© National Strength and Conditioning AssociationVolume 28, Number 1, pages 68-74

Keywords: back belt; weight belts; interabdominal pressure; injuryprevention

A Review of the Use of Lifting BeltsGregory J. Renfro, PTA, CSCSLanglade Memorial Hospital, Antigo,Wisconsin

William P.Ebben,MS,CSCS,*DMarquette University, Milwaukee,Wisconsin

s u m m a r y

This manuscript reviews the litera-

ture on the effects of the use of back

belts in industrial and strength and

conditioning applications. Although

the results are mixed, the prepon-

derance of evidence supports some

use of back belts during resistance

training.

O ne oi the more controversialissues in both industrial andstrength and conditioning set-

tings centers around the use oi a de-vice known as the lifting belt, weightbelt, or back belt. A recent survey othealch club members determined that27% were lifting bell users. Ninetypercent oF those who used a lifting beltreported doing so to prevent injury,whereas 22% wore one to improve per-formance (8). However, questions re-main as to the effectiveness ofa liftingbelt on lifting performance in eitheroccupational or strength and condi-tioning settings.

In the last several years, consumer andcoaching publications (5, 10, 14, 18) andliterature reviews (9, 1 1. 20-22) have ex-amined the use of the lifting belt. Withthe exception of the litetature review byGenaidy and Simmons (11), who suggestthat lifting belts can reduce load on thelumbar spine, most reviews assessing theuse of lifting belts in occupational settingsreport that tbere is insufficient evidenceto recommend tbeir use (20, 21). Further-more, lifting belts reduce lumbar motionbut do not appear to reduce electromyog-raphy (EMG) of the erector spinae andabdominal oblique muscles or increase in-terabdominal pressure (IAP), thereforeoffering insufficient reason to recom-mend them for industrial workers (22). Areview by Frankel and Kravitz (9) notesthat industrial and fitness settings differ,as do laboratory and applied fitness set-tings, and that use of the lifting belt maybe appropriate in some cases. However,industrial settings do not replicate gymconditions because loads are typicallylower and exercise or exertion duration istypically more endurance-oriented.

In an attempt to empirically determinethe effectiveness of the lifting belt, a num-ber of studies have been conducted, withresults appearing in occupational {3, 6,12, 16, 18,23,24, 26-28) and sports sci-

ence (1, 2, 4, 7, 13, 15, 17, 25, 29) re-search publications. Fables 1 and 2 sum-marize the results of the occupational andsports science research studies, respective-ly. Collectively, these studies have at-tempted to assess the effect of wearing lift-ing belts by examining a number ofvariables including the effect of liftingbelts on incidence of injury, hemodynam-ics, IAP, spinal compression, range of mo-tion, EMG of trunk muscles and primemovers, fatigue, and resistance trainingexercise performance. The purpose of thisarticle is to review the research evaluatingthe use of lifting belts and to summarizethe data so recommendations related tolifting belt use can be made.

Effect of Lifting Belts onIncidence of InjuryAll of the research investigating tbe inci-dence of injury associated with likingbelt use or nonuse has been conducted inoccupational settings. Studies have exam-ined the incidence of injury with andwithout belts, as well as a cost analysis ofinjuries sustained with or without using abelt (16, 23, 28). Results demonstrate theuse of the lifting belt was either marginal-ly effective at lowering the rate of injury(16, 23) or had no effect (28). Accordingto Wassell et al. (28), based on 9,377 sub-jects completing baseline interviews.

February 2006 • Strength and Conditioning Journal

Table 1Summary of Occupational Weight Belt Research Studies

Author

Bobicketal.(2001)

Cireilioetal.[1995)

Giorcellietal.(2001)

Krausetal.(2002)

Majkowski etal.(1998)

McGorryetal.(1999)

Mitchell etal.(1994)

