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REVIEW ARTICLE
Year : 2016  |  Volume : 16  |  Issue : 1  |  Page : 15-19

Incidence and prevalence of weight lifting injuries: An update


Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, K. S. A

Date of Web Publication7-Jan-2016

Correspondence Address:
Qassim I Muaidi
Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, P.O. Box: 2435, Postcode: 31451, Dammam, Eastern Provience
K. S. A
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DOI: 10.4103/1319-6308.173476

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  Abstract 

Weightlifting is considered as a dynamic strengthen exercise and power sport in which the athletes lifts a maximum weight with one repetition. The weightlifting as other sports has common musculoskeletal injuries in different body location corresponding to the sports beneficial. However, identifying the injuries incidence and the etiology is a first two-step in the model of the injury prevention in order to introduce preventive measures for sports. Therefore, this literature review is aimed to focus on the incidence and the etiology related to injuries of the weightlifting. However, the incidence injuries studies revealed that the children have more injuries related to accident than the adults. Whereas, the adults have more injuries related to strain and sprain. The most common injured locations are shoulder, lumbar spine, knee, elbow, hand, and wrist in the weightlifters. The percentage of the injuries according to location is the shoulder (36%), lumbar spine (24%), elbow (11%), and the knee (9%). In the other hand, the rule and regulation in the weightlifting had been changed since 1972 in which the clean and press lift eliminated from the competition due to the risk of this lift. Finally, weightlifting considered as safe sport if it is compared with other sports.

  Abstract in Arabic 

إصابات رفع الأثقال حدوثها و انتشارها
يعد رفع الاثقال رياضة حيوية لتعزيز ممارسة الرياضة والقوة حيث إنّ
الرياضيين فيها يرفعون الحد الأقصى للوزن مع تكرار واحد.
و رياضة رفع رفع الاثقال كغيرها من الألعاب الرياضية تشيع فيها
إصابات العضلات والعظام في مواقع الجسم المختلفة ..
ومع ذلك، فإن التعرف على الإصابات والمسببات يعد الخطوة الأولى من خطوتين في نموذج الوقاية من الإصابات من أجل اتخاذ تدابير وقائية للألعاب الرياضية. لذلك، تهدف هذه المقالة إلى التركيز على الحالات والمسببات المتعلقة بالإصابات في رفع الاثقال.
ومع ذلك، كشفت الدراسات أن الأطفال لديهم أكثر تعرضا للإصابات
من الكبار. في حين، أن البالغين ينعرضون إلى المزيد من الإصابات المتعلقة الإجهاد والإلتواء.
و تعدّ الكتف والعمود الفقري القطني، الركبة والكوع، من ناحية، والمعصم المواقع الأكثرتعرضا للإصابة في رفع الاثقال. النسبة المئوية للإصابات وفقا للموقع هي الكتف (36٪)،
العمود الفقري القطني (24٪)، الكوع (11٪)، والركبة (9٪).
في جهة أخرى، فقد تغيرت قوانين و لوائح لعبة رفع الاثقال منذ عام 1972 حيث تم إقصاء الرفع النظيف و رفع الضغط من المنافسة بسبب خطر هذا النوع من الرفع .
أخيرا، تعدّ رفع الاثقال تعتبر رياضة آمنة إذا ما قورنت مع غيرها من الألعاب الرياضية.

Keywords: Powerlifting, shoulder injuries, strength training


How to cite this article:
Alabbad MA, Muaidi QI. Incidence and prevalence of weight lifting injuries: An update. Saudi J Sports Med 2016;16:15-9

How to cite this URL:
Alabbad MA, Muaidi QI. Incidence and prevalence of weight lifting injuries: An update. Saudi J Sports Med [serial online] 2016 [cited 2020 Jan 20];16:15-9. Available from: http://www.sjosm.org/text.asp?2016/16/1/15/173476


