Injuries in strength training: review and practical application
Purpose: This systematic review examines what is known about injuries in strength training.
Methods: A systematic search was performed in PubMed and SportDiscus. Studies were included if they examined powerlifters, weightlifters, strongman athletes, bodybuilding athletes, individuals who undertook recreational weight training or weight training to complement athletic performance. Exposure variables were incidence, severity and body part injury.
Results: After examining 1214 titles and abstracts, 62 articles were identified as potentially relevant. Finally, 11 were included in this systematic review. Conflicting results were reported on the relationships between injury definition and incidence or severity recorded. The lower back followed by the shoulder and knee are the most frequently affected areas in strength sports.Conclusion: Strength training is safe. However, the variety of injury definitions has makes it difficult to compare different studies in this field. New styles of reporting injuries have appeared, and could make increases these ratios. If methodological limitations in measuring incidence rate and severity injuries can be resolved, more work can be conducted to define the real incidence rate, compare it with others sports, and explore cause and effect relationships in randomized controlled trials.
Ades, P. A., Ballor, D. L., Ashikaga, T., Utton, J. L., & Nair, K. S. (1996). Weight training improves walking endurance in healthy elderly persons. Ann Intern Med, 124(6), 568-572.
Bahr, R. (2009). No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med, 43(13), 966-972. doi:43/13/966 [pii]10.1136/bjsm.2009.066936
Bahr, R., & Krosshaug, T. (2005). Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med, 39(6), 324-329.
Basford, J. R. (1985). Weightlifting, weight training and injuries. Orthopedics, 8(8), 1051-1056.
Benjamin, H. J., & Glow, K. M. (2003). Strength training for children and adolescents: what can physicians recommend? Phys Sportsmed, 31(9), 19-26. doi: 10.3810/psm.2003.09.482
Best, T. M., & Shrier, I. (2007). From study design and analysis to conclusion: new horizons for epidemiological rigor in sport medicine. Clin J Sport Med, 17(3), 175-176. doi: 10.1097/JSM.0b013e318061b75d
Brooks, J. H., & Fuller, C. W. (2006). The influence of methodological issues on the results and conclusions from epidemiological studies of sports injuries. Sports medicine, 36(6), 459-472.
Calhoon, G., & Fry, A. C. (1999). Injury Rates and Profiles of Elite Competitive Weightlifters. J Athl Train, 34(3), 232-238.
Carpinelli, R. N. (2012). Critical commentary: the NSCA position statement on youth resistance training. Medicina Sportiva, 16(1), 46-50.
Colado, J. C., & Garcia-Masso, X. (2009). Technique and safety aspects of resistance exercises: a systematic review of the literature. Phys Sportsmed, 37(2), 104-111. doi: 10.3810/psm.2009.06.1716
Cresswell, T. R., & Smith, R. B. (1998). Bilateral anterior shoulder dislocations in bench pressing: an unusual cause. Br J Sports Med, 32(1), 71-72.
Esenkaya, I., Tuygun, H., & Tuerkmen, I. M. (2000). Bilateral anterior shoulder dislocation in a weight lifter. The Physician and sportsmedicine, 28(3).
Faigenbaum, A. D., Kraemer, W. J., Blimkie, C. J., Jeffreys, I., Micheli, L. J., Nitka, M. (2009). Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res, 23(5 Suppl), S60-79. doi: 10.1519/JSC.0b013e31819df407 [doi]
Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. Br J Sports Med, 44(1), 56-63. doi: bjsm.2009.068098 [pii]
Faigenbaum, A. D., Myer, G. D., Farrell, A., Radler, T., Fabiano, M., Kang, J. (2014). Integrative Neuromuscular Training and Sex-Specific Fitness Performance in 7-Year-Old Children: An Exploratory Investigation. Journal of athletic training, 49(2).
Feeley, B. T., Kennelly, S., Barnes, R. P., Muller, M. S., Kelly, B. T., Rodeo, S. A. (2008). Epidemiology of National Football League training camp injuries from 1998 to 2007. The American journal of sports medicine, 36(8), 1597-1603.
Finch, C. (2006). A new framework for research leading to sports injury prevention. J Sci Med Sport, 9(1-2), 3-9; discussion 10. doi: S1440-2440(06)00023-5 [pii]10.1016/j.jsams.2006.02.009
Finch, C. F., & Cook, J. (2013). Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries. British Journal of Sports Medicine.
Finch, C. F., Orchard, J. W., Twomey, D. M., Saleem, M. S., Ekegren, C. L., Lloyd, D. G. (2012). Coding OSICS sports injury diagnoses in epidemiological studies: does the background of the coder matter? British Journal of Sports Medicine.
Fuller, C. W., Ekstrand, J., Junge, A., Andersen, T. E., Bahr, R., Dvorak, J. (2006). Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med, 16(2), 97-106. doi: 00042752-200603000-00003 [pii]
Gabbe, B. J., Finch, C. F., Bennell, K. L., & Wajswelner, H. (2003). How valid is a self reported 12 month sports injury history? Br J Sports Med, 37(6), 545-547.
