0363-5465/102/3030-0248$02.
00/0
THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 30, No. 2
2002 American Orthopaedic Society for Sports Medicine
Injury Incidence and Prevalence among
Elite Weight and Power Lifters
se Raske,* RPT and Rolf Norlin, MD, PhD
From the *Linkoping Medical Centre, the Department of Orthopaedics, University Hospital,
and the Division of Orthopaedics, Department of Neuroscience and Locomotion, Faculty of
Health Sciences, Linkoping University, Linkoping, Sweden
ABSTRACT
The purpose of this study was to investigate the inci-
dence and prevalence of injuries among elite weight
lifters and power lifters, with a special focus on shoul-
der injuries and possible injury-provoking exercises. In
1995, a questionnaire was administered to 110 male
and female elite lifters to evaluate injuries and training
characteristics. A follow-up of the athletes from 1995
was conducted in 2000, and a new 2000 elite group
was also queried. In 1995 and again in 2000, the
athletes sustained, on average, 2.6 injuries per 1000
hours of activity. Most common in 1995 were low back
injuries, with an injury rate of 0.43 per 1000 hours, and
shoulder injuries, with a rate of 0.42 per 1000 hours.
Shoulder injuries dominated in 2000, with an injury rate
of 0.51 per 1000 hours of activity. There was a differ-
ence in injury pattern between weight lifters, who
mostly sustained low back and knee injuries, and
power lifters, in whom shoulder injuries were most
common. No correlation was found between shoulder
injuries and any specific exercise. Although the total
injury rate was the same during the two periods of
study, the rate of shoulder injuries had increased.
Competitive weight lifting is divided in two types: weight
lifting and power lifting. Weight lifting consists of two
events: the snatch and the clean and jerk movement (Fig.
1). Power lifting consists of the squat lift, dead lift, and
bench press (Fig. 2). The goal of both forms of competitive
lifting is to lift the maximum weight in each event so that
the total amount of weight lifted will be as high as
possible.
Address correspondence and reprint requests to se Raske, Linkoping
Medical Center, Klostergatan 68, S-58223 Linkoping, Sweden.
No author or related institution has received any financial benefit from
research in this study.
248
In weight lifting, the primary aim is to lift the greatest
weight above the head either in a single-stage movement,
as in the snatch, or in a two-stage movement, as in the
clean and jerk. To accomplish this, great mechanical effi-
ciency is required, especially in the development of maxi-
mum power and balance and in the ability to perform the
lift along the line of least resistance. 20 World records in
weight lifting indicate that the athletes body is exposed to
loads that exceed body weight by as much as two to three
times.3 The technique must be learned so that it will not
fail during stress and pressure.20
Power lifting involves other difficulties. During the
squat lift, performed as a deep knee bend, and the dead
lift, in which the barbell is lifted from the floor up to knee
height in front of the lifter, the extensors of the spine, hip,
knee, and ankle help to prevent the body from collapsing
under the load.5 The bench press presents totally different
problems for the lifter; the musculoskeletal system of the
shoulder girdle has to provide a base of support for the
motion of the barbell from and to the chest. Elbow flexors
and horizontal flexors in the shoulder act alternately in
concentric and eccentric contractions.5 The load in power
lifting, according to current world records, exceeds body
weight by, in some cases, more than five times.3
Previous studies regarding the incidence and character
of weight-training injuries have investigated adolescent
power lifters5 and football players involved in weight
training30 but not adult elite lifters involved in competi-
tive forms of lifting. The types of injuries that have been
found in athletes involved in weight lifting or weight
training were summarized by Reeves et al.27, 28 Overuse-
related tendon injuries, anterior instability of the shoul-
der, atraumatic clavicular osteolysis, spondylolysis, knee
osteoarthrosis, and stress fractures were the chronic con-
ditions described.28 Acute injuries such as ligament
sprains, meniscal tears, fractures, and muscle ruptures
have also been found to occur in this group of athletes.27
However, no distinction was made in those reports be-
tween athletes involved in competitive lifting and those
Vol. 30, No. 2, 2002
Figure 1. Competition movements for the weight lifter. A,
the snatch. B, the clean and jerk movement.
who used weight training only as a complement to other
sports.
Scavenius and Iversen33 found the prevalence of atrau-
matic clavicular osteolysis to be 28% (7 of 25) in a small
group of elite weight lifters. Low back injuries have pre-
viously been reported in 30% to 50% of weight lifters.1, 5, 28
The prevalence of osteoarthrosis in the patellofemoral or
tibiofemoral joint in former weight lifters was found to be
Injury among Weight Lifters and Power Lifters 249
Figure 2. Competition movements for the power lifter. A, the
squat lift. B, the dead lift. C, the bench press.
31% (of 29 lifters).19 In former soccer players, the preva-
lence of osteoarthrosis in the same joints was 29% (of 31
players) in one study19 and 15% in another study.30
We were unable to find a study that presents the prev-
250 Raske and Norlin American Journal of Sports Medicine