  Introduction Top


The utility of physical training in promoting health, building up body for competitive sports are well documented. There have been misconception regarding participating in sports that contain resistance exercise could lead to increase a violence in the community,[1] but actually involving in any physical activity lead to enhance the level of health in general and increase the perception and awareness.[2],[3] Furthermore, some countries begin to incorporate of resistance training in their schools among children and adolescent as contemporary education curricula to decrease misconception about this type of sport and increase popularity by enhancing participation.[4] This will provide optimal supervision on athletes by educated coach who is responsible for training part and watching the performance of participants that decrease risk of players' injuries during school time. However, this literature review will expose to weightlifting sport, which is unpopular sport as much as football. Moreover, as any sport, the athletes' injuries are expected through the career in the weightlifting. Moreover, each sport have a particular common injury or an injury which may occur whether during training activity or in a competition field. In fact, injuries in sport at general are inevitable. Hence, identify risk factors of weightlifting injuries are very important in order to minimize or prevent injuries. To better understand of the risk factor, we should recognize an intrinsic factor, which is relevant to athlete and extrinsic factor, which is relevant to sport.[5] Hence, It is important to identify a term and skill related to weightlifting and powerlifting, which is used during a training and competition for a comprehension understanding of etiology of injury and risk factor from different aspects such as physiology, psychology, and biomechanics.

This type of sports is conceder one of resistance training with variables modes, in general, which is containing free weight and tools related a given sport. Weightlifting has two different types of lifting to success in competition. An athlete should perform the snatch and the clean and jerk. Whereas, powerlifting which is a discipline of weightlifting is consist of three types of lifting, which are a squat, deadlift, and a bench press.[6] The aim of an athlete in weightlifting is to complete his attempt to lift with maximum weight as much as he can and successfully.[7] Weightlifters' classification is depending on their body weight as classes: Men 56 kg, 62 kg, 69 kg, 77 kg, 85 kg, 94 kg, 105 kg and >105 kg; and women 48 kg, 53 kg, 58 kg, 63 kg, 69 kg, 75 kg and >75 kg.[8] As well as, there is a category of weightlifter according to the age of athlete: Junior, youth, and master. In addition, the weightlifters have special equipment such as a suit, elbow and knee sleeves, hook straps and bandages, lumber or back belt and shoes, which could contribute to injury.


  Biomechanics Top


In the weightlifting, body component plays an effective role during competition and resistance training. An athlete with shorter height and limb lengths in weightlifting present mechanical advantages when he is trying to lift heavy loads by reducing the mechanical torque and the vertical distance while the athlete attempts to place the barbell over his body and that will give him better performance. Moreover, there is a study showed that the weightlifters somatotype is most likely ectomorphic or mesomorphic with a body fat percentage of 5–10%.[8]

A biomechanics study of weightlifting shoes to evaluate the angle of foot segment that constitutes 3.5° during performs of barbell back squat by a weightlifter. This study reveals two advantages of weightlifting shoes. The first one is increasing of knee extensor activation and the second one is reducing of a forward trunk lean.[9] Moreover, there is another study that discuss the effect of heel high of foot ware on the muscle of the back and it shows positive effect, which reveals a significant activation of erector spinae muscles with increase of the heel high.[10]


  Physiology Top


In the physiology, individuals that participate in any physical activity or certain sport they will use and develop one type of muscle fiber more than anther fiber, which would be dominant because repeating of using the same fiber for same activity.

In fact, muscle contains two types of fibers. The first type is a slow-twitch fiber (type I), which is also called red fiber because it has a high amount of myoglobin and rich capillary contain oxidative blood. While, the second type is a fast-twitch fiber (type II), and it has an alternative name called white fibers. The fast twitch fiber divided into two groups (type IIa) that is oxidative fast and (type IIb) glycolytic fast.[11],[12] Muscle fiber had been classified depend on speed of contraction of the muscle, and it can be classified in vary ways. For example, biochemical, motor unit classification, and motor unit/muscle fiber plasticity. However, it was reported that (type IIa) was great in weightlifters. Studies argue that a frequent intensive training exercise of weightlifting result in hypertrophy of type IIa, which can produce high power more than type I fiber.[8] In addition, it was mentioned in the study that fast twitch type IIa could be changed to slow twitch fiber with the progress of time as an adaptation of body in an individuals whose has intensive endurance exercise.[13] Muscle fibers in the body have the capability of adaptation depend on type of physical activity that individual practice whether aerobic or anaerobic. However, a study conducts to show the correlation of age and anaerobic performance which is revealed that the declines of performance with age was greater in women than in men in weightlifting.[14] Other study had been done to determine the level of lactate in blood for an athlete. It was revealed that the lactate was higher in clean and jerk than snatch. Furthermore, anaerobic glycolysis was not stimulated when the lifting duration is only 4–5 s and the production of lactate affects by repetition of lift more than intensity.[15]


