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Year : 2019  |  Volume : 19  |  Issue : 2  |  Page : 38-42

Common injuries in resistance training

Department of Physical Therapy, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Date of Submission01-May-2020
Date of Acceptance26-May-2020
Date of Web Publication07-Jul-2020

Correspondence Address:
Mr. Ahmed Mohammed Alqarni
2421, Prince Muteb Street, Ashulah District, Dammam, 34271
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjsm.sjsm_4_20

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Many life-threatening medical illnesses are caused by physical inactivity. The rising awareness of this issue has motivated people to incorporate sports into their daily activities. Resistance training (RT) is a popular form of training, and there are an increasing number of people practicing it due to its enormous range of health benefits. The possibility of injuries while practicing RT raises the question of whether RT is safe and worth the health benefits. Most RT injuries are preventable by various corrective actions that can be easily taken. Most RT injuries occur in the shoulder, back, and knee joints. Shoulder injuries can be of the acute or overuse type and are caused by biomechanical and physiological factors that can be addressed and corrected. Back injuries occur mainly in the lumbar area. Injuries vary from traumatic to overuse injuries. Lumbar kinematics and physiological components are the main factors that contribute to injuries, which can be prevented by adjusting the method of training, using proper machines, and using protective equipment. Knee injuries are the least common injuries. They are caused by the biomechanical and physiological changes caused by repeated flexion and extension while bearing weight during RT. Furthermore, anatomical knee joint abnormalities expose the knee injuries. Early detection of these abnormalities, proper training, and good coaching could prevent such injuries.

Keywords: Knee, low back pain, resistance training, shoulder, sports injuries

How to cite this article:
Alqarni AM. Common injuries in resistance training. Saudi J Sports Med 2019;19:38-42

How to cite this URL:
Alqarni AM. Common injuries in resistance training. Saudi J Sports Med [serial online] 2019 [cited 2023 Sep 21];19:38-42. Available from: https://www.sjosm.org/text.asp?2019/19/2/38/289161

  Introduction Top

Physical inactivity is a major social and health concern and is believed to be the source of many health-related illnesses. The physiological nature of people is against them being physically inactive. Physical inactivity could lead to “sedentary death syndrome,” which is a cause of many human diseases and millions of early deaths each year. A closer look at the global causes of death reveals that sedentary lifestyle causes around two-thirds of deaths around the world.[1] It has been shown in studies that physical activity increases the efficiency of cellular metabolism, which increases the life expectancy of the living cell.[2] Scientists have also proved that, during cellular aging, residues from the natural cellular damage process accumulate inside the cell. The benefit of physical activity lies in the fact that it enhances the process of tissue repair that eliminates these residues within each cell. Eventually, physical activity will create a state of greater health and increase overall life expectancy.[2],[3] It has been shown in studies that physical inactivity and poor nutrition are the most common causes of death.[1],[3],[4]

Fortunately, the public has also become aware of this concerning issue and has started to take it into serious consideration. As a result of this awareness, people have started incorporating sports into their daily activities. These activities improve health and decrease the risks of developing chronic medical illnesses such as diabetes, hypertension, obesity, strokes, and heart attacks. Eventually, deaths related to physical inactivity will decline.[1] It is evident that participation in sports has a variety of effects in improving not only physiological but also psychological and social health.[5],[6] However, sports participation comes with its own risk. This risk lies solely in being injured while participating in sports activities, which raises the question of whether the benefits of sports participation outweigh the risk of injury.[1],[4],[5]

Sports-related injuries can include, among others, sprains, strains, fractures, dislocations, and overuse. To predict what type of injury could happen during sports participation, intensive analysis of each sporting activity should be done to determine what kind of injury could occur. Specific biomechanical, physiological, and psychological analysis of the sporting activity could help in reaching a conclusion regarding what type of injury the participant is at risk of while practicing it. One of the most popular forms of training that people practice and incorporate in their daily activities is resistance training (RT).[7]

