Why is weight lifting associated with injury?
“This type of physical activity is frequently considered dangerous in spite of the innumerable scientifically proven benefits” (3).
The appearance and sensation of holding your breath, exerting, and straining has long been associated with negative emotions and feelings of harm through societal beliefs. The appearance of someone in physical duress is unpleasant as is the sensation of being under duress especially if you are not accustomed to it through regular exposure. In reality, this is unavoidable and automatic with any daily activity such as going to the bathroom or performing any movement that requires moderate to hard physical effort. A lot of injuries happen when someone is in a situation of strain and physical duress, thus we associate any strain with potential injury. However, there is always more to the story.
In the medical setting, you are only going to see people who have been hurt while weight training, so you are naturally going to be biased to see weight training as bad and injurious. You don't see people who are training and not getting seriously hurt which is likely much much more in number than the people getting hurt enough to seek medical care
It’s more prevalent on social media to see people getting hurt while lifting. This again will bias your perception of what happens when lifting weights
Pain and injury are going to happen and often come about without any particular injurious event. Oftentimes, if someone is lifting weights during the time pain occurs, even if it did not start while actually lifting, they tend to blame the lifting. A typical response then is to stop lifting and medical providers will often give the same advice, thus perpetuating the narrative that lifting weights is bad and injurious.
The Facts:
Pain and injury are a part of life and are going to occur whether you weight train or not. So, thinking you can avoid pain and injury by not lifting weights or only lifting light weights does not make you less likely to experience pain and injury. Also, if you are not strong enough to meet demands of your normal activity, you are potentially more at risk to getting injured or developing a pain issue.
The actual data from research on powerlifting and weightlifting injuries suggests very low incidences: 1-4.4 and 2.4-3.3, 2.6 injuries per 1,000 hours of participation for powerlifting and weightlifting respectively.(1,2,3). Injury occurrence is also similar to other non-contact sports which require strength and power and lower compared to contact sports (1). These numbers are lower than other sports such as football: 9.6 injuries/1,000 hours, wrestling: 5.7 injuries/1,000 hours and soccer: 15 injuries/1,000 hours (1,3). Soccer, judo and basketball have shown the highest injury rates in another study, while weight training was amongst the lowest with only cycling and swimming having lower injury rates (4). NCAA and collegiate club sports had injury rates of 3.8-9 injuries/1,000 hours in practices and increased to 13.79-18.3 injuries/1,000 hours in competitions and 10.28 injuries/1,000 hours in intramural sports (4). Funny thing is, people are typically ok with playing sports with much higher injury risk than lifting weights but not ok with lifting weights which is statistically less injurious.
Further, no study identified risk factors for injuries in weightlifting and powerlifting. They did not see any indications nor clear relationships between specific exercises and injuries, nor exercises leading to more injuries (1).
“It seems that powerlifting is, in general, quite safe and only a low risk of injury exists” (3).
Resistance training (lifting weights) has more benefits than downsides:
“Resistance training has been associated with fewer episodes of low back pain, fewer arthritic pain symptoms, increased independence in daily activities, improved movement control, and faster walking.” (2)
When people get hurt lifting, a good majority of the time they likely attempted something they were not yet prepared for. Examples would be trying to max out or lift a weight well beyond anything they have handled recently or doing way more volume suddenly than what they are currently accustomed to. People can regularly lift heavy and perform high volumes and tolerate this well provided that they started at a point appropriate for them and progress as they are able to adapt to over time. The devil is in the details: it's typically not the weight lifting that is the problem, it's how people go about it which can be the difference between effective and sustainable or potentially problematic. This is further proven in one of the studies as subjects who performed individualized and sport-specific physical preparation training as well as training load that was adapted to their abilities experienced lower injuries (4). Also, significant differences were observed between subjects who carried out an individualized (matching what was appropriate for them) and sport-specific physical preparation and those who did not (4).
Sometimes freak things and injuries happen, even with benign training. However, this also occurs in daily life outside of the gym, so we could assume this is not particularly unique to lifting weights.
You don't have to, nor need to start out pushing as heavy as you can. Lifting is infinitely scalable to meet you at an appropriate and tolerable start place that you can progress from. It does not have to be a max effort all the time nor that often to still get benefits. It needs to be challenging and some degree of hard but there is a difference between hard and all out max effort.
Conclusion: The benefits of lifting weights far outweigh the risks
References:
Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017 Feb;51(4):211-219. doi: 10.1136/bjsports-2016-096037. Epub 2016 Oct 4. PMID: 27707741.
Bukhary HA, Basha NA, Dobel AA, Alsufyani RM, Alotaibi RA, Almadani SH. Prevalence and Pattern of Injuries Across the Weight-Training Sports. Cureus. 2023 Nov 30;15(11):e49759. doi: 10.7759/cureus.49759. PMID: 38046743; PMCID: PMC10689975.
E. Dudagoitia, A. García-de-Alcaraz, L.L. Andersen, Safety of powerlifting: A literature review, Science & Sports, Volume 36, Issue 3, 2021, Pages e59-e68, ISSN 0765-1597, https://doi.org/10.1016/j.scispo.2020.08.003. (https://www.sciencedirect.com/science/article/pii/S0765159720302069)
Prieto-González P, Martínez-Castillo JL, Fernández-Galván LM, Casado A, Soporki S, Sánchez-Infante J. Epidemiology of Sports-Related Injuries and Associated Risk Factors in Adolescent Athletes: An Injury Surveillance. Int J Environ Res Public Health. 2021 May 2;18(9):4857. doi: 10.3390/ijerph18094857. PMID: 34063226; PMCID: PMC8125505.