  Psychology Top


Recently, psychology scientist has developed a lot of theories that interfering and applicable in sport. These theories are useful to explain a behavior of a participant in the physical activity. Hence, sport psychologist is playing an effective role in injury prevention. However, self-determination theory is known as the explanation of the motivated behavior in health including sport injury, which determines the motivational factor that support social behavior and social factors in the environment. Moreover, the theory of planned behavior is another theory that explains the processes by which belief-based social cognitive such as attitudes, subjective norms, and perceptions of control. Furthermore, the researcher has utilized these two theories to evolve the integration theory, which is presenting an overall explanation of a factor, which is related to a person, social and environment of athlete's behavior that associates to reduce sport injury.[16]

This evolved theory is suitable to apple for all type of sports and can make a significant change in the meaning of injury prevention. The existence of the sport psychologist within a given population would reveal the intrinsic factor related to each athlete who may face a stress whether during competition time or personal issue. Also, the extrinsic factor that is relevant to social or environment. Furthermore, the sport psychologist can assist athlete who got injured to pass this period of time and get rid of a factor that may delay the healing from an injuries such as anxiety, acceptance of being injured and depression. Sport psychologist would prepare athlete mentally to enhance his focus and motivate him for better performance in competition.

Incidence and prevalence

According to the incidence of injury related to age in weightlifting, which is reported that children have shown more injury relevant to an accident like dropping weight in their body. In other hand, adults showed increase the number of injuries related to sprain and strain.[17] So, that led us to understand that younger athletes are less exposure to injuries relevant to joints and muscles such as sprain and strain in weightlifting, which contain resistance training. Furthermore, the incidence of injuries according to the location in body were showed that the shoulder is most common injured place in the weightlifting sport and more than other part in the body, also it was reported injuries of lumbar spine, knee, elbow, hand, and wrist.[18] In a controversy, there is a study has argued that lumber region is the most injured area in weightlifting.[19] Whereas, it seems that is no agreement or consensus about which is most injured region in body for weightlifting that may be result of the conducting of both studies in different time, but actually both regions have high percentage than other regions. However, the proportion of injuries in upper extremity is higher in the age above 40. In female gender is noticed that injuries of hand and wrist are more than male gender.[18],[20]

Shoulder injuries

Shoulder problems had been reported as most injured area associated with resisted training with percentage of (36%).[18],[20] There is a different intrinsic factor for shoulder's injury. The cases that reported are overuse syndrome that has an intrinsic and extrinsic factor, dislocation, soft-tissue damage, acromioclavicular, instability, and peripheral nerve injury.[21] However, the intrinsic factor of overuse injury is a sequence of muscle imbalance and muscle weakness with repetitive of movement that could lead to tendonitis, bursitis, and impingement in the shoulder.[22] While, extrinsic factor such as when the acromioclavicular joint in an athlete develops what is called “weightlifter's shoulder” which is referred to osteolysis at the end of clavicle. It is characterized with protrusion or prominence as a result of recurrent microtrauma that associate with bench press exercise.[21] In addition, weightlifters could suffer from impingement-link with overhead activity when they lifting weight, that refer to unfused anterior meso-acromial fragment which also known as painful os acromiale. It is characterized by Local tenderness over the acromion near the same coronal plane as the posterior border of the clavicle.[23] In other hand, dislocation and instability, which is referring to a condition that the shoulder unable to maintain integration of structure and function as result of lose or lack of whether dynamic stabilizer or static stabilizer.[24] Instability of glenohumeral joint is a primary risk factor of anterior shoulder dislocation.[25] Most cases of shoulder dislocation were happened in contact sport such as players hit with each other and this injury is consequence of trauma with elbow in extension direction which forcing shoulders to go beyond the limit range of motion.[26] Moreover, Occurrence of rotator cuff tear after shoulder dislocation is high with the progress of age.[27] However, the peripheral nerve injury was reported in study that may happen in weightlifting due to intensive exercise, which lead to pain at scapula region.[28] Also, there is axillary nerve injury reported in weightlifting as a sequence of severe stretch contusion injury.[29]