RT is one of the most popular forms of exercise. Its practice is widespread among different ages and types of people, and it can be practiced in different ways to achieve a variety of goals.[8] These training methods are designed for rehabilitation, prevention of injury, general fitness, recreational sports, enhancing performance, competitive sports such as weightlifting, also called “Olympic weightlifting,” powerlifting, and bodybuilding.[9] RT can be used as a general term to describe different modes of training. It is agreed that RT is a general term because it includes numerous types of exercises and each has its own goal, but the types of injury risks that they carry are generally similar.[10]

When the amount of energy transferred to the body exceeds the tissue's threshold, injury occurs.[11] Many factors contribute to injury, including low level of skills, over-exercising, and fatigue. Psychological factors such as stress and lack of attention can also lead to injury.[12] A significant proportion (46%) of injuries that occur during RT are sprains and strains caused by dropping weights, with 30% of injuries caused by overuse due to repetitive microtrauma.[13] Injuries occur in different anatomical locations in the body, but in RT, specifically, the sites most susceptible to injury are the shoulder, knee, and back, because of their biomechanical role in absorbing and distributing load.[14]

  Shoulder Injuries Top

It is reported that 36% of RT injuries occur in the shoulder complex.[15] Different intrinsic and extrinsic factors can expose the shoulder joint to injuries. The main intrinsic factor for the high rate of shoulder injuries in RT is the anatomical components of the shoulder complex, which expose it to injury more than any other joint. Another intrinsic factor is that, during RT, the shoulder joint is put under a huge amount of load, yet it is anatomically built as a nonweight-bearing joint. A further important intrinsic factor contributing to shoulder joint injury is inappropriate training routines that lead to agonist and antagonist muscle imbalance. This state of muscle imbalance compromises shoulder kinematics and causes joint instability, which exposes the shoulder joint to injuries.[7],[15] As stated in the literature, shoulder injuries can be of the acute or overuse type. They include soft-tissue injuries, such as biceps tendon injury and pectoralis major rupture, and joint injuries such as anterior shoulder joint instability.[15]

Rupture of the biceps tendon can occur during RT when lifting heavyweights. Gilcreest[16] stated that most traumatic biceps tendon ruptures occur with activities involving lifting of a weight of 68 kg or more. He also mentioned that the long head of the biceps tendon has the highest rate of injuries occurring on the biceps tendon.[15],[16] Other common sites for biceps tendon rupture are the labrum and the musculotendinous junction.[15],[16] Degenerative changes that accumulate over long periods of training and the abuse of anabolic steroids can cause the tendon to be vulnerable to rupture injuries. Both these causes decrease the ability of the tendon to absorb energy, so when muscle power increases over time with training, the tendon eventually fails and injury happens.[17]

Rupture of the pectoralis major muscle is another common injury reported in RT. This injury takes place, most commonly, during the bench press exercise.[18] The nature of the bench press exercise places both upper limbs in an abduction and internal rotation, so the pectoralis major muscle is contracted while in a stretched position to lift the weight up. During lowering of the weight, the pectoralis major acts as an eccentric to prevent the weight from falling on the chest. Any mechanical error, muscle fatigue, or imbalance will lead to the athlete dropping the weight on either side. This sudden contraction under tension leads to the rupture injury.[18],[19]

Shoulder instability is another kind of injury mentioned in the literature, more specifically anterior instability.[15] Shoulder stability is preserved mainly by the glenohumeral joint. The humeral head should always be maintained within the glenoid fossa. Any intrinsic or extrinsic force that causes the humeral head to move out of the glenoid fossa will cause shoulder instability. RT involves many types of exercises that frequently place the upper limbs in an abducted and externally rotated position. These exercises cause repeated anterior translation of the humeral head over the glenoid fossa, which leads, over time, to anterior hyperlaxity and eventually to anterior instability.[20]

