Abstract
Background:
Weightlifting improves physical fitness; however, injuries can lead to impaired functionality and long-term complications. Data on weightlifting-related injuries are limited.
Purpose:
To evaluate the epidemiologic trends of weightlifting-associated upper extremity injuries, further stratified by age.
Study Design:
Descriptive epidemiologic study.
Methods:
This analysis used the National Electronic Injury Surveillance System (NEISS) database, including all patients presenting to the emergency department (ED) with a primary upper extremity weightlifting injury between 2021 and 2024. Outcomes included patient demographic characteristics, final diagnosis, primary body region injured, and mechanism of injury (MOI). Patients were stratified into 4 age groups: pediatric (<18 years), young adult (18-39 years), middle-age (40-64 years), and geriatric (≥65 years). Chi-square tests and post hoc comparisons were used to evaluate categorical variables. Linear and logistic regression analyses were used to evaluate associations between age groups. Statistical significance was predetermined at <.05.
Results:
After application of inclusion and exclusion criteria, 3189 upper extremity weightlifting injuries (national estimate [NE] = 127,667) were analyzed. Across all ages, sprain/strain (NE = 36,054; 26.2%), fracture/crush/avulsion (NE = 22,388; 15.8%), and laceration/puncture (NE = 9020; 7.2%) were the most common diagnoses. Injuries most frequently involved the shoulder (NE = 45,825; 33.8%), finger (NE = 32,398; 28.1%), and upper arm (NE = 7827; 8.8%). The most common MOIs were drop/crush injuries (NE = 34,757; 30.1%), pulling movements (NE = 14,232; 10.5%), and overhead movements (NE = 11,110; 8.3%). Pediatric patients were 2.5 times more likely to sustain finger injuries (odds ratio [OR], 2.536; 95% CI, 2.191-2.935; P < .001) and injuries from drop/crush mechanisms (OR, 2.484; 95% CI, 2.166-2.849; P < .001) compared with all other age groups. The geriatric age group was 2 times more likely to sustain injuries from pushing movements (OR, 2.037; 95% CI, 1.326-3.130; P < .001) compared with all other age groups.
Conclusion:
Sprain/strain and fracture/crush/avulsion were frequent upper extremity weightlifting injuries, often secondary to drop/crush injuries and overhead movements. Pediatric athletes were more likely to sustain finger and drop/crush injuries, whereas shoulder injuries affected all adult age groups. The low proportion of geriatric weightlifters suggests there may be underuse of a sport effective in combating osteoporosis. These insights into overall and age-specific injury patterns can help shape evidence-based recommendations to reduce the overall injury burden and promote safe resistance training.
Keywords
Participation in resistance training has significantly increased in recent years, with current data estimating that >40% of American adults engage in some form of weightlifting-based exercise. 3 This growth reflects a broader public appreciation of the numerous health benefits of weightlifting, including improved metabolic function, cardiovascular health, muscular strength, bone density, psychological well-being, and overall quality of life.28,30,33 Among children and adolescents, properly supervised strength training programs have been shown to improve motor skills, enhance muscular strength, and support skeletal development. 16 For older adults, weightlifting is a key intervention for preventing sarcopenia, maintaining independence, and reducing fall risk. 12
Current literature has identified common upper extremity weightlifting injuries, including pectoralis major and biceps brachii tendon ruptures, which can be associated with several factors, including overuse, attrition, improper nutrition, anabolic steroid use, or, most common, an eccentric overloading of a degenerated weakened tendon with antecedent tendinitis.7,9 Moreover, high rates of orthopaedic-related upper extremity injuries, such as biceps and pectoralis major tears, have been observed in young and middle-aged adults when performing strength training compared with aerobic exercises.4,10,11 However, minimal reviews have compared weightlifting-associated upper extremity injury patterns across various age demographics. Inherent physiological differences associated with age, including changes in motor coordination, muscle mass, and bone density, may predispose individuals of different ages to other injury mechanisms. 6
Although previous studies have attempted to describe trends in weightlifting-associated upper extremity injuries, these studies are often limited to athletes and fail to stratify by physiologic age groups.5,27 Improved understanding of trends among various ages may provide greater insight on specific injury patterns at different stages of life and shape existing safety guidelines to decrease overall injury burden. Therefore, this study aimed to identify epidemiologic patterns of upper extremity injuries associated with weightlifting by using data from the National Electronic Injury Surveillance System (NEISS). We hypothesized that the physiologic differences between pediatric, adult, and geriatric age groups would demonstrate distinct injury trends regarding body region, mechanism of injury, and final diagnosis.
