Valsalva Maneuver: What It Is and How to Do It

Medically Reviewed By Alana Biggers, M.D., MPH
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The Valsalva maneuver involves bearing down while holding your breath. It can slow your heart rate while raising the pressure in your abdomen and eyes. It is safe and does not usually cause side effects. However, people with certain conditions should avoid it. The Valsalva maneuver first featured in the works of Antonio Maria Valsalva, who was an Italian physician, in 1704. Nowadays, healthcare professionals use this maneuver frequently to diagnose and treat certain conditions.

It can be especially useful in diagnosing autonomic disorders and heart failure and treating arrhythmias.

The Valsalva maneuver is generally safe and does not usually cause side effects. However, because of the raised pressure it causes, people with retinopathy and intraocular lens implantation should avoid performing this maneuver. Since it can change the heart rhythm, people with certain heart conditions should also be cautious when trying the Valsalva maneuver.

Keep reading to learn more about the Valsalva maneuver, including how to do it and whether or not there are any risks involved.

How to do the Valsalva maneuver

a woman is pinching her nose to do the reverse valsalva maneuver
AH86/Getty Images

According to one 2020 article, doctors may recommend the following instructions for a standard Valsalva maneuver:

  1. Lie at a 45-degree angle on a bed. You can use pillows to achieve this.
  2. Breathe normally for one breath cycle.
  3. Close your glottis. This may feel like you are “closing” the back of your throat, blocking the air that would normally pass through there as you breathe.
  4. With the glottis closed, tense your muscles as if you were trying to breathe out. This is also called bearing down. It is the maneuver that some people do when passing a bowel movement. Do this for 10–15 seconds.
  5. Exhale normally, and stay at the 45-degree angle for 1 minute.

Modified Valsalva maneuver

The same 2020 article also mentioned a modified Valsalva maneuver that may be more effective in helping treat a common arrhythmia called paroxysmal supraventricular tachycardia. This modification does not involve closing the glottis. Instead, it involves exhaling forcefully into a syringe.

Medical professionals may ask people to use the following steps for this modification:

  1. Sit down or lie at a 45- to 90-degree angle on a bed.
  2. Breathe normally for one breath cycle.
  3. Blow into a narrow, 10-milliliter syringe, increasing the force of the exhalation until the syringe reads 40 millimeters of mercury. When it has reached this reading, hold this force for 15 seconds.
  4. Immediately lie down with your legs raised to a 45-degree angle. Remain here for 15 seconds.
  5. Return to lie down at a 45- to 90-degree angle for 45 seconds.

Researchers note that people exhaling forcefully during this modification may notice that the jugular vein on their neck seems larger, that their abdominal muscles are tensed, and that their skin becomes flushed. This is normal.

Reverse Valsalva maneuver

Researchers in a 2021 article described a new technique called the reverse Valsalva maneuver. They found that it had positive effects on treating supraventricular tachycardia (SVT) and explained that people could try this maneuver at home.

To complete a reverse Valsalva maneuver, use the following steps:

  1. Breathe in and out normally, emptying your lungs of air.
  2. Before you inhale, pinch your nose and cover your mouth.
  3. Inhale as best you can for 10 seconds against your closed nose and mouth. Do not swallow.
  4. Release and breathe normally.

What happens in the body during a Valsalva maneuver?

Experts break the standard Valsalva maneuver down into four phases to describe what is happening in the body throughout the process.

Phase 1

In this phase, the person has begun to exert force by bearing down.

Blood empties a little from the larger veins and lungs. This causes the person’s blood pressure to rise.

Phase 2

The person is still bearing down at this stage.

The rise in blood pressure means that less blood is being returned to the heart. This causes a drop in blood pressure. Baroreceptors in the heart, which notice these changes in pressure, become active and put the body into a state called vagal withdrawal. This resets the heart’s output and increases the heart rate and narrowing of the blood vessels, which means that blood pressure returns to normal.

Phase 3

The person has stopped bearing down and released the pressure they were exerting before.

This causes the blood vessels in the lungs to open up, and blood pressure drops suddenly.

Phase 4

The normal blood flow to the heart that began in phase 2 causes blood pressure to rise again. This is because the resetting of the blood flow to the heart causes a response in the sympathetic nervous system.

In turn, this stimulates the baroreflex, which is a type of reflex in the heart that responds to pressure changes. The baroreflex causes the heart rate to slow and blood pressure to return to normal.

Visit our heart health hub here.

Why do my ears pop during the Valsalva maneuver?

Some people clear their ears by pinching their nose, closing their mouth, and breathing out forcefully. This raises the pressure in the middle ear and forces air through your sinuses and eustachian tube.

Forcing the air in this way can help unclog ears and sinuses that have filled with wax, mucus, or other substances. This can cause a popping sound.

Learn more about feelings of fullness in your ear here.

When to do the Valsalva maneuver

The Valsalva maneuver can be especially useful for the following circumstances:

  • Treating SVT: SVT is a type of arrhythmia wherein the heart beats too quickly. It can occur in episodes. The Valsalva maneuver can help stop these episodes.
  • Diagnosing autonomic dysfunction: This maneuver can help medical experts assess the responses of a person’s autonomic nervous system.
  • Addressing ear complaints: The Valsalva maneuver can help people unblock clogged ears. It can also help physicians diagnose conditions that affect the eustachian tube.

Learn when to contact a doctor for ear wax here.

Is the Valsalva maneuver safe?

Generally speaking, the Valsalva maneuver is safe. Doctors often advise people to carry it out at home. However, because it causes a rise in abdomen and eye pressure, some people should avoid doing this maneuver.

People who should not try this maneuver include those with retinopathy, including diabetic retinopathy, and intraocular lens implantation, which can happen during cataract surgery.

Some people with other conditions should also be careful when trying the Valsalva maneuver and seek advice from their doctor before doing so. This includes people with:

Summary

The Valsalva maneuver is common in modern medicine. It can help treat and diagnose conditions such as SVT, ear issues, and autonomic dysfunction.

This maneuver involves bearing down with force against a closed throat. However, some variations exist, and these may be more effective in some circumstances.

The Valsalva maneuver is generally safe, but people with certain eye and heart conditions should contact a doctor before considering it.

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Medical Reviewer: Alana Biggers, M.D., MPH
Last Review Date: 2022 Feb 28
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