15 Common Powerlifting injuries (Prevention & Treatment)

The 15 most common powerlifting injuries, from back strain and herniated discs to knee damage, rotator cuff trouble, bicep tears and hernias.

Squat, bench and deadlift each stress different joints, so wrist and elbow injuries, hamstring and groin strains and hip trouble follow, every one with its causes and prevention pointers.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
Powerlifting injury incidence ranges from 1.0 to 4.4 injuries per 1,000 hours of training across studies.	powerlifters, systematic review search conducted February 2024, published December 2024	Aasa et al., “Injuries in weightlifting and powerlifting: an updated systematic review”, BMJ Open Sport & Exercise Medicine
The most common powerlifting injury sites are the lower back and pelvis, the shoulder, and the elbow and upper arm.	powerlifters, systematic review search conducted February 2024, published December 2024	Aasa et al., “Injuries in weightlifting and powerlifting: an updated systematic review”, BMJ Open Sport & Exercise Medicine
One study found a point prevalence of 70 percent for painful conditions that impair training or competition among powerlifters.	powerlifters (one report within the review), systematic review search conducted February 2024, published December 2024	Aasa et al., “Injuries in weightlifting and powerlifting: an updated systematic review”, BMJ Open Sport & Exercise Medicine
Pelvic floor dysfunction such as urinary incontinence affects about 50 percent of female weightlifters and powerlifters versus 9.3 percent of males.	female and male weightlifters and powerlifters combined, systematic review search conducted February 2024, published December 2024	Aasa et al., “Injuries in weightlifting and powerlifting: an updated systematic review”, BMJ Open Sport & Exercise Medicine

Overview

Injury	Body area	Typical time out
Back injuries (muscle strains, herniated discs)	Lower back	2 to 6 weeks, months with nerve pain
Knee injuries (ACL, meniscus)	Knee	3 to 8 weeks, up to a year post op
Shoulder injuries (rotator cuff, strains)	Shoulder	4 to 12 weeks, months after repair
Bicep and tricep strain	Upper arm	2 to 6 weeks, 4 to 6 months post op
Wrist injuries (sprains, strains)	Hand and wrist	2 to 6 weeks, 3 months if fractured
Elbow injuries (tendonitis)	Elbow	6 to 12 weeks, longer if chronic
Hernias	Abdomen and groin	3 to 6 months to max lifts post op
Hip injuries (strains)	Hip	3 to 8 weeks, months at the tendon
Hamstring strains	Thigh	2 to 6 weeks, months at the sit bone
Groin strains	Groin	2 to 6 weeks, 3 months at the bone
Neck injuries (muscle strain)	Neck	1 to 3 weeks, longer with arm pain
Hand injuries (blisters, sprains)	Hand and wrist	Days for skin, 2 to 6 weeks sprains
Ankle sprains	Ankle	1 to 3 weeks, up to 12 for grade 3
Head injuries (concussions, from dropping weights)	Head	1 to 4 weeks, longer if symptoms last
Rib injuries (bruises, fractures)	Ribcage	3 to 6 weeks, 6 to 12 if fractured

Back injuries (muscle strains, herniated discs)

Most powerlifting back complaints involve the erector spinae and quadratus lumborum muscles or the tissue around a lumbar disc, usually at L4/L5 or L5/S1. Heavy deadlifts and low bar squats load the spine in flexion under compression, and the last repetitions of a hard set are where the back rounds and the load shifts onto passive tissue. A disc problem becomes relevant when the outer ring of the disc is irritated enough to press on a nerve root and send pain into the leg.

Symptoms

• A sharp catch or spasm in the lower back during or right after a heavy pull
• Stiffness that is worst in the morning and after sitting for a while
• Pain when bending forward or when getting out of a car
• With nerve involvement: pain, tingling or numbness running into the buttock, thigh or calf
• Coughing or sneezing sends a jolt into the back or the leg

How serious it is: A simple muscular strain is graded 1 to 3, from a few overstretched fibers to a full tear with visible loss of function. The dividing line that matters in practice is whether the pain stays in the back, which is usually benign, or travels below the knee with weakness or numbness, which points at a nerve root and needs an examination.

