A National 20-year Analysis of Weight Lifting-related Injuries and Fractures Among Adolescents.

BACKGROUND: Increasing strength through weightlifting has become a core component of competitive sports training, recreational exercise programs, and school physical education classes. Although many health benefits exist, there is concern for injury, especially with improper supervision and accelerated progression of training loads. Though organizations have advocated safe training practices, trends in the national health burden of injuries, specifically fractures, associated with weightlifting in the adolescent population have not been investigated. METHODS: The National Electronic Injury Surveillance System database was queried between 2002 and 2021 for patients aged 11 to 21 years presenting to US Emergency Departments with weight lifting-related injuries. The narrative component of each case identified was analyzed to include only patients noted to be using weightlifting equipment or free weights at the time of injury. Estimates and analyses were performed with 95% CIs. RESULTS: Although there has been some variability in weight lifting-related injuries, the incidence remained roughly constant over the 20 years ( R2 =0.0364). 14,497 cases were identified, reflecting a national estimate of 540,986 total injuries and an annual estimate of 27,049 injuries. Most injuries occurred among 15-to-18-year olds (44.1%±1.6%) and 19-to-21-year olds (38.3%±2.0%). The most common injuries were sprain/strain (36.7%±1.3%), contusion/abrasion (15.7%±0.7%), and fracture (9.9%±0.3%). There were 53,813 estimated fractures, giving an annual incidence of 2,691 fractures. As a portion of all injuries, the number of fractures decreased significantly as patients got older, accounting for 26.8%±3.3% at age 11 and only 8.3%±0.9% at age 21 ( R2 =0.6626). Fingers (37.1%±1.8%) and toes (27.9%±1.4%) were the most fractured body parts. Overall, fractures mainly occurred either at school (25.3%±2.0%) or places of recreation (24.7%±2.2%). CONCLUSIONS: Despite the guidelines to improve safety, the national health burden of weight lifting-related injuries among adolescents has remained constant over the past 20 years. Given that most of the fractures occur in the distal extremities, such as toes and fingers, at school and places of recreation, there may be an opportunity to promote safer weightlifting practices and the development of weightlifting equipment with in-built safety mechanisms, especially at gyms and schools. LEVEL OF EVIDENCE: Level III-prognostic.

Part II: Comparison of Crossfit-Related Injury Presenting to Sports Medicine Clinic by Sex and Age.

OBJECTIVE: To examine CrossFit-related injuries based on sex and age. DESIGN: Retrospective case series. SETTING: A tertiary-level pediatric sports medicine clinic. PARTICIPANTS: CrossFit athletes. MAIN OUTCOME MEASURES: CrossFit-related injuries by sex (males vs females) and age groups (≤19 years vs >19 years) using a χ analysis with P = 0.05, odds ratio (OR), and 95% confidence interval (95% CI). RESULTS: Among injured CrossFit athletes, female athletes sustained lower extremity injuries more frequently than male athletes (P = 0.011; OR, 2.65; 95% CI, 1.25-5.65). In observed CrossFit injuries, shoulder injuries were more frequently observed in male athletes compared with female athletes (P = 0.049; OR, 2.79; 95% CI, 0.98-7.95). Additionally, a greater proportion of CrossFit athletes aged 19 years and younger suffered trunk/spine injuries than those older than 19 years (P = 0.027; OR, 2.61; 95% CI, 1.10-6.21) in injured CrossFit athletes. CONCLUSIONS: The current results indicated sex- and age-specific susceptibility to CrossFit-related injuries based on body parts and diagnoses. The presented information may be useful to develop a safer exercise program, especially for pediatric and adolescent CrossFit participants.

Comparison of Post-Exercise Hypotension Responses in Paralympic Powerlifting Athletes after Completing Two Bench Press Training Intensities.

