Sports Medicine

, Volume 47, Issue 3, pp 479–501 | Cite as

The Epidemiology of Injuries Across the Weight-Training Sports

  • Justin W. L. KeoghEmail author
  • Paul W. Winwood
Systematic Review



Weight-training sports, including weightlifting, powerlifting, bodybuilding, strongman, Highland Games, and CrossFit, are weight-training sports that have separate divisions for males and females of a variety of ages, competitive standards, and bodyweight classes. These sports may be considered dangerous because of the heavy loads commonly used in training and competition.


Our objective was to systematically review the injury epidemiology of these weight-training sports, and, where possible, gain some insight into whether this may be affected by age, sex, competitive standard, and bodyweight class.


We performed an electronic search using PubMed, SPORTDiscus, CINAHL, and Embase for injury epidemiology studies involving competitive athletes in these weight-training sports. Eligible studies included peer-reviewed journal articles only, with no limit placed on date or language of publication. We assessed the risk of bias in all studies using an adaption of the musculoskeletal injury review method.


Only five of the 20 eligible studies had a risk of bias score ≥75 %, meaning the risk of bias in these five studies was considered low. While 14 of the studies had sample sizes >100 participants, only four studies utilized a prospective design. Bodybuilding had the lowest injury rates (0.12–0.7 injuries per lifter per year; 0.24–1 injury per 1000 h), with strongman (4.5–6.1 injuries per 1000 h) and Highland Games (7.5 injuries per 1000 h) reporting the highest rates. The shoulder, lower back, knee, elbow, and wrist/hand were generally the most commonly injured anatomical locations; strains, tendinitis, and sprains were the most common injury type. Very few significant differences in any of the injury outcomes were observed as a function of age, sex, competitive standard, or bodyweight class.


While the majority of the research we reviewed utilized retrospective designs, the weight-training sports appear to have relatively low rates of injury compared with common team sports. Future weight-training sport injury epidemiology research needs to be improved, particularly in terms of the use of prospective designs, diagnosis of injury, and changes in risk exposure.


Team Sport Injury Risk Tendinitis Bench Press Weight Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Meng-Xiao Michelle Miao and Petra Pühringer for their expertise in translating the text of the studies written in Chinese and German, respectively.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Justin Keogh and Paul Winwood declare they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2016_575_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)