TABLE 1
Response Rate of Different Groups and Number of Athletes in the Reevaluated Groups Still Active in 2000
All elite lifters male and female Male elite weight lifters
Variable Elite 1995 Elite 1995 Elite 2000
Elite 1995 Elite 2000 Elite 1995
reevaluated reevaluated 1995

Number of athletes 110 90 115 50 41 50

2 dead 1 dead
Response rate % (N) 84 (92) 76 (68) 91 (105) 84 (42) 76 (31) 86 (43)
Percent of athletes still 62% (42) 68% (21)
active from 1995
Injury caused end of 16% (11) 16% (5)
career (% of all)

TABLE 2
Mean ( SD) Age, Years of Experience in Lifting, and Hours of Weekly Training
All elite lifters, male and female Male elite weight lifters
Variable 1995 1995
1995 2000 1995 2000
reevaluated reevaluated

Age (years) 29.8 7.1 35.0 7.6 30.5 7.2 27.4 7.0 31.7 7.0 29.4 7.3
Years of experience from 12.4 6.5 16.1 6.4 12.1 6.9 12.9 6.0 15.8 5.8 14.8 6.7
lifting
Hours of training per week 10.2 4.1 6.4 4.5 8.5 4.2 11.7 4.5 6.9 4.8 8.6 4.6

alence or incidence of different musculoskeletal injuries in
a large group of elite lifters, nor has any study compared
the injury prevalence or incidence between weight lifters
and power lifters. Because the competitive movements in
the two disciplines are different, the stress and the injury
pattern could be expected to vary.
We found no previous study that elucidates whether
particular training exercises lead to an increased occur-
rence of shoulder injuries. However, clinical experience
and reports in the literature show that a lifter with an
injured acromioclavicular joint suffers from symptoms
mostly when performing the bench press and the jerk
movement in the clean and jerk. 6, 33 Athletes with ante-
rior instability, overuse injuries of the rotator cuff, im-
pingement syndrome, or a glenoid labrum lesion will suf-
fer from symptoms when performing other training
exercises as well.12 The question of whether exercises that
increase symptoms in the already injured shoulder will
also alter the risk for sustaining new injuries has not been
answered. The purpose of this study was to investigate the
incidence and prevalence of injuries among elite Swedish
weight lifters and power lifters, with a special focus on
shoulder injuries and possible injury-provoking exercises.
included as well as a new group of elite athletes. The new
elite group consisted of 100 male lifters (50 weight lifters
and 50 power lifters) and 15 female lifters (5 weight lifters
and 10 power lifters). Those lifters who participated in
1995 and who were still in the elite group in 2000 were
included twice. All participants were contacted by mail
and a coded questionnaire was sent out. A reminder letter
was sent to those who did not answer within 2 weeks.
Lifters who did not respond to the second letter were
telephoned.
The questionnaire contained questions about current
injuries and injuries that had occurred during the last 2
years. The definition of injury was an inability to train or
compete as planned because of symptoms. Questions re-
garding lifting experience, training intensity, and which
exercises the athlete regularly performed were also in-
cluded, as well as the location, type, and duration of inju-
ries. Injuries causing loss of participation time of less than
a month were later classified as minor, and those causing
loss of participation time for more than a month, as major.
All injuries were classified, by the responders, either as
acute muscle injuries, overuse-related tendon injuries, or
other type.