Typical time out: Two to six weeks for a grade 1 muscular strain if you keep moving and load it gently, six to twelve weeks for a stubborn strain, and three to six months or more for a disc problem with nerve symptoms, since nerve tissue settles far more slowly than muscle. Most disc cases improve without surgery, which is why the range is so wide.

See a doctor if: Go to a doctor the same day if you lose sensation around the groin or inner thighs, cannot control bladder or bowel, or a leg gives way or feels clearly weak.

What helps

• Keep moving within a pain limit you can tolerate: walking, hip hinging with a broomstick, light unloaded movement beats lying still
• Reduce load rather than stopping training completely, for example trap bar or block pulls instead of pulls from the floor
• Rebuild the pattern with tempo work and moderate loads before returning to maximal singles
• Physiotherapy early if the pain has not clearly improved in two to three weeks or keeps coming back
• Imaging only when symptoms point at a nerve, follow a fall, or fail to improve, since scans of pain free lifters also show disc changes

Knee injuries (ACL, meniscus)

In powerlifting the knee is loaded almost straight ahead, so a true ACL rupture is uncommon and usually needs the knee to twist or collapse inward under load. The far more frequent problems are a degenerative meniscus tear, where the cartilage wedge between thigh bone and shin bone is compressed and sheared in a deep squat, and patellar tendinopathy at the lower edge of the kneecap. Both are driven by squat volume, deep range under heavy load and a knee that drifts inward on the way up.

Symptoms

• Pain on the joint line, felt exactly at the level of the knee crease, when squatting deep
• Clicking, catching or a feeling that the knee locks briefly
• Swelling that builds over hours after the session rather than instantly
• With a ligament injury: a pop at the moment of injury and a knee that feels unstable on stairs
• Pain right below the kneecap when you start a set, which fades as you warm up

How serious it is: Ligament injuries are graded 1 to 3, from a stretched ligament to a complete rupture with an unstable joint. Meniscus tears range from a small stable flap that settles with rehabilitation to a displaced tear that mechanically blocks the joint.

Typical time out: Three to eight weeks for a mild meniscus irritation or patellar tendinopathy that responds to load management, three to six months for a meniscus tear treated with rehabilitation, and nine to twelve months before heavy competition squats after ACL reconstruction. The spread comes from whether the joint is mechanically blocked and whether surgery is involved.

See a doctor if: See a doctor if the knee locks and will not straighten, swells within an hour of the injury, or gives way when you put weight on it.

What helps

• Squat in a shortened range with a box or pins for a few weeks instead of stopping entirely
• Heavy slow resistance for patellar tendinopathy: slow controlled squats and leg extensions, three seconds down and three seconds up
• Fix knee collapse with cued foot pressure and hip abductor strength work rather than only with a knee sleeve
• Physiotherapy if catching, swelling or instability persists past three to four weeks
• MRI only when there is a mechanical block, real instability or no progress after a fair rehabilitation attempt

Shoulder injuries (rotator cuff, strains)

The rotator cuff tendons, above all supraspinatus, run through a narrow space between the humeral head and the acromion, and they are compressed and stretched at the bottom of a heavy bench press with a wide grip and flared elbows. The long head of the biceps tendon in the groove at the front of the shoulder and the AC joint at the tip of the collarbone are the other two usual suspects. Low bar squats add to it, because they park the arms in extreme external rotation with the bar pressing down on the back.

Symptoms

• Pain at the front or outer shoulder at the bottom of the bench press
• A painful arc when raising the arm sideways at about shoulder height
• Trouble sleeping on that side
• Weakness when lifting the arm out or rotating it against resistance
• A pinpoint sore spot on the tip of the collarbone when reaching across the body

How serious it is: Cuff problems run from tendinopathy without a tear, through a partial thickness tear, to a full thickness tear with genuine weakness. AC joint injuries are classified type I to III, where type I is a sprain of the ligaments and type III leaves a visible step at the end of the collarbone.

