Spilling “blood, sweat, and tears” is not just a common idiom for hard work. It’s nearly literally what happened to 37-year-old strongman Mikhail Shivlyakov when he tried to dead-lift nearly half a ton of iron at the 2018 Arnold Sports Festival in Columbus, Ohio this weekend. A few seconds into the lift, Shivlyakov’s nose suddenly gushed horrific amounts of blood, which spilled onto his red, sweating face. And, to everyone’s horror, the blood-smeared strongman didn’t even stop lifting.

That Shivlyakov continued trying to lift the insane 427-kilogram weight while losing such an enormous amount of blood seems like a medical emergency waiting to happen. But Dr. Jonathan Overdevest, a Rhinology and Skull Base Surgery Surgical Fellow at Stanford University School of Medicine, tells Inverse that Shivlyakov’s blood-fountain probably would have stopped spilling over eventually.

“Most nosebleeds seen in rare instances of vigorous straining are self limited, as long as the individual is not on any medications that prolong clotting or have any bleeding disorders,” he tells Inverse. The process that kickstarts one of these nosebleeds, it seems, is not a particularly unusual one.

Warning: graphic content ahead.

Anyone who exerts themselves physically inevitably ends up putting a lot of pressure on the blood vessels, largely because extreme exertion leads your blood pressure to increase, says Overdevest. Since the body’s network of blood vessels is a closed-loop system, high pressure in one area will raise pressure everywhere, and sometimes smaller blood vessels can’t handle it. Like balloons, these vessels will burst when the pressure inside them is too great.

In Shivlyakov’s case, his deadlift probably first raised the intrathoracic pressure — the pressure in his chest cavity — which naturally increases during exhalation. This, in turn, would increase his venous blood pressure (the pressure of the blood as it returns to the heart from the rest of body), which would lead to an increase in arterial pressure (the pressure of blood as it leaves the heart).

“This increased pressure can at times cause the fragile vessels that supply our nasal mucosa to rupture, resulting in a nose bleed,” says Overdevest.

weightlifting nosebleed
Increased blood pressure can lead to blood vessels bursting. 

There are less extreme activities than lifting a 427-kilogram weight that could lead to nosebleeds — known medically as epistaxis — but Overdevest doesn’t think most people should be too worried.

“Aggressive sneezing, abrupt strong coughing, and bearing down can all lead to epistaxis,” he says. “Nasal bleeding under these circumstances rarely occurs though, as the nasal blood vessels for most individuals are robust enough to sustain the pressure increase.”

It’s possible that Shivlyakov’s nasal blood vessels are dainty little channels rather than thick, robust pipes and simply can’t handle the rush of blood prompted by the lift. Or, more likely, perhaps the blood pressure induced by his near-superhuman effort really was higher than any part of the human body is meant to handle.

But blood loss aside, the worst part about Shivlyakov’s spill is that it didn’t even result in a win. He was beat by Thor Bjornsson, the enormous strongman that plays The Mountain on Game of Thrones, who lifted 472 kilograms without spilling so much as a drop of life force out of his face-holes. Shivlyakov’s blood and sweat, it seems, had gushed in vain; the tears, no doubt, came after.

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