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.
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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.
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.
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.
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.
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.
Gill IP, Mbubaegbu C. Fracture shaft of clavicle, an indirect injury from bench pressing. Br J Sports Med. 2004;38(5):E26.
George SM. Simultaneous acute rotator cuff tear and distal biceps rupture in a strongman competitor. Orthop. 2010;16:268–70.
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.
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.
National Center for Catastrophic Sport Injury Research. 2016. Definition. In: Catastrophic injury. http://nccsir.unc.edu/definition-of-injury/. Accessed 13 May 2016.
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.
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.
Brown EW, Kimball RG. Medical history associated with adolescent powerlifting. Pediatrics. 1983;72(5):636–44.
Malina RM. Weight training in youth-growth, maturation, and safety: an evidence-based review. Clin J Sport Med. 2006;16(6):478–87.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Raske A, Norlin R. Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med. 2002;30(2):248–56.
Winwood PW, Hume PA, Cronin JB, et al. Retrospective injury epidemiology of strongman athletes. J Strength Cond Res. 2014;28(1):28–42.
Calhoon G, Fry AC. Injury rates and profiles of elite competitive weightlifters. J Athl Train. 1999;34(3):232–8.
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.
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.
Siewe J, Rudat J, Rollinghoff M, et al. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011;32:703–11.
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.
McLennan JG, McLennan JE. Injury patterns in Scottish heavy athletics. Am J Sports Med. 1990;18(5):529–32.
Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. Epub 22 November 2013.
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.
Kulund DM, Dewey JB, Brubaker CE, et al. Olympic weight-lifting injuries. Phys Sportsmed. 1978;6:111–8.
Konig M, Biener K. Sport-specific injuries in weight lifting. Schweiz Z Sportmed. 1990;38(1):25–30.
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.
Eberhardt A, Dzbański P, Fabirkiewicz K, et al. Frequency of injuries in recreational bodybuilding. Phys Educ Sport. 2007;51:40–4.
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.
Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clin Sports Med. 1991;10(3):615–21.
Winwood PW, Keogh JWL, Harris NK. The strength and conditioning practices of strongman competitors. J Strength Cond Res. 2011;25(11):3118–28.
Fleck SJ, Kraemer WJ. Designing resistance training programs. 2nd ed. Champaign: Human Kinetics; 1997.
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.
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.
Stone MH, Pierce KC, Sands WA, et al. Weightlifting: program design. Strength Cond J. 2006;28(2):10–7.
Wretenberg P, Feng Y, Arborelius UP. High- and low-bar squatting techniques during weight-training. Med Sci Sports Exerc. 1996;28(2):218–24.
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.
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.
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.
Granhed H, Morelli B. Low back pain among retired wrestlers and heavyweight lifters. Am J Sports Med. 1988;16(5):530–3.
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.
Hughes G, Watkins J. A risk-factor model for anterior cruciate ligament injury. Sports Med. 2006;36(5):411–28.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
McGill SM. Ultimate back fitness and performance. Waterloo: Wabuno Publishers; 2004.
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.
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.
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.
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.
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.
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Keogh, J.W.L., Winwood, P.W. The Epidemiology of Injuries Across the Weight-Training Sports. Sports Med 47, 479–501 (2017). https://doi.org/10.1007/s40279-016-0575-0
- Team Sport
- Injury Risk
- Bench Press
- Weight Training