Typical time out: Four to twelve weeks for cuff tendinopathy that is managed with load and technique changes, three to six months for a partial tear, and four to six months or more after cuff repair surgery. The wide range reflects that pain often settles long before the tendon tolerates a maximal bench again.

See a doctor if: See a doctor if you cannot lift the arm at all after an acute injury, the shoulder looks visibly deformed, or the arm feels numb or weak into the hand.

What helps

• Narrow the bench grip slightly, tuck the elbows and bench to a board or pin height that stays under the pain threshold
• Progressive loading of external rotation and scapular work three times a week, taken to a real training load rather than a light band
• Swap low bar squats for high bar or safety bar squats while the shoulder is irritated
• Physiotherapy if pain persists beyond six weeks or comes with weakness
• Corticosteroid injection only as an exception: it can calm severe pain briefly, but repeated injections are associated with worse tendon outcomes

Bicep and tricep strain

The classic powerlifting injury here is a distal biceps tendon tear at the elbow, which happens when a heavy deadlift is pulled with one arm supinated in a mixed grip and the bar starts to slip. Triceps injuries sit at the tendon just above the elbow tip and are loaded by heavy lockouts, boards and close grip benching. Both structures are tendon rather than muscle belly, which is why they fail suddenly rather than getting gradually sore.

Symptoms

• A sudden pop or tearing sensation in the front of the elbow or above the elbow tip
• Bruising that spreads down the forearm over the next day or two
• A visible change in muscle shape, for example a biceps that bunches up toward the shoulder
• Clear weakness when turning a doorknob or locking out a press
• With a milder strain: aching in the muscle belly the day after heavy pressing or pulling

How serious it is: Muscle belly strains follow the grade 1 to 3 scale and mostly recover with time and graded loading. A complete distal biceps or triceps tendon rupture is a different situation entirely and is usually referred for surgical repair within the first two to three weeks, because a delayed repair is technically harder.

Typical time out: Two to six weeks for a grade 1 or 2 muscle strain, four to six months after surgical repair of a ruptured distal tendon before heavy pressing or pulling is back. The gap between the two is the reason a sudden pop deserves a prompt assessment rather than a wait and see approach.

See a doctor if: Get seen quickly if you felt or heard a pop with bruising and a change in the shape of the arm, since tendon ruptures are repaired best in the first weeks.

What helps

• Switch from a mixed grip to a hook grip or straps for heavy pulls, which removes the main mechanism for distal biceps tears
• Load the arm again early within pain limits: light curls or pushdowns beat total rest for a muscle strain
• Rebuild with higher repetitions and controlled tempo before returning to heavy lockout work
• Physiotherapy for any strain that is not clearly improving after two weeks
• Prompt orthopedic assessment for a suspected complete tendon tear, not a delayed one

Wrist injuries (sprains, strains)

Bench pressing and overhead work push the wrist into extension with the bar sitting behind the line of the forearm, which strains the ligaments on the palm side and irritates the extensor tendons over the back of the wrist. The triangular fibrocartilage complex on the little finger side is the other frequent target, loaded when the wrist bends sideways under a heavy bar. Front squats add a further stretch because the rack position demands extreme wrist extension.

Symptoms

• Pain on the back of the wrist when the bar sits in the hand during a press
• Aching that lingers for hours after the session rather than settling right away
• Weakness of grip, for example when opening a jar
• Clicking on the little finger side when you turn the palm up and down
• Swelling or tenderness over one specific spot on the wrist

How serious it is: Sprains follow the grade 1 to 3 pattern from stretched to fully torn ligaments. What separates a nuisance from a real problem is pain in the small hollow at the base of the thumb after a fall, which can mean a scaphoid fracture, and that can be missed on the first X-ray.

Typical time out: Two to six weeks for a mild sprain with wrist wraps and a modified bar position, six to twelve weeks for a significant ligament or cartilage injury, and three months or more if a scaphoid fracture is involved because that bone heals slowly.

See a doctor if: See a doctor if the wrist is tender in the hollow at the base of the thumb after a fall, if it is visibly deformed, or if the hand goes numb.

