6 March 2020
Will Poor Lifting Technique Get You Hurt – Part 1: An introduction to injury in barbell sports
“Don’t extend your neck”, “Don’t let your chest drop”, “Don’t let your lower back round”. These are just a few of the common movement ‘flaws’ that are avoided like the plague in the personal training and strength and conditioning world. As I’m sure many of you have seen or experience, many fitness professionals cringe at…
“Don’t extend your neck”, “Don’t let your chest drop”, “Don’t let your lower back round”. These are just a few of the common movement ‘flaws’ that are avoided like the plague in the personal training and strength and conditioning world. As I’m sure many of you have seen or experience, many fitness professionals cringe at even the slightest deviations in a lifters technique that violates their preconceived notion of what should constitute ‘good’ form. To them, lifting without proper technique is a combination of carelessness, ignorance and foolishness.
Given most practitioners centre the bulk of their practice around ‘technical assessments’ and corrections and obtain significant buy-in from clients via their knowledge of movement and ability to correct and fix poor technique, concerns for movement quality seem warranted, at a glance.
It seems that the fitness industry has an ineluctably created an idealistic belief that in order to improve a lifters physique or performance and minimise the risk of injury, they must subscribe to the idea that technique is of paramount importance.
However, it begs the question–is technique really as important as we all believe for optimising gains and preventing injury?
A question not so regularly asked by many of us in the fitness industry, myself included.
For anyone wanting to increase their strength, size or performance, it makes logical sense to think of technique as the all-important piece of the lifting puzzle – a variable that will keep us injury free and optimise our gains. If we stray too far from perfect technique, then welcome to snap city b**** and you can kiss your sweet gains goodbye.
But how important is technique when it comes to reducing injury risk?
The relationship between lifting technique and injury risk has been a topic of debate for a while now and has made its way into evidence based discussions of late which is great for discourse and furthering our understanding of this topic.
More specifically, folks have been arguing about two primary issues:
- Is lifting technique an independent mechanism that contributes to injury risk in barbell sports? and
- If so, to what magnitude does poor technique increase a lifters risk of injury?
Without detracting from the primary points of discussion, and before we get into the meat and potatoes of the complexities of technique and injury, I first want to briefly discuss a few points that I feel are extremely important to note and be aware of if we are going to venture down the injury risk rabbit hole…
Framing Your Beliefs – Avoid Dichotomous Thinking
I first want to address the importance of keeping an open mind, and make known the dangers of thinking in absolutes or extremes. This is what is known as dichotomous thinking – viewing matters as black or white, good or bad, relevant or irrelevant.
I bring this up because nuance and shades of grey are all but necessary features of getting to the core of a given matter and elucidating the most accurate representation of the facts available to us.
Conversely, adopting a dogmatic, close-minded stance on a topic is in many cases a bug. Whilst it can be a feature to think in absolutes in certain contexts, when it comes to intricate and complex issues such as injury risk, this kind of thinking is malware in your cognitive systems that will without doubt pervert your quest for the truth and cause more problems than it solves.
Moving on, there seems to be two main camps that have formed:
Camp #1 – Technique is the be all end all for reducing injury risk; and
Camp #2 – F*** technique man, you can lift however you want because hey, we’re adaptable and you’re being a little pu$$* if you aren’t going ham!
The fact that there are two camps is problematic in and of itself. The idea that people position themselves as either a technique nihilist or a form aficionado is a false dichotomy and only serves to perpetuate a camp’s ideology – baring in mind that these camps are created mainly by those being presented information (that’s us, the audience!). At the level of experts however, we often see less dogma, more critical thinking and more uncertainty…
When people assume a ‘side’, they often buckle down on their beliefs, refute information from those outside their camp and regurgitate the opinions held by their groups leaders. Not only is this kind of polarisation super unproductive for discourse, but often deleterious to those who follow blindly and cannot think critically for themselves.
As you’ll soon read, we need to understand that injury risk is multifactorial, context dependent and vastly influenced by variation at the level of the individual.Try not to think about ‘picking a side’ when it comes to the importance of technique, or any topic for that matter. Instead think about the following:
- What do we know about lifting technique and injury risk?
- Where are there gaps in our knowledge on this topic?
- What does the weight of the evidence suggest?
- In what contexts does lifting technique influence injury risk?
- To what degree does lifting technique influence injury risk in those contexts?
These are the all important questions we must seek to answer if we are to further our understanding of how technique plays into injury risk and hopefully, this article will provide some fruitful insights.
My stance on the topic?
To clarify my stance on this topic, I don’t intend to criticize the points of view of others, but instead outline what both sides of the debate are and try my hand at formulating an opinion on how technique can relate to injury risk in individual circumstances so that I can inform my own practice and that of others.