MATERIALS AND METHODS
In 1995, the 110 highest ranked lifters in Sweden partic-
ipated in a cross-sectional study. There were 50 male
power lifters and 50 male weight lifters together with 5
female power lifters and 5 female weight lifters. A control
group, consisting of 50 randomly assigned, non-elite
weight lifters, was also included. The questionnaire used
had previously been used in a pilot study conducted with
local weight lifters in Linkoping.
A follow-up investigation was performed in 2000. The
same male and female elite athletes as in 1995 were
Statistics
An unpaired, two-tailed t-test was used for comparison
between groups. The chi-square test was used to calculate
differences in injury appearance and between athletes
who did or did not perform different exercises. The level of
significance was set at P 0.003 (after correction for use
of multiple t-tests).23
RESULTS
The response rate was between 78% and 100% in the
groups that were evaluated for the first time. The reeval-
Vol. 30, No. 2, 2002 Injury among Weight Lifters and Power Lifters 251

TABLE 1
Continued
Male elite power lifters Female elite lifters
Control group
Elite power Elite 1995 Elite Female Female 1995 Female 1995
1995 reevaluated 2000 1995 reevaluated 2000

50 40 50 10 9 15 50
1 dead
82 (41) 72 (29) 92 (46) 100 (10) 89 (9) 100 (15) 78 (39)
62% (18) 38% (3)

14% (4) 25% (2)

TABLE 2
Continued
Male elite power lifters Female elite lifters
Control
1995 1995 group 1995
1995 2000 1995 2000
reevaluated reevaluated

32.7 6.8 38.5 7.0 31.7 7.0 28.1 3.8 33.9 4.0 29.7 7.6 43.7 8.5
13.3 6.5 18.0 6.8 11.5 6.4 6.4 5.5 11.2 3.5 6.8 5.3 18.2 8.7

8.7 3.5 6.5 3.9 8.12 3.8 9.7 4.2 5.0 5.3 9.5 4.1 6.5 2.8

uated elite groups had a response rate of 72% to 89%
(Table 1). Sixty-two percent of the athletes from the elite
group of 1995 were still active on a competitive level.
Thirty-eight percent (16 of 42) of those from 1995 who
were still active also belonged to the elite group in 2000
and were therefore included twice. Sixteen percent (11 of
68) of the athletes from 1995 were no longer active in 2000
due to injury.
The average age of the elite groups of both 1995 and
2000 was 30 7 years. The average lifting experience was
12 6 years in 1995 and 12 7 years in 2000. The
athletes of the 1995 group exercised for an average of 10
4 hours per week. In 2000, the average training hours per
week was 8 4 (Table 2).
Because one aim of this study was to investigate exer-
cises that might provoke shoulder injury, information on
the training habits of the elite groups from the different
years was collected and is presented in Table 3, together
with the number of shoulder injuries present among ath-
letes who did or did not use the particular movements. No
difference in the incidence of shoulder injuries was seen
between those who did and did not use specific exercises
(Table 3).
Exposure time was calculated as follows. Injuries re-
ported had occurred during 2 years of training. In 1995,
the athletes exercised an average of 10 hours per week,
which amounts to 520 hours per year or approximately
1000 hours per 2 years. This means that the number of
injuries reported for the 2 years of training is equal to
injuries per 1000 hours of activity. In 2000, the hours of
exercise during 1 year decreased to 410 hours, or approx-
imately 800 hours per 2 years. To compare injury rates
between 1995 and 2000, we multiplied the number of
injuries reported in 2000 by 1.25 (1000 divided by 800).
The rate of injuries per 1000 hours of activity among the
elite athletes, male and female, in 1995, was 2.6 injuries
per 1000 hours. Most problems were seen in the lower
back and in the shoulder (Table 4). The injury rate for low
back injuries was 0.43 per 1000 hours of activity and for
shoulder injuries, 0.42 per 1000 hours.

