Injuries in powerlifting

The injury rate in powerlifting appears to be relatively low, ranging from 1.0–4.4/1000 training hours. For the purpose of this article, an injury is defined as a condition of pain or functional impairment that affects powerlifting training. There is evidence that disordered eating behaviors as well as excessive alcohol consumption (5 standard drinks per week) are associated with musculoskeletal injuries. These individuals do not achieve optimal post-training recovery, which is linked to a higher susceptibility to injuries.

Injury-causing factors in powerlifting

Injury-promoting behaviors in powerlifting include a lack of optimal training progression. It is important to understand that ligaments and the nervous system recover more slowly than muscle tissue; therefore, testing one-rep maxes in every training session is not optimal for recovery and may lead to dangerous injuries. Both the lack of optimal technique (although, let’s agree that for everyone it will be individual and we are not striving for “textbook ideals,” because they do not exist) contribute to overload, which in turn leads to injury. Reduced adaptation to high or maximal loads during competition may increase injury risk. It is known that pre-competition training should become increasingly specific, as different training stimuli produce different physiological adaptations. Training load or intensity is one of the main determinants influencing not only the power and kinematics of the movement but also neuromuscular structural adaptations. Therefore, selecting appropriate training loads and repetition ranges may reduce injury risk by improving adaptation.

Prevention in the squat

One study examined three categories of biomechanical effects in the squat, specifically:

(A) tibiofemoral compressive and shear forces as well as patellofemoral compression,

(B) quadriceps and hamstring muscle activity, and

Regarding compressive and shear forces, they were shown to increase with greater knee flexion. It is also important to consider the load on structures within and around the knee joint during squats performed with simultaneous knee flexion, hip adduction, and internal femoral rotation (valgus stress). The deeper the squat, the greater the load on the hip and knee joints, provided the same weight is used. Regarding foot stance, an excessively wide stance may increase tibiofemoral compressive forces on the patella, while a narrow stance increases anterior shear forces. A higher lowering velocity (a “bounce” squat style) increases anteroposterior shear and compressive forces in the knee joint. Furthermore, a bouncing motion at the bottom of the squat increases shear forces in the knee. A fast and uncontrolled descent may cause excessive deformation and shear forces acting on the spine and collateral ligaments, potentially damaging these structures. An uncontrolled descent also affects spinal posture—greater forward lean has been observed during repeated squats (>10 reps) performed at high speed. Increased forward lean is associated with higher shear forces in the lumbar spine. A high bar position shifts part of the load from the hips to the knees. Squats involve many injuries, such as knee pain, which may result from insufficient patellar stabilization; strengthening the VMO may help. Improper foot mechanics may functionally shorten the first ray (big toe to heel and external rotation), affecting overall squat biomechanics and potentially causing injuries. Excessive “gripping the ground with the toes” during lifts may lead to overdevelopment of the flexor muscle group, disrupting proper foot function, which should serve as a stable base for the entire kinetic chain. Frequent groin strains may result from improper glute activation, leading to overload of the adductors, which compensate for hip extension (often seen as knees collapsing inward). Elbow pain during squats is often linked to improper scapular mechanics or imbalances between forearm extensors and flexors. These are simplified examples, as there may be many contributing factors.

Bench press injury prevention

Studies on the bench press have shown that using a wide grip places the shoulder joint in an unfavorable position, increasing stress on the acromioclavicular ligaments, the coracohumeral ligament, and the pectoralis major muscle. Additionally, assuming constant shoulder abduction/extension angles, a wider grip increases shoulder torque, increasing demands on the rotator cuff and biceps tendon, which stabilize the humeral head. The most common injuries during the bench press include shoulder dislocations, pectoralis major tears (most common in men), overuse injuries and strains of ligaments and rotator cuff muscles, and tendon inflammation. Causes are often found in improper scapular mechanics and lack of anterior scapular depression during lifts. Additionally, insufficient latissimus dorsi engagement and overreliance on the pectoralis major lead to overload and injury. Lack of scapular stability leads to rotator cuff overload and instability of the shoulder joint, resulting in dislocations or tendon injuries. Poor technique may also contribute to lumbar spine overload, as excessive lumbar arching instead of thoracic extension leads to compensation and overload. Proper technique allows longer, injury-free training of the shoulder girdle.