Publication

Appl.Ergonomics

Spine

Spine

Int.J.Occu-pat.Environ,Health

Spine

Spine

J. Occupat.Med.

Category

CVandrespiratory

Lumbarfatigue

ROM andvelocity

Occupationalback injury

EMG andstrength

Lumbarandpelvis ROM

Occupationalback injury

Independent variables

30-m(n lifting session withor without belt

Floor to 76.2 cm lifting andlowering task, repeated

Lifting large or small boxfrom 79 cm,60 degrees tothe right

Back belt group, lifting ad-vice,andcontrol

Lifting tasks with and with-out the belt using a LIDO lift10times/minfor20 min

Lifting with and without thevalsava with elastic, rigid,and no belt conditions

Belt use, lifting require-ments,and tx hx

Dependent variables

HR.Oj consumption, BP,respiratoryfrequency

Belt use, lifting with andwithoutthe belt

Amount of torso lateralbending,spine flexion, hipand knee flexion torsotwisting,and velocity

Incidence of low backinjury

EMGof paraspinalsandisometric force during lift

Trunk and pelvisdisplacements

Cost of belts, injury, andtost or limited work days

Miyamottoetal.(1997)

ConferenceProceedings

Trunk cross sec-tion assessedby CT scan

With and without valsalva Trunk cross section as-sessed by CTscan

Results

No effect. Belt wearing had no effect onany of the assessed variables except foroverall mean 0^ consumption

No effect. Back extensor EMG the samefor each condition after 4 hours of liftingeither with or without the belt

Reduced ROM. Subjects with belts liftedmore slowly and used more of a squattechnique employing more knee and hipflexion. Belts reduced torso motions

Minor benefit. Back belt group had mar-ginally lower incidence of injury

No effect. Back belt had no effect onmuscle fatigue or isometric lifting force

Reduced ROM. Lumbar ROM significant*ly decreased with belt use during bothlifting and lowering

Mixed results. Use of back belt is mar-ginally effective at reducing injury.Costanalysis shows less intensive injury andlowercost per injured worker withoutthe belt

Possible benefit. Round trunk crosssection may mean that intramuscularpressure in the erector spinae is in-creased

Reddelletal. Appl. Injury risk(1992) Ergonomics

Sohetal. Appl. Respiration11997) Ergonomics

Warren et al.(2001)

Wassell etal.(2000)

J.Orthop.Sports Phys.Ther.

JAMA

EMG (abdomi-nal obliques)

Occupationalback injury;back injuryclaim rates andback pain

Wearing belts, not wearingbelts,and injury rates afterD/C belt use

Incidence of low backinjury

During repetitive lifting with Frequency of respiration3 different belts, nylon, in-flatable,elasticvest

Kin-Com machine squat liftwith and without belt

EMG (abdominalobliques)

Belt use frequency and store Injury rate and reportedpolicy back pain

Increase injury risk. Injury risk amongbaggage handlers was greater amongthose who had worn a belt but discontin-ued its use

No positive effect. Frequency of respi-ration increased at rest with belt use andduring lifting task. The nylon back beltdemonstrated this effect more so thanother types of belts

Reduced EMG. Mean EMG values towerwith the belt than without. However, 5 of6 male subjects demonstrated increasedEMG while wearing the belt

No effect. Neither frequent back beltuse nor store policy requiring belt usewas associated with reduced incidenceof back injury claims or low back pain

BP = blood pressure; CV = cardiovascular; CT= computed tomography; EMG = electromyography; D/C = discharge; ROM - range of motion;tx hx = treatment history; HR = heart rate.

February 2006 • Strength and Conditioning Journal

Aursianian(1994)

Baueretal.(2001)

Table 2Summary of Sports Science Weight Belt Research Studies

Author Publication Category Exercise examined

Mastersthesis

J. StrengthCond. Res.

Spinalcompression

EMG

Asymmetric lifting

Back squat with 6reps @ 60% of theIRM

independentvariabies

Lifting with andwithoutthe weightbeit

Squat with andwithout the belt

Dependent variabies

Spinal compression inaddition toother vari-ables

EMG of erector spinae

Results

Possible benefit. Use of theweight belt reduced spinal com-pression in addition to othervariables

PossJbie benefit. EMG wasgreater when the belt was used

Bourne etal. Br.J. Sports(1991) Med.