What helps

• Stack the wrist under the forearm on the bench instead of letting the bar sit back in the palm
• Wrist wraps for heavy work only, not for every warm up set, so the joint keeps building its own strength
• Straps for a strained wrist on pulling days, and a strap assisted front rack for front squats
• Grip and forearm strengthening with light loads once the acute pain has settled
• Imaging after a fall onto the outstretched hand, even if the first X-ray looks normal, when thumb side tenderness persists

Elbow injuries (tendonitis)

Powerlifters usually get medial elbow pain, where the common flexor tendon attaches to the bony bump on the inner side, or triceps tendinopathy at the back of the elbow. The medial side is loaded by hard gripping under a heavy bar and by the sideways strain of a wide bench grip, the triceps side by heavy lockouts and board presses. The tendon is not inflamed in the classic sense but degenerated and disorganized, which is why it responds to loading rather than to rest alone.

Symptoms

• A sore point on the inner or outer bony bump of the elbow that you can press on and reproduce
• Pain that shows up during warm up sets and eases once you are warm, then returns worse afterward
• Aching when carrying a shopping bag or shaking hands
• Loss of grip strength without any obvious injury
• Stiffness in the elbow the morning after a pressing session

How serious it is: There is no formal grading. The mild form is pain only at the start of a session that settles with warm up, the moderate form is pain throughout the session, and the severe form is constant pain including at rest and at night, which takes far longer to reverse.

Typical time out: Six to twelve weeks for a recent case managed with load adjustment and progressive strengthening, six months or more if it has been ignored for a year, because tendon tissue remodels slowly. Full time off is not what shortens it, controlled loading is.

See a doctor if: See a doctor if the pain comes with numbness or tingling in the ring and little finger, which points at the ulnar nerve rather than the tendon.

What helps

• Progressive isometric and slow eccentric loading of the wrist flexors or triceps, done daily at a level that keeps pain tolerable
• Reduce bench grip width, drop the pressing volume for a block and keep the total training load steady rather than swinging up and down
• A forearm strap or elbow sleeve for symptom relief while the loading program does the actual work
• Physiotherapy if there is no clear progress after six weeks of self directed loading
• Corticosteroid injection is not a first choice: short term relief but poorer long term outcomes in tendinopathy, so treat it as an exception

Hernias

An inguinal hernia is a bulge of fat or bowel through a weak point in the abdominal wall in the groin, and heavy lifting raises intra abdominal pressure enormously, particularly with a maximal Valsalva breath hold under a squat or deadlift. A belt and a hard brace raise that pressure further, which is useful for spinal stability but is also the load the abdominal wall has to contain. Powerlifters can also get a hernia at the navel or through an old surgical scar.

Symptoms

• A soft bulge in the groin or at the navel that appears when you strain and disappears when you lie down
• A dragging or heavy feeling in the groin toward the end of a training day
• Discomfort when coughing, straining or bracing under a bar
• Aching that gets worse over the course of the day rather than better
• For some, no pain at all and only a visible lump

How serious it is: The mild form is a reducible hernia that slides back in and mostly causes discomfort. The dangerous form is an incarcerated or strangulated hernia, where the contents get stuck and lose their blood supply, which is a surgical emergency within hours.

Typical time out: Training around a small symptomatic hernia is often possible with reduced load, but the hernia does not close by itself. After open or keyhole repair, expect two to four weeks before light training, and three to six months before maximal squats and deadlifts, depending on the technique used and your surgeon’s guidance.

See a doctor if: Go to an emergency department if the bulge becomes hard, painful and will not push back in, especially with nausea, vomiting or a fever.

