You see them in the gym in all shapes, sizes, colors, and patterns. Every month there seems to be a new version. The women wear them matching every spandex outfit they have. The men are leaving the old, worn leather ones for the style and comfort of the latest rage. Of course, we are talking about the weightlifting belt (WB). Although everyone thinks it’s a necessity in the gym, we’ll explain to you why it is only the latest in fashion accessories.

A Little History
Weightlifting belts are not new, but rather were first used by Olympic weightlifters to prevent trunk hyperextension during overhead lifts (1). The device was then promoted in the industrial setting with workers who lifted heavy loads daily. Bodybuilders took the WB idea and ran with it. Once used for a very specific purpose, the WB was turned into a fad by the bodybuilding community. Used indiscriminately and often, the abuse of weightlifting belts may be increasing the risk of injuries instead of preventing them.

Purpose of a Belt
The real purpose of a belt is to provide support for the back by increasing the intra-abdominal pressure (IAP) and the intrathoracic pressure (ITP). The IAP and ITP compress (2) or prevent the protrusion of (3) the abdominal compartment, and this reduces the force the low back muscles must exert to support a heavy load. It has been reported that reducing how hard the low back muscles have to work may prevent disc compression injuries (3). But, If the purpose is to increase IAP and ITP by compressing the abdominal contents, not supporting the back, then why is the widest part of the belt centered on the back instead of the stomach? We contend that the design of the traditional weightlifting belt is all wrong. The Soviets questioned that too, and designed a WB that had a plastic piece over the entire contour of the abdomen and was thin in the back. They found this belt to be superior at increasing IAP than the traditional belt.

A Little Science
Interestingly a study performed on industrial workers wearing WBs during short duration lifting tasks, showed that breath-holding increased the IAP more significantly than wearing the WB (4). The research also showed less erector spinae (low back muscle) activity with the breath-held group than the WB group. This means that breath holding was more effective at supporting the back than wearing a WB.
Another study measuring oxygen consumption during submaximal squatting and stooping found that no difference existed with or without a WB (5). The study authors suggested that the low back muscles do not get extra help with a WB or the oxygen consumption values would be lower.
Liberty Mutual, an insurance carrier, commissioned a study to determine the effects that a WB had on endurance and fatigue of the low back muscles (6). They were looking for evidence that showed WB would decrease muscular fatigue and prevent injuries. They found that no difference existed in endurance values between a WB group and non-WB group during heavy lifting and lowering tasks.
A study performed with industrial lifting belts also showed that the belt had no effect during maximal exertions on how much weight could be pulled, or on minimal exertions and trunk muscle activity (7). In fact, even the National Institute for Occupational Safety and Health (NIOSH) recommended against back belt use by healthy people (8).
Wearing a WB has also been purported to decrease inguinal hernias. An extensive search through Medline did not show one study that linked inguinal hernias with WBs for either prevention or exacerbation. Two studies showed the risk factor for inguinal hernias to be lifting heavy objects repeatedly over long periods of time for young, poorly educated manual workers (9, 10). Since education is truly the key to the prevention of all injuries, what role does education play with the use of WB?

Muscular Strength and Technique
Postural muscles, the abdominal and lower back musculature, perform isometric contractions throughout most lifts (1). If they are not strong enough to provide support during loaded situations, injury can, and often does, occur. A WB will only support your stomach if you are supporting your stomach, too, through isometric contractions. John Garhammer, an internationally respected biomechanist (a specialist in human movement and performance) said that a WB ”…is not a necessity in most cases and should not be used as a substitute for strong low back and abdominal muscles (11).” A recent study showed that lumbosacral support belts were not more effective for those with weak abdominals than those with strong abdominals (12). Additionally, Lander, et al reported decreased EMG activity of the trunk musculature when a WB was worn (2). This further supports the contention that wearing a belt robs the user from exerting postural control over their abdominal and low back muscles.
Two studies that focused on breathing techniques, IAP, and postural muscle activity concluded that with proper breathing techniques and isometric contractions of the abdominal musculature, the IAP will rise and stress will be taken off the low back musculature (13, 14). The breathing technique these studies alluded to was the Valsalva maneuver. The maneuver increases IAP and ITP by exhaling with the glottis (opening at the back of the tongue) closed. This is a popular technique and should be used with the knowledge that it briefly increases blood pressure and heart rate (15). It must be used in healthy people who have no history of cardiovascular disease. Usually the Valsalva maneuver is performed unknowingly throughout many lifts.
When technique is mentioned, it is important to remember proper technique of the exercises we are doing. Injuries rarely occur when excellent technique is utilized. With good technique, it is impossible to lift more weight than your body is capable of lifting or to perform “cheating” movements. WBs can often suppress inhibitory mechanisms and give a false sense of security. This can lead to exposing the spine to greater loads and increasing the potential for injury. Istvan Javorek, a former Romanian National and Olympic coach said that “if we teach perfect technique, a belt is not necessary (14).”