TABLE 3
Weekly Exercises of Athletes with and without Shoulder Injuries
Elite group 1995 N 92 Elite group 2000 N 105
Exercise
Injured Not injured Total Injured Not injured Total

Bench press 34 45 79 40 50 90
No bench press 7 6 13 7 8 15
Lean bench press 25 24 49 13 26 39
No lean bench press 16 27 43 34 32 66
Flies 16 18 34 25 23 48
No flies 25 33 58 22 35 57
Dips 12 21 33 16 25 41
No dips 29 30 59 31 33 64
Snatch 19 29 48 15 33 48
No snatch 22 22 44 32 25 57
Clean and jerk 16 29 45 15 33 48
No clean and jerk 25 22 47 32 25 57
252 Raske and Norlin American Journal of Sports Medicine

TABLE 4
Incidence of Injuries in Different Groups
Weight lifting men Power lifting men Power and weight lifting women
Area injured Injuries/1000 hours Injuries/1000 hours Injuries/1000 hours

Elite 1995 Elite 2000 Elite 1995 Elite 2000 Elite 1995 Elite 2000

Shoulder 0.31 0.34 0.57 0.71 0.44 0.34

Elbow 0.22 0.16 0.24 0.18 0.44 0.27
Wrist 0.22 0.23 0.13 0.05 0.22 0.34
Neck 0.12 0.10 0.05 0.13 0.22 0.13
Thoracic spine 0.22 0.05 0.19 0.13 0.44 0.13
Lumbar spine 0.45 0.44 0.43 0.41 0.33 0.27
Hip 0.16 0.10 0.19 0.13 0.11 0.27
Knee 0.43 0.49 0.24 0.33 0.33 0.20
Foot/ankle 0.06 0.05 0.08 0 0.11 0
Biceps muscle 0 0 0.05 0.05 0 0
Triceps muscle 0 0 0 0.05 0 0
Pectoral muscle 0 0 0.19 0.13 0 0.07
Anterior thigh 0.02 0.13 0.03 0.03 0 0.07
Posterior thigh 0.02 0.13 0.05 0.10 0 0.07
Gluteal muscle 0.02 0.05 0.11 0.13 0 0
Calf muscle 0.02 0 0.08 0.03 0.11 0
Other muscle 0.16 0.13 0 0.05 0.33 0.07
Other tendon 0.04 0 0.08 0.03 0.11 0
Total 2.4 2.4 2.7 2.7 3.2 2.2

In 2000, the rate of total injuries was still 2.6 per 1000
hours of activity (Table 4). Most common were problems in
the shoulder, with a rate of 0.51 per 1000 hours. The rate
for low back injuries was 0.41 per 1000 hours and for knee
injuries, 0.38 per 1000 hours of activity (Table 4).
No effort was made to specially study injury patterns in
the control group. However, their responses are presented
as a reference. The control group in 1995 had an injury
rate of 2.9 injuries per 1000 hours of activity. Even in this
group, the shoulder, the lower back, and the knee were
most frequently injured.
There was no difference in the overall injury rate be-
tween the elite groups in 1995 and in 2000. The difference
noted between the two groups in regard to the occurrence
of certain injuries was not significant (shoulder, P 0.23;
lower back, P 0.94; and knee, P 0.63). A comparison
between the elite group of 1995 and the control group
revealed no significant difference in the total rate of inju-
ries (P 0.37) ) (Table 5).
Injury prevalence was significantly lower in 2000 than
in 1995 (P 0.0009) (Table 6). The total number of inju-
ries in 1995 was 76 (0.8 injuries per athlete). In 2000,
there were 48 injuries among 105 athletes (0.4 injuries per
athlete). It was not possible to evaluate all injuries when
assessing prevalence, especially muscle injuries, because
we did not differ between current muscle injuries and
injuries that had occurred during the last 2 years.
A classification of severity of injuries among the elite

TABLE 5
Incidence of Injuries in the Combined Elite Groups and in the Control Group
Injuries 19982000 per 1000 hours
Injuries 19931995 per 1000 Injuries 19931995 per 1000
Area injured Elite group 1995
hours in the elite group Elite group 2000 hours in the control group
reevaluated

