The Physician and Sportsmedicine

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Weight Training Injuries

Ronald K. Reeves MD, Edward R. Laskowski MD & Jay Smith MD

To cite this article: Ronald K. Reeves MD, Edward R. Laskowski MD & Jay Smith MD (1998)
Weight Training Injuries, The Physician and Sportsmedicine, 26:2, 67-96

To link to this article: http://dx.doi.org/10.3810/psm.1998.02.939

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 Weight Training Injuries
Part "1 : Diagnosing and Managing Acute Conditions

Ronald K. Reeves, MD
Edward R. Laskowski, MD
Jay Smith, MD
Photo: © 1998. Steven Peters/Tony Stone

When patients present with

acute weight training injuries, fa-
miliarity with the demands of the
The Physician and Sportsmedicine 1998.26:67-96.

activity can help physicians get the most

out of the patient history. Probable risk
factors for injury include errors in tech-
nique (described in a sidebar), skeletal
immaturity, and anabolic steroid abuse.
Common acute injuries in weight training
include sprains, strains, tendon avulsions,
and compartment syndrome. Possible
nonmusculoskeletal problems include
retinal hemorrhage, radiculopathy, and
various cardiovascular complications.
Treatment of acute musculoskeletal in-
juries varies, but usually includes sports
medicine mainstays such as prompt
RICE. Chronic weight training injuries will
be described in part 2 of this series.

0
ver the past 20 years, the popularity
of weight training has exploded.
More than 45 million Americans
train with weights regularly. Fortu-
nately, serious injuries are relatively rare. In 1986,
weight training injuries accounted for an esti-
mated 43,400 emergency department visits out
continued

-¥- For CME credit, see page 111

Dr Reeves is chief resident, Dr Laskowski is a consultant,

and Dr Smith is a senior associate consultant in the depart-
ment of physical medicine and rehabilitation at the Mayo
Clinic in Rochester, Minnesota. Dr Laskowski is codirector
and Dr Smith is a staff physician at the Mayo Sports Medi-
cine Center, and Dr Laskowski is an associate professor
and Dr Smith is an assistant professor at Mayo Medical
School in Rochester.

THE PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98 67

 weight training injuries continued
Illustrations © I 998: Terry Boles
The Physician and Sportsmedicine 1998.26:67-96.
Figure 1. In Olympic weight lifting competition, athletes
execute two lifts. In the snatch (a and c), the weight is lifted
from the floor to an overhead position in one motion. The
clean and jerk (a,b, and c) is a two-step lift; the athlete first
lifts the weight from the floor to the shoulders, then lifts the
weight from the shoulders to an overhead position.
of a total of 5.6 million visits for all sports.' In
1995, the last year for which statistics are avail-
able, emergency room visits for weight training
injuries totaled 56,400, out of more than 5.4 mil-
lion visits for all sports.'
This article, the first of a two-part series, fo-
cuses on the diagnosis and treatment of acute
weight training injuries. Part 2, to appear in an
upcoming issue, will cover overuse and chronic
conditions in weight lifters.
Out of the Circus
In the late 1800s, weight training was primari-
ly the activity of circus strongmen. The first Eu-
ropean weight lifting championship was held in
Rotterdam in 1896, and the first world champi-
onship was in Vienna in 1898. In the first modem
Olympics in 1896, Viggo Jensen and Launceston
Elliot tied with lifts of 245 lb. The International
Weightlifting Federation was founded in 1905,
and since the 1970s the popularity of weight lift-
ing has soared.
68
Though the popular image of a weight lifter is
a bodybuilder such as Arnold Schwarzenegger
or Lee Haney, most people who weight train do
so as part of a comprehensive fitness program.
Weight Training Methods
There are several different styles of weight lift-
ing/training. In this article the term "weight
training" refers to exercises that use weight or re-
sistance to build strength and muscle mass. The
term "weight lifting" here refers to specific com-
petitive activities such as Olympic lifting and
power lifting. Though each style and method
predisposes participants to a characteristic set of
injuries, many injuries are common to all types
of weight lifting/training.
The use of machines may be the most com-
mon method of fitness-related weight training at
present. Machines allow exercisers to circuit
train or to focus on individual muscles or muscle
groups (eg, shoulders, hamstrings).
Circuit training. Circuit training involves a
rapid transition from one muscle-group exer-
cise to the next with 15 to 30 seconds of rest be-
tween exercises. Participants use weights that
are about 40% to 60% of their one-repetition
maximum (lRM). Strength and aerobic gains
from circuit training are modest-30% to 50%
of the gains seen in dedicated strength or aero-
bic exercise regimens. The primary benefit of
circuit training is the shorter workout time. Bal-
lor et al' showed that alternating 15 seconds of
exercise with 15 seconds of rest allows the great-
est amount of work in the shortest time. This
technique, when properly used, poses minimal
risk of musculoskeletal injury, though the brief
recovery time between exercises presents a risk
for overuse injuries.~.'
Focused weight training. Focused weight
training emphasizes specific muscle groups and
can be performed with strength training ma-
chines or free weights; typically, both are used.
Focused weight trainers usually lift weights as
part of a comprehensive recreational fitness pro-
gram. Training structure, loads, and training vol-
umes vary. Focused weight trainers draw from
Vol 26 • No. 2 • February 98 e THE PHYSICIAN AND SPORTSMEDICINE
The Physician and Sportsmedicine 1998.26:67-96.

