I see people using belts in training all the time. I don’t see this as a bad thing by any means but I don’t know if people fully understand why or how to use the belt. In fact I will often ask people why they are wearing a belt just to see what their response is. Typically they will respond with “it helps keep my low back stable” or something along those lines. This isn’t exactly wrong but when I see the way they use the belt I see that it isn’t exactly true.

To understand what the belt is for, first you need to understand few other topics:

Intra-abdominal pressure or IAP is what you are striving for. It is what it sounds like, being able to create pressure in your abdomen. This increase in pressure is what helps stabilize the spine. So being able to create increased IAP is the goal when you want to lift maximal loads with a stable midsection.

So how do you do this? Well creating increased IAP happens when you draw or breathe in air pressing your diaphragm muscle down which presses out against the rest of your abdomen. The more you can draw down the diaphragm the more pressure you can create in the abdomen (see image below).

A very simple analogy that I hear a lot and seems to make sense to people is the comparison of your abdomen to a pop can. Imagine an un-opened aluminum pop can, if you had it sitting in front of you, you could step on it without it bending or cracking. Now if you took that same pop can and opened just the top and stepped on it then it would likely crumble. And again if you took an empty pop can that had a dent in the side and you stepped on that, it would likely crumble even easier. (let’s be clear, your body is much more resilient than a pop can and you won’t “crumble” under minimal loads, this is simply a comparison so you can fully understand IAP).

When you are able to take a big breath of air in and drive your diaphragm down, this increases the IAP and your spine is able to handle much higher loads with less risk of shear forces (like an unopened pop can). Now imagine you could take that same unopened pop can and shrink it down just a little bit but keep the same amount of contents inside. This would increase the pressure inside the can making it harder for it to deform.

This is the exact mechanism of how the weightlifting belt should be viewed as. When you are ready to lift heavy you should be able to take a big breath in which lowers your diaphragm and presses out on your abdomen increasing the IAP. Then if you used a belt you could sinche down the size of our abdomen even more which increases the IAP (assuming you can get the same amount of breathe in). This is often why you will hear people say “press out on the belt”. In my opinion the way you should put on a belt is this: let as much air as you are comfortable with out of your lungs, then strap the belt tight to your comfort level and then take a big deep breath to allow your belly to be pressing out against the belt. This will give you a higher IAP and like the analogy used earlier a more “stable” spine.

Caveat: I like to develop my ability to create as much IAP without a belt as possible. I typically don’t use a belt until I am very close to maxing out my squats and I rarely (almost never) use a belt for deadlifting. I think there is a time and place for a belt but especially when the athlete knows exactly how to use it. Thanks and I hope you enjoyed it!

My sister called me the other day to ask if I had any recommendations on a Chiropractor in Texas for her husband, as I was walking her through who I think she should send her husband to I realized that I wish more people had this same knowledge when it comes to selecting a Chiropractor.

Of course I am biased when it comes to what I think makes a good Chiropractor but I think there are some commonalities when it comes to the few good ones out there. I’ll start with a short list of things I think are important and add my commentary at the end.

If they claim to correct subluxations and clear/free the bodies innate ability to heal itself, I would be very skeptical and steer clear.
If the Chiropractor takes X-Rays on every patient they see, I would again be very hesitant to see them.
I would encourage people to look for a Sports Chiropractor or DC with a CCSP or DACBSP distinction.
Look for a Chiropractor that offers more than simply adjusting the spine, some soft tissue and a focus on active care are equally if not more important.
Treatment times in general should be longer than 5-15 minutes.
Look for a Chiropractor who is familiar with the things you do.

So in the world of Chiropractors there are two big camps, those who practice what is called “straight” chiropractic and then those who are more “mixed” in the way they practice. What this means is that the “straight” chiros choose to only adjust the spine (some only work on the upper neck region) and the idea is they are realigning the spine, taking pressure off of nerves and allowing the body's innate ability to heal itself to be reestablished. This has somehow been eaten up by the general population of people but unfortunately there are few great scientific studies that support this type of treatment.

“Mixers” on the other hand tend to look outside of just the spine they will do some soft tissue work and spend time on active care. This is where there is much more backing from scientific evidence, some manual therapy plus active care for best patient outcomes. The “mixers” or “Forward Thinking” group of Chiros tend to look more towards evidence for treatment whereas the “straight” will look towards philosophy of treatment.

The second point I made suggests you shouldn’t see a Chiropractor if they regularly take X-rays of all patients. First, the evidence for imagining being reliable for diagnosing has become very poor. There are multiple studies on shoulders, low backs and even hips, when someone gets an image of these areas we could see actual damaged tissue but the patient could be reporting zero pain. The opposite is true, we could take an image and see nothing wrong yet the patient will report pain, does that mean specific structures aren’t responsible for pain? Not really, it just means that it is very hard to tell just by looking at an image if a structure needs helping or not. Not to mention each X-ray will expose you to a certain amount of radiation (although small) if it can be avoided it probably should.

Point three is one of my personal biases, I would first look to someone who recognizes themselves as a “Sports” clinician and there are a few distinctions Chiropractors can get to be recognized as such. One of those is a CCSP or Certified Chiropractic Sports Physician, another is a DACBSP or a Diplomate American Chiropractic Board of Sports Physicians. The CCSP is basically the first step to getting the DACBSP and requires extra hours learning more sport specific management of patients or events. I happen to have a Masters degree in sports medicine and that is another thing you could look for in your Chiropractor is to have additional degrees. I want to be clear here though, I know tons of Chiropractors who aren’t CCSP’s or have a Masters degree that are very good clinicians and would be considered some of the best in the profession.

Point four is similar to point one, but I just want to re emphasise that the best evidence for treatment of pain for a patient incorporates more than just passive treatment (simply adjusting or only manual therapy). In fact there has been more research suggesting that exercise is your best bet for treatment and if the Chiropractor doesn’t try and get patients to do some sort of active care then they probably aren’t doing what is best for the patient.

Point five here is again similar to my last point, but if there isn’t some sort of time dedicated to educating the patient on the mechanics of the situation or exercises that could benefit them then I don’t feel that Chiropractor is doing the absolute best care.

Finally, something that I feel strongly about is if you are going to see a Chiropractor or physical therapist or even your family doctor for that matter, I think there is a lot to be said for being able to understand the sport/activities that the patient does. For example if you do CrossFit or dance or garden or play basketball, wouldn’t you want your practitioner to be familiar with the demands of that thing? Just like there are specializations in the medical field, there are Chiropractors and physical therapists that understand the demands of different activities better than others. So look for that, do they incorporate things in their website or bio that you like and can relate to?

Ultimately the choice is yours, you can see who you want and spend your money where you like. My intention for this is to simply get you to ask why, why do you want to see someone? If you have been dealing with pain or dysfunction in an area don’t you want to best most comprehensive and evidence based approach? This blog isn’t too scientific in itself or the few things I selected to write about but I think if you as the patient are seeking that out these few things to look for will steer you in the right direction.

How to correctly use a weightlifting belt

Choosing a Chiropractor: Where to start