Shoulder 0.42 0.51 0.50 0.64

Elbow 0.24 0.18 0.17 0.27
Wrist 0.18 0.17 0.22 0.15
Neck 0.08 0.12 0.07 0.08
Thoracic spine 0.23 0.12 0.11 0.04
Lumbar spine 0.43 0.41 0.44 0.53
Hip 0.16 0.14 0.22 0.04
Knee 0.35 0.38 0.46 0.53
Foot/ankle 0.07 0.02 0.04 0.11
Biceps muscle 0.02 0.02 0.02 0
Triceps muscle 0 0.02 0.02 0.08
Pectoral muscle 0.07 0.06 0.04 0.08
Anterior thigh 0.02 0.08 0.04 0.11
Posterior thigh 0.03 0.11 0.07 0.04
Gluteal muscle 0.05 0.08 0.02 0.08
Calf muscle 0.05 0.01 0.04 0
Other muscle 0.11 0.08 0.15 0.08
Other tendon 0.06 0.01 0.07 0.08
Total 2.6 2.5 2.7 2.9
Vol. 30, No. 2, 2002 Injury among Weight Lifters and Power Lifters 253

TABLE 6
Injury Prevalence among Elite Lifters
Injury prevalence in 1995 Injury prevalence in 2000
(N 92) (N 105)
Area injured Number Number
% of all % of all % of all % of all
of of
athletes injuries athletes injuries
injuries injuries

Shoulder 16 17 21 14 13 29
Elbow 7 8 9 2 2 4
Wrist 7 8 9 3 3 6
Neck 3 3 4 1 1 2
Thoracic spine 7 8 9 4 4 8
Lumbar spine 13 14 17 13 12 27
Hip 7 8 9 2 2 4
Knee 15 16 20 9 8 19
Foot/ankle 1 1 1 0 0 0
Total number 76 48
of injuries
Mean injuries 0.8 0.4
per
individual

Figure 3. Distribution and rate of acute muscle injuries. E Figure 4. Distribution and rate of overuse-related tendon
1995, combined elite group in 1995 (weight power lifters/ injuries. E 1995, combined elite group in 1995 (weight
male female). E 2000, combined elite group in 2000. power lifters/male female). E 2000, combined elite group in
2000.