  1. 1.
    Cholewicki J, McGill SM, Norman RW. Lumbar spine loads during the lifting of extremely heavy weights. Med Sci Sports Exerc. 1991;23(10):1179–86.CrossRefPubMedGoogle Scholar
  2. 2.
    Escamilla RF, Fleisig GS, Lowry TM, et al. A three-dimensional biomechanical analysis of the squat during varying stance widths. Med Sci Sports Exerc. 2001;33(6):984–98.CrossRefPubMedGoogle Scholar
  3. 3.
    Escamilla RF, Fleisig GS, Zheng N, et al. Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc. 1998;30(4):556–69.CrossRefPubMedGoogle Scholar
  4. 4.
    Escamilla RF, Francisco A, Fleisig GS, et al. A three-dimensional biomechanical analysis of sumo and conventional style deadlifts. Med Sci Sports Exerc. 2000;32(7):1265–75.CrossRefPubMedGoogle Scholar
  5. 5.
    McGill SM, McDermott A, Fenwick CMJ. Comparison of different strongman events: trunk muscle activation and lumbar spine motion, load, and stiffness. J Strength Cond Res. 2009;23(4):1148–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Gill IP, Mbubaegbu C. Fracture shaft of clavicle, an indirect injury from bench pressing. Br J Sports Med. 2004;38(5):E26.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    George SM. Simultaneous acute rotator cuff tear and distal biceps rupture in a strongman competitor. Orthop. 2010;16:268–70.Google Scholar
  8. 8.
    George DH, Stakiw K, Wright CJ. Fatal accident with weight-lifting equipment: implications for safety standards. Can Med Assoc J. 1989;140(8):925–6.Google Scholar
  9. 9.
    Luke JL, Farb A, Virmani R, et al. Sudden cardiac death during exercise in a weight lifter using anabolic androgenic steroids: pathological and toxicological findings. J Forensic Sci. 1990;35(6):1441–7.CrossRefPubMedGoogle Scholar
  10. 10.
    National Center for Catastrophic Sport Injury Research. 2016. Definition. In: Catastrophic injury. Accessed 13 May 2016.
  11. 11.
    Caine D, Harmer P, Schiff M. Preface. In: Caine D, Harmer P, Schiff M, editors. The encyclopaedia of sports medicine: the epidemiology of injury in Olympic sports. Oxford: Blackwell; 2009. p. xi–xiii.CrossRefGoogle Scholar
  12. 12.
    Keogh JWL. Weightlifting. In: Caine D, Harmer P, Schiff M, editors. The encyclopaedia of sports medicine: the epidemiology of injury in Olympic sports. Oxford, England: Blackwell; 2009. p. 336–50.CrossRefGoogle Scholar
  13. 13.
    Brown EW, Kimball RG. Medical history associated with adolescent powerlifting. Pediatrics. 1983;72(5):636–44.PubMedGoogle Scholar
  14. 14.
    Malina RM. Weight training in youth-growth, maturation, and safety: an evidence-based review. Clin J Sport Med. 2006;16(6):478–87.CrossRefPubMedGoogle Scholar
  15. 15.
    Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(S5):S60–79.CrossRefPubMedGoogle Scholar
  16. 16.
    Lloyd RS, Faigenbaum AD, Stone MH, et al. Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med. 2014;48(7):498–505. doi: 10.1136/bjsports-2013-092952.CrossRefPubMedGoogle Scholar
  17. 17.
    Lopes AD, Hespanhol LCJ, Yeung SS, et al. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012;42(10):891–905.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kluitenberg B, van Middelkoop M, Diercks R, et al. What are the differences in injury proportions between different populations of runners? A systematic review and meta-analysis. Sports Med. 2015;45(8):1143–61.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nauta J, Martin-Diener E, Martin BW, et al. Injury risk during different physical activity behaviours in children: a systematic review with bias assessment. Sports Med. 2014;45(3):327–36. doi: 10.1007/s40279-014-0289-0.CrossRefGoogle Scholar
  20. 20.
    Keogh J, Hume PA, Pearson S. Retrospective injury epidemiology of one hundred one Oceania competitive power lifters: the effects of age, body mass, competitive standard, and gender. J Strength Cond Res. 2006;20(3):672–81.PubMedGoogle Scholar
  21. 21.
    Goertzen M, Schoppe K, Lange G, et al. Injuries and damage caused by excess stress in body building and power lifting. Sportverletz Sportsc. 1989;3(1):32–6.CrossRefGoogle Scholar
  22. 22.