Gross, M. L., Brenner, S. L., Esformes, I., & Sonzogni, J. J. (1993). Anterior shoulder instability in weight lifters. Am J Sports Med, 21(4), 599-603.
Gumbs, V. L., Segal, D., Halligan, J. B., & Lower, G. (1982). Bilateral distal radius and ulnar fractures in adolescent weight lifters. Am J Sports Med, 10(6), 375-379.
Hak, P. T., Hodzovic, E., & Hickey, B. (2013). The nature and prevalence of injury during CrossFit training. Journal of strength and conditioning research/National Strength & Conditioning Association.
Hamill, B. P. (1994). Relative safety of weightlifting and weight training. J Strength Cond Res, 8(1), 53-57.
Hammond, L. E., Lilley, J., & Ribbans, W. J. (2008). Coding Sports Injury Surveillance Data: Has Version 10 of the Orchard Sports Injury Classification System improved the classification of sports medicine diagnoses? Br J Sports Med. doi: bjsm.2008.051979 [pii]10.1136/bjsm.2008.051979
Harbili, E., & Alptekin, A. (2014). Comparative Kinematic Analysis of the Snatch Lifts in Elite Male Adolescent Weightlifters. Journal of sports science & medicine, 13(2), 417.
Harman, E. (1994). Weight training safety: a biomechanical perspective. Strength and Conditioning.
Haupt, H. A. (2001). Upper extremity injuries associated with strength training. Clin Sports Med, 20(3), 481-490.
Hayden, J. A., Cote, P., & Bombardier, C. (2006). Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med, 144(6), 427-437. doi: 144/6/427 [pii]
Hooper, D. R., Szivak, T. K., Comstock, B. A., Dunn-Lewis, C., Apicella, J. M., Kelly, N. A. (2014). Effects of Fatigue From Resistance Training on Barbell Back Squat Biomechanics. The Journal of Strength & Conditioning Research, 28(4), 1127-1134.
Hootman, J. M., Dick, R., & Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train, 42(2), 311-319.
Jones, C. S., Christensen, C., & Young, M. (2000). Weight training injury trends: a 20-year survey. The Physician and sportsmedicine, 28(7).
Keogh, J., Hume, P. A., & Pearson, S. (2006). Retrospective injury epidemiology of one hundred one competitive Oceania power lifters: the effects of age, body mass, competitive standard, and gender. J Strength Cond Res, 20(3), 672-681. doi: R-18325 [pii]10.1519/R-18325.1
Kerr, Z. Y., Collins, C. L., & Comstock, R. D. (2010). Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med, 38(4), 765-771. doi: 0363546509351560 [pii]10.1177/0363546509351560
Lavallee, M. E., & Balam, T. (2010). An overview of strength training injuries: acute and chronic. Curr Sports Med Rep, 9(5), 307-313. doi: 10.1249/JSR.0b013e3181f3ed6d
Leppänen, M., Aaltonen, S., Parkkari, J., Heinonen, A., & Kujala, U. M. (2013). Interventions to prevent sports related injuries: A systematic review and meta-analysis of randomised controlled trials. Sports medicine, 1-14.
Lubetzky-Vilnai, A., Carmeli, E., & Katz-Leurer, M. (2009). Prevalence of injuries among young adults in sport centers: relation to the type and pattern of activity. Scand J Med Sci Sports, 19(6), 828-833. doi: SMS854 [pii]10.1111/j.1600-0838.2008.00854.x
Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A. (2013). Position statement on youth resistance training: the 2014 International Consensus. British Journal of Sports Medicine, bjsports-2013-092952.
Maffulli, N., & Mikhail, H. M. (1990). Bilateral anterior glenohumeral dislocation in a weight lifter. Injury, 21(4), 254-256.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8(5), 336-341.
doi: S1743-9191(10)00040-3 [pii]10.1016/j.ijsu.2010.02.007
Moinuddin, I., Collins, E., Kramer, H., & Leehey, D. (2012). Exercise in the management of obesity. J Obes Weig Los Ther, 2, 117.
Mundt, D. J., Kelsey, J. L., Golden, A. L., Panjabi, M. M., Pastides, H., Berg, A. T. (1993). An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. The Northeast Collaborative Group on Low Back Pain. Am J Sports Med, 21(6), 854-860.
Myer, G. D., Quatman, C. E., Khoury, J., Wall, E. J., & Hewett, T. E. (2009). Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res, 23(7), 2054-2060. doi: 10.1519/JSC.0b013e3181b86712
Nicholl, J. P., Coleman, P., & Williams, B. T. (1995). The epidemiology of sports and exercise related injury in the United Kingdom. British Journal of Sports Medicine, 29(4), 232-238.