Methods
Study Design
This descriptive epidemiologic analysis retrospectively evaluated data from the NEISS database. The NEISS database queries >100 US hospitals, each with ≥6 inpatient beds and 24-hour emergency services, to provide patient encounter information after use of emergency services. 14 This injury surveillance database is published by the US Consumer Product Safety Commission and provides publicly available and de-identified data. This study was exempt from institutional review board oversight. Based on hospital size and geographic location region, each entry is assigned a statistical weight, and national estimates (NEs) can be calculated by multiplying the associated statistical weight by the raw data point. 15 Percentages were derived from weighted NEs. From the database, inquiries of weightlifting-related injuries (product code 3265: weightlifting [activity, apparel, or equipment]) involving the shoulder (product code 30), upper arm (product code 80), elbow (product code 32), lower arm (product code 33), wrist (product code 34), hand (product code 82), and finger (product code 92) were built. All other body regions not included within the aforementioned categories were defined as “other.” Similarly, the NEISS database provides inquiries of weightlifting-related diagnoses including sprain/strain, fracture/crush/avulsion, laceration/puncture, contusion/abrasion, dislocation, and hematoma/internal injury. All other injuries not falling within these categories were defined as “other.”
All patient encounters related to weightlifting-associated upper extremity injuries occurring between January 1, 2021, and December 31, 2024, were identified with corresponding NEISS codes and included for evaluation. The first 3 authors (P.L., C.N., and J.U.) reviewed all patient narratives to confirm that injuries were secondary to weightlifting as well as categorize the mechanism of injury (MOI). If there were disagreements upon reviewing narratives, the senior author (J.W.) was consulted. MOIs were classified into 1 of 10 predefined categories: impact with floor (eg, falls), impact with equipment (eg, struck hand on weight machine), drop/crush injuries, pulling movements, pushing movements, overhead movements, overuse, nonspecific overexertion (eg, headache, nonspecific chest pain), and “other” (from narratives lacking specific detail on MOI; eg, “hurt while weightlifting”).
Exclusion Criteria
Narratives were also reviewed to determine whether patients met exclusion criteria. Exclusion criteria included injuries that did not occur while actively weightlifting (eg, injured while walking to/from the gym) and injuries that originated from a separate activity but were exacerbated from weightlifting (eg, hurt shoulder throwing baseball and worsened with shoulder pressing).
Outcomes of Interest
Outcomes of interest include patient demographic characteristics such as date of presentation, age, sex, race, ethnicity, and discharge disposition. Additionally, trends in the most common final diagnoses, body regions injured, and MOIs were evaluated. Patients were further stratified into 4 age groups: pediatric (<18 years), young adult (18-39 years), middle-age (40-64 years), and geriatric (≥65 years); trends were provided to evaluate the effects of physiologic and biomechanical differences and to provide specific injury prevention recommendations. These age groups have been defined similarly in previous analyses of the NEISS dataset. 14
Statistical Analysis
All statistical analyses were performed with the IBM SPSS software (Version 29.0; IBM Corp). Descriptive statistics were used to provide trends in patient demographics, injury diagnoses, affected body regions, and MOIs. Categorical variables were analyzed with chi-square tests, and post hoc comparisons were adjusted using the Holm method to control for multiple testing. Linear and logistic regression analyses were conducted to evaluate for associations between age groups and sex while controlling for confounding variables including race, treatment location, and disposition. Statistical significance was determined to be P < .05.
Results
Patient Demographics
The initial data query yielded a total of 3224 weightlifting-associated upper extremity injuries (NE = 131,652). After we applied inclusion and exclusion criteria, 3189 such injuries (NE = 127,667; 98.9%) remained. There were 1503 (NE = 60,943; 47.7%) young adults, the mean age was 30.6 ± 21.8 years, and patients were primarily male (n = 2443; NE = 98,216; 76.9%) The most common races were White (n = 1400; NE = 60,050; 47.0%) and Black (n = 725; NE = 26,844; 21.0%), and patients predominantly belonged to non-Hispanic ethnicities (n = 2011; NE = 81,601; 63.9%). After evaluation in the emergency department (ED), patients were most frequently discharged home (n = 3016; NE = 121,434; 95.1%).