“Weightlifter's shoulder” is another condition linked to RT. In a literature review done by Yo and Habib,[21] investigating RT-related injuries using magnetic resonance imaging, it was found that weightlifter's shoulder represented 28% of the injuries documented. It is a condition characterized by osteolysis of the clavicle, mainly the distal part near the acromioclavicular joint. Repetitive microtrauma that occurs during the bench press exercise could be the main reason for clavicle osteolysis. In this condition, the acromioclavicular joint space is increased, the incidence of subchondral stress fractures increases, and there is bone lysis occurring at the distal part of the clavicle bone.[15]

RT exercises that involve repeated end-range external rotation and conversely rare end-range internal rotation can lead to range loss in internal rotation with a tightness of the posterior shoulder muscles. This disturbance in the joint mechanics will result in shoulder joint dysfunction and expose the shoulder joint to the risk of serious injury.[15],[22],[23]

Given the fact that most risk factors for RT-related shoulder injuries are well addressed, it is important to incorporate modifications in the way RT is practiced in order to overcome the risk of injury. Improving training skills is an important way to avoid injuries and can be achieved easily through proper supervision during training, proper machine selection and maintenance, and a gradual increase in the exercise intensity. In addition, adding stretching exercises, warm-ups, and range-of-motion exercises to the exercise routine can overcome many factors that contribute to shoulder injuries.[15]

  Low Back Injuries Top

Lower back injuries are considered to represent 24% of injuries associated with RT.[24] Around 10%–15% of athletes tend to experience low back pain when participating in sports.[25] Low back injuries related to RT can be either of the acute or overuse type. Numerous intrinsic and extrinsic factors contribute to low back injuries during RT. Abdominal muscle weakness, lower limb muscle imbalance, low endurance, decreased lumbar lordosis, poor skills, fatigue, overtraining, improper training techniques, and equipment malfunction are all among the factors that can cause low back injuries.[7],[25] Moreover, the immense amount of compressive, torsional, tensile, and shear forces applied to the lumbar spine during RT increases the likelihood of injury. Muscle and ligament strains are responsible for the highest rate of injuries to the lower back during RT.[26] A study surveying the incidence of back injuries during a weightlifting competition showed that 75% of the reported injuries were diagnosed as muscle strains.[10]

Luckily, most lower back muscle strain injuries result from improper loads, improper exercise techniques, or overtraining that leads to fatigue. This implies that these injuries are easily preventable with skills and proper training.[26] More serious injuries to the lower back during RT are those involving the intervertebral disc, pars interarticularis, or vertebral end plate. Injuries to these parts can be caused by the kinematic changes they bear during various types of RT. Most kinds of RT exercises include flexion and extension of the spine. During flexion, the superior vertebral segment tilts up and slides forward, while the posterior fibers of the annulus pulposus and the posterior ligaments tighten, with the opposite happening during extension. This biomechanical analysis showcases the lumber components' susceptibility to injury during RT exercises that involve repeated flexion and extension of the back. More specifically, most injuries occur during flexion activities, which can be explained by the fact that, during flexion, the posterior annulus fibrosis is weak and tight, so it is exposed to injury. Another serious injury is an end plate fissure that causes the nucleus pulposus to lose its content to the vertebral body, which will decrease disc space height and alter the back kinematics and eventually lead to injury after repeated stress and weight compression.[26],[27],[28]

Given knowledge of the most common causes of lower back injuries, most of these injuries are theoretically preventable. Injury prevention can be achieved by modifying the way the athlete lifts weights, performing assistive exercises that help in overcoming muscle imbalances, and wearing protective equipment such as a lifting belt during training.[26] Weightlifting during RT can be adjusted to decrease the possibility of lower back injury. It is believed that lifting with lordotic lower back posture decreases the possibility of lumber injury since it provides more biomechanical stability and more neuromuscular control.[29] Trunk muscle imbalance is common in RT. In particular, the posterior trunk muscles such as the iliocostalis, longissimus, spinalis, multifidus, rotators, and semispinalis tend to be ignored while training. More focus on strengthening these groups of muscles will decrease the possibility of back injury.[26] Wearing a lifting belt during RT is claimed to help decrease the rate of back injury, although there is not enough evidence of its effect on decreasing the load on the lumbar area during RT. Moreover, it is observed that wearing a lifting belt gives a false sense of stability leading people to lift weights that are not appropriate for their level of strength and ignore other factors that are known to prevent back injuries.[26],[30] Controlling inhalation and exhalation during RT is a technique that also can be used to decrease the intra-abdominal pressure, which could decrease the amount of force sustained by the lumbar spine during weight lifting.[30] Physiotherapists should emphasize this and introduce it to their rehabilitation and prevention programs.

