Common Injuries in Olympic Weightlifting

What is Olympic Weightlifting?

Weightlifting, not to be confused with the more commonly known powerlifting, is an Olympic sport in which athletes compete in lifting a loaded barbell from the ground, finishing with the weight overhead. The goal is to lift as heavy of a barbell as efficiently as possible. Weightlifting consists of two lifts: the snatch, in which the athlete lifts the barbell overhead in one swift motion, and the clean and jerk, where the barbell is first lifted from the ground to the front of the shoulders (clean), and then driven from the shoulders to overhead (jerk).

Snatch

Clean

Split Jerk

Unlike other strength sports, Olympic weightlifting tests explosive strength and requires more mobility, greater range of motion, coordination between all major muscle groups, and accuracy. A weightlifting program generally consists of variations and different components of the snatch and clean and jerk so that the lifter can master each phase of the lifts and translate that into performance of the full lift. In competition, a lifter is judged on how much they lift and how well they lift; the athlete will not be credited for their attempt if it was executed with marked technical errors, such as the arms not locking out fully at the end of a snatch or a jerk. Therefore, the physical and mental requirements of Olympic weightlifting make it a highly technical sport that requires years of training and thousands of practice hours to master.

Injuries

Due to the highly repetitive nature of weightlifting training, most injuries occur from overuse. A systematic review by Aasa et al reports the incidence of injury in weightlifting to be between 2.3 and 3.3 injuries per 1000 hours of training. This is similar to other non-contact sports that require strength and power, but considerably lower compared to that of contact sports that also require strength and power (eg. rugby, footy).

No studies have specifically examined the risk factors associated with injuries in the sport of weightlifting. However, poor body mechanics, overuse of poor technique, lack of qualified coaching and supervision, and insufficient time spent on accessory work and recovery are likely factors that predispose lifters to greater risk of injury.

Common Injuries in Weightlifting

The shoulder, lumbar spine (lower back), elbow, and knee are the most common sites of injury among Olympic weightlifters (Calhoon and Fry 1999).

Lumbar Degenerative Disk Disease

What it is: The intervertebral discs provide support, flexibility, and minor load-sharing to the vertebral column. A disc protrusion, often referred to as a bulging disc, occurs when the nucleus pulposus, or soft, jelly-like center of the disc, pushes against the annulus fibrosus, or the tough, flexible outer ring of the disc. If the pressure continues, the ring bulges and can mechanically compress nearby nerve roots, and in more severe cases, the spinal cord itself. The disc, when herniated, also releases chemical irritants that contribute to nerve inflammation, producing sciatica-like symptoms (Park 2010).

Causes: Rate of degeneration and risk of disc herniation is likely to be exacerbated by excessive loading of the lumbar spine. In weightlifting, the requirements of lumbar spine loading are quite high, such as when maintaining a neutral spine during the initial pull of the lift, maintaining an upright trunk in the catch position (ie. When the weightlifter receives the barbell), and routinely performing relatively heavy back squats, a staple of most weightlifting programming. Furthermore, some lifters may present with excessive anterior pelvic tilt, putting the lumbar spine in a more compressive position. Combined with inactive or imbalanced recruitment of core muscles (ie. Rectus abdominus, obliques, posterior spinal muscles, quadratus lumborum, glutes), this leads to increased forces traveling through the lumbar spine while lifting.

Presentation: The athlete will present with pain around L4/5/S1, often radiating into the posterior leg and dorsal foot (Donnally III et al 2023), although some athletes may be asymptomatic (Shimozaki et al 2018). They may present with neurological findings such as decreased strength and sensation in one side, and produce a positive Straight Leg Raise test, which mechanically stresses lumbosacral nerve roots. If the athlete presents with signs of cauda equine syndrome, this is a medical emergency and they should be sent to the hospital immediately.

Management: Non-surgical management includes at least 6 weeks of physiotherapy with an emphasis on core strengthening, stretching, and movement modifications, and pain management such as NSAID’s and soft tissue release to the lower back and upper glute muscles. The athlete may be advised to make specific technique changes to their lifts to reduce loading of the lumbar spine and spend more of their training time doing rehab exercises as part of their accessory work. Goals of prescribed exercises may include increasing glute medius/minimus activation to maintain a level pelvis, and single leg balance and strength to minimise excessive pelvic rotation and improve stability in the catch.

