Injury In Powerlifting; Getting To The Root Of It All
A systematic solution to pain and injury free powerlifting
Why Most Powerlifters Get Pain Wrong
The biggest mistake I see in powerlifting is treating symptoms while ignoring root causes.
Within The Pain Free Powerlifter programme lifters will always recall a story of how they tried to fix the current issue by focusing solely on where the pain is.
Shoulder pain? Stretch the pecs.
Lower back ache? Foam roll thorugh the back
Knee discomfort? Ice and ibuprofen.
This approach, although not completely wrong, is reactive and may give some releif momentarily but ultimatley the pain will return at some point in the training cycle.
They are treating the symptom not the cause. The underlying dysfunction that created a. lot of the issue in the first place is not being addressed.
The Research on Recurrent Injuries
Previous injury is the strongest single predictor of future injury across all athletic populations.
A comprehensive decade-long study of over 78,000 high school sports injuries found that 10.5% of all injuries were recurrent, with these recurrent injuries resulting in significantly more time away from sport and higher surgical intervention rates compared to new injuries. This research, published through the High School RIO surveillance system tracking injuries from 2005-2016, revealed that recurrent injuries were associated with greater time loss from sport, higher risk of sport discontinuation, and increased likelihood of requiring surgical intervention. Studies of professional football players show even higher recurrence rates, with 18.8% of all injuries being recurrent, including 14.9% early recurrences within 2 months and 3.9% delayed recurrences.
The data consistently shows that athletes with injury history face dramatically elevated risk across all injury types:
General injury risk increases 9-fold - A prospective study of 182 athletes found that those with previous injury had 9.4 times higher odds of sustaining a new injury compared to those without injury history
Specific injury recurrence is 2-3x more likely - In professional football, players with previous hamstring, groin, and knee injuries were two to three times more likely to suffer an identical injury in the following season
Lower back injuries show the strongest recurrence patterns - A prospective study of 679 varsity athletes found that those with a history of low back injury were three times more likely to sustain another low back injury in the following year, while athletes who still had pain at assessment were six times more likely to experience recurrence
Two-thirds of people will re-injure their lower back - Research shows that 69% of people experience a recurrence of low back pain within 12 months after recovery, with systematic reviews concluding that "a history of previous episodes was the only factor that consistently predicted recurrence"
The risk compounds with each episode - One modeling study showed that athletes with previous injury had a 9-fold higher chance of future injury, with an odds ratio of 21 compared to previously uninjured athletes, demonstrating how injury history creates cascading vulnerability
Powerlifting shows similar patterns despite lower overall injury rates - While powerlifting has relatively low injury rates (1.0-4.4 injuries per 1000 hours of training), research specifically examining powerlifters found that 70% were currently dealing with pain affecting their training, with 87% having experienced injury within the past 12 months. Previous injury was identified as the most common risk factor, with the lower back, shoulders, and hips being the most frequently affected areas
What this means for you as a lifter is that every day you spend chasing symptoms instead of causes is a day closer to being back at square one. The forces that created your original pain haven't changed. Your movement compensations are still there. The muscle imbalances that started the whole cascade are still present.
With each episode of injury the likelihood of that injury happening again will go up and up, so the challenge is to mitigate the risk as much as possible, to have sustained periods of training and acheive the powerlifting goals set out at the beginning of the training cycle.
Understanding your pain is the difference between short-term relief and long-term performance.
The question then becomes: how do you actually identify what's really going on?
A Framework for Finding Root Causes
The systematic approach I prefer with every lifter who comes through the assessment process, whether that's for The Pain Free Powerlifter or the Podium Program.
Kinetic Chain Assessment
Pain rarely occurs in isolation. The shoulder pain you're experiencing might be coming from poor thoracic mobility. That persistent knee ache could be the result of ankle stiffness or hip restriciton. You must assess the joints above and below the painful area to identify compensation patterns that might be forcing your symptomatic area to work harder than it should.
Isolated Strength Assessment
Once we've identified potential movement compensations, we need to determine if specific muscle groups are genuinely weak or if they're simply not being recruited effectively during the compound movement. This involves testing individual muscle groups in isolation, things like single leg glute bridges, copenhagens, isolated rotator cuff tests. Often what appears to be a "tight" muscle is also a comperatively weak muscle trying it’s best to provide stability elsewhere in the kinetic chain.
Movement Analysis
The first step is always video analysis of the problematic movement pattern. Not just filming yourself from one angle, but getting multiple angles to see exactly how you execute the desired movements and when the breakdown occurs. Is the pain happening during the eccentric (lowering) phase? The concentric (lifting) phase? At a specific joint angle or under certain loads? This gives us our first clue about what structures are being overloaded.
Training Load Analysis
The final piece is understanding what changed in your training in the 2-4 weeks before the pain started. Did you increase volume too quickly? Add a new exercise? Change your technique? Increase training frequency? Often there's a clear loading error that triggered the initial problem, and unless we identify and correct it, you'll be stuck in the same cycle.
This systematic approach is what allows for a more predictable and reliable outcome.
Why Root Cause Analysis Actually Works
The lifters who go through this process don't just get better faster - they stay better longer.
When you understand what's actually causing your pain, you can make targeted interventions that address the real problem. Instead of hoping your symptoms don't return, you have confidence that you've eliminated the underlying dysfunction. You also develop the knowledge to recognise early warning signs and adjust your training before minor issues become major problems.
In my time working with powerlifters, those who have the biggest amount of trouble finding a solution aren't digging deep enough to find a root cause or causes.
Understanding your pain provides three crucial advantages:
You eliminate the guesswork and stop wasting time and money on treatments that only provide temporary relief
You gain the ability to modify your training intelligently based on what you know is actually wrong, rather than just avoiding movements that hurt
You develop a deeper understanding of your body's mechanics that helps you prevent future issues before they derail your progress
Understanding your pain gives you more robust solutions.
That's the difference between hoping for the best and knowing you've solved the problem.