Figure 2. In power lifting competitions, athletes typically perform three lifts. In the squat, a
weight is placed across the shoulders of a standing athlete. The lifter lowers his or her body to a
squatting position (a}, then returns to standing (b). In the bench press (c) the supine lifter lowers
and raises the weight to and from the chest. In the dead lift (d) the weight is raised from the
floor to the midthigh by standing up from the squatting position (e).

other styles of weight training or competitive
weight lifting and are at risk for acute and over-
use injuries. Because training commonly pro-
duces discomfort, pain from overuse injuries is
often misinterpreted as a normal result of the
training. As in many other lifting styles, athletes
often ignore the pain until performance suffers.
Bodybuildrnng.Bodybuildingisexceedin~y
popular with younger people. The primary goal
is to attain significant, symmetric muscle hyper-
trophy. Strength gains are secondary. Bodybuild-
ing involves exhaustive workouts primarily in-
volving free weights, using multiple sets and
exercises and special training techniques for
each muscle. Weight loads are frequently 80% to
100% of 1RM, with 1 to 12 repetitions. Special
techniques are periodically used to alter training
and facilitate consistent gains; examples include:
• eccentric contractions or "negatives,"
• forced repetitions to muscle failure,
• supersets (rapidly paired exercises of different
muscle groups in the same anatomic region), and
• compound sets (rapidly matched exercises of
the same muscle group).
Bodybuilders are at risk for both acute in-
juries (ie, from loss of control of a weight) and
overuse injuries. Many turn to ergogenic agents
such as anabolic steroids, human growth hor-
mone, and nutrition supplements in an attempt
to enhance training effects.
Olympic weight lifting. Olympic weight lifting
involves a sin~e-repetition maximum lift in two
exercises: the snatch and the clean and jerk (fig-
ure 1). The combined weight of the two lifts is the
score in competition. Failure to observe proper
technique in both lifts places athletes at risk for
acute injuries from loss of control of the weight.
Power lifting. Power lifting competitions in-
volve three lifts: the squat, the bench press, and
the dead lift (figure 2). As in Olympic lifting, the
athlete seeks a single-repetition maximum in each
exercise to generate a total score. Injuries in power
lifting are similar to those seen in Olympic lifting,
body building, and focused weight training.
continued

THE PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98 69

 weight training injuries continued

Table 1. Injuries Reported in Three Studies of Adolescent and College Weight

Trainers

Study Brown and Kimball" Risser et al• Zemper7

Study Group Adolescent Adolescent College

power lifters football players football players
No. of Athletes 71 354 10,908
No. of Injuries 28 27 36

(% of injuries)* No. (%) of Injuries * No. (%) of injuries*

Injury 1\fpe
Muscle strain (61) 20 (74) 15 (41.7)
Sprains (4) 3 (11.1) 7 (19.4)
The Physician and Sportsmedicine 1998.26:67-96.

