The Foundations of Weight Training Injuries – Where Lifters go Wrong

Weight training and strength sports get a bad rap as being activities that lead to injuries. In reality, the injury rates of both are less than that of running (1) and, when done correctly, proper weight training can have a lot of physiological and psychological health benefits. That said, it’s not uncommon to see serious lifters and strength or physique athletes complaining about some kind of ache or pain.

In an upcoming three part series I aim to address upper limb, spinal, and lower limb issues in the lifting audience. Before getting into weight training injuries by area (upper limb, spinal, lower limb) I want to discuss common general mistakes many lifters make along with ways to troubleshoot some of the common issues experienced.

If you like this topic, I highly recommend checking out this Masterclass by Dr. Teddy Willsey on Exercise Prescription in Sports Rehab.

Part 1: Understanding common mistakes in lifters

Before getting too deep into this it’s important to understand common mistakes made by gym-goers and lifters in their programming.

1) Too much weight (too soon)

Let’s call a spade a spade – we’ve all seen and heard our fair share of lifters that get hurt doing one-rep max (1RM) testing either too often or with way more weight than what the client has handled before.

Don’t get me wrong, as a semi-retired powerlifter I get that 1RM testing is fun and in some cases (i.e. powerlifting, strongman) it is a necessary part of the sport. But, you have to look at it from the perspective of “is the risk of injury and the overall fatigue that I’ll encounter worth the benefit?” and, if you do decide to do it, program it appropriately. By appropriately, I mean:

• Not super frequently: a lot of powerlifters only compete 1-3 times a year. With that in mind, testing your max every 1-3 months is way too much.
• Not on a random whim – it should be something you plan for and makes sense in the context of your training plan
• Not shortly after recovering from an injury

2) Too much volume or frequency, again particularly too soon

The single biggest reason I’ve seen people end up in my clinic with weight training related issues is doing too much volume too soon. I’ve seen this in two situations:

1. People rushing back to the gym after a layoff (i.e. covid shutdowns), vacation, illness, or just break from training
2. People who usually after reading or watching something on the internet, decide to sharply increase the volume/frequency of their training routine. This is a mistake I see a lot in people who, while being more beginner-early intermediate in nature, try to emulate programs of advanced lifters or bodybuilders. There’s also unfortunately a culture & belief out there that if you’re a beginner/intermediate or drug free lifter that you automatically have to do high volume and high frequency which can be problematic if the client has not built up the work capacity for those routines.

I’m not anti-high frequency or high volume but they need to be done the right way and for the right reasons. Sometimes reducing the volume (in particular, junk volume that isn’t really contributing to anything meaningful), and building up gradually is all that’s needed.

3) Technique that puts a lot of strain on the affected area

I don’t want to stir up another debate about “proper” lifting technique as that’s been covered ad nauseam. I am going to refer to this as technique that puts more strain on the affected area. Common examples that I see in lifters are:

• (Excessive) spine flexion or falling forward during a squat or deadlift
• A high level of forward knee movement during a squat
• Flaring of the elbows and protracting the shoulders during a bench press

We know from a lot of research that movement changes can occur due to pain (2) but if a client has specific pain in a specific area with a specific movement, and the technique the client uses puts a lot of strain on the area, I will tweak that technique to help offload the painful area.

Some people would argue for graded exposure but, while I don’t disagree, I’d rather keep clients training hard if possible with technique modifications and then worry about load management and the other factors below.

4) Poor eating & sleeping

Poor sleep is well established as a risk factor for injury (3) and I do anecdotally see issues with clients who are running a hard training schedule yet, when I ask about nutrition, seem to be missing meals and not eating much food on top of poor sleep habits.

5) Psychosocial factors

To the best of my knowledge psychosocial factors have not been extensively studied in respect to weight training injuries. More of the research is extrapolating from other sports (4) injuries. Admittedly, I don’t see psychosocial factors as much leading up to weight-training injury as I do the other factors above. That said:

• Psychosocial factors can be a potential risk factor and are something to watch for in these (and all) clients.
• It’s not uncommon to see clients with a great deal of apprehension returning to weights after injury.

Psychosocial factors can also feed into physical factors. Some clients may do a lot of extra volume, max out randomly or spontaneously add in more intensity techniques (i.e. drop sets, rest pause) just as a means of stress relief. This is a big example of where bio-psycho-social factors should be considered.

6) Imbalances

I don’t want to spend a ton of time on imbalances as they are, again, a controversial topic. However, there is some evidence that having greater strength or endurance in one area relative to another can be problematic. These include:

• Asymmetric performance from side to side on side planks and back pain (5)
• Hip ab/adductor strength and groin injury (6)

I don’t freak out if someone can bench more than they can row but, (this actually happened to a client of mine), if a client has shoulder pain benching 2 plates (225 lbs) but can’t barbell row 70 lbs, I’m inclined to think that big of an imbalance is problematic.

I disagree with people that assume you should do 2x as much posterior work than anterior work because:

1. Most people will overtrain when jumping up that kind of volume right off the bat
2. Most people need to do their posterior work (back, glute, ham) correctly first before adding volume. Quite often doing those movements right is the first step to benefitting from them.

Part 2: Common modifications that can be made

Each of these ideas will work for someone but none will work for everyone and are all dependent on assessment, goals and needs.

• Simply backing training volume down to a manageable level
• If doing a bro split (i.e. chest day, leg day) spreading one big workout up into two smaller workouts
• Restricting the range of motion of an exercise to one that can be done painfree
  • I.e. doing a box squat instead of a full ROM squat
• Choosing different exercises that work that same muscle group
  • I.e. switching from lunges to reverse lunges if the former irritate the knees
• Adjusting the technique of the exercise
• Lowering the weight of an exercise (i.e. barbell squat, barbell deadlift) and in order to get a training effect:
  • Putting it at the end of a workout (as long as technique isn’t compromised)
  • And/or using pauses or slow eccentrics

Wrapping up

If you’re someone who understands weight training injuries you may be thinking “well thanks Captain Obvious” but to a healthcare provider who isn’t educated on working with weight training aches and pains, these foundational pieces of advice can make a huge difference keeping a client active while managing an injury.

Stay tuned for the next three parts in this series where we cover upper limb, back and lower limb issues. In the meantime, check out this excellent Masterclass on Exercise Prescription in Sports Rehab by Dr. Teddy Willsey.

As always – thanks for reading!!