Background and objective: Post-exercise hypotension, the reduction of blood pressure after a bout of exercise, is of great clinical relevance. Resistance exercise training is considered an important contribution to exercise training programs for hypertensive individuals and athletes. In this context, post-exercise hypotension could be clinically relevant because it would maintain blood pressure of hypertensive individuals transiently at lower levels during day-time intervals, when blood pressure is typically at its highest levels. The aim of this study was to compare the post-exercise cardiovascular effects on Paralympic powerlifting athletes of two typical high-intensity resistance-training sessions, using either five sets of five bench press repetitions at 90% 1 repetition maximum (1RM) or five sets of three bench press repetitions at 95% 1RM. Materials and Methods: Ten national-level Paralympic weightlifting athletes (age: 26.1 ± 6.9 years; body mass: 76.8 ± 17.4 kg) completed the two resistance-training sessions, one week apart, in a random order. Results: Compared with baseline values, a reduction of 5-9% in systolic blood pressure was observed after 90% and 95% of 1RM at 20-50 min post-exercise. Furthermore, myocardial oxygen volume and double product were only significantly increased immediately after and 5 min post-exercise, while the heart rate was significantly elevated after the resistance training but decreased to baseline level by 50 min after training for both training conditions. Conclusions: A hypotensive response can be expected in elite Paralympic powerlifting athletes after typical high-intensity type resistance-training sessions.

Weightlifting Shoulder Injuries Presenting to U.S. Emergency Departments: 2000-2030.

Weightlifting is associated with a significant risk of shoulder injury. We used the National Electronic Injury Surveillance System (NEISS) database to identify patients presenting to U.S. emergency departments between 2000 and 2017 with weightlifting-associated shoulder injuries to determine how the health burden and demographic characteristics of these patients have changed over time. Our analyses demonstrated a significant increase in the national estimate of weightlifting-associated shoulder injuries between 2000 (N=8.073; C.I. 6.309-9.836) and 2017 (N=14.612; C.I. 12.293-16.930) (p<0.001), with linear regression (R2=0.87, P<0.001) projecting 22.691 national cases by 2030. Patients were most often males (83.3%; C.I. 81.5-85.2%) between 20-29 years of age (30.5%; C.I. 28.2%-32.8%) sustaining a sprain, strain, or muscle tear (65.1%; C.I. 60.4-69.8%). Additionally, the average age of injury (34.33 years; C.I. 33.43-35.23 years) in the 2012-2017 period was significantly higher than in prior periods (p<0.001). We postulated these findings may reflect older individuals more frequently participating in resistance training than in the past, and considered that contemporary fitness trends such as CrossFit might have higher injury rates. We believe increased awareness of this burden, coupled with focus on injury prevention strategies, could yield substantial national health and cost savings.

Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder.

BACKGROUND: Bodybuilding is a demanding sport, which requires high-volume, high-resistance weight training and augmented nutritional intake, toward an increase of overall body muscle mass accompanied by an overall decrease of body fat percentage and mass. Among bodybuilders, the use of various legal and illegal supplements is common. These supplements may be naturally occurring or man-made. CASE REPORT: We discuss the case of a 30-year-old male bodybuilder presenting with coma due to severe hypoglycemia from unknown cause, necessitating iterative glucose infusions, which was subsequently found to be related to cryptic insulin injections. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In strength athletes, especially amateurs, the recourse to performance-enhancement drugs (e.g., insulin) is frequent. Beyond the specificity of care required for surreptitious insulin intoxication, emergency physicians should be alert to the possibility that exogenous insulin has been injected for use as an ergogenic aid by bodybuilders and others seeking to increase their body muscle mass when they encounter a patient with a decreased level of consciousness and treatment-refractory hypoglycemia. Moreover, in case of suspicion of such intoxication, the use of other illegal supplements should be screened, due to potentially associated risks of complication.

Lifting and pregnancy outcomes: feasibility of a randomized controlled trial.

Background: The highest incidence of preterm birth (18%) occurs in Africa but the causes are largely unknown. Some studies have reported adverse effects of maternal physical exertion on birth outcomes. A randomized controlled trial (RCT) is proposed to determine the effectiveness of an intervention reducing lifting and carrying in pregnant women in reducing preterm birth and low birthweight. Aims: To test the feasibility and acceptability of the proposed lift-less intervention RCT. Methods: We recruited pregnant women and midwives from antenatal clinics within the Greater Accra Region of Ghana. The midwives were trained to administer the intervention during a 5-week trial. Four intervention trial sessions were organized at weekly intervals. Results: Seven pregnant women and six midwives participated. After piloting, we observed a reduction in participants' self-reported daily exposure to heavy lifting and carrying. The daily average frequency of lifting by a participant within the first seven days of the study was 3.5 (SD 1.7) with an estimated mean total weight of 41.1 kg (SD = 13.3 kg). This had decreased to 2.3 (SD = 1.0) and the amount to 13.4 kg (SD = 10.9) within the last seven days of the study. Conclusions: The findings provide insight into the daily physical exertion experienced by pregnant women in Ghana. The lift-less intervention trial is feasible with modifications and has the potential to reduce excessive physical exertion among pregnant women in Ghana to improve birth outcomes.