Tendinitis (12) 1 (3.7} 2 (5.6)

Fractures/ (3) 2 (7.4) 2 (5.6)
dislocations
Nerve (3) (3.7)
Other (17) 10 (27.8)

Injury Location
Lower back (50) 13 (48.1) 15 (41.7)
Shoulder (6) 3 (11.1) 5 (13.9)
Upper back (4) 3 (11.1) 6 (16.7)
Knee (8) 2 (7.4) 3 (8.3)
Hand (4) 2 (7.4)
Other (28) 4 (14.8) 7 (19.4)

• Percentages may not add up to 100% because of rounding. Data in Brown and Kimball reported only
as percentages.

Adapted with permission from Mazur LJ, Yetman RJ, Risser WL: Weight-training injuries: common
injuries and preventative methods. Sports Med 1993; 16(1 ):57 -63.

Injury Rates and Risk Factors
Studies examining the incidence and types of
weight training injuries report varying injury
rates, but similar distributions of injury types
(table 1).
Brown and Kimball' found that 39.4% (28 of
71) of adolescent power lifters entered in a
teenage power lifting championship (ages 14 to
19) sustained injuries during training. The au-
thors suggest that the high rate of injuries may
have been from lack of supervision. Risser et al6
in a retrospective survey observed that only 7.6%
(27 of 354) of adolescent football players in a su-
pervised weight training program sustained in-
juries, and Zemper' found only a 0.3% rate of
weight training injuries in a 4-year study of ana-
tional sample of college football players who
trained under supervision.
There are no risk-factor studies of weight
training injuries, but poor technique, lack of su-
pervision, skeletal immaturity, and steroid abuse
are recognized as contributing factors."" For a
discussion of common weight training tech-
niques that can cause injuries, see "Honing
Technique to Avoid Injury," page 74.
Multiple cases of weight-training injuries as-
sociated with steroid abuse have been report-
ed. The risks and benefits of these agents have
been extensively reviewed elsewhere.' In brief,
steroids are classified as controlled substances