I don’t believe that perfect technique will magically and meaningfully reduce injury risk. There will always be large variations in movement quality (even intra-set) and technique is a small (and perhaps important) part of what we can work on to reduce potential injury – in some situations. As a personal trainer I often use ‘technique’ as a means of getting my clients and athletes to ‘buy-in’ to the coaching process. Oftentimes when I break down a lifters technique and get them moving more efficiently, they think I am a wizard. Similarly, I’ve been hurt lifting and seen many other lifters get hurt under the bar. So, as you can see, my personal experiences may sway my views/opinions to be a little more open to the notion that the form matters for preventing technique.
Anyhow, with the preamble out of the way, it’s time to get stuck into the good stuff.
What is injury?
A good starting point for our discussion is to try and define what injury is. For the sake of this article we are going to try and KISS (‘keep it simple stupid’). I like the following definition by Timpka (hello bias?):
Timpka et al. 2014:
“A physical complaint or observable damage to body tissue produced by the transfer of energy experienced or sustained by an athlete during participation in Athletics training or competition, regardless of whether it received medical attention or its consequences with respect to impairments in connection with competition or training.”
Another definition that is particularly useful from an operational William Prinitis in his book Principles of Athletic Training:
“Mechanical injury force applied to any part of the body results in a harmful disturbance in function and or structure. These forces result in alterations to anatomical structures that are of sufficient magnitude to cause damage to that tissue.”
Now, taking a single definition (of many) with limited context isn’t perfect, but it at least brings some simplicity to the complexity party. Given the above, we’re going to talk about injury in the context of acute trauma with the sudden onset of symptoms, resulting in reduced performance.
Performance is an important word here, as it is a major concern when talking about injury in the context of barbell sports. The severity of the injury and the impact it has on training and competition outcomes is fundamentally what matters for strength athletes and lifting enthusiasts and whilst injury can impair performance in some cases, so too can pain. This is where things get a little more complicated as we are bringing pain into the injury discussion and pain does not always equate to injury. There isn’t a linear relationship with the amount of tissue damage someone sustains and the amount of pain they feel.
However, as I said, we will try to KISS to ensure the article is useful and prevent things from turning into a fecal hurricane (you can thank Sapolsky for that term).
Now that we’ve defined injury, kind of, let’s see how ‘weight-training’ sports stack up in the injury department. Let’s take a look at some statistics from Keogh et al 2016 and Aasa et al 2017 which compared injury rates per 1000 hours of participation in weight-training sports and how these findings compare to other sports…
Aasa et al 2017 also compared to other sports:
- Track & field 3.57 injuries/ 1000 hours
- Alpine Skiing 1.7 injuries/ 1000 hours
- American football 9.6 injuries/ 1000 hours
- Wrestling 5.7 injuries/ 1000 hours
What can we make of the injury risk research for resistance training?
From what the above tells us, most of the weight-training sports are actually pretty damn safe when compared to other sports per 1000 hours of involvement. Videbaek et al looked at injury rates per 1000 hours in novice and recreational runners and estimated the pooled risk at 17.8 running-related injuries per 1000 hours of training. Hootman, 2007 also compared some other sports, and found the following:
- Mens baseball – 5.8 per 1000 hours of participation
- Men’s soccer – 18.6 injuries per 1000 hours of participation
- Men’s football – 35.9 injuries per 1000 hours of participation.
This is actually great news for barbell enthusiasts – it’s one less barrier to entry for folks who may be fearful of injury or carry some additional injury baggage.
So despite a smaller risk of injury when lifting, what actually causes these injuries?
The jury is still out on this and more research is needed before we draw any concrete conclusions.
That being said, from the available data we can establish a few things:
- Weight-training sports have fewer injuries compared to other sports; and
- Some weight-training sports have fewer injuries than other weight-training sports.
The statistics above don’t tell us why some weight-training sports incur more injuries than others, nor does the research explain the relationship between lifting technique and injury risk.
What we can infer from the data is that perhaps each weight-training sport has a number of characteristics that differ from others and that maybe these differences are what influences injury risk.
It has been suggested that sports that involve rapid change of directions, high velocities and require greater dynamic movements are likely to impose a greater risk of injury, and if we are to relate that to resistance training in the gym, we can assume that the following maypredispose us to a higher degree of injury risk:
1. Creating extreme changes in rep to rep variability; and
2. Loading structures with high forces and/or high velocities;
3. Exposing structures/tissue to stressors that exceed adaptive thresholds.
Although we cannot say for certain what causes the variance in injury rates between different weight-training sports, the above factors are likely to be playing at least some role and perhaps it is the unique characteristics inherent in some barbell sports (both in training and competition) that is playing a role.
