Injuries in powerlifting

The injury rate in powerlifting appears to be relatively low, at 1.0-4.4/1000 hours of training. For the purposes of this article, an injury is defined as pain or impairment of bodily function that affects powerlifting training. There is evidence that disordered eating behaviours and excessive alcohol consumption (5 standard drinks per week) are associated with musculoskeletal injuries. These individuals do not achieve optimal recovery after training, which is associated with greater susceptibility to injury.

Injury-causing factors in powerlifting

Injury-prone behaviours in powerlifting include a lack of optimal training progression. We need to be aware that ligaments and the nervous system take longer to regenerate than muscles, so testing your maxes every training session is not optimal in terms of regeneration and can lead to dangerous injuries. Both the lack of optimal technique (okay, let's agree that it will be individual for everyone, we are not striving for ‘textbook ideals’ because they do not exist) and the lack of optimal training progression contribute to the development of overload, which in turn leads to injury. Reduced adaptation to high or maximum loads during competition can contribute to a greater risk of injury. It is well known that training before a competition should be increasingly specific, as different training methods cause different physiological adaptations. The load or intensity of training is one of the main determinants, affecting not only the power and kinematics of the trained movement, but also neuromuscular structural adaptations. Therefore, selecting appropriate training loads and repetition ranges can reduce the risk of injury by improving adaptation.

Prevention in the squat position

One study examined three categories of biomechanical effects in squats, namely: (A) tibiofemoral compression and shear forces and patellofemoral compression, (B) quadriceps and hamstring muscle activity, and (C) anterior-posterior and medial-lateral knee stability. In terms of compressive and shear forces, they showed that these increase with increasing knee flexion. The pressure on the structures in and around the knee joint during squatting with simultaneous knee flexion, hip adduction and internal rotation of the femur (valgus stress) is also important. The deeper the squat, the greater the load on the hip and knee joints, provided that the same weight is used. As for foot spacing, too wide a stance can increase tibiofemoral compressive forces on the patella, while a narrow stance increases anterior shear forces. A higher descent speed (we are talking about a ‘bomb’ style squat here) increases anterior-posterior shear and compressive forces in the knee joint. In addition, it has been shown that bouncing at the bottom of the squat increases shear forces in the knee joint. It is said that a fast and uncontrolled descent causes excessive deformation and shear forces to the cruciate ligaments and collateral ligaments, which could damage these structures. Uncontrolled descent also affects spinal posture - greater forward lean has been shown during repetitive squats (>10 repetitions) at high speed. And greater forward lean was associated with increased shear forces in the lumbar spine. The high position of the barbell shifts some of the load from the hips to the knees. Squats can cause many injuries, such as knee pain, which can be caused, for example, by insufficient patella stabilisation. Strengthening the VMO can help here. Incorrect foot function can functionally shorten the first ray (big toe to heel and everything else on the outside) which affects the entire biomechanics of the squat and can cause many injuries. Excessive ‘gripping the ground with your toes’ during squats can also lead to hypertrophy of the flexor muscle group, which also disrupts the proper functioning of the foot, which should be a stable base on which the entire kinematic chain begins or ends during squats. Frequent tears and strains of the muscles in the groin area can be caused by improper functioning of the gluteal muscles, which overloads, for example, the adductors, which take over the work of hip extension (here, too, you can often see the ‘knees coming together in the middle’ during squats). On the other hand, I would look for the causes of elbow pain, a common injury during squats, in the incorrect mechanics of the shoulder blade or in the disproportion between the extensor and flexor groups of the forearm. However, I am simplifying these examples, of course, because there can be many causes, and I only want to show you some of them.

Prevention in bench presses

Research on bench presses has shown that using a wide grip puts the shoulder joint in an unfavourable position, placing strain on the acromioclavicular joint, coracohumeral ligaments and pectoralis major muscle. Additionally, provided that the angle of abduction/extension of the shoulder remains the same, a wider grip increases the torque on the shoulder, which increases the demands on the rotator cuff and biceps tendon, which stabilise the head of the humerus. The most common injuries during bench presses are shoulder joint dislocations, pectoralis major tears (most common in men), overuse and tears of the rotator cuff ligaments and muscles, and tendon inflammation. I would look for the causes in incorrect shoulder blade mechanics and a lack of anterior depression in individual repetitions. In addition, the lack of involvement of the latissimus dorsi muscle and the work on the pectoralis major muscle leads to its overload, resulting in injuries. Lack of stabilisation in the shoulder blade leads to overloading of the rotator cuff and muscles stabilising the shoulder joint, resulting in dislocations, humeral instability or injuries to the tendons surrounding the joint. Incorrect technique also leads to strain on the lumbar spine, as excessive bridging in the lumbar spine instead of the thoracic spine (because here we often have limited mobility and excessive kyphosis or flattening) causes compensation and excessive strain. Proper technique allows you to enjoy training longer without injuries to the shoulder girdle.