Weightlifting Belt Warnings
Along with increasing frequency of respiration (16), which leads to an elevated heart rate, wearing a WB belt has also been shown to increase diastolic blood pressure (17). The WB puts an extra load on the cardiovascular system that could increase the risk of heart attacks and strokes.
Wearing a WB is not a functional part of daily life. It may be fine to use the WB in the gym during all lifts or just heavy lifts, but what happens when you need to move that couch in your family room, or help your friend push a stalled car? You must know how to brace your abdominals to prepare your trunk for this heavy lifting and these muscles must be strong. If your body is used to wearing a WB while lifting, what will happen when you lift without it? Obviously, the potential for injury will be increased.
There is no valuable transfer to sports when WBs are worn. During a sport’s dynamic, ballistic, and sometimes collision situations, there is no opportunity to wear a WB. It prohibits the body from using its own kinesthetic and proprioceptive mechanisms to provide balance. This is detrimental for participation in non-lifting sports, recreational or competitive.
A study recently performed suggested that wearing a WB might increase potential for injury in other joints (18). WBs restrict your back flexion and extension and increase your hip ROM. Although this decreases one risk factor for low back pain (excessive back flexion), it may set up risk factors for pathology in the hips, knees, and ankles.
Professionals in the healthcare field worry that assistive devices may make people dependent and, in turn, render themselves ineffective in situations where the device is not used. People develop neuropathways of pushing out against the WB to develop more IAP. When the WB is removed, the body will remember pushing out the abdominal musculature, instead of correctly tightening it up and holding it in, and become more susceptible to an injury.

When to Use - Why to Use
Although some of the best weightlifters in the world do not use WBs (19), there are certain competitive weightlifting and powerlifting situations where WBs are appropriate and beneficial. When performing a lift like the clean and jerk or squat, WBs are effective in increasing IAP for lifts at 90% of the 1RM (one repetition maximum). This may translate into heavier weights being lifted. If the lifter wears the WB in the gym with these heavy loads, then they should wear it in competition and vice versa.
Given all the scientific data, it can’t be recommended to wear a WB at any other time. The purpose of bodybuilding is not only to create a better looking body, but also to create a better functioning body. With the use of assistive devices like the WB, this is not possible.
References

1) Faigenbaum A, & N Liatsos. The use and abuse of weightlifting belts. Strength and Conditioning. 16(4): 60-62. Aug. 1994
2) Lander JE, Simonton RL, & Giacobbe JK. The effectiveness of weight-belts during the squat exercise. Medicine & Science in Sports & Exercise. 22(1):117-26, 1990 Feb.
3) Harman EA, RM Rosenstein, PN Frykman, & GA Nigro. Effects of a belt on intra-abdominal pressure during weight lifting. Medicine & Science in Sports & Exercise. 21(2):186-190, 1989 April.
4) McGill SM. Norman RW. Sharratt MT. The effect of an abdominal belt on trunk muscle activity and intra-abdominal pressure during squat lifts. Ergonomics. 33(2):147-60, 1990 Feb.
5) Duplessis DH. Greenway EH. Keene KL. Lee IE. Clayton RL. Metzler T. Underwood FB. Effect of semi-rigid lumbosacral orthosis use on oxygen consumption during
repetitive stoop and squat lifting. Ergonomics. 41(6):790-7, 1998 Jun.
6) Ciriello VM. Snook SH. The effect of back belts on lumbar muscle fatigue. Spine. 20(11):1271-8; discussion 1278, 1995 Jun 1.
7) Lavender SA. Chen SH. Li YC. Andersson GB. Trunk muscle use during pulling tasks: effects of a lifting belt and footing conditions. Human Factors. 40(1):159-72, 1998 Mar.
8) NIOSH Back Belt Working Group. Workplace use of back belts. Review and recommendations. US Dept of Health & Human Services. July 1994
9) Carbonell JF, JL Sanchez, RT Peris, et al. Risk factors associated with inguinal hernias: a case control study. European Journal of Surgery. 159(9): 481-486, Sept. 1993.
10) Flich J, JL Alfonso, F Delgado, et al. Inguinal hernia and certain risk factors. European Journal of Epidemiology. 8(2): 277-282, March 1992.
11) NSCA Roundtable: Power clean. NSCA Journal. 7(1): 10-25, January 1985.
12) Smith EB, AA Rasmussen, DE Lechner, MR Grossman, JB Quintant, et al. The effects of lumbosacral support belts and abdominal muscle strength on functional lifting ability in healthy women.
13) Wedin S, R Leanderson, & E Knutsson. The effect of voluntary diaphragmatic activation on back lifting. Scandinavian Journal of Rehabilitation Medicine. 20(3): 129-132, 1988.
14) Hemborg B, U Moritz, & H Lowing. Intra-abdominal pressure and trunk muscle activity during lifting IV. The causal factors of the intra-abdominal pressure rise. Scandinavian Journal of Rehabilitation Medicine. 17(1): 25-38, 1985.
15) MacDougall JD, D Tuxen, DG Sale, JR Moroz, & JR Sutton. Arterial blood pressure response to heavy resistance exercise. Journal of Applied Physiology. 58(3):785-790, March 1985.
16) Soh TN. Parker PL. Crumpton LL. Mealins C. An investigation of respiration while wearing back belts. Applied Ergonomics. 28(3):189-92, 1997 Jun.
17) Rafacz W. McGill SM. Wearing an abdominal belt increases diastolic blood
pressure. Journal of Occupational & Environmental Medicine. 38(9):925-7, 1996 Sep.
18) Sparto PJ. Parnianpour M. Reinsel TE. Simon S. The effect of lifting belt use on
multijoint motion and load bearing during repetitive and asymmetric lifting. Journal of Spinal Disorders. 11(1):57-64, 1998 Feb.
19) Dreschler, A. The Weightlifting Encyclopedia: A Guide to World Class Performance. A IS A Communications: Whitestone, NY.