70 Vol 26 • No. 2 • February 98 e THE PHYSICIAN AND SPORTSMEDICINE

 ~ble 2. Grading of Ligament Sprains and Muscle Injuries
Physical Exam Findings
Grade Sprains
1 Pain on palpation, solid end-
point on examination
2 Pain on palpation, mild laxity
compared to contralateral ligament
3* Significant laxity without a solid
endpoint
• A grade 3 muscle injury may be a partial or complete rupture.
The Physician and Sportsmedicine 1998.26:67-96.
by the US Food and Drug Administration, mak-
ing steroid use other than for approved medical
indications illegal. Though steroid abuse caus-
es significant gains in strength and muscle
mass, side effects may include acne, male pat-
tern baldness, testicular atrophy, liver function
abnormalities and hepatomas, myocardial isch-
emia, gynecomastia, hypertension, aggressive-
ness, and death.• Steroids may cause physiologic
changes in muscle, tendon, and ligaments, mak-
ing them more susceptible to failure under load
or repetitive use.
Steroid abuse has been associated with many
acute injuries. Patients should be questioned re-
garding any history of such abuse. If individuals
have such exposure, appropriate risk factor edu-
cation and assistance with discontinuation
should be offered.
Children's skeletal immaturity presents a par-
ticular risk for growth plate injuries from weight
training. Therefore, the American Academy of
Pediatrics has issued guidelines for weight train-
ing in children. 10 These guidelines call for close
supervision by knowledgeable trainers and
medical professionals for children and adoles-
cents who strength train and advise that adoles-
cents reach Tanner stage 5 before participating
in vigorous weight training.
THI PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98
Strains
Pain on palpation, little or no weakness,
no palpable defect or asymmetry
Significant pain and mild weakness
Possible muscle asymmetry with a
palpable defect, significant weakness
Musculoskeletal Injuries
Though strains and sprains represent a large
proportion of weight training injuries, they of-
ten do not come to medical attention unless
the injury is particularly severe or symptoms
are prolonged.
Ugament sprains. Sprains cause pain, ten-
derness, and swelling at a ligament. The severity
can be graded by the degree of laxity noted on
examination (table 2). In general, a grade 1
sprain is painful without ligament laxity on ex-
amination, grade 2 lesions involve slight laxity,
and grade 3 injuries feature gross instability.
Medial and lateral collateral knee ligament
sprains may occur during squats, leg presses,
and lunges with high loads or improper lower-
extremity placement. Complete ligament dis-
ruption due to weight training is uncommon,
but Freeman and Rooker 11 reported on a body-
builder who had a history of steroid use and pre-
sented with a spontaneous anterior cruciate lig-
ament rupture.
Most sprains and strains can be managed
nonoperatively with protection, rest, ice, com-
pression, and elevation (PRICE).
In addition to knee sprains, medial meniscus
cartilage tears have been associated with knee
flexion exercises (hamstring curls) and dead lift:s. 1'
continued
71
 weight training injuries continued
Honing Technique to Avoid Injury
Most patients who work out with weights do either circuit training or focused strengthen-
ing of specific muscle groups. To help them improve their form, avoid injury, and get the
most from their workouts, it's a good idea to advise them about five common mistakes and
safer alternative techniques.
Technique 1: Latissimus Dorsi Pull-Down
Problem: When the weight is
lowered behind the neck, this
The Physician and Sportsmedicine 1998.26:67-96.
exercise excessively flexes the
cervical spine and loads the
shoulders at the extreme of ex-
ternal rotation. The line of pull
does not oppose the muscle
fibers of the latissimus dorsi,
and this does not maximally
challenge the muscle. The be-
hind-the-neck position in-
creases the load on the cervical
disks and the risk of spinous process fracture. The ex-
ercise puts the shoulder at a mechanical disadvantage
that may contribute to rotator cuff injury or anterior
shoulder instability. An excessively wide grip on the
bar should also be avoided because it may increase
shear forces across the glenohumeral joint.
Technique 2: Knee Extension
Problem: Knee extensions are examples of open-ki-
netic-chain exercises, which isolate a particular muscle
group-in this case, the quadriceps-and involve mo-
tion distal to the axis of the joint. During knee exten-
sions, potentially damaging tibiofemoral shear forces
are greater during the last so to 1oo of extension and al-
so if one "hyperextends" the knee. In addition, at the
extremes of knee flexion (greater than 60°), increased
patellar compression is potentially hannful. 1•2
74
Solution: The safer way to
perform the exercise is to sit or
kneel on one knee, lean back
slightly at the hips, grip the bar
slightly wider than shoulder
width, and pull it down in front
ofthehead.
Another exercise that effec-
tively challenges the latissimus
dorsi is seated rowing, an ac-
tivity that minimizes shear
force at the shoulder.
Solution: Avoid "hyperextension'' of the knee at the
completion of knee extension, and train in a range that
avoids extremes of knee flexion and extension, espe-
cially as the load is increased. Also, try to incorporate
closed-kinetic-chain exercises, which involve pre-
dictable coordinated muscle contractions with motion
at multiple joints in a limb whose segment meets fixed
or constrained resistance.
Squats and leg presses can each be dosed-kinetic-
chain exercises, and shear force is generally less with
these exercises, though a recent studi suggests that
strain on the anterior cruciate ligament (ACL) is sirn-
milar in both open- and closed-chain exercises.
Vol 26 • No. 2 • February 98 e THE PHYSICIAN AND SPORTSMEDICINE
 Technique 3: Bench Press and Chest Fly

Problem: Hyperextension of Solution: The preferred

the shoulders during bench way to perform the exercises
press or chest fly exercises is to adjust the exercise ma-
(dropping the elbows below chine or starting position so
or behind the plane of the that the elbows are even
body) places the pectoralis with or above the frontal
muscles at a mechanical dis- plane when beginning the
advantage, contributes to lift and during repetitions.
glenohumeral instability
through repetitive shoulder capsule trauma, and places
excessive traction on the acromioclavicular joints.4
The Physician and Sportsmedicine 1998.26:67-96.