What helps

• Get a suspected bulge examined rather than training around it, since surgical repair is the only definitive fix
• Until then reduce maximal attempts and prolonged breath holds, and take more breaths within a heavy set
• Reduce constipation and straining, which add to the same pressure the abdominal wall has to hold
• Rebuild trunk strength after surgery under guidance, starting with breathing and low load work before bracing under a bar
• Return to heavy attempts in steps over months, not in one session

Hip injuries (strains)

The usual powerlifting hip injuries are a proximal hamstring or adductor strain where the tendon attaches to the pelvis, gluteal tendinopathy on the bony point at the side of the hip, and hip joint impingement pain deep in the front of the groin. Deep squatting with a stance that does not match your hip anatomy pinches the front of the joint at the bottom position. The tendon attachments at the pelvis get loaded most at the start of a heavy deadlift, when the hip is at its most flexed.

Symptoms

• A deep pinching pain in the front of the groin at the bottom of a squat
• Pain sitting on a hard surface, felt right where the hamstring meets the pelvis
• Soreness on the bony point at the side of the hip when lying on that side at night
• Stiffness in the hip when getting up after sitting for a long time
• A feeling that one hip does not open as far as the other

How serious it is: Muscle and tendon strains follow the grade 1 to 3 scale. The practical distinction is between a strain that hurts at the start of a session and warms up, which usually responds to loading, and one that hurts through the whole session and at rest, which points at a more established tendon problem or a joint issue.

Typical time out: Three to eight weeks for a grade 1 strain with modified squats, three to five months for a proximal hamstring tendon injury, which is well known for being slow. Impingement related pain often settles in weeks once stance and depth are adjusted, but can persist if the squat is not changed.

See a doctor if: See a doctor if the hip cannot bear weight, if there was a pop with immediate bruising at the back of the thigh, or if pain wakes you at night without any position relieving it.

What helps

• Find the stance width and foot angle that lets you reach depth without a pinch, and accept less depth for a block if needed
• Progressive loading of the adductors, for example Copenhagen style work, and of hip abductors for gluteal tendinopathy
• Avoid stretching into the painful pinch: compressive stretching makes gluteal and hamstring tendon problems worse
• Squat to a box or use a safety bar to keep training while the hip settles
• Physiotherapy if groin or deep hip pain persists past four to six weeks, and imaging only if it does not respond

Hamstring strains

In powerlifting the hamstring is usually injured at its upper tendon near the sit bone rather than in the muscle belly, because the muscle is loaded at long length and slow speed in stiff legged deadlifts, good mornings and the start of a conventional pull. The muscle is holding an eccentric contraction while the hip is deeply flexed, which is the position where a strain occurs. Sumo pullers tend to feel it more toward the inner side, where the hamstring and adductor overlap.

Symptoms

• A pulling or tearing sensation at the back of the thigh during a heavy hinge
• Pain right at the sit bone when sitting on a hard chair or driving
• Tightness that does not release with stretching and often feels worse afterward
• Reduced power on that side when pulling, without much pain at rest
• Bruising down the back of the thigh in the days after an acute tear

How serious it is: Graded 1 to 3, from a few torn fibers with mild loss of strength to a complete rupture or an avulsion where the tendon pulls off the sit bone, sometimes with a piece of bone. Injuries at the tendon attachment take considerably longer than those in the muscle belly.

Typical time out: Two to six weeks for a grade 1 belly strain, two to four months for a grade 2, and four to six months or longer for a proximal tendon injury or after surgical reattachment. Injuries closer to the sit bone consistently sit at the long end of the range.

See a doctor if: See a doctor if you felt a pop with rapid bruising and cannot walk normally, or if the back of the thigh feels weak enough that the leg buckles.

What helps

• Start loading within days at a tolerable pain level rather than resting until it feels normal
• Eccentric and long length work such as Nordic curls, Romanian deadlifts and 45 degree back extensions, progressed slowly
• Rebuild through a reduced range hinge, for example rack pulls, before returning to pulls from the floor
• Avoid aggressive static stretching of a fresh strain, it delays rather than speeds recovery
• Physiotherapy for any injury at the sit bone, since these are the ones that recur

Groin strains

The adductor muscles run from the pubic bone down the inner thigh and pull the leg toward the midline, and they are heavily loaded in a wide sumo deadlift stance and a wide squat stance where the hip is abducted and externally rotated under a maximal load. The injury is usually at the adductor longus tendon close to the pubic bone. Related pain at the pubic bone itself, sometimes called athletic groin pain, sits on the same continuum.