    Engebretsen L, Soligard T, Steffen K, et al. Sports injuries and illnesses during the London Summer Olympic Games 2012. Br J Sports Med. 2013;47:407–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Wang WY, Shi HF, Zuo H, et al. An epidemiological survey and comparative study of the injuries in weightlifting. Sports Sci. 2000;4:44–6.Google Scholar
  24. 24.
    Kim EK, Kim TG. Analysis of sports injuries among Korean national players during official training. J Korean Data Inf Sci Soc. 2014;25(3):555–65.Google Scholar
  25. 25.
    Raske A, Norlin R. Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med. 2002;30(2):248–56.PubMedGoogle Scholar
  26. 26.
    Winwood PW, Hume PA, Cronin JB, et al. Retrospective injury epidemiology of strongman athletes. J Strength Cond Res. 2014;28(1):28–42.CrossRefPubMedGoogle Scholar
  27. 27.
    Calhoon G, Fry AC. Injury rates and profiles of elite competitive weightlifters. J Athl Train. 1999;34(3):232–8.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Junge A, Engebretsen L, Mountjoy ML, et al. Sports injuries during the Summer Olympic Games 2008. Am J Sports Med. 2009;37(11):2165–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Haykowsky MJ, Warburton DER, Quinney HA. Pain and injury associated with powerlifting training in visually impaired athletes. J Vis Impair Blind. 1999;93:236–41.Google Scholar
  30. 30.
    Siewe J, Rudat J, Rollinghoff M, et al. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011;32:703–11.CrossRefPubMedGoogle Scholar
  31. 31.
    Siewe J, Marx G, Knoll P, et al. Injuries and overuse syndromes in competitive and elite bodybuilding. Int J Sports Med. 2014;35(11):943–8.CrossRefPubMedGoogle Scholar
  32. 32.
    McLennan JG, McLennan JE. Injury patterns in Scottish heavy athletics. Am J Sports Med. 1990;18(5):529–32.CrossRefPubMedGoogle Scholar
  33. 33.
    Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. Epub 22 November 2013.Google Scholar
  34. 34.
    Weisenthal BM, Beck CA, Maloney MD, et al. Injury rate and patterns among CrossFit athletes. Orthop J Sports Med. 2014;2(4):2325967114531177. doi: 10.1177/2325967114531177.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kulund DM, Dewey JB, Brubaker CE, et al. Olympic weight-lifting injuries. Phys Sportsmed. 1978;6:111–8.CrossRefGoogle Scholar
  36. 36.
    Konig M, Biener K. Sport-specific injuries in weight lifting. Schweiz Z Sportmed. 1990;38(1):25–30.PubMedGoogle Scholar
  37. 37.
    Xiaojun Z, Taotao LI. Sport injury law and preventing methods of Chinese elite bodybuilding players. J Shenyang Inst Phys Educ. 2008;27(4):75–7.Google Scholar
  38. 38.
    Eberhardt A, Dzbański P, Fabirkiewicz K, et al. Frequency of injuries in recreational bodybuilding. Phys Educ Sport. 2007;51:40–4.CrossRefGoogle Scholar
  39. 39.
    Kolber MJ, Beekhuizen KS, Cheng MS, et al. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Res. 2010;24(6):1696–704. doi: 10.1519/JSC.0b013e3181dc4330.CrossRefPubMedGoogle Scholar
  40. 40.
    Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clin Sports Med. 1991;10(3):615–21.PubMedGoogle Scholar
  41. 41.
    Winwood PW, Keogh JWL, Harris NK. The strength and conditioning practices of strongman competitors. J Strength Cond Res. 2011;25(11):3118–28.CrossRefPubMedGoogle Scholar
  42. 42.
    Fleck SJ, Kraemer WJ. Designing resistance training programs. 2nd ed. Champaign: Human Kinetics; 1997.Google Scholar
  43. 43.
    Kraemer WJ, Koziris LP. Olympic weightlifting and powerlifting. In: Lamb DR, Knuttgen HG, Murray R, editors. Physiology and nutrition for competitive sport. Carmel: Cooper; 1994. p. 1–54.Google Scholar
  44. 44.
    Swinton PA, Lloyd R, Agouris I, et al. Contemporary training practices in elite British powerlifters: survey results from an international competition. J Strength Cond Res. 2009;23(2):380–4.CrossRefPubMedGoogle Scholar
  45. 45.
    Stone MH, Pierce KC, Sands WA, et al. Weightlifting: program design. Strength Cond J. 2006;28(2):10–7.Google Scholar
  46. 46.
    Wretenberg P, Feng Y, Arborelius UP. High- and low-bar squatting techniques during weight-training. Med Sci Sports Exerc. 1996;28(2):218–24.CrossRefPubMedGoogle Scholar
  47. 47.