Orchard, J., Rae, K., Brooks, J., Hägglund, M., Til, L., Wales, D. (2010). Revision, uptake and coding issues related to the open access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and 10.1. Open access journal of sports medicine, 1, 207.
Powell, K. E., Heath, G. W., Kresnow, M. J., Sacks, J. J., & Branche, C. M. (1998). Injury rates from walking, gardening, weightlifting, outdoor bicycling, aerobics. Medicine and science in sports and exercise, 30(8), 1246-1249.
Powell, K. E., Paluch, A. E., & Blair, S. N. (2011). Physical activity for health: What kind? How much? How intense? On top of what? Public Health, 32(1), 349.
Quatman, C. E., Myer, G. D., Khoury, J., Wall, E. J., & Hewett, T. E. (2009). Sex differences in "weightlifting" injuries presenting to United States emergency rooms. J Strength Cond Res, 23(7), 2061-2067. doi: 10.1519/JSC.0b013e3181b86cb9 [doi] 00124278-200910000-00021 [pii]
Rae, K., & Orchard, J. (2007). The Orchard Sports Injury Classification System (OSICS) version 10. Clin J Sport Med, 17(3), 201-204. doi: 10.1097/JSM.0b013e318059b53600042752-200705000-00007 [pii]
Raske, A., & Norlin, R. (2002). Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med, 30(2), 248-256.
Reeves, R. K., Laskowski, E. R., & Smith, J. (1998). Weight training injuries. Part 1: diagnosing and managing acute conditions. Physician and sportsmedicine, 26(2), 67-71;74-75;79-80;83;96.
Requa, R. K., DeAvilla, L. N., & Garrick, J. G. (1993). Injuries in recreational adult fitness activities. Am J Sports Med, 21(3), 461-467.
Reynolds, K. L., Harman, E. A., Worsham, R. E., Sykes, M. B., Frykman, P. N., & Backus, V. L. (2001). Injuries in women associated with a periodized strength training and running program. J Strength Cond Res, 15(1), 136-143.
Risser, W. L. (1990). Musculoskeletal injuries caused by weight training. Guidelines for prevention. Clin Pediatr (Phila), 29(6), 305-310.
Risser, W. L. (1991). Weight-training injuries in children and adolescents. Am Fam Physician, 44(6), 2104-2108.
Risser, W. L., Risser, J. M., & Preston, D. (1990). Weight-training injuries in adolescents. Am J Dis Child, 144(9), 1015-1017.
Rossi, F., & Dragoni, S. (1990). Lumbar spondylolysis: occurrence in competitive athletes. Updated achievements in a series of 390 cases. J Sports Med Phys Fitness, 30(4), 450-452.
Ruiz, J. R., Sui, X., Lobelo, F., Morrow, J. R., Jr., Jackson, A. W., Sjostrom, M. (2008). Association between muscular strength and mortality in men: prospective cohort study. BMJ, 337, a439.
Scavenius, M., & Iversen, B. F. (1992). Nontraumatic clavicular osteolysis in weight lifters. Am J Sports Med, 20(4), 463-467.
Stevenson, J. H., Beattie, C. S., Schwartz, J. B., & Busconi, B. D. (2014). Assessing the Effectiveness of Neuromuscular Training Programs in Reducing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes A Systematic Review. The American journal of sports medicine, 0363546514523388.
Strasser, B., & Schobersberger, W. (2011). Evidence for resistance training as a treatment therapy in obesity. J Obes, 2011. doi: 10.1155/2011/482564
Timpka, T., Alonso, J.-M., Jacobsson, J., Junge, A., Branco, P., Clarsen, B. (2014). Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement. British Journal of Sports Medicine, 48(7), 483-490.
Timpka, T., Jacobsson, J., Bickenbach, J., Finch, C. F., Ekberg, J., & Nordenfelt, L. (2014). What is a sports injury? Sports medicine, 1-6.
Van Mechelen, W., Hlobil, H., & Kemper, H. C. (1992). Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med, 14(2), 82-99.
Weisenthal, B. M., Beck, C. A., Maloney, M. D., DeHaven, K. E., & Giordano, B. D. (2014). Injury Rate and Patterns Among CrossFit Athletes. Orthopaedic Journal of Sports Medicine, 2(4), 2325967114531177.
Westcott, W. L. (2012). Resistance Training is Medicine: Effects of Strength Training on Health. Curr Sports Med Rep, 11(4), 209-216. doi: 10.1249/JSR.0b013e31825dabb8
Winwood, P. W., Hume, P. A., Cronin, J. B., & Keogh, J. W. (2014). Retrospective Injury Epidemiology of Strongman Athletes. The Journal of Strength & Conditioning Research, 28(1), 28-42.
Zemper, E. D. (1990). Four-year study of weightroom injuries in a national sample of college football teams. National Strength and Conditioning Association Journal, 12(3), 32-34.