Technique 4: Military Press

Problem: Extreme shoul- Solution: The safer way

der external rotation and to do military presses is to
abduction during behind- lift the weight in front of
the-neck military presses the neck.
stress the shoulder capsule
and inferior glenohumeral ligament, which can cause
anterior shoulder instability.5·6 Extreme cervical flexion
puts patients at risk for spinous process fracture and
neck strains.

Technique 5: Squats

Problem: In a deep squat, when the thighs are parallel Solution: Weight lifters should avoid deep squats and
to the floor or lower, there is an excessive amount of extremes of hyperflexion and hyperextension, and
shear load on the knee in a position in which the articu- they should maintain lumbar spine stability during
lar cartilage is thinnest. Descending to this position is squat lifts.
done by power lifters who must meet technical specifi-
cations during competition, but they also place them-
selves at risk of cartilage damage.

References
l. Beynnon BD, Fleming BC, Johnson RJ, et al: Anterior cruciate
ligament strain behavior during rehabilitation exercises in vi-
vo. Am J Sports Med 1995;23(1):24-34
2. Palmitier RA, An KN, Scott SG, et al: Kinetic chain exercise in
knee rehabilitation. Sports Med 1991; 11 (6):402-413
3. Beynnon BD, Johnson RJ, Fleming BC, et al: The strain be-
havior of the anterior cruciate ligament during squatting and
active flexion-extension: a comparison of an open and a
closed kinetic chain exercise. Am J Sports Med 1997;25(6):
823-829
4. Wolfe SW, Wickiewicz TL, Cavanaugh JT: Ruptures of the
pectoralis major muscle: an anatomic and clinical analysis.
Am J Sports Med 1992;20(5):587-593
5. Gross ML, Brenner SL, Esformes I, et al: Anterior shoulder
instability in weight lifters. Am J Sports Med 1993;21(4):
599-603
6. Neviaser TJ: Weight lifting: risks and injuries to the shoul-
der. Clin Sports Med 1991;10(3):615-621