Lumbar injuries

Lumbar spine is the second region in the body gets injured with proportion of (24%).[18] The injury of spine can be dividing to two groups depend on type of sport that have possibility of contact of athletes with each other, contact sport and noncontact sport. Chronic spine injury most likely occur as noncontact sports injury result of overuse whereas, acute spine injury occur as contact sports injury result of trauma.[30] Most injuries of lumbar spine in weightlifting are noncontact overuse injuries, which are leading to strain of muscles around lumber spine.[31] In fact, the lumbar spine is moving in multidirectional including flexion, extension, and rotation et cetera. Most movement of the lumbar spine that used in weightlifting is flexion and extension, which is a predisposing factor for disc injury because the involvement of exercises such as good morning exercise and deadlift. Also, performing techniques with full flexion. Furthermore, a compressing injury of facet joint could occur during the repetition of extension movement. However, a percentage of fracture injury of spine in weightlifting is very low,[31] and that may be because this sport is noncontact sport so risk of impact trauma to the spine is low. However, there is a study of the effect of weightlifting's belt on lumbar spine to decrease risk of developing low back pain, which is showed 10% reducing of load on lumbar spine.[32]

Elbow injuries

Injuries of the elbow are most likely overuse injury at medial, and lateral epicondyle and a suitable term for these conditions are epicondylosis.[33] The proportion of elbows injury in weightlifting is (11%).[18] In fact, functionally the elbow moves in two directions flexion and extension. The direction of transfer energy (force of trauma) plays a role in the direction of dislocation whether anterior dislocation or posterior dislocation which is common direction of displacement.[34],[35] Elbow dislocation is conceder a second common large joint in sport could occur for athletes, and most dislocated elbows are stable after reduction.[36] Nevertheless, dislocation posteriorly of the elbow associated with fracture of radial head and coronoid process of ulnar is unstable and difficult to manage.[37],[38] However, nerve injury as entrapment of median nerves in elbows that following dislocation is a rare complication.[39]

Knee injuries

The proportion of knee injury in weightlifting is (9%).[18] There is a different type of injuries in the knee, which is reported in the study as patellar disorders, injury of meniscus, cruciate ligament tear or sprain and instability of the knee.[40] Also, overuse injuries would happen in the knee such as iliotibial band syndrome, and it is common in sports that conclude activities with repetitive bending of joint. It is characterized by pain at lateral aspect of knee.[41] Whereas, anterior knee pain (AKP) that is refer to patellofemoral joint has a complex multi-factorial. It is associated with or as a sequence of factors such genu-valgum, femoral anteversion, and external tibial torsion.[42] Furthermore, these etiologies reveal that mal-alignment of lower extremity can lead to the incidence of AKP. However, most studies argue that the etiology of AKP is unknown. In other hand, there is another viewpoint in studies that discuss causes related to AKP, which they are arguing about the alignment of lower extremity during movement as predispose factor for AKP. This study shows that dynamic knee valgus could develop to an AKP. It is a faulty movement of the knee during performing a single leg squat where the knee collapses to medial direction.[43] Furthermore, people with patellofemoral pain have 32% increases medial-to-lateral peak force during single leg squat and that going to increase load on medial aspect of the foot.[44] However, to who concern about muscle strength and activation of muscle imbalance of quadriceps. There is a study showed that it is not necessary to have AKP when a quadriceps muscles got imbalance in the activation between vastus medialis oblique and vastus lateralis, but still it is important to assess muscle strength of quadriceps before start a plan of treatment because quadriceps strength plays a good role in decrease pain of the knee.[45]


  Conclusion Top


Studies reveal that weightlifting has low rate of injuries if it is compared with other type of sport. Children and junior weightlifters are more susceptible to injuries like fall down of the weight on the body due poor performance techniques, whereas in adults more sprains and strains are reported. Shoulder girdle is the most common injured area with high percentage more than other location such as lumbar spine, elbow, knee, hand, and wrist. In addition, studies mentioned that weightlifter could develop the osteolysis at the end of clavicle as consequences of micro trauma result of repeating of bench press exercise. The load on lumbar spine can be decreased up to 10% by using the weightlifting belt but still the risk of getting injury is expected. The proportion of knee injury in weightlifting is 9%, which is less than lumbar spine injury proportion. Researcher argued that dynamic knee valgus could develop to an AKP. Weightlifter with shorter height and limb lengths is presenting mechanical advantages when he is trying to lift heavy loads by reducing the mechanical torque and the vertical distance while an athlete attempts to place the barbell over his body that will give him better performance.

Acknowledgments

We express our sincere thanks to Dr. Shibili Nuhmani for helping in the review process.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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