Exploring why some barbell sports more injurious than others?
Potential explanations for why certain sports carry a higher injury risk than others may be found by looking at the nature of each sport itself.
Firstly, by design, some sports are fundamentally different to others. This is hopefully a very obvious proposition, but one that is salient to the discussion at hand. Just take playing darts versus boxing. Clearly one is less likely to get you hurt than the other. This mostly explains why contact sports have higher injury risks than non-contact sports, duh.
But such a simple observation only helps us so much in answering the question at hand.
Further examination into the differences between various barbell sports may shed light on the variance in injury risk. Although it has been found that well-developed physical qualities are associated with a reduced risk of injury, and training hard is the best way to prepare athletes for competition, the process of developing physical qualities could itself be a factor in injury risk.
By virtue of the sport itself, some barbell sports require athletes to adhere to the SAID (specific adaptations to imposed demands) principle more than others. For such sports, this means that adherence to the SAID principle during training (especially the periods right before competition) is required if athletes are to attain the specific neurological and morphological qualities needed to perform at their best on game day.
Although training for the specific fitness qualities required by the sport is needed to enhance performance and prevent injury, too much specificity can be problematic and lead to overtraining syndrome.
A recent meta-analysis investigating the mechanisms of over-training syndrome by Grandou et al 2019 found that:
“Overtraining may be related to frequent high intensity and monotonous resistance training.“
Given the above, we can tentatively say that in barbell sports that require athletes to (or when they choose to) compete more regularly within the annual training plan, the likelihood of non-functional overreaching and subsequently overtraining syndrome is increased. This is probably due to the fact that in such cases, athletes are exposed to high training intensities more often and the training plan is likely be more monotonous throughout the year.
This makes managing the training plan imperative– especially for barbell sports whereby the competition demands can be very closely replicated in training.
In contrast, the competition demands of some ‘barbell sports’ cannot be easily mimicked in training and/or don’t require athletes to compete as frequently. Whilst this may reduce non-functional overreaching and overtraining syndrome, it can be equally problematic. Too much variation in the training stress may impair an athletes acquisition of the sports specific physical qualities they require in competition, thus making athletes more prone to injuries either in training or competition.
While too much variation in the training stress can be problematic, for the most part, less specificity in training will reduce monotony and strain and the likelihood of overtraining syndrome. Sports that have 1) less transfer from training-competition or 2) longer time frames between competitions are likely to need less specificity in the annual training plan. This facilitates more flexibility in program design, greater variation in workloads and fewer periods of seriously high intensity training. The aforementioned are all wins when it comes to injury prevention.
So, could it be that, by virtue of the SAID principle and the regularity of competition, some barbell sports are more injurious than others?
Comparing the Pair: Powerlifting VS Bodybuilding…
In powerlifting competition, athletes are afforded 9 attempts across three lifts–the squat, bench press and deadlift. Athletes take three attempts for each lift and aim to lift the most weight possible to produce their best total. The lifter with the biggest total wins.
Obviously, athletes can indeed perform the competition lifts in training and lift maximal loads on the squat, bench press and deadlift to train for the specific qualities needed to perform that task. Thus, in many cases, powerlifters training programs will impose a high degree of specificity and mirror their competition demands closely in the weeks and months prior to competition.
Moreover, powerlifters typically compete 2-4x per year, meaning that athletes will train in a highly specific manner for a significant portion of the annual training plan.
When looking at bodybuilding, competition outcomes are dependent on how well the athlete scores against a set of criteria that assesses their muscularity, conditioning, symmetry, proportions and stage presence. This is in stark contrast to other weight-training sports as competition demands are purely aesthetically based and do not require the expression of trainable fitness qualities–excluding muscle hypertrophy. Additionally, a bodybuilder will typically compete every 1-3 years which is far less than most other sports.
Consequently, bodybuilders have the lowest rate of injury per 1000 hours and have significantly lower injury rates than powerlifters. Some interesting observations that are definitely worthy mentioning and thinking about further.
- A dogmatic view of the factors causing/contributing to injuries in barbell sports is misguided;
- Injury is hard to define and is highly context dependent
- Barbell sports carry less risk of injury per 1000 hours of participation than most other sports
- The cause of injury risk in barbell sports is lesser known
- The nature of the sport and the demands it places on athletes during training and in competition may be a factor in injury risk.
I hope this article has helped you better understand injury, where the research is currently at on the topic, what we do and don’t know about injury in weight-training sports and has begun opening your eyes to how technique may or may not influence injury risk.
Stay tuned for Part 2 of this series where I will explore further the relationship between lifting technique and injury risk, review the research and share my insights into whether or not the way you lift matters for injury prevention.