Symptoms

• A sharp pull on the inner thigh when setting up wide or coming out of the hole
• Tenderness you can press on close to the pubic bone
• Pain when squeezing the knees together against resistance
• Discomfort getting out of a car or rolling over in bed
• Stiffness in the inner thigh the morning after a heavy sumo session

How serious it is: Graded 1 to 3, from overstretched fibers with a pull you can train around to a full tear with a defect you can feel. The more relevant distinction for lifters is whether pain sits in the muscle, which settles reasonably quickly, or right at the pubic bone, which is more persistent.

Typical time out: Two to six weeks for a grade 1 strain, six to twelve weeks for a grade 2, and three months or more for pain at the pubic bone attachment. The spread depends mainly on how close to the bone the injury sits.

See a doctor if: See a doctor if there is a bulge in the groin, if pain radiates into the testicle, or if you cannot bear weight on the leg.

What helps

• Narrow the stance temporarily: conventional deadlifts and a closer squat stance usually stay pain free while sumo does not
• Progressive adductor loading, for example Copenhagen planks and adductor squeezes, starting with isometrics
• Increase sumo volume in small steps when returning, since abrupt stance changes are a common trigger
• Brief cooling in the first hours for pain relief, then get the leg moving
• Physiotherapy if the pain sits at the pubic bone or has lasted longer than six weeks

Neck injuries (muscle strain)

The upper trapezius and levator scapulae take direct pressure from the bar in a low bar squat, and the small deep neck muscles work hard to hold the head position during a maximal attempt. A strain occurs when the head is forced into extension or side bending under load, for example when the bar sits unevenly or you crane your head up out of the bottom. Bench pressers also strain the neck by pushing the head hard into the bench during a heavy leg drive.

Symptoms

• A one sided catch in the neck that appears during or shortly after a squat session
• Stiffness turning the head toward one side, for example when checking a blind spot
• A dull ache running from the base of the skull into the shoulder blade
• Headache starting at the back of the head
• Pain when the bar sits on the traps, even at light weights

How serious it is: Graded 1 to 3 like other muscle strains, and most cases are grade 1 and settle on their own. What changes the picture is pain, tingling or weakness travelling into the arm or hand, which suggests a nerve root rather than muscle.

Typical time out: One to three weeks for a simple muscular strain, four to twelve weeks or longer if a nerve root is irritated and symptoms run into the arm. Most lifters keep training the lower body throughout.

See a doctor if: Seek care if there is weakness, numbness or tingling in the arm or hand, or if severe neck pain follows a fall or a dropped bar.

What helps

• Keep the neck moving gently within a comfortable range instead of holding it rigid
• Keep the chin neutral under the bar rather than looking up, and check bar placement and symmetry
• Use a bar pad or a high bar or safety bar position while the traps are sore
• Progressive neck and upper back strengthening once the acute pain settles
• Physiotherapy if symptoms run into the arm or have not improved in two to three weeks

Hand injuries (blisters, sprains)

The knurling on a barbell shears the skin of the palm against the underlying tissue and produces a blister or a torn callus, most often at the base of the fingers on pulling days. Ligament sprains happen in the thumb, where a mixed grip or a hook grip levers the joint at the base of the thumb, and in the fingers when a bar is caught awkwardly. The hook grip in particular compresses the thumb between the bar and the fingers, which bruises the nail bed and irritates the thumb ligaments.

Symptoms

• A raised fluid filled blister or a torn flap of callus in the palm after heavy pulls
• Burning or stinging pain in the palm when gripping the bar
• Pain at the base of the thumb when pinching or turning a key
• Swelling and bruising of a finger joint after catching a bar
• Loss of grip because the hand hurts rather than because it is weak

How serious it is: A blister is a skin injury and heals in days, but an open torn callus can become infected. Thumb and finger ligament sprains follow the grade 1 to 3 scale, and a complete tear of the thumb ligament often needs surgical repair because the joint stays unstable.