    Gabbett TJ, Domrow N. Relationships between training load, injury, and fitness in sub-elite collision sport athletes. J Sports Sci. 2007;25(13):1507–19.CrossRefPubMedGoogle Scholar
  48. 48.
    Hawkins RD, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med. 1999;33(3):196–203.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Kujala UM, Marti P, Kaprio J, et al. Occurrence of chronic disease in former top-level athletes. Predominance of benefits, risks or selection effects? Sports Med. 2003;33(8):553–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Granhed H, Morelli B. Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med. 1988;16(5):530–3.CrossRefPubMedGoogle Scholar
  51. 51.
    Mundt DJ, Kelsey JL, Golden AL, et al. An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. Am J Sports Med. 1993;21(6):854–60.CrossRefPubMedGoogle Scholar
  52. 52.
    Hughes G, Watkins J. A risk-factor model for anterior cruciate ligament injury. Sports Med. 2006;36(5):411–28.CrossRefPubMedGoogle Scholar
  53. 53.
    Clausen MB, Zebis MK, Moller M, et al. High injury incidence in adolescent female soccer. Am J Sports Med. 2014;42(10):2487–94. doi: 10.1177/0363546514541224.CrossRefPubMedGoogle Scholar
  54. 54.
    Williams S, Trewartha G, Kemp S, et al. A meta-analysis of injuries in senior men’s professional rugby union. Sports Med. 2013;43(10):1043–55. doi: 10.1007/s40279-013-0078-1.CrossRefPubMedGoogle Scholar
  55. 55.
    Orchard J, James T, Kountouris A, et al. Changes to injury profile (and recommended cricket injury definitions) based on the increased frequency of Twenty20 cricket matches. Open Access J Sports Med. 2010;1:63–76.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Barlow JC, Benjamin BW, Birt PJ, et al. Shoulder strength and range-of-motion characteristics in bodybuilders. J Strength Cond Res. 2002;16(3):367–72.PubMedGoogle Scholar
  57. 57.
    Gross ML, Brenner SL, Esformes I, et al. Anterior shoulder instability in weight lifters. Am J Sports Med. 1993;21(4):599–603. doi: 10.1177/036354659302100419.CrossRefPubMedGoogle Scholar
  58. 58.
    Keogh JWL, Hume PA, Pearson SN, et al. Can absolute and proportional anthropometric characteristics distinguish stronger and weaker powerlifters? J Strength Cond Res. 2009;23(8):2256–65.CrossRefPubMedGoogle Scholar
  59. 59.
    Keogh JWL, Hume PA, Pearson SN, et al. Anthropometric dimensions of male powerlifters of varying body mass. J Sport Sci. 2007;25(2):1365–76.CrossRefGoogle Scholar
  60. 60.
    Kraus JF, Schaffer KB, Rice T, et al. A field trial of back belts to reduce the incidence of acute low back injuries in New York City home attendants. Int J Occup Med Environ Health. 2002;8(2):97–104.CrossRefGoogle Scholar
  61. 61.
    Reddell CR, Congleton JJ, Huchingson DR, et al. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers. Appl Ergon. 1992;23(5):319–29.CrossRefPubMedGoogle Scholar
  62. 62.
    Fees M, Decker T, Snyder-Mackler L, et al. Upper extremity weight-training modifications for the injured athlete. A clinical perspective. Am J Sports Med. 1998;26(5):732–42.PubMedGoogle Scholar
  63. 63.
    McGill SM. Ultimate back fitness and performance. Waterloo: Wabuno Publishers; 2004.Google Scholar
  64. 64.
    Gabbett TJ. Incidence, site, and nature of injuries in amateur rugby league over three consecutive seasons. Br J Sports Med. 2000;34(2):98–103. doi: 10.1136/bjsm.34.2.98.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Parkkari J, Kujala UM, Kannus P. Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work. Sports Med. 2001;31(14):985–95.CrossRefPubMedGoogle Scholar
  66. 66.
    Gabbe BJ, Finch CF, Bennell KL, et al. How valid is a self reported 12 month sports injury history? Br J Sports Med. 2003;37:545–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
  2. 2.Sports Performance Research Institute New Zealand (SPRINZ), AUT MillenniumAUT UniversityAucklandNew Zealand
  3. 3.Faculty of Science, Health, Education and EngineeringUniversity of the Sunshine CoastSippy DownsAustralia
  4. 4.Department of Sport and Recreation, School of Applied ScienceBay of Plenty PolytechnicTaurangaNew Zealand

Personalised recommendations