Spinal shrink-age

Circuit weighttraining

Circuit weighttrain-ing, 1 sequencewith and 1 withoutthe belt

Spinal shrinkage asmeasured by a stan-diometer

Possible benefit. The circuittraining sequence resulted in astature loss of 3.59 mm withoutthe beit and 2.87 with the belt

Escamillaet Med.Sci,al.(20021 Sports

Exerc.

EMG

Finnie J.StrengthCond.Res.

Motivationsfor use

Sumoand conven-tional deadlift

None

Deadlifts with andwithoutthe belt

Qualitative study

EMG of rectus abdomi-nus and obliques

27% used belts, 90% ofbelt users used themto prevent injury. 22%used them to improveperformance

Harman etal.(1989)

Med.Sci.SportsExerc.

lARGRRIiftingmechanics

Deadlift @ 90 IRM Deadlift performedwith orwithout belt

IAP, GRF, liftingmechanics

Mixed results. EMG activity wasgreater in the rectus abdominuswhen the belt was used. EMGactivity was greater in the exter-nal obliques when the belt wasnot used

27% used belts, 90% wore belts toprevent injury. 22% wore belts toimprove performance

Possible benefit.lAP rose signifi-cantly with the belt. Peak and av-erage IAP higher with the belt. In-creased IAP thought to decreasedisc compressive force

Mixed results.WB resulted inhigher systolic BP and HR foraerobic and isometric activities.Significant HR increase duringthe aerobic exercise

Possible benefit-WB repetitionsperformed with more velocity,especially during later reps;W8IAP was greater

Possibie benefit. Mean shrink-age was greater when no beltwas worn than when the beltwas worn

No effect. NSDin EMG betweengroupsWB group performed the exercisewith more velocity

IAP - interabdominal pressure; HR - heart rate; BP - blood pressure; 1 RM = 1 repetition maximum; EMG = electromyography; GRF - groundreaction force; WB = weight belt; NSD - no statistical difference.

Hunter

Lander etal.(1992)

Reilly

Zinketal.(2001)

J.Appl.Sports Sci.Res.

Med.Sci.SportsExerc.

J. SportsSci.

J. StrengthCond.Res.

HRandBP

Velocity, GRF,IAP, EMG

Spinalshrinkageperception ofeffort

EMG andkinematics

Bicycle ergometer.isometric dead lift,and 1-arm benchpress

Squat

Deadlift8setsof20reps with 10kg

Back squat at 90%IRM

Effect of weightbelt during exerciseon a bicycle er-gometer,unilateralbench press,andisometric deadlift

8RM squat with andwithoutthe belt

Deadlift sets per-formed with andwithoutthe weightbelt

Squat with andwithout the belt

HRandBP

Velocity, GRF, IAP, EMG

Intervertebraldlscshrinkage

EMG of 5 musclegroups kinematics (bar-bell velocity, etc.)

February 2006 • Strength and Conditioning Journal

there were 195 back injury claims.Among the 6,311 subjects who complet-ed basehne and follow-up interviews,there were 1,088 cases of back pain, withno statistically significant difference be-tween those who did and did not wearbelts. However, Mitchell et al. (23) indi-cated that tbere were less extensive in-juries and lower costs per worker whenrbc belt was not worn, despite a modestdecrease in overall rate of injury associat-ed witb belt use. Tbe effect of lifting beltuse on incidence of in)ury in occupation-al settings remains inconclusive.

Effect of Lifting Belts onFatigueStudies oi tbe effect of belt use on fa-tigue have primarily examined repetitivesimulated occupational lifting tasks. Inone study (6), EMG was assessed in backextensors near the end oi a 4-hour liftingtask performed with and without thebelt. Difference in back extensor EMGbetween tbe 2 conditions was not statis-tically different, leading tbe authors toconclude cbat the belt did not attenuatelumbar fatigue (6). Similarly, Majkow-ski et al. (19) found tbat tbe lifting beltbad no effect on muscle fatigue in theparaspinals, as evidenced by no differ-ences in EMG.