Typical time out: Three to ten days for a blister or torn callus once the skin closes, two to six weeks for a mild thumb or finger sprain, and six to twelve weeks or more if a ligament is fully torn or repaired surgically.

See a doctor if: See a doctor if a torn callus becomes red, hot or oozes, if a finger looks crooked, or if the thumb feels unstable when you pinch.

What helps

• File calluses down regularly with a pumice stone so they do not build up and tear
• Chalk instead of gloves for most lifters, since gloves add material that bunches and increases shear
• Cover an open blister with a clean dressing and keep training with straps until the skin closes
• Tape the thumb for hook grip work, and give the thumb a break by using straps on back off sets
• See a hand specialist for a suspected thumb ligament tear, since a delayed repair is harder

Ankle sprains

The ligaments on the outer ankle, above all the anterior talofibular ligament, are sprained when the foot rolls inward, which in a gym happens when stepping off a platform, walking over a loose plate or losing balance while walking a squat out of the rack. Powerlifting itself rarely sprains an ankle, but limited ankle dorsiflexion is a common reason for a squat to break down, so a stiff or previously sprained ankle shows up in the squat rather than as a fresh injury.

Symptoms

• Sudden pain on the outer ankle after the foot rolls
• Swelling that appears within an hour, often ahead of the outer ankle bone
• Bruising along the outside of the foot over the following days
• Pain when putting weight on the leg or pushing off
• A feeling that the ankle gives way on uneven ground

How serious it is: Graded 1 to 3, where grade 1 is a stretched ligament with mild swelling and full weight bearing, grade 2 is a partial tear with clear swelling and limping, and grade 3 is a complete tear with marked instability.

Typical time out: One to three weeks for a grade 1 sprain, three to six weeks for grade 2, and eight to twelve weeks or more for grade 3. Upper body training usually continues throughout, and the range depends mainly on how much balance and strength work is done, since untreated sprains recur.

See a doctor if: See a doctor if you cannot take four steps on the ankle, or if you are tender directly on the bone at the back edge of either ankle bone, which suggests a fracture.

What helps

• Load the ankle early within pain limits: protected weight bearing beats immobilization for most sprains
• Balance and proprioception work, single leg stance progressing to unstable surfaces, which lowers the recurrence rate
• Calf and peroneal strengthening, and mobility work for dorsiflexion so the squat is not compromised
• An ankle brace for the first weeks back and for sports with more cutting, not indefinitely
• Physiotherapy or imaging if the ankle still swells or gives way after six weeks

Head injuries (concussions, from dropping weights)

A concussion is a functional disturbance of the brain caused by a blow or a rapid acceleration of the head, without any structural damage visible on a normal scan. In a gym it comes from a plate dropping onto the head, a bar tipping when plates slide off one side, a failed bench press without safeties or a faint after a maximal attempt with a long breath hold. The last of these matters because a blackout under load can also drop the bar on someone.

Symptoms

• Headache and pressure in the head after the impact
• Feeling foggy, slowed down or unable to concentrate
• Dizziness, nausea or sensitivity to light and noise
• Blurred or double vision
• Feeling more irritable or emotional than usual, and sleeping badly

How serious it is: Concussion is no longer graded by numbers. What matters is the course: most people improve within two weeks, a minority take longer, and any loss of consciousness, seizure, repeated vomiting or worsening symptoms shifts it into a category that needs urgent imaging to rule out bleeding.

Typical time out: Symptoms usually settle within one to four weeks, and a staged return to lifting follows once you are symptom free at rest and with light activity. Heavy bracing and maximal attempts come last, since the Valsalva pressure spike can bring symptoms back. Repeat concussions and a longer symptom course extend this to months.

See a doctor if: Go to an emergency department for any loss of consciousness, a seizure, repeated vomiting, worsening headache, confusion or one pupil larger than the other.