General Trends in Final Diagnoses, Body Locations, and Mechanisms of Injury
Overall, the most common final diagnoses were sprain/strain (n = 834; NE = 36,054; 28.2%), fracture/crush/avulsion (n = 636; NE = 22,388; 19.9%), and laceration/puncture (n = 233; NE = 9020; 7.3%). There were 1138 (NE = 45,347; 35.7%) final diagnoses of “other.” The most injured body regions were shoulder (n = 1078; NE = 45,825; 33.8%), finger (n = 897; NE = 32,398; 25.4%), and upper arm (n = 282; NE = 12,417; 8.8%). The most common MOIs were drop/crush injuries (n = 961; NE = 34,757; 27.2%), pulling movements (n = 336; NE = 14,232; 11.1%), and overhead movements (n = 265; NE = 11,110; 8.7%). There were 870 (NE = 35,987; 29.3%) “other” lifting injury mechanisms. Descriptive of the overall distribution of final diagnoses, body locations injured, and MOIs can be found in Table 1.
Most Common Weightlifting-Associated Upper Extremity Injury Locations, Diagnoses, and Mechanisms of Injury
Injury Patterns When Stratified Among Different Age Groups
Data regarding body region, diagnosis, and MOI stratified by age groups can be found in Table 2. Regarding the pediatric population, the most common diagnoses were sprain/strain (n = 221; NE = 9702; 28.5%), fracture/crush/avulsion (n = 146; NE = 6364; 18.84%), and laceration/puncture (n = 59; NE = 2185; 6.4%). The most commonly injured body regions were shoulder (n = 292; NE = 13,054; 38.4%), finger (n = 256; NE = 8936; 26.3%), and wrist (n = 73; NE = 2802; 8.2%). The most common MOIs were drop/crush injuries (n = 259; NE = 9055; 30.5%), overhead movements (n = 82; NE = 3504;9.7%), and pulling movements (n = 72; NE = 3007; 8.5%).
National Estimates of the Most Common Weightlifting-Associated Upper Extremity Injury Locations, Diagnoses, and Mechanisms of Injury Stratified by Age a
Data are expressed as national estimate (%).
Regarding the young adult group, the most common diagnoses were sprain/strain (n = 387; NE = 17,608; 28.9%), fracture/crush/avulsion (n = 230; NE = 10,228; 16.8%), and laceration/puncture (n = 108; NE = 4171; 6.8%). The most commonly injured body regions were shoulder (n = 497; NE = 21,177; 34.7%), finger (n = 410; NE = 14,958; 24.5%), and upper arm (n = 151; NE = 6964; 11.4%). The most common MOIs were drop/crush injuries (n = 454; NE = 16,412; 30.2%), pulling movements (n = 175; NE = 3007; 12.8%), and pushing movements (n = 123; NE = 5128; 8.23%).
Regarding the middle-aged adult group, the most common diagnoses were sprain/strain (n = 171; NE = 6703; 27.4%), fracture/crush/avulsion (n = 89; NE = 4152; 17.0%), and laceration/puncture (n = 45; NE = 1744; 7.1%). The most injured body regions were shoulder (n = 217; NE = 8,830; 36.1%), finger (n = 172; NE = 6433; 26.3%), and upper arm (n = 49; NE = 2006; 8.2%). The most common MOIs were drop/crush injuries (n = 180; NE = 6814; 29.1%), pulling movements (n = 69; NE = 2881; 11.2%), and overhead movements (n = 51; NE = 1847; 8.3%).
Regarding the geriatric population, the most common diagnoses were sprain/strain (n = 46; NE = 1670; 28.0%), fracture/crush/avulsion (n = 30; NE = 1250; 21.0%), and laceration/puncture (n = 12; NE = 503; 7.6%). The most injured body regions were shoulder (n = 57; NE = 2093; 35.2%), finger (n = 41; NE = 1242; 20.9%), and wrist (n = 17; NE = 531; 8.9%). The most common MOIs were drop/crush injuries (n = 50; NE = 1673; 29.9%), pushing movements (n = 19; NE = 568; 11.4%), and pulling movements (n = 18; NE = 476; 10.8%).
Post Hoc Analyses in Evaluating Differences in Proportions
One-way analyses of variance demonstrated that pediatric patients had the highest proportion of finger injuries (26.3%; P < .05) and drop/crush injuries (26.6%; P < .05) compared with all other age groups. The geriatric age group had the highest proportion of wrist injuries (8.9%; P < .05), pushing-related injuries (9.5%; P < .05), and fracture/crush/avulsion (18.4%; P < .05) compared with all other age groups.