Effect of Lifting Belts onHemodynamicsIn addition to assessing rbe effect ofweight belt use on injury rate and fatigue,some studies bave evaluated the effects ofthe lifting belt on hemodynamic vari-ables. Bobicket al. (3) demonstrated thatuse ofa lifting belt during a 30-minutesimulated occupational lifting sessionbad no effect on heart rate (HR), bloodpressure (BP), and frequency of respira-tion. Only mean oxygen consumptionwas affected, as evidenced by a small in-crease associated with lifting belt use. Incontrast, another study of repetitive sim-ulated occupational lifting assessed theuse of 3 different types of lifting belts andfound tbat frequency of respiration didincrease witb the use of lifting belts (26).Hunter et al. (15) also assessed hemody-

namic variables associated with liftingbelt use during the perfotmance of exer-cise. This study demonstrated that HRand systolic BP was significantly higherduring bicycle ergometer work and theisometric deadlift performed witb itcompared witb the exercise without cheuse of tbe lifting belt. However, in thesame study no significant difference inhemodynamic variables was found be-tween the lifting belt and nonlifting beltgroups during tbe performance of a i-arm dumbbell bench press (1 5).

Effect of Lifting Belts onInterabdominal PressureResearch bas also evaluated tbe effect ofthe lifting belt on IAP, demonstratingthat performance of exercises such as thesquat and deadlift while wearing cheweight belt resulted in greater peak andaverage IAP (13, 17), as well as a fasterrate of increase in IAP during the initialsurge of the deadlift exercise performedat 90% of maximuni load (13). Landeret al. (17) demonstrated that IAP was25-40% greater wben subjects wore thelifting belt during ihc performance of an8RM back squat. Tbis result is thoughtto be beneficial during the performanceof resistance training exercises such astbe deadiift and squat, since increasedIAP has been proposed as a mechanismtbat stabilizes the spine and decreasesspinal compressive forces (13).

Effect of Lifting Belts onSpinal Compression andCross-sectional AreaTbeoretically, an increased IAP may affectspinal stability during resistance trainingexercises. In an attempt to examine thepotential effect of the lifting belt on spinalstabilization, 3 studies evaluated the ef-fects of tbe lifting belt on spinal compres-sion. All demonstrated that lifting belt useresulted in reduced spinal compression(1,4, 25). For example. Bourne et al. (4)demonstrated that subjects who used thelifting belt during the performance of acircuit weight training program of 3 setsof 6 exercises bad less loss of stature, as as-sessed by a stadiometer, tban those who

did not wear the belt (2.87 ± 1.65 mm lossof stature compared with a 3.59 ± 3.3 mmloss of stature without tbe belt). Similarly,Reilly et al. (25) found that mean shrink-age of intervertebral discs was 2.08 ± 0.51mm when the lifting belt was used com-pared witb 4.08 ± 1.28 mm when tbe beltwas not used during the performance of 8sets of 20 repetitions of the deadlift. Addi-tionally, wearing tbe belt also decreasedthe perception of effort. In addition tostudies of spinal compression, Miyamotoet al. (24) used computed tomography(GT) scans to assess the shape of tbe trunkat tbe level of the third lumbar vertebrae.Geometrical measutements of the CT-scanned images demonstrated that wear-ing the lifting belt caused rbe trunk to beneatly round witb increased intctmuscu-lar pressure in the erector spinae. It is like-ly that the trunk remains round, albeitcompressed, when wearing a liliing belt.Tbis round trunk configuration is likely aresult of increased incermuscular pressureand greater activation of the erectorspinae and rectus abdomims muscles, re-spectively.

Effect of Lifting Belts on Rangeof MotionIn a .study assessing tbe effect of liftingbelts on range of motion and velocity oflarge- and small-box lifting, Giorcelli etal. (12) demonstrated tbat lifting beltssignificantly reduced maximum spinalflexion and extension angular velocitiesas well as lateral bending angular veloci-ties while increasing hip and knee flex-ion, regardless of the box size lifted.When lifting large boxes, lifting beltssignificantly reduced some movementssuch as right lateral bending and lefttwisting of the torso. The authors re-ported tbat subjects lifted more slowlyand were more likely to use a squat-lifttechnique while wearing tbe belt, imply-ing tbat beit use may be benefV'ial.