  Knee Injuries Top

Knee injuries account for around 10% of RT injuries and are ranked third after shoulder and back injuries.[24] The knee joint is susceptible to injuries during RT secondary to the nature of the sporting activity itself, which includes repetitive flexion and extension of the knee while bearing weights. RT involves a variety of activities that include repetitive squatting with enormous weight loads. These kinds of exercises expose the knee joint to different types of acute and overuse injuries, including iliotibial band syndrome, anterior knee pain, meniscus injury, and anterior cruciate ligament injuries, which are mentioned in the literature as the most common knee injuries in RT.[31],[32]

Iliotibial band syndrome is an overuse injury. Its presence within the list of RT injuries can be explained by the repetitive nature of the exercises involved in RT. Squatting, bending, and extending the knee while lifting weights cause irritation and excessive friction of the iliotibial band. Friction and irritation occur repeatedly and accumulatively over time and cause repetitive microtrauma, which eventually leads to iliotibial band syndrome. Pain, aching, and a burning sensation over the lateral aspect of the knee are the most common symptoms seen in this syndrome and are most likely to be present during the exercise.[32],[33]

Another common injury that occurs during RT is anterior knee pain (or patellofemoral syndrome).[34] Patellofemoral articulation is one of the most loaded joints in the body.[35] There are many intrinsic and extrinsic factors that contribute to anterior knee pain. Patellar malalignment, knee genu valgum deformity, and hyperextended knee joint are intrinsic factors that increase the incidence of anterior pain during RT. In addition, weak quadriceps muscles and an imbalance between the vastus lateralis and the vastus medialis are believed to contribute to anterior knee pain, although there is no firm evidence proving a strong connection between the previously mentioned muscle imbalance and anterior knee pain.[34],[36] The repetitive nature of RT, including repeated knee flexion and extension and also repeated weight loading, is an extrinsic factor that is mentioned in studies as increasing the possibility of having anterior knee pain.[34],[37]

Meniscus injuries are common when doing RT and represented 9.59% of gym injuries in a study conducted in the USA.[38] The meniscus plays a significant role as force distributor, load absorber, and shock absorber, besides its role in proprioception and stability.[39] Injuries to the meniscus during RT are mainly mechanical and occur when the meniscus fails to do its biomechanical function due to excessive load or sudden uncontrolled change of position while lifting a heavyweight.[40]

Prevention of knee injuries during RT can be achieved by focusing on a strengthening routine for the quadriceps muscle to avoid muscle weakness and muscle imbalance. Incorporating exercises that emphasize the neuromuscular control of the knee joint with the routine RT exercises will have a positive impact on reducing the possibility of injury. Moreover, a gradual increase in RT level is the correct way to decrease the chance of knee injury while participating in weightlifting exercises. Early detection of any knee joint deformities can also be the most important factor in preventing both acute and overuse knee injuries.[34],[37],[38],[40] Athletic coaches and RT practitioners should be encouraged to incorporating neuromuscular control training and maintain muscular strength balance and incorporate it into the exercise routine.

  Conclusion Top

RT is one of the popular forms of training practiced by athletes in different sports and by the public to maintain health and stay active. Many injuries are linked to the practice of RT. Most injuries occur to the shoulders, lower back, and knee joint. Fortunately, most of these injuries are preventable by various corrective actions that can be easily taken. Moreover, recognizing the most common injuries and their underlying causes is one of the most important steps in the injury prevention process.

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