Examples of Rehab Exercises:

Child pose with twist
Bird dogs – slide, not lift
Dead bugs with knees bent, feet off the ground
Paloff press with resistance band, split stance
Kneeling hip abduction’s, resistance band around knees, small movements, keep pelvis as neutral as possible
Standing thoracic rotations, 1 arm on resistance band, alternate between “Superman” arms

Subacromial Impingement

What it is: An umbrella term used to describe narrowing of the subacromial space (see above), which leads to the lifter experiencing a painful and/or uncomfortable sensation when performing overhead shoulder movements.

Causes and Pathophysiology: Repetitive, heavy overhead lifting can stir up and irritate structures that pass through or sit within the subacromial space. Pain can stem from inflammation of the subacromial bursa or the supraspinatus tendon. There is an increased risk of shoulder injury when shoulder is abducted and externally rotated, which is what a lifter achieves after completing the snatch. Research has also shown that a broader grip that a lifter uses for the snatch may increase the risk of shoulder injury (Green and Comfort, 2007), possibly due to the rotator cuff muscles and ligamentous structures of the glenohumeral joint having to work harder to stabilise the humeral head and prevent dislocation from the glenoid.

Presentation: Commonly presents as pain in the front or top of the shoulder when performing overhead lifting tasks. The athlete may present with a painful arc during 60-120° abduction, and test positive in the clinic with three or more subacromial impingement tests (Michener et al 2009).

Management: Initial conservative management includes physiotherapist-prescribed exercises, and pain management via over-the-counter medication, heat therapy, and soft tissue release. Physiotherapy exercises will focus on strengthening the rotator cuff, scapular control to minimise scapular dyskinesia, and addressing other strength imbalances in the upper extremities. Corticosteroid injections may be indicated depending on severity of pain and its impact on the athlete’s ability to perform ADL’s. If there is no clinical improvement 6 weeks after conservative management, consideration for advanced imaging with MRI is recommended (Creech and Silver 2023).

Examples of Rehab Exercises:

Scapular protractions/retractions against the wall
W/T/Y raises while lying prone
Resistance band single arm rows in ready stance (single leg in standing, slightly bent, opposite heel up, toes barely touching the ground)
Gentle shoulder shrugs with empty barbell, in both snatch and clean grip
Kettlebell single arm, bottom up overhead press (with light KB weight)

References

Calhoon, G., & Fry, A. C. (1999). Injury rates and profiles of elite competitive weightlifters. Journal of athletic training, 34(3), 232–238.

Creech JA, Silver S. Shoulder Impingement Syndrome. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554518/

Donnally III CJ, Hanna A, Varacallo M. Lumbar Degenerative Disk Disease. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448134/

Green, C. M., & Comfort, P. (2007). The affect of grip width on bench press performance and risk of injury. Strength & Conditioning Journal, 29(5), 10-14.

Hyong, I. H., & Kang, J. H. (2013). Activities of the Vastus Lateralis and Vastus Medialis Oblique Muscles during Squats on Different Surfaces. Journal of physical therapy science, 25(8), 915–917. https://doi.org/10.1589/jpts.25.915

Michener, L. A., Walsworth, M. K., Doukas, W. C., & Murphy, K. P. (2009). Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Archives of physical medicine and rehabilitation, 90(11), 1898–1903. https://doi.org/10.1016/j.apmr.2009.05.015

Park, D. K. (2010). Herniated disk in the lower back – orthoinfo – AAOS. Aaos.org. https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/

Shimozaki, K., Nakase, J., Yoshioka, K., Takata, Y., Asai, K., Kitaoka, K., & Tsuchiya, H. (2018).
Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study. PLOS ONE, 13(10), e0206125. https://doi.org/10.1371/journal.pone.0206125

Stokes, I. A., Gardner-Morse, M. G., & Henry, S. M. (2011). Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clinical biomechanics (Bristol, Avon), 26(8), 797–803. https://doi.org/10.1016/j.clinbiomech.2011.04.006