group of 2000 showed that 93% of the shoulder injuries (44

of 47), 85% of the low back injuries (32 of 38), and 80% of
the knee injuries (28 of 35) were major, with a duration of
symptoms for more than a month. Shoulder injury was the
most common problem among power lifters, whereas knee
and low back problems dominated in the group of weight
lifters. The difference in occurrence of shoulder injuries
between the two groups was significant in 2000 (Table 4)
(P 0.0004). No difference was seen between weight
lifters and power lifters when comparing the rate of total
injuries. Comparisons between the two weight lifting or
power lifting groups from 1995 and 2000 revealed no dif-
ferences, nor did comparisons between women from the 2
years. No significant differences were found between fe-
male and male lifters (Table 4).
Only half of all injuries were classified as either acute
muscle injuries or overuse-related tendon injuries. The
most common sites for acute muscle injuries were the
shoulder and the thigh (Fig. 3). The overall rate for acute
muscle injuries showed a nonsignificant increase from
1995 to 2000 from a rate of 0.44 injuries to 0.60 injuries
per 1000 hours (P 0.13). The injury rates for the shoul-
der, the thigh, and the gluteal muscles showed the largest
increase between the 2 years, but these differences were
not significant.
Overuse-related tendon injuries were mostly seen in the
shoulder and in the knee (Fig. 4). The rate for overuse-
related tendon injuries changed from 0.71 to 0.61 injuries
per 1000 hours of activity, but this difference was not
significant (P 0.37). Overuse injuries of the shoulder
showed a nonsignificant (P 0.20) increase from 0.17 to
0.25 injuries per 1000 hours.
DISCUSSION
Injuries associated with weight lifting have been previ-
ously reported, mostly as case reports, including frac-
tures,15, 29 stress fractures,7, 26, 34 dislocations,9, 18, 21, 22
muscle and tendon ruptures,2, 10, 16, 36, 38 compartment
syndromes,4, 25 and spondylolysis.32 Information on how
often different injuries occur among competitive elite
254 Raske and Norlin
weight and power lifters has not previously been reported,
to our knowledge.
In this cross-sectional study, including two time periods,
we managed to obtain a high response rate in the different
groups. The lowest response rates were in the reevaluated
groups. The dropouts did not answer repeated letters and
could not be contacted by phone. The fact that the athletes
from 1995 who were still performing at the elite level were
counted twice, thus making the results from the elite
group of 2000 partially dependent on the experience of the
1995 participants, does not change the results or validity
of the study.
We found that the rate of 2.6 injuries per 1000 hours of
activity was the same during the two periods of study.
Brown and Kimball5 found that 39% (28 of 71) of adoles-
cent power lifters had sustained injuries during training.
However, the weekly amount of training of athletes in that
study is unknown, and, therefore, a proper comparison
with our study is difficult to perform. The adolescent lift-
ers had a much shorter experience with lifting (mean, 1.5
years) than the investigated group in our study (mean, 12
years). Even though the experience of training in our
group was long, the rate of injuries was high. Also, most of
the injuries were major ones, with the duration of symp-
toms lasting more than 1 month. In the study by Brown
and Kimball, each injury caused a discontinuance of train-
ing for an average of 11.5 days, which would imply that
the injuries in our study were more severe. An explanation
of the fact that our study, in contrast to that of Brown and
Kimball and of most other epidemiologic studies, revealed
more major than minor injuries could be a result of recall
bias. It is probably easier to remember more severe inju-
ries than those that were less extensive. The fact that we
found more major than minor injuries may suggest that
minor injuries were under-reported. However, the bias
should be universal among all the participants and should
imply a greater number of minor injuries.
Injury prevalence showed a significant decrease among
the lifters studied (P 0.0009). Because we could not
assess all injuries in the prevalence study, as we could
when investigating the incidence, the true prevalence,
both in 1995 and 2000, was probably higher than the
reported values. However, the same types of injuries were
assessed during both periods, so the decrease in preva-
lence is likely to be true.
The results show that the shoulder, the lower back, and
the knee are the locations most commonly injured among
both weight and power lifters. This is in accord with the
findings of Brown and Kimball,5 who reported that in
adolescent lifters the shoulder and the elbow were most
frequently injured in the upper extremity, the lower back
in the trunk, and the knee in the lower extremity. In
contrast to our study, they found shoulder injuries to
account for only 6% of the 28 injuries; 50% were low back
problems and 8% were knee injuries. Differences in age
and in lifting experience may explain the different distri-
bution of injuries.
Van der Wall et al.37 studied shoulder injuries and
confirmed some diagnoses around the shoulder in weight
lifters by using scintigraphy. Soft tissue damage of the
American Journal of Sports Medicine
rotator cuff, the biceps tendon, and the capsular and lig-
amentous insertions was shown. Scavenius and Iversen33
found osteolysis of the distal clavicle and stress fractures
of the scapula in weight lifters. Repetitive loading of the
acromioclavicular joint is a precipitating factor for osteol-
ysis of the distal clavicle.6, 35 Lifters may also experience
anterior shoulder instability.17 Neviaser24 described
trauma as the main reason for instability and the repeti-
tive exercises needed in training for a weight lifter as a
cause of chronic rotator cuff diseases.
Even though it may seem as if power lifting should lead
to more shoulder injuries, we were unable to show that
any particular movement used in weekly training led to an
increased risk of shoulder injuries, including the bench