Prevention in dead lift

It is believed that lumbar lordosis reduces the risk of injury during deadlifts. It is also important to keep the barbell close to the body to improve performance and reduce the risk of injury due to the more economical movement of the barbell along the body and the correct functioning of the shoulder blade together with the latissimus dorsi muscle. As for the knees, it is said that it is important not to extend the knees prematurely or excessively to avoid what is called a straight-leg deadlift, which occurs when the knees are close to or fully extended. This reduces the activity of the quadriceps and increases the activity of the spinal extensors, but perhaps more importantly, it results in a less upright torso position. This does not appear to affect the compressive forces on the L4/L5 disc, but it does reduce the L4/L5 moment and shear forces compared to a more bent posture. Performing deadlifts (especially with improper technique) more than once a week can lead to overloading the ligaments near the sacroiliac joint and, as a result, injury. A common sight at competitions in the context of deadlift injuries is a torn biceps during a mixed grip (so-called interception), most often caused by a lack of extension in the elbow joint and a shortened biceps brachii, because a muscle that cannot work at its full physiological range is weakened.

Pelvic floor muscles

I wouldn't be myself if I didn't mention the pelvic floor muscles (PFM) in this article. Although not everyone would necessarily call it an injury, I am talking about stress urinary incontinence, but it is a very important issue for me, which I would like to discuss in order to normalise this topic as much as possible. There are various causes for this phenomenon. According to studies among female powerlifters, it occurs more often due to overly tense PFMs than to the fact that they are weak, because strength training with appropriate progression should strengthen them. However, a constantly tense muscle will be weakened - imagine that you are clenching your fist, after 5 minutes it is quite okay, after an hour it starts to hurt and after a longer time you do not have the strength to keep your fist clenched - PFMs behave in the same way; if we do not take care to relax them, they will function like the fist I described earlier. Without going into detail, I would like to point out here that stress urinary incontinence occurs in this sport and there is no shame in it, but you should seek help from a urogynaecological physiotherapist. Of course, this can also happen to men, more often in the form of rectal prolapse, but this dysfunction is definitely more common among women.

Conclusion

So what preventive measures should be taken to minimise the risk of injury in powerlifting? Powerlifters should definitely start paying more attention to cardio, which has a positive effect on the circulatory system, including the heart, and improves regenerative capabilities. Of course, at the beginning, I would recommend increasing the amount of walking and, if possible, increasing the intensity of aerobic exercise. In addition, do not underestimate the value of GPP, i.e. additional training with movements that are not specific to powerlifting, because it is worth moving in other planes than just the static three lifts. Studies show that regular use of the sauna is correlated with a lower rate of injuries, thus confirming its regenerative effect on the musculoskeletal system through the presumed mechanisms of increased blood flow in the skin and muscles, faster degradation of metabolic products, and the regulation of many genes specific to muscle growth and atrophy (9). Swimming as a form of leisure activity was correlated with fewer injuries (p = 0.027, r = -0.288). Additionally, I would like to remind you that 7-8 hours of sleep also has a positive effect on better regeneration and well-being. It would also be good to limit the amount of blue light exposure for at least half an hour before going to bed (use filter apps on your phone/laptop or special glasses, or pick up a book and read for half an hour :) ). Research indicates that older athletes (>30 years old) sustained significantly fewer injuries (p = 0.004; r = -0.373) than younger athletes. This may indicate greater training and competition experience. I also believe that more experienced individuals benefit from the help of coaches who create a tailored periodisation plan for them, rather than testing their maximum capacity every week during training, as is customary for younger individuals who are just starting their adventure in powerlifting.

BPC-157 in powerlifting

When it comes to nutrition, powerlifters are not the best example, as they often do not pay attention to the nutritional value of the meals they eat, they do not limit their alcohol consumption, and in many cases they are overweight. If we add the use of performance-enhancing drugs to all this, our liver and internal organs may not necessarily be able to cope with inflammation. The BPC-157 peptide, which has a very low frequency of side effects, can be helpful in regenerating the digestive system. People who use BPC-157 report very good results in alleviating various symptoms related to stomach or intestinal function. If we are unable to avoid injury, studies on BPC 157 have consistently shown positive and rapid healing effects for various types of injuries, both traumatic and systemic, and for many soft tissues. It is a therapy for healing and restoring the functional capacity of soft tissue damage, with an emphasis on healing tendons, ligaments and skeletal muscles. Among the mechanisms of BPC's regenerative action is its ability to promote faster fibroblast growth, which results from increased expression and activation of FAK and palixilin proteins. Another healing mechanism is the stimulation of a process called angiogenesis (the formation of new blood vessels).

Bibliography:

1. “Prevalence and Consequences of Injuries in Powerlifting A Cross-sectional Study Edit Stro¨ mba¨ ck,*” Ulrika Aasa, Kajsa Gilenstam and Lars Berglund, Investigation performed at Umea University, Ume ˚ a, Sweden 2. “Injuries and Overuse Syndromes in Powerlifting” J. Siewe, J. Rudat, M. R ö llinghoff, 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. Krivic, M. Majerovic, I. Jelic, 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 i Ellahham, 2001; Leppäluoto i wsp., 1986; McGorm, Roberts, Coombes i Peake, 2018