Spontaneous hepatic rupture in a bodybuilder: a case report and review of the literature.

This article is the first description of a spontaneous hepatic rupture in a young bodybuilder with a history of clenbuterol and ephedrine alkaloid use. The patient presented with a sudden mid-epigastric pain and vomiting. Hemoglobin levels decreased a few hours later and a computed tomography scan was performed which revealed a rupture of the right liver capsule and hemoperitoneum. Two attempts at transarterial embolization did not control the bleeding and a right hemihepatectomy was performed. The pathological report identified a hepatic adenoma, a capsular tear and diffuse peliosis hepatis. The patient was discharged in a good condition after eleven days. Spontaneous hepatic ruptures are rare and life-threatening and are usually described in association with tumors, connective tissue diseases and gestosis. This article is a review of the available literature with regard to this condition, with a focus on its relation to peliosis hepatis and banned substance used by body image fanatics. The present case highlights the challenging diagnosis of this potentially fatal liver complication in a healthy appearing male, the risk associated with the online trade of performance enhancing drugs and its relation with peliosis hepatis.

US and MR Imaging of Pectoralis Major Injuries.

During the past 2 decades, the frequency of pectoralis major muscle injuries has increased in association with the increased popularity of bench press exercises. Injury of the pectoralis major can occur at the muscle origin, muscle belly, musculotendinous junction, intratendinous region, and/or humeral insertion-with or without bone avulsion. The extent of the tendon injury ranges from partial to complete tears. Treatment may be surgical or conservative, depending on the clinical scenario and anatomic characteristics of the injury. The radiologist has a critical role in the patient's treatment-first in detecting and then in characterizing the injury. In this article, the authors review the normal anatomy and anatomic variations of the pectoralis major muscle, classifications and typical patterns of pectoralis major injuries, and associated treatment considerations. The authors further provide an instructive guide for ultrasonographic (US) and magnetic resonance (MR) imaging evaluation of pectoralis major injuries, with emphasis on a systematic approach involving the use of anatomic landmarks. After reviewing this article, the reader should have an understanding of how to perform-and interpret the findings of-US and MR imaging of the pectoralis major. The reader should also understand how to classify pectoralis major injuries, with emphasis on the key findings used to differentiate injuries for which surgical management is required from those for which nonsurgical management is required. Familiarity with the normal but complex anatomy of the pectoralis major is crucial for performing imaging-based evaluation and understanding the injury findings. ©RSNA, 2017 Online supplemental material is available for this article.

Injuries among weightlifters and powerlifters: a systematic review.

BACKGROUND: Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports. OBJECTIVE: The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting. DESIGN: Systematic review. DATA SOURCES: Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality. RESULTS: 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4-3.3 injuries/1000 hours of training and 1.0-4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors. SUMMARY/CONCLUSIONS: The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries. TRIAL REGISTRATION NUMBER: PROSPERO CRD42015014805.

The Outcome Of Surgical Management Of Chronic Pectoralis Major Ruptures In Weightlifters.

Pectoralis major repair is increasing in frequency due to the uptake of weight training. Chronic tendon injuries tend not to have as favourable outcomes. We report our outcome of chronic pectoralis major ruptures following surgical repair. Retrospective analysis of 8 patients who were weightlifters, treated for primary pectoralis major repair by one surgeon. Surgical repair was direct via suture anchors and one additionally required fascia lata graft due to tendon retraction. Outcome was assessed by comparing strength to the contralateral pectoralis muscle and the Oxford Shoulder Score. All patients were male with mean age of 36 years. Mean delay to surgery was 25.6 months. Mean followup was 19.6 months and mean Oxford Shoulder Score was 43.7. Six out of eight patients had full strength compared to the contralateral side. Complications included visible skin tethering not associated with weakness, stiffness associated with weakness and a seroma at fascia lata donor site. This is the largest documented study of Chronic Pectoralis Major repair showing excellent outcomes with repair, even if delayed.

Quadrilateral Space Syndrome Treated with Ultrasound-Guided Corticosteroid Injection: A Case of Isolated Teres Minor Atrophy and Review of the Literature.

