According to epidemiological study of weight training-related
injuries in US emergency departments from 1990
to 2007, most injuries occurred with free weights (90.4%) with
weights dropping on the patient (65.5%). The majority of weight
lifting injuries occur among males, adolescents, and older persons.
Injuries occur most commonly in the low back and shoulders, consisting
mostly of strains and strains (46.1%). (Kerr 2010)
Several risk factors for injury in weight training have been
suggested in the scientific literature.
Examples of Potentially Vulnerable Movements
Many Potentially Vulnerable movements
have been proposed in the literature.
- Shoulder abduction with external rotation as seen in behind
neck pressing and behind neck pulldowns (Gross 1993)
- Bench Pressing with hand spacing wider than 1.5 times biacromial
width (Fees 1999, Green 2007)
- Rounded back position as seen in Straight Leg Deadlift with
spinal articulation (Zatsiorsky & Kraemer 1995)
Also see Controversial
Exercises and Over
Generalizations. Interestingly, many individuals can apparently
perform these movements years on end with little to no repercussions.
It appears risk for injury is multifaceted, meaning more than
a single factor plays a role in a given weight training injury.
Risser (1990) reported an increased risk of injury with an
inadequate warm-up. See exercise
specific warm-up for weight training.
Kolber (2010) remarks that weight training routines often
emphasize large muscles that produce gains in strength and hypertrophy,
subsequently neglecting the smaller muscles responsible for stabilization
(such as the rotator cuff and scapular musculature) which predisposes
participants to shoulder strength imbalances. This combination
of repetitive loading, unfavorable positioning and biased exercise
selection creates joint and muscle imbalances, thus may place
weight training participants at-risk for injury.
Kolber (2010) identifies shoulder joint and muscle imbalances
associated with weight training include:
- Limited internal rotation mobility
- Excessive external rotation mobility
- Occult anterior shoulder instability
- Posterior Shoulder Tightness
- Relative weakness of External Rotators compared to internal
rotators or abductors
- Relative weakness of Lower Trapezius compared to abductors
Low back pain has been attributed to mechanical factors, particularly
overloading the spine. Low back pain occurs more frequently in
people with weak or nonproportionally developed muscles. Issues
may include weak abdominal wall and spinal lordosis. (Zatsiorsky
& Kraemer 1995)
Also see common Weaknesses,
and Postural Impairments.
Overuse / Overtraining
risk of injury is further exacerbated by overuse brought about
by the inappropriate use of advanced weight training techniques
or poor workout design. These practices include the constant
use of high volume training, chronic use of near maximal workloads,
and the practice of advanced techniques such as forced repetitions
and negatives (Green 2007). Similarly, Zatsiorsky & Kraemer
(1995) recognize the dangerous of a novice attempting to replicate
and engage in a more advanced sports conditioning program. Also
Loss of Form under Heavy Resistance
Risser (1990) reported an increased risk of injury with loss
of form when lifting heavy weights. Kolber (2010) however could
not find evidence to support the notion that using heavy weights
increased the risk of injury. In fact he found no evidence that
individuals who lifted lighter weights and higher reps were less
at risk than the individual performing 1 repetition maximum or
powerlifting. (Kolber 2010)
Technical performance errors increase the risk of shoulder
anterior instability, atraumatic osteolysis of distal clavicle,
and Pectoralis Major rupture. In Olympic-style weightlifters,
losing control of a heavy load during a weightlifting exercise
is the most common mechanism for acute subluxation or dislocation
and concurrent instability. Risk of injury has also be attributed
to altered proprioception from shoulder instability or past injury
Lack of Proper Coaching or Supervision
Van der Wall (1999) suggested the high incidence of shoulder
injuries reported in weightlifters and bodybuilders may be a
consequence of reduced professional supervision, especially at
the amateur level.
steroids (AAS) have been suggested to increase the risk of
tendon tears in athletes particularly when combined with rapid
increases in training intensity and volume. This is thought to
be primarily due to the mechanical stresses encountered from
the rapid increases in muscular performance when using these
substances (Hoffman & Ratamess 2006, Butt 2015).
Resistance progression can increase dramatically from work
out to work out during the start of a cycle or soon after increased
dosage. The muscle and accompany structures may also be more
susceptible to injury as AAS levels decrease.
Problems with Information
Kolber (2010) warns that the majority of the documented shoulder
injuries identified in the literature are from retrospective
surveys and descriptive epidemiological reports. Therefore it
is difficult to determine with certainty the precise etiological
mechanisms of injury in nontraumatic cases, particularly since
many of the surveys use an athletic population. This makes it
even more difficult to ascertain the true cause of these injuries
(ie: sport or weight training). Kolber also warns caution when
interpreting injury surveys because there are various levels
of participation and not all training programs and designs are
of the same intensity and format despite being labeled as weight
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Green CM, Comfort P (2007). The Affect of Grip Width on Bench
Press Performance and Risk of Injury. Strength and Conditioning
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Gross ML, Brenner SL, Esformes I, Sonzogni JJ (1993). Anterior
shoulder instability in weight lifters. Am J Sports Med. 21(4):599-603.
Hoffman JR, Ratamess MA (2006). Medical Issues Associated
with Anabolic Steroid Use: Are They Exaggerated? J Sports Sci
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Kerr ZY, Collins CL, Comstock RD (2010). Epidemiology of weight
training-related injuries presenting to United States emergency
departments, 1990 to 2007.
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Kolber MJ, Beekhuizen KS, Cheng MS, Hellman MA (2010). Shoulder
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Risser WL (1991). Weight-training injuries in children and
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Van der Wall H, McLaughlin A, Bruce W, Frater CJ, Kannangara
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Zatsiorsky VM, Kraemer WJ (1995). Injury Prevention. Science
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