continued

THE PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98 75

 weight training injuries continued
Muscle strains and ruptures. The hallmarks
of acute muscle strain are pain, muscle belly or
myotendinous junction tenderness, limited
range of motion, and relatively preserved
strength (table 2). Grade 1 and grade 2 muscle
strains are quite painful and are distinguished by
the absence (grade 1) or presence (grade 2) of
weakness. Hamstring muscle and low back (in-
cluding paraspinal muscle) strains are particular-
ly common among those who train with weights.
Muscle ruptures are essentially severe (grade
3) muscle strains. They are distinguished from
strains by significant weakness and possibly a pal-
The Physician and Sportsmedicine 1998.26:67-96.
pable muscle defect at the myotendinous junc-
tion. Tendon avulsions--disruption of the ten-
don-bone interface-are less common. In either
injury, patients often report feeling a sudden
"pop." Table 3 lists several reports of muscle rup-
tures and tendon avulsions in weight trainers. Ste-
roid abuse was a factor in several of these injuries.
In most instances, treatment is surgical repair
or reattachment unless the lifter does not intend
to return to his or her sport.
PeMc avulsions. Avulsion of the anterior su-
perior iliac spine (ASIS) is etiologically similar to
a tendon avulsion; both are caused by excessive
tension. In adolescents, the unfused ossifying ili-
ac crest apophysis is relatively weak and suscep-
tible to injury. Young weight trainers report a
sudden pain and may feel a "pop" in the anterior
pelvis when attempting forceful hip extension
while the knee is flexed. This injury can also oc-
cur with lumbar hyperextension exercises and
dead lifts. 1' Typically, sartorius muscle contrac-
tion avulses the bony fragment. Examination re-
veals swelling and tenderness, and radiographs
confirm the diagnosis.
Treatment is generally nonoperative, and
most patients respond well to crutch ambulation
and PRICE. Hip and lower-extremity strength
training is initiated after symptoms subside.
Some authors have reported success with open
reduction and internal fixation. 11· 11
Ischial apophysis and hamstring avulsions
may also occur during weight training. Like ASIS
avulsions, ischial apophysis avulsions occur in
THE PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98
Table 3. Rare Weight-Training-Related
Musculoskeletal Injuries and Other Acute Events
Muscle and Tendon Ruptures
Bilateral quadriceps muscle/tendon ruptures29 *
Distal biceps brachii tendon avulsion 30*
Patellar tendon rupture31
Pectoralis major muscle rupture'
Pectoralis major tendon avulsion 32
Triceps tendon avulsion with radial neuropathy33 *
Acute Fractures and Dislocations
Lunate dislocation34
Second rib fracture associated with bench press 35
Talar dome fracture associated with squatting 36
Acute Medical Events
Aortic dissection24 *
Death 3 7.38
Effort thrombosis39
External iliac artery stenosis•o
Myocardial infarction 41 ·42 *
Pulmonary embolism 43*
Spontaneous pneumothorax..
Stroke45 *
Subarachnoid hemorrhage23
Tetraplegia46
*Associated with anabolic steroid use.
skeletally immature athletes and are most com-
monly associated with sprinting, running, or
jumping activities. 1" Weight training activities
that can lead to ischial apophysis and hamstring
avulsions include dead lifts, squats, and ham-
string curls. The authors are unaware of any case
reports of ischial apophysis avulsion injuries as-
sociated with weight training, though they may
occur in skeletally immature athletes. Hamstring
avulsions in adults have been reported.
Treatment is somewhat controversial, though
ischial avulsion injuries can usually be managed
nonoperatively. Orava and Kujala 1" reported
their surgical experience with several cases of
hamstring avulsions associated with dead lifts
and squats. They recommend early surgical re-
pair to prevent muscle contracture that may
otherwise preclude anatomic reconstruction.
COil ti 1111ed
79
 weight training injuries continued
Acute fractures. Fortunately, fractures ac-
count for only a small percentage of weight
training injuries. The presentation may be acute
and dramatic or chronic and insidious. Grumbs
et ai 17 reported on two adolescent boys who per-
formed clean and jerk lifts; each lost control of
the overhead weight and sustained bilateral ra-
dius or bilateral radius and ulna fractures. Reider
et ai 1' reported nonunion of a scaphoid fracture
in a 17-year-old boy who developed wrist pain
while attempting a 430-lb bench press 5 months
before presentation. The patient did not seek
immediate medical atten-
The Physician and Sportsmedicine 1998.26:67-96.
tion because he assumed
Slow exhalation the injury was merely a
during the strain sprain. Table 3 lists other
part of a lift can related case reports.
significantly
reduce blood Acute Medical
pressure elevation. Conditions
Various other uncom-
mon medical conditions
have been linked with weight training (table 3).
Tremendous blood pressure elevations during
maximal lifts may contribute to vascular in-
juries. Studies of blood pressures during weight