Quadrilateral space syndrome (QSS) is a rare orthopedic condition caused by compression, entrapment, or injury to the axillary nerve or posterior humeral circumflex artery as they arise from the quadrilateral space. QSS can present with point tenderness over the quadrilateral space and weakness and paresthesia in the axillary nerve distribution. It is commonly associated with repetitive overhead activities and is seen in athletes engaging in such activities. Here we report a case of QSS in a 42-year-old male weight lifter who presented with pain and soreness in the posterior aspect of his right shoulder radiating around his arm as well as slight weakness of his right shoulder of a few weeks duration. MRI results of his shoulder demonstrated moderate atrophy and fatty infiltration of the teres minor. His diagnosis of QSS was confirmed with electro diagnostic testing which showed axillary neuropathy. He was treated with ultrasound guided corticosteroid injections and gained relief from this treatment. His axillary neuropathy was shown to be resolving on repeat electro diagnostic testing at six-months follow-up. Here we report a case of QSS and provide a brief review of the literature.

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days.

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7-day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete-days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete-days (95% CI 24.0-42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8-29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.

Subchondral Impaction Fractures of the Medial Femoral Condyle in Weightlifters: A Report of 5 Cases.

Although subchondral impaction fractures have already been reported in the non-weight-bearing portion of the lateral femoral condyle, this study reveals the presence of an intra-articular impaction fracture of the postero-superior region of the non-weight-bearing portion of the medial femoral condyle recognized in 5 of a group of 22 representatives of the Polish national Olympic weightlifting team, who underwent 1.5T magnetic resonance imaging examination. Articular cartilage lesions varied with regard to the type of injury and its severity ranging from healed or subchronic injuries to acute trauma. All described individuals had no clinical history of acute knee trauma and only 3 of them had minor pain symptoms. The accumulation of microtraumas occurring during participation in particular activities associated with weightlifting training seems to be responsible for the development of this type of contusion. This is the first description of impaction fracture observed in this location in professional weightlifters.

Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury.

Partial semitendinosus tendon tear in a young athlete: a case report and review of the distal semitendinosus anatomy.

Distal semitendinosus tears have been infrequently reported in the radiology literature, and a detailed description of the anatomy and imaging features of these injuries is lacking. The semitendinosus tendon is clinically relevant, as it is frequently grafted in knee ligament reconstructions and plays an important role in performing competitive activities. We present a case of a 31-year-old man who developed a partial semitendinosus tear during competitive training. This case highlights the common clinical and imaging findings found with distal semitendinosus tears, and explores the various modalities available to treat this injury. We also review the clinically pertinent anatomy of the distal semitendinosus tendon and discuss the pitfalls that musculoskeletal radiologists may encounter, to avoid misdiagnosing these rare injuries.

Weightlifter's Nodule: A New Variant of Athlete's Nodule.

A 17-year-old high school football player presented to our dermatology clinic complaining of two asymptomatic lumps on the upper part of his back. The first lump was noticed on the right side of the upper aspect of his back following a weightlifting session. The second lump appeared on the left side of the upper part of his back several weeks later. The patient's personal and family medical history was unremarkable. Physical examination revealed an ill-defined, firm, mobile subcutaneous nodule measuring approximately 3 cm on the right upper part of the back and a similar but smaller nodule on the left upper portion of the back (Figure 1). The location of the lesions corresponded to the areas of maximal pressure produced by a squat bar that he uses frequently during weightlifting (Figure 2). Histologic analysis of the right lesion revealed a markedly expanded dermis caused by a striking increase in the number of collagen bundles that were relatively normal in thickness, accompanied by a subtle increase in the number of fibroblasts (Figure 3). In some foci, fibroplasia along with increased deposition of mucin further contributed to the expansion of the dermis (Figure 3). Although the process spanned the entire dermis, it was more pronounced in the deep reticular dermis, particularly near the subcutis as collagen bundles were arranged in a more haphazard array in this region. Verhoeff-Van Gieson stain revealed diminished and fragmented elastic fibers within some of the involved areas. This reactive fibrosis can be seen in athlete's nodules as a result of repetitive blunt pressure. We proposed a diagnosis of weightlifter's nodule to further classify these lesions and the patient was instructed to discontinue associated weightlifting activities.

An unusual complication of weightlifting: a case report.

Acute exertional compartment syndrome is an uncommon illness that occurs after a period of strenuous exercise. We present a case of acute exertional compartment syndrome of the bilateral supraspinatus muscles after weight lifting. The diagnosis was made in the emergency department and the patient subsequently underwent successful decompressive fasciotomies of both compartments. We highlight the unusual presentation of this case and the approach to make the diagnosis.