Linear regression analyses demonstrated pediatric patients were 2.5 times more likely to sustain finger injuries (odds ratio [OR], 2.536; 95% CI, 2.191-2.935; P < .001) and injuries from drop/crush mechanisms (OR, 2.484; 95% CI, 2.166-2.849; P < .001) compared with all other age groups. Contrarily, the geriatric age group was 2 times more likely to sustain injuries from pushing movements (OR, 2.037; 95% CI, 1.326-3.130; P < .001) compared with all other age groups. No significant association was found between the geriatric population and wrist injuries (P = .284) or rate of fracture/crush/avulsion (P = .105).
Diagnoses and Mechanisms of Shoulder and Finger Injuries
When we evaluated all shoulder injuries, the most common diagnoses were sprain/strain (n = 418; NE = 18,252; 40.0%) and dislocation (n = 118; NE = 5213; 11.4%). The most common MOIs were overhead movements (n = 234; NE = 9831; 21.6%) and pushing movements (n = 159; NE = 6616; 14.5%). Among all finger injuries, the most common diagnoses were fracture/crush/avulsion (n = 377; NE = 13,047; 40.5%) and laceration/puncture (n = 164; NE = 6213; 19.3%). The most common MOIs were drop/crush injuries (n = 791; NE = 27,844; 86.4%) and impact with equipment (n = 46; NE = 1744; 5.4%).
Body Regions and Mechanisms of Fracture/Crush/Avulsion and Sprain/Strain Injuries
When evaluating all fracture/crush/avulsion, we found that the most common body regions injured were finger (n = 377; NE = 13,047; 58.8%) and wrist (n = 42; NE = 1312; 5.9%). The most common MOIs were drop/crush injuries (n = 417; NE = 14,687; 66.2%) and impact with the floor (n = 54; NE = 1933; 8.7%). Among all sprains and strains, the most common body regions injured were shoulder (n = 418; NE = 18,252; 28.2%) and wrist (n = 95; NE = 4103; 6.4%). The most common MOIs were pulling movements (n = 332; NE = 14,746; 22.8%) and pushing movements (n = 282; NE = 12,630; 19.5%).
Discussion
The major findings of this study demonstrated that males (76.9%) and young adults (47.7%) comprised a majority of all upper extremity weightlifting injuries. The most common overall MOIs were drop/crush injuries (NE = 34,757; 30.1%), pulling movements (NE = 14,232; 10.5%), and overhead movements (NE = 11,110; 8.3%). Despite the notable incidence of injuries over a 4-year period, only 5% of all patients required admission. Pediatric athletes more frequently sustained finger fracture/crush/avulsion from drop/crush injuries, whereas shoulder injuries predominated all age groups. Despite geriatric participants comprising the smallest proportion of all weightlifting-associated injuries, they were significantly more likely to sustain injuries secondary to pushing movements.
The Significant Burden of Finger Drop/Crush Injuries in Pediatric Athletes
Pediatric patients were 2.5 times more likely to sustain both finger injuries and drop/crush injuries when compared with all other age groups. Gupta et al 8 focused specifically on pediatric weightlifting injuries and reported a fracture incidence of 9.9% of all injuries, lower than the 17.2% seen in the current study. However, Gupta et al defined the pediatric age group as 11 to 21 years and did not evaluate MOIs or compare rates with those of older adults. More general population studies have found fracture to be the most common upper extremity injury type in all ED presentations. 32 Pediatric bone responds differently to significant load bearing when compared with adult bone, as the cortical immaturity trades away tensile and compressive strength for greater flexibility. 29 These physiologic characteristics likely contribute to pediatric patients sustaining more sprains and strains and fewer fractures, a classic paradigm. Similar to our study, Lopes et al 19 evaluated 155 pediatric patients with hand trauma and found that the most common MOI in patients younger than 10 years was drop/crush injuries, with complications occurring in up to one-third of all patients. Therefore, specific safety changes should be implemented to decrease the overall incidence of finger drop/crush injuries within this population and may include adequate education emphasizing safe load-handling practices and how to properly load and unload equipment to mitigate the risk of dropped weights. Additionally, increased supervision on safety training, integration of safer equipment such as plastic/rubber plates, and emphasis on slow and controlled eccentric movements may further help in preventing injury.