What helps

• Stop the session immediately, do not lift again that day, and have someone stay with you
• Relative rest for the first day or two, then light aerobic activity below the symptom threshold rather than a dark room for a week
• A staged return: light cardio, then bodyweight movement, then loaded lifting, then maximal work, with a step back if symptoms return
• Medical clearance before returning to maximal attempts, especially after a second concussion
• Prevent the mechanism: collars on every bar, safeties or a spotter on the bench, and no maximal singles alone

Rib injuries (bruises, fractures)

Ribs are bruised by direct impact, for example a bar bouncing off the chest, and they can be strained where the intercostal muscles run between the ribs or where the rib cartilage meets the breastbone. In powerlifting the more subtle problem is a stress reaction in a rib from repeated heavy bracing, and irritation of the cartilage at the front of the chest from the bar touching in the bench press. A hard Valsalva compresses the whole ribcage, which is why coughing and deep breathing hurt afterward.

Symptoms

• A sharp local pain in one spot on the ribcage when breathing in deeply
• Pain when coughing, sneezing or laughing
• Discomfort rolling over in bed or getting up from lying down
• A tender point you can press on that reproduces exactly the same pain
• Pain when bracing under a bar, out of proportion to the weight

How serious it is: A bruise or muscle strain between the ribs is uncomfortable but harmless. A single undisplaced rib fracture is treated the same way, with pain control and breathing exercises. Multiple fractures, a fracture with shortness of breath, or one that follows major trauma are a different matter and need assessment.

Typical time out: Three to six weeks for a bruise or intercostal strain, six to twelve weeks for a rib fracture before heavy bracing is comfortable again. Ribs move with every breath, which is why they take longer than the size of the injury suggests.

See a doctor if: Seek care if you are short of breath, cough up blood, or the pain follows a hard fall or a heavy impact rather than a lift.

What helps

• Keep breathing deeply and cough while hugging a pillow, since shallow breathing raises the risk of a chest infection
• Do not strap or bind the chest tightly, it restricts the lung expansion you need
• Pain relief so that you can breathe fully, and brief cooling over the sore spot in the first hours
• Train the lower body and unloaded movement while avoiding maximal bracing for a few weeks
• An X-ray or an assessment when pain follows real trauma or does not ease over two to three weeks

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in Powerlifting

• Change your training load in small steps. Most powerlifting injuries turn up in the weeks when volume or intensity jumps, not on a single bad rep, so plan increases and keep a record of the load you actually lifted.
• Treat technique breakdown as your cutoff, not the number on the bar. When the back rounds on a pull, the knees fall in on a squat or the bar drifts on a press, the set is over, whether or not you could grind out another repetition.
• Build in lighter weeks and vary the stimulus. Blocks with more repetitions at moderate load, variations such as pause squats, box squats or block pulls, and planned deload weeks give the tendons and the lower back a break without losing training.
• Train the supporting structures directly. Rotator cuff and upper back work for the bench, hip abductors and adductors for a wide stance, and hamstring work at long length are the three areas that repeatedly show up in powerlifting injury reports at the shoulder, lower back and hip.
• Manage the pressure in your bracing. Long maximal breath holds raise abdominal and pelvic floor pressure sharply, so keep them to the reps that need them, breathe between repetitions, and take pelvic floor symptoms seriously rather than accepting them as normal.
• Set up so a failure is survivable. Collars on every bar, safety pins at the right height for squats and bench, and a spotter or a rack for maximal attempts remove the mechanisms behind the worst gym injuries.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• A suspected fracture: a visible deformity, a bone that is tender at one exact point, or a limb you cannot bear weight on.
• A head impact with loss of consciousness, a seizure, repeated vomiting, confusion or a headache that keeps getting worse.
• Numbness, tingling or weakness in an arm or leg, or loss of sensation around the groin, which points at a nerve rather than a muscle.
• A joint that will not move or that gives way completely under load, or one that swells within an hour of the injury.
• A sudden pop with rapid bruising and a change in the shape of a muscle, which suggests a tendon rupture that is best repaired early.
• Chest pain with shortness of breath, dizziness or fainting during or after a maximal attempt.

Sources

• Aasa et al., “Injuries in weightlifting and powerlifting: an updated systematic review”, BMJ Open Sport & Exercise Medicine

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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