press. Fees et al.12 reported risks during different weight
lifting exercises, such as the bench press, the shoulder
press, the clean and jerk movement, and the squat. Mod-
ifications and warnings for the athlete with a shoulder
injury were presented. However, they had not investi-
gated whether these exercises influence the emergence of
new shoulder injuries. We hypothesize that the bench
press is a critical event for the shoulder among power
lifting events because the shoulder girdle must provide a
stable base of support for the lifting motion of the barbell.
The shoulder muscles have to alternate between maximal
concentric and eccentric contraction when stabilizing, lift-
ing, or lowering the barbell. Proper technique, as de-
scribed by Neviaser,24 including muscle stretching and a
thorough warm-up together with a training schedule that
will spread out exercises that stress one muscle group over
the week, seems to be important for competitive lifters to
prevent injury.
Weight lifting has previously been reported as one of the
sports in which low back injuries most commonly occur.1
Brown and Kimball5 also showed that 50% of 28 injuries
among adolescent power lifters were low back problems.
In our study more weight lifters than power lifters had low
back problems. Competitive events in weight lifting are
the snatch and the clean and jerk movements; both are of
a complex nature and require balance, maximal loading
on the lumbar spine, and speed.8
The prevalence of knee osteoarthrosis in former weight
lifters has been found to be 31% (9 of 29 lifters) in the
tibiofemoral joint and 28% (8 of 29 lifters) in the patel-
lofemoral joint.19 These prevalence values are higher
than, for instance, those for former soccer player or run-
ners.19 Reeves et al.28 explained that squats performed
with heavy loads and with a knee flexion angle exceeding
90 will place a significant load on the thinnest part of the
femoral cartilage. The weight lifters we studied frequently
had knee injuries, even though they do not compete in the
squat movement. However, they do perform the same
movement, a very deep knee flexion as in the squat, dur-
ing the snatch and the clean part of the clean and jerk
movement.
It was possible to classify half of the injuries reported
in our study as either acute muscle injuries or overuse-
related tendon injuries. According to Gibala et al.,13, 14
muscle fibers may disrupt under both concentric and ec-
centric loading, with the greatest disruption occurring
Vol. 30, No. 2, 2002
during the eccentric phase of lifting.14 In the competition
events of power lifting, this would be the phase of lowering
the barbell toward the chest in the bench press and
during the squat lift when the knees are bent to the
point where the upward lifting begins. Wolfe et al.38
have shown that another critical moment during the
bench press is in the initiation of the lift; the pectoralis
muscle is most active in this phase. Eccentric muscle
loading occurs during weight lifting, both when bending
knees during the drop of the body under the barbell and
in performing the snatch and the clean and jerk move-
ment. The ventral shoulder muscles produce an eccen-
tric moment when decelerating the barbell over the
head, in the final position of the snatch, and in the clean
and jerk movement. These critical moments explain
why the most common sites of acute muscle injuries
were the shoulder, the thigh, and the pectoralis muscle.
Overuse-related tendon injuries occurred mostly around
the shoulder and the knee. Neviaser24 pointed out the
disadvantages for the rotator cuff during lifting. The re-
peated training exercises with the rotator cuff in unfavor-
able positions lead to an increased risk for injury. Possi-
bly, the tendons, as well as tendon sheaths and
surrounding bursae, will respond to overuse with inflam-
mation and consequent swelling. Usually, the pain is not
so intensive in the first stage of the injury, and the lifter
can continue to exercise and further irritate these tissues.
A chronic overuse condition will develop over time. Over-
use injuries have previously been found to make up 3% to
12% of all injuries among weight training athletes.28
As many as 62% of the elite group from 1995 were still
active in 2000. Among those who had ended their career,
43% indicated that injury was the reason for stopping,
indicating that weight lifters sustain a substantial num-
ber of injuries. However, comparable figures are seen
among elite soccer players in Sweden; after 7 years, 50%
had stopped playing due to injuries.11
Although the overall rate of injuries in Swedish elite
weight and power lifters was the same during the two
periods of study, shoulder injuries seemed to occur with an
increasing rate. In the total elite groups from 1995 and
2000, the rates of shoulder injury were 0.42 and 0.51
injuries per 1000 hours of activity, respectively, indicating
that this is a problem in both weight and power lifting.
When injury distribution between weight and power
lifters was compared, it was shown that weight lifters
more frequently suffered from injuries in the lower back
and knee and that shoulder injuries dominated in the
group of power lifters. Our hypothesis that different com-
petitive movements would lead to different injury pat-
terns seemed to be valid.
CONCLUSIONS
The rate of injuries was 2.6 per 1000 hours of activity for
the elite lifters both in 1995 and in 2000. The rate of
shoulder injuries had increased from 0.42 to 0.51 injuries
per 1000 hours. The rate of other injuries had slightly
decreased in 2000 compared with 1995. There was a dif-
ferent pattern of injuries among weight lifters than among
Injury among Weight Lifters and Power Lifters 255
power lifters. Low back and knee injuries were most fre-
quently present among weight lifters, whereas shoulder
injuries were most common in power lifters.
ACKNOWLEDGMENTS
The authors thank Hkan Johansson of the Swedish
Weightlifting Federation, Stockholm, Sweden, and Bjorn
Bull of the Swedish Powerlifting Federation, Stockholm,
for their enthusiasm and valuable help in establishing
contact with all Swedish elite lifters.
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