lifting have reported readings as high as
480/350 mm Hg. 1" MacDougall et ai"' also stud-
ied blood pressure responses in several lifting
situations and found that blood pressure eleva-
tions were similar across contraction types (ec-
centric, concentric, isometric) when intensity
was controlled. Narloch and Brandstater' 1
demonstrated that slow exhalation during the
strain phase of a lift significantly reduces blood
pressure elevation. Thus, avoiding Valsalva's
maneuvers during weight lifting may help limit
blood pressure elevations.
Retinal hemorrhages cause acute unilateral
changes in vision and typically resolve without
surgical intervention." Subarachnoid hemor-
rhage and stroke are rare, but patients who have
known aneurysms and bleeding risks should be
advised to avoid heavy weight training.'' Many
of the vascular complications noted in table
3 were associated with steroid abuse, which may
80 Vol 26 • No. 2 • February 98 e THE PHYSICIAN AND SPORTSMEDICINE
be a more significant risk factor than weight
training itself.
In four aortic dissections described by de Vir-
gilio et ai,' 1 two patients had a history of steroid
abuse and hypertension. All four patients had
cystic degeneration of the aortic media, but it is
unknown if this was related to weight training or
to an unidentified factor such as occult hyper-
tension or unrecognized Marfan syndrome.
Rhabdomyolysis and acute compartment
syndromes of the limbs have been reported by
several authors."'" Clinical suspicion of compart-
ment syndrome should be high when patients
present with progressively severe muscle pain
following strenuous workouts, especially if ec-
centric exercises were involved. The cardinal
signs of acute compartment syndromes are pain
and pressure in a muscle or muscle compart-
ment, pain with stretching of that muscle, pare-
sis, and paresthesias. A pulse may or may not be
palpable. Compartment pressures should be
measured when this condition is suspected.
However, compartment syndrome is a clinical
diagnosis based on the examination and the pa-
tient's overall medical status. Fasciotomy for
pressure relief must be performed in a timely
fashion to minimize permanent nerve and mus-
cle injury.
Rhabdomyolysis in isolation or due to com-
partment syndrome can be life threatening be-
cause of the potential for acute renal failure and
electrolyte abnormalities. Creatine kinase eleva-
tions to 76,000 IU/L have been reported.' 'Treat-1
ment involves aggressive hydration, urine alka-
lization, and brisk diuresis.
Since acute radiculopathies are often associ-
ated with heavy lifting, many assume that
weight lifters are at increased risk for radiculopa-
thy. Certainly, acute radiculopathy can occur
during weight training, and Jordan et a!" have
reported three patients who developed acute
cervical radiculopathies while training. In an
epidemiologic study of possible risk factors for
cervical and lumbar disc herniation, Mundt et
ai"' did find a possible association between free
weight training and cervical radiculopathy (rela-
continued
 weight training injuries continued
tive risk, 1.87; 95% confidence interval, 0.74 to
4.74). They found no increased risk for lumbar
disc herniation.
Weight Training Awareness
Knowing weight lifting methods and the de-
mands of the sport can make the patient history
more productive. A detailed history and physical
examination often leads to a narrow, focused
differential diagnosis. Part 2 of this series will
cover the diagnosis and treatment of chronic
conditions that can result from weight training,
The Physician and Sportsmedicine 1998.26:67-96.
References
1. Mazur LJ, Yetman RJ, RisserW: Weight-training in-
juries: common injuries and preventative methods.
Sports Med 1993;16(1):57-63
2. National Electronic Injury Surveillance System: 1995
summary on injuries caused by weight lifting and
sports. US Consumer Products Safety Commission,
Washington DC, 1997
3. Ballor DL, Becque MD, Marks CR, et a!: Physiologic
responses to nine different exercise/rest protocols.
Med Sci Sports Exer 1989;21(1):90-95
4. Namey TC, Carek JC: Power lifting, weight lifting,
and bodybuilding. In Fu FH, Stone DA (eds): Sports
Injuries: Mechanisms, Prevention, Treatment. Balti-
more, Williams & Wilkins, 1994, pp 515-529
5. Brown E\N, Kimball RG: Medical history associated
with adolescent powerlifting. Pediatrics 1983;72(5):
636-644
6. RisserWL, Risser JM, Preston D: Weight-training in-
juries in adolescents. Am J Dis Child 1990;144(9):
1015-1017
7. Zemper ED: Four-year study of weight room injuries
in a national sample of college football teams. NSCA
Journal1990;12(3):32-33
8. Ghaphery NA: Performance-enhancing drugs. Or-
thop Clin NorthAm 1995;26(3):433-442
9. Dickerman RD, Schaller E Prather I, et a!: Sudden
cardiac death in a 20-year-old bodybuilder using
anabolic steroids. Cardiology 1995;86(2): 172-173
10. American Academy of Pediatrics Committee on
Sports Medicine: Strength training, weight and pow-
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THE PHYSICIAN AND SPORTSMEDICINE e Vol 26 • No. 2 • February 98
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