Protecting the Glenohumeral Joint in a Weightbearing Sport
The shoulder was the most commonly injured body region of all age groups, with overhead and pushing movements the most common MOIs. The glenohumeral joint is the most mobile and dynamic joint in the body, allowing for complex and coordinated movements in 3 degrees of freedom. 1 Because the glenohumeral joint is a ball-and-socket joint with a relatively shallow glenoid cavity, its extensive mobility is largely dependent on stabilization from the rotator cuff muscles. 1 Therefore, any muscular imbalances, which can originate from acute traumatic events or unequal strength training, would lead to excessive and inadequately compensated forces imposed onto the joint space. 34 Previous population studies have evaluated the burden of shoulder injuries in weightlifters, reporting that men aged 20 to 29 years were most commonly affected. 23 In powerlifting/Olympic lifting specifically, Raske et al 24 found that the overall incidence of shoulder injuries substantially increased over a 5-year period, with 0.42 injuries per 1000 hours of activity in 1995 to 0.51 injuries per 1000 hours in the year 2000. Properly supervised exercise programs and adequate warm-up with muscle cue and activation are key in preventing unequally distributed forces and subsequent damage to the joint space and surrounding structures. 25 Exercises that strengthen the rotator cuff, such as face pulls, serratus wall slides, and external rotation with bands, offer significant benefit in joint stabilization, which is especially important in geriatric patients due to the high prevalence of degenerative disease and rotator cuff tears, both symptomatic and asymptomatic. 20 Mitigating high-risk movements that place significant mechanical strain on the shoulder can prevent muscle imbalances and scapular dyskinesis. 21
The Unique Utility of Weightlifting in Geriatric Athletes
Geriatric patients had the highest proportion of fractures among all age groups and were nearly twice as likely to sustain injuries secondary to pushing mechanisms. Therefore, geriatric athletes should avoid high load-bearing press exercises such as dumbbell and barbell press, substituting with alternative, low-impact exercises such as cable flys. 21 With the rapidly aging US population, rates of musculoskeletal disease, notably osteoporosis and osteoporotic fractures, have seen significant increases over the past decade. 22 Moreover, annual osteoporotic fractures are estimated to increase by 68% within the coming decades, increasing from 1.9 million in 2018 to a staggering 3.2 million by 2040. 17 However, the low proportion of geriatric weightlifters suggests that this population may be underusing a sport effective in combating osteoporosis. The mechanical stress placed on bones allows for continuous remodeling, and strong evidence indicates that resistance training significantly increases bone mineral density when compared with lower tension exercises such as walking, running, and biking.30,31 Because of these reasons, weightlifting is a pragmatic solution to combat the notable increases in population age and musculoskeletal disease, and clinicians should educate geriatric and osteoporotic patients about the risks and benefits of weightbearing exercises. 13
Existing Guidelines, Clinical Implications, and Recommendations
Currently, societies such as the American Academy of Orthopaedic Surgeons recommend weightlifting as a form of exercise, emphasizing adequate warm-ups and proper form to reduce injury burden. 2 Similarly, the National Strength and Conditioning Association recommends resistance training in athletes of all age groups to improve overall musculoskeletal health. 18 However, these recommendations are nonspecific and do not consider the differences in injury patterns when stratifying by ages. Findings from the current analysis highlight the pressing need for more granular and age-specific recommendations based on the populational trends observed. Specifically, we recommend that all schools consider implementing strength training courses to teach safe and appropriate lifting techniques to pediatric athletes given the significantly higher likelihood of sustaining fractures from drop/crush injuries. Adult weightlifters should avoid high-risk exercises such as high-energy overhead movements and should engage in dynamic warm-ups before upper body training, particularly to decrease the overall incidence of shoulder injuries. Given the aging population and increase in osteoporotic fractures, clinicians should recommend weightlifting and other weightbearing exercises to geriatric populations to improve bone density and functional strength. Additionally, future research should investigate the management strategies of weightlifting-associated upper extremity injuries, including operative versus nonoperative clinical outcomes associated with these interventions, and potentially should explore injury patterns seen in weightlifters using anabolic steroids in order to provide additional insight and specific recommendations to decrease overall injury prevalence.
Limitations
Despite the new evidence that this analysis provides to the current literature, there are several noteworthy limitations. First, all database studies are inherently limited by the quality of the input data. Although the NEISS database is effective in providing large-scale population trends over time, it significantly lacks granularity in variables such as injury severity, final diagnoses (33.6%), mode of diagnosis (ie, radiograph, computed tomography, magnetic resonance imaging [MRI]), the diagnosing provider's level of training (ie, MD, PA, and NP), management strategies, and long-term outcomes (ie, functionality, time away from sport). Moreover, narrative fields used to determine MOIs are largely dependent on the specificity that the ED clinician provides, and therefore a notable proportion of our MOIs were nonspecified (27.3%), although this is a smaller proportion than previously published NEISS studies. 26 The narrative fields also lack the ability to stratify whether cases involve professional athletes or the general population, which may influence injury prevalence due to differences in technique and safety precautions exercised. