg. 43A:327-351, 1961.
13. TROUP, 1.D.0. Relation of lumbar spine disorders to heavy manual work
and lifting. Lancet 1:857-861, 1965.
14. TROUP, J.D.G. Dynamic factors in the analysis of stoop and crouch
lifting mathods: A methodological approach to the development of safe
materials handling standards. Orthopedic Clinics of North America
8(l): 201-209, 1977.V

......... 1111111 :: I..j

sa.
 13

TEXT TO FIGURES

Figure 1. Ground reaction force and intre-abdominal pressure during a dead

lift. Vertical dashed lines indicate times of weight lift-off
and lift completion (full upright body posture).
 14

Table 1. Subject descriptive statistics (Mean*SD)

subjects 8 mles, 1 female

age 28.2*6.6 years
body mass 77.4*8 kg a

dead-lift 1 RM 143.*27 kg

.........
Table 2. Event times relative to bar lift-off (Mean*SD)

Event Time of event (sec)

No Belt Belt
start of force rise -.31*.15 -.38*.16 #
start of pressure rise -. 30~.17 -. 56*.2O #
peak force 1.06a.75 .79*.67
peak pressure .45*.37 .42*.46
start of force plateau .31*.16 # .33a.16 #
start of pressure plateau .20*.06 * .10*.13 #
peak pre-plateau rate of force increase -.1O*.14 -.1O*.16
peak pre-plateau rate of pressure increase -.08*.12 -.09*.09
peak post-plateau rate of force increase 1.6.59 1.76*.69
peak post-plateau rate of pressure increase 1.591.6 1.O9*.58
lift completion 2.41*.41 2.43*.36

* significant (p<.06) difference between belt and no-belt conditions

# significant (p<.06) difference between pressure and force timing
 5. w V 4
-'~ C&-I"k- W' r 1r I -10r

* Table 2. Event times relative to bar lift-off (Mean&SD)

Event Time of event (sec)

No Belt Belt
start of force rise -. 31*.15 -. SS*.16
start of pressure rise -.30*.17 -.56*.2O #
peak force 1.O8*.75 .79*.$7
*peak pressure *45*.37 .42*.46
start of force plateau .316.16 # .33*.16 #
start of pressure plateau .20*.06 # .10*.13 #
a.peak pro-plateau rate of force increase -.1O'.14 -.1O*A.16
peak pre-plateau rate of pressure increase -.O8*.12 -.09*.09
peak post-plateau rate of force increase 1.85&.59 1.76*.Sg
-. peak post-plateau rate of pressure increase 1.6g*.63 1.O9*..58
lift completion 2.41*.41 2.43*.36

*significant (p<.06) difference between belt and no-belt conditions

a. 9 significant (p<.05) difference between pressure and force timing
 16

Table 3.

Intra-abdominal pressure magnitude, time area and rate of change (Mean*SD)

1.00 kPa z 7.50 mntg

No Belt Belt

peak pressure (kP&) 20.8*3.6 23.4*4.3 .

pressureetime area: start to lift-off (kPaesec) 2.27*1.7 3.84*2.0 *

pressureotime area: lift-off to end (kPa.sec) 34.5*11.0 38.6*8.7

peak pre-plateau rate of press. incr. (kPa/sec) 1516*552 1432*596

avg. pre-plateau rate of press. incr. (kPa/sec) 40.9*15.0 33.9*8.7 *

peak post-plateau rate of press. incr. (kPa/sec) 188*75 220*98 *

average pressure: start to lift-off (kPa) 6.71*3.3 7.02*2.9

average pressure: lift-off to end (kPa) 13.92*3.1 15.77*2.9

- significant (p(.05) difference between belt and no-belt conditions

,.'

J
 VLJII -jkW ril .. NtV6M I 91r. A
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pi

17

Table 4. Ground reaction force variables (Mean*SD)

No Belt Belt

peak force (N) 22294345 2229*306

impulse: force start to lift-off (Nosec) 354*185 432*198

impulse: lift-off to end (NOsOc) 4904*1299 4948*1269

peak pro-plateau rate of force incr. (N/sec) 71382*15258 69482*19156

peak post-plateau rate of force incr. (N/see) 56464*26677 45984*24578 f

peak force as % over body * bar weight ()10.5*2.5 10.9*4.3

average force: start to lift-off (N) 1154*173 1123*155

average force: lift-off to end (N) 2001*303 205*304

-significant (p<.05) difference between belt and no-belt conditions

 18

Table S. Selected significant (p(.05) correlations

NO-belt Belt
Peak pressure with:
Peak pro-plateau rate of pressure increase .69 .84
pressureetime area: lift-off to end .71 .83
Average pressure: lift-off to end .83 .88
Area under the pressure versus time curve - lift-off to end with:
Peak force .58 .80
Peak pre-plateau rate of pressure increase with:
Peak pro-plateau rate of force increase .87 .4
Time of peak pro-plateau rate of pressure increase with:
Time of peak pro-plateau rate of force increase .83 .86
 %

AUTHORS' STATEMENT 1

J..
This manuscript represents original unpublished material, except in
abstract form, that is not under consideration for publication elsewhere.
Further, it will not be submitted for publication elsewhere until a
decision is made regarding its acceptability for publication in MEDICINE
AND SCIENCE IN SPORTS AND EXERCISE. If accepted for publication, we agree
that it will not be published elsewhere, in whole or in part, without the
consent in MEDICINE AND SCIENCE IN SPORTS AND EXERCISE.
We the undersigned authors hereby transfer, assign, or otherwise convey
all copyrighted ownership of our manuscript entitled 'Effects of a belt on
intra-abdominal pressure during weight lifting' to the American College of
Sports Medicine if this manuscript is published in MEDICINE AND SCIENCE IN
SPORTS AND EXERCISE.

Signed:_____________ ___
Everett A. Harman

Richard M. Rosenstein

Peter N. Frykman

George A. Nigro
 ,, (FORCE (N) VS. TIME (SEC-))
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