Deadlift injury prevention

It is believed that maintaining lumbar lordosis during the deadlift reduces injury risk. Keeping the bar close to the body is also important for efficiency and injury prevention due to a more economical bar path and proper scapular and lat engagement. Regarding the knees, it is recommended not to lock or excessively extend them early to avoid a stiff-leg deadlift pattern. This reduces quadriceps activity and increases spinal erector activity, but more importantly leads to a less upright torso position. This does not appear to affect compressive forces on the L4/L5 disc but reduces L4/L5 moment and shear forces compared to a more flexed posture. Performing deadlifts (especially with poor technique) more than once a week may overload ligaments around the sacroiliac joint, leading to injury. A common competition injury is biceps rupture with a mixed grip, often caused by lack of elbow extension and a shortened biceps muscle that is unable to function through its full range of motion.

Pelvic floor muscles (PFM)

I would not be myself if I did not mention the pelvic floor muscles (PFM) in this article. Although this is not necessarily considered an injury, I am referring to stress urinary incontinence, which is an important issue worth addressing to normalize the topic. There are various causes of this condition. Studies among female powerlifters suggest it is more often associated with excessively tense PFMs rather than weakness, since strength training with proper progression should strengthen them. However, a constantly contracted muscle becomes functionally weaker—imagine holding a clenched fist: after five minutes it is fine, after an hour it starts to hurt, and after longer periods it becomes impossible to maintain. The same applies to PFMs if they are not properly relaxed. Stress urinary incontinence occurs in this sport and there is no reason for shame; rather, it is advisable to seek help from a urogynecological physiotherapist. It can also occur in men, more commonly as rectal prolapse, although it is significantly more frequent in women.

Conclusion

What should injury prevention in powerlifting look like to minimize risk? Athletes should pay more attention to cardio training, which positively affects the cardiovascular system and improves recovery capacity. It is recommended to gradually increase walking volume and aerobic training intensity when possible. Additionally, general physical preparedness (GPP), meaning non-specific training movements outside the three main lifts, should not be neglected. Regular sauna use has been correlated with lower injury rates, suggesting regenerative effects on the musculoskeletal system through increased blood flow, faster metabolite clearance, and regulation of genes related to muscle growth and atrophy (9). Swimming has also been associated with fewer injuries (p = 0.027, r = -0.288). Furthermore, sleep lasting 7–8 hours positively affects recovery and well-being. Reducing blue light exposure at least 30 minutes before sleep is recommended. Older athletes (>30 years) have shown significantly fewer injuries (p = 0.004; r = -0.373) than younger athletes, likely due to greater training experience and better periodization rather than frequent max testing as seen in beginners.

BPC-157 in powerlifting

In terms of nutrition, powerlifters are not the best example, often neglecting nutritional value and consuming alcohol, and in many cases being overweight. Combined with the use of performance-enhancing substances, this may strain the liver and internal organs. A peptide that may support gastrointestinal recovery is BPC-157, which is associated with a very low incidence of side effects. Users report positive effects on gastrointestinal symptoms. If injuries do occur, studies on BPC-157 have shown consistently positive and rapid healing effects across various types of injuries, both traumatic and systemic, especially in soft tissues. It promotes healing of tendons, ligaments, and skeletal muscle tissue. Mechanisms include increased fibroblast growth via FAK and paxillin activation, as well as stimulation of angiogenesis (formation of new blood vessels).

References:

1. “Prevalence and Consequences of Injuries in Powerlifting A Cross-sectional Study Edit Strömback,*” Ulrika Aasa, Kajsa Gilenstam and Lars Berglund, Investigation performed at Umeå University, Sweden

2. “Injuries and Overuse Syndromes in Powerlifting” J. Siewe, J. Rudat, M. Röllinghoff, U. J. Schlegel, P. Eysel, J. W.-P. Michael

3. “Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift” Victor Bengtsson, Lars Berglund, Ulrika Aasa

4. “Injuries among weightlifters and powerlifters: a systematic review” Ulrika Aasa, Ivar Svartholm, Fredrik Andersson, Lars Berglund

5. “Incidence and characteristics of acute and overuse injuries in elite powerlifters” Thomas Reichel, Martin Mitnacht, Annabel Fenwick, Rainer Meffert, Olaf Hoos & Kai Fehske

6. “Modulation of early functional recovery of Achilles tendon to bone unit after transection by BPC 157 and methylprednisolone” A. Krivić, M. Majerović, I. Jelić, S. Seiwerth, P. Sikiric

7. “Gastric pentadecapeptide body protection compound BPC 157 and its role in accelerating musculoskeletal soft tissue healing” Daniel Gwyer, Nicholas M. Wragg, Samantha L. Wilson

8. “The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration” Chung-Hsun Chang, Wen-Chung Tsai, Miao-Sui Lin, Ya-Hui Hsu, and Jong-Hwei Su Pang

9. Hannuksela and Ellahham, 2001; Leppäluoto et al., 1986; McGorm, Roberts, Coombes and Peake, 2018