The Epidemiology of Injuries Across the Weight-Training Sports
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Sports Med DOI 10.1007/s40279-016-0575-0 SYSTEMATIC REVIEW The Epidemiology of Injuries Across the Weight-Training Sports 1,2,3 2,4 Justin W. L. Keogh • Paul W. Winwood Ó Springer International Publishing Switzerland 2016 Abstract Methods We performed an electronic search using Background Weight-training sports, including weightlift- PubMed, SPORTDiscus, CINAHL, and Embase for injury ing, powerlifting, bodybuilding, strongman, Highland epidemiology studies involving competitive athletes in Games, and CrossFit, are weight-training sports that have these weight-training sports. Eligible studies included peer- separate divisions for males and females of a variety of reviewed journal articles only, with no limit placed on date ages, competitive standards, and bodyweight classes. These or language of publication. We assessed the risk of bias in sports may be considered dangerous because of the heavy all studies using an adaption of the musculoskeletal injury loads commonly used in training and competition. review method. Objectives Our objective was to systematically review the Results Only five of the 20 eligible studies had a risk of injury epidemiology of these weight-training sports, and, bias score C75 %, meaning the risk of bias in these five where possible, gain some insight into whether this may be studies was considered low. While 14 of the studies had affected by age, sex, competitive standard, and bodyweight sample sizes[100 participants, only four studies utilized a class. prospective design. Bodybuilding had the lowest injury rates (0.12–0.7 injuries per lifter per year; 0.24–1 injury per 1000 h), with strongman (4.5–6.1 injuries per 1000 h) and Highland Games (7.5 injuries per 1000 h) reporting the highest rates. The shoulder, lower back, knee, elbow, and wrist/hand were generally the most commonly injured anatomical locations; strains, tendinitis, and sprains were Electronic supplementary material The online version of this the most common injury type. Very few significant dif- article (doi:10.1007/s40279-016-0575-0) contains supplementary ferences in any of the injury outcomes were observed as a material, which is available to authorized users. function of age, sex, competitive standard, or bodyweight class. & Justin W. L. Keogh [email protected] Conclusion While the majority of the research we reviewed utilized retrospective designs, the weight-train- 1 Faculty of Health Sciences and Medicine, Bond University, ing sports appear to have relatively low rates of injury Gold Coast, QLD, Australia compared with common team sports. Future weight- 2 Sports Performance Research Institute New Zealand training sport injury epidemiology research needs to be (SPRINZ), AUT Millennium, AUT University, Auckland, improved, particularly in terms of the use of prospective New Zealand 3 designs, diagnosis of injury, and changes in risk Faculty of Science, Health, Education and Engineering, exposure. University of the Sunshine Coast, Sippy Downs, QLD, Australia 4 Department of Sport and Recreation, School of Applied Science, Bay of Plenty Polytechnic, Tauranga, New Zealand 123 J. W. L. Keogh, P. W. Winwood training competition to that performed in ancient or med- Key Points ieval times, with some of the events found in the sports traditionally performed as tests of manhood in many The weight-training sports appear to have lower rates countries. These tests of manhood typically had farming of injury than many common team sports. However, and/or military applications and involved the lifting or it is acknowledged that this conclusion may partly throwing of a variety of natural and man-made objects that reflect some limitations in the weight-training sport have been available for hundreds or thousands of years. injury epidemiology literature, primarily study Specifically, strongman events utilize a variety of heavy design, diagnosis of injury, and changes in risk implements such as stones for lifts and carries, tires for exposure. flipping, logs and stones for overhead pressing, and trucks or sleds for pulling. While some of these strongman events Each of the weight-training sports tended to have are similar to weightlifting and powerlifting, with the some subtle differences in their injury epidemiology, athletes attempting to lift the heaviest load for one repeti- particularly their proportional injury rates across the tion, many of the events are timed, with the winner being various anatomical locations as well as the onset and the fastest athlete to complete the task. Highland Games severity of injury. events are further ancient/mediaeval examples of tests of The intrinsic factors of sex, competitive standard, manhood and typically involve a range of heavy throwing age, and bodyweight class may only have a relatively events such as the caber, stone put, hammer throw, or sheaf minor influence on the injury epidemiology of the toss, as well as weight for height and distance. The variety weight-training sports. of weight-for-distance events are simply much heavier versions of many of the throwing events currently seen in regular track and field competitions. CrossFit is the newest of the weight-training sports. CrossFit programs, known as ‘workouts of the day’ 1 Introduction (WODs), typically exceed 10–20 min and include a variety of bodyweight and resistance exercises, gymnastics, Weight training is a popular physical activity typically weightlifting, powerlifting, and endurance activities. These performed to increase muscular hypertrophy, strength, and exercises are generally combined into high-intensity endurance. Weight training typically uses the force of workouts performed in rapid succession with limited or no gravity acting upon resistances, including the exerciser’s recovery time. CrossFit athletes also compete in the own bodyweight or specialized forms of equipment such as CrossFit games, where the winner is the athlete who barbells, dumbbells, and resistance-training machines to completes the WOD in the shortest period of time. target specific muscle groups and joint actions. While many Bodybuilding differs from the other weight-training people who regularly exercise perform weight-training sports in that it is not judged on the weight lifted or the along with cardiovascular or flexibility exercise for overall time taken to complete an event, but rather on the physical health benefit, several athletic groups also compete in appearance of the athlete. Bodybuilding competitors sports in which weight training is the primary form of therefore also perform regular high-intensity weight train- training and/or the competitive event. These sports include ing to develop muscle bulk, balance between muscle weightlifting, powerlifting, bodybuilding, strongman, groups (symmetry), muscular density, and definition, as Highland Games, and CrossFit. these criteria are judged in competition. Weightlifting requires the lifter to lift maximal loads for Most of these weight-training sports included in this one repetition in two exercises: the clean and jerk and the review have annual world championship events for male snatch. As these exercises require the barbell to be lifted and female athletes, with some of these sports also offering explosively from the floor to an overhead position, they various bodyweight or age (junior, open, and masters) may produce the greatest power outputs of any human classes. However, weightlifting is the only one of these activity [1]. Up until 1972, weightlifting also involved a sports currently included in the Olympic Games, although third lift, the overhead (shoulder) press. Powerlifting is powerlifting (bench press only) is also a part of the Para- similar to weightlifting, with lifters attempting to lift the lympics. Figure 1 shows some common weight-training maximum loads for one repetition. However, in power- exercises performed by the athletes competing in the lifting competitions, the three lifts performed are the squat, sports. bench press, and deadlift. Given the intense, heavily loaded activities commonly The Scottish Highland Games and strongman competi- performed by these athletes in training and competition, the tions are in some ways the most similar form of weight- joint moments (torques) as well as shear and compressive 123 Injuries in Weight Training Sports Fig. 1 Illustration of various events/poses in the weight training e strongman (Shaun Ellis), and f Highland Games (Alain Cadu). sports: a weightlifting (Carl Pilon), b powerlifting (Mitya Galiano), Photos reprinted with permission from respective photographers c bodybuilding (Amanda Richards), d CrossFit (CrossFit Auckland), (acknowledged in brackets) forces produced during these types of exercises can be very outcomes advocated by the International Olympic Com- large [1–5]. Members of the public, sporting, medical, and mittee (IOC) [11]. The secondary objective was to gain scientific communities may therefore believe these activi- some insight into whether demographic characteristics ties are inherently dangerous and that their performance such as age, sex, competitive standard, and bodyweight will result in numerous serious and/or long-term injuries. class influenced the injury epidemiology of these weight- Such a view may also reflect the many case studies found training sports. in the literature in which needless weight training-related severe injuries [6, 7] and catastrophic incidents have been reported [8, 9]. According to the National Center for 2 Methods Catastrophic Sport Injury Research [10], catastrophic injuries can be defined as ‘‘fatalities,