Effect of Lifting Belts on EMGof Trunk Muscles and PrimeMoversA number of studies bave assessed averageEMG of trunk muscles during simulated

February 2006- Strength and Conditioning Journal

occupational lifting tasks using ma-chines, as well as during the performanceof resistance training exercises. For exam-ple. Warren et al. (27) demonstrated thatfor all subjects wbo performed simulatedoccupational tasks, mean EMG values oftbe abdominal obliques were lower whilewearing a lifting belt, with average EMGvalues of 29.7 ± 3.13 mV compared with33.3 ± 3.05 mV in tbe lifting belt andnonlifting belt conditions, respectively.This finding was particularly true for fe-male subjects. However, 5 of 6 male sub-jects demonstrated higher average EMGvalues wbile wearing tbe belt. The resultsof a study by Escamilla et al. (7) are simi-larly equivocal regarding the question ofthe effect of lifting belt use on trunk mus-cle EMG (EMG data was normalized andaveraged). In this study, researchersfound tbat during the performance of thesumo and conventional deadlift, subjectswho did not wear lifting belts demon-strated greater EMG activity in tbeobliques wben compared witb subjectswho wore belts, as evidenced by EMGvalues of 53 ± 21% maximal voluntarycontraction (MVG) for subjects wearingthe lifting belt and 62 ± 26% MVC forthose who did not. However, tbe samestudy showed tbat tbe use of the belt re-sulted in more EMG activity in the tectusabdominus when compared with thosesubjects who did not wear belts. Subjectswbo wore tbe lifting belt demonstrated63 ± 32% MVC compared with 56 ±26% MVC for those who did not. Otherresearchers bave used median power spec-tral frequency EMGs to assess trunk mus-cles and the effect of muscle fatigue ofsubjects wbo performed a repetitive lift-ing task (19), witb results indicating thatthe lifting belt bad no effect on muscle fa-tigue.

In addition to EMG studies during sim-ulated occupational lifting tasks, re-searcbers have examined the effect of thelifting belt on trunk muscles and primemover motor unit activity during theback squat. Results reveal no significantdifference in EMG of erector spinae andother hip and knee extensors between

lifting belt and nonlifting belt condi-tions (29). Although exact numericaldata are not shown, the accompanyingfigure suggests that lifting belt and non-lifting belt conditions were approxi-mately witbin 1-4% of each other, withall values in a range of 52-57% of peakEMG. Nonetheless, other evidence sug-gests tbat use of the lifting belt increasesEMG of prime movers such as the vastuslateralis and biceps femoris (althoughthe trunk muscles showed no effect here;17), and as mucb as a 23% increasedEMG of muscles such as tbe erectorspinae (2), when comparing lifting belttise to nonuse.

Effect of Lifting Belts onResistance Training ExercisePerformanceSome evidence suggests that repetitionsof an exercise are performed wich morevelocity when cbe lifting belt was used(17, 29), although use of the lifting beltmay not promote an increase in force(19). Two studies demonstrated that theuse of the lifting belt increases velocity ofthe squat. For example, Zink et al. (29)reported [bat squats are performed witba biglier velocity when the belt is used. Intbeir study, wben lifting belts were used,squats were performed in an average timeof 2.96 ± 0.65 seconds compared witb3.21 ± 0.77 seconds when performedwithout tbe lifting belt. Also, accordingto Lander et al. (17), 8 repetition maxi-mum (8RM) squats were performedwitb more velocity, especially duringlater repetitions in the set, for those whowore the lifting belt. Repetitions per-formed witb the lifting belt took an aver-age of 3.34 seconds compared with 3.56seconds without the belt.

DiscussionLifting belts seem to affect range of mo-tion, although it is hard to say what ad-vantages tbis affords, if any. In simulatedindustrial applications, altered range ofmotion may increase the likelihood thatsubjects would use a squat-lifting tech-nique, tbus flexing more at the kneesand hips to lift heavy objects (12), wbicb

would seem desirable. Nonetheless,studies evaluating actual injury rate inoccupational settings are inconclusive(16, 23, 28). Eurtbermore, tbe liftingbelt does not appear to reduce the rate oflumbar fatigue during occupational ac-tivities (6, 19). Thus, the occupationalresearch sheds little light on tbe use oftbe lifting belt for strength and condi-tioning purposes, and no studies havespecifically evaluated the incidence ofinjury associated with lifting belt use ornonuse in strength and conditioningsettings despite tbe fact that some evi-dence suggests that most wearers usethem to prevent injury (8).

Lifting belts seem to have no negative af-fect on hemodynamic variables such asHR and BP (3), with the only exceptionoccurring during a study of isometricdeadlifts (1 5), wbich arc an unlikely ex-ercise option in most strength and con-ditioning settings. Additionally, no evi-dence exists to implicate resistancetraining bemodynamic responses withpossible injury, even if tbose responseswere higher than normal. As commonlybelieved, IAP increases with tbe use ofthe lifting belt, which most likely servesto reduce spinal compression during theperformance of a variety of resistancetraining exercises (1, 4, 25).

The significance of the effect of the lift-ing belt on motor unit recruitment as ev-idenced by cbanges in EMG activity de-pends on whether it is an occupational orstrength and conditioning setting. In oc-cupational settings, less muscle activa-tion may be desirable in order to reducefatigue, thus reducing joint reactionfortes. In strength and conditioning set-tings, more motor unit activity repre-sents a better training stimulus and isdesirable. Previous anecdotal claims sug-gest that belt use reduced tbe training ef-fect of tbe trunk muscles (5, 10). Howev-er, EMG studies are inconclusive.Studies suggest that tbe effect of liftingbelts may depend on tbe trunk musclestudied (7) and gender (27). In fact,some evidence suggests that there is more

February 2006 • Strength and Conditioning Journal

erector spinae EMG activity associatedwith wearing the lifting belt (2) and thattbere is more EMG activity associatedwith tbe prime movers during the squatwbile wearing the lifting belt (17). I hisfinding may be part of the reason tbatstudies demonstrate increased velocity ofexercises sucb as the squat (1 7, 29) whenlifting belts are used.

In summary, the litetature suggests a gen-eral lack of evidence indicating tbe bene-fits of wearing lifting belts in industrialand occupational settings. The sport sci-ence and strength and conditioning liter-ature suggests tbere is no strong argu-ment against the use of the lifting belt.Hive of 8 studies of lifting belt use in sportscience and strengtb and conditioningapplications suggest tbat lifting belt usemay provide some benefit. Sport scienceevidence suggests that lifting belts may bebeneficial m reducing spinai compres-sion, stabilizing the spine, increasingmotor unit recruitment in prime movers,and increasing exercise velocity. Two ofthe 8 sport science and strength and con-ditioning studies showed mixed results.Only 1 of tbe 8 studies showed no posi-tive effect.

Several questions remain regarding lift-ing belt use. The evidence in the occupa-tional settings reveals little to no posi-tive effects via the use of lifting belts, buttbe sport science/strengtb and condi-tioning body of evidence shows enoughpositive effect tbat further study is war-ranted. •

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February 2006 • Strength and Conditioning Journal

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Renfro

Greg Renfro coordinatesthe Sports Med-icine and Optimal Performance Programsat Langiade Memorial Hospital in Antigo,Wisconsin.

Ebben

William Ebben is a clinical faculty mem-ber and researcher at Marquette Universi-ty, Milvwaukee, Wisconsin.

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know about the ERP program.

Applications can be found online at www.nsca-lift.org/ERP/, by contacting

the NSCA National Headquarters at 800-815-6826, or by sending email

to kcinea@nsca-lift.org. For more information on the electronic format,

contact Keith Cinea at the NSCA National Headquarters by the toll-free

phone number or email address below.

"The Educational Recognition Program has had a positive effect on our

program in two ways. First, it has helped us recruit students with a strong

interest in conditioning. Second, university administrators see the (NSCA)

Education Recognition Program as evidence that we are striving to

improve our program."

T. Jeff Chandler, EdD, CSCS,*D - Marshall University

Next Application DeadlineJANUARY 1,2006

800-815-6826 * kcinea@nsca-lift.org

National Strength and Conditioning Association800-815-6826 • www.nsca-lift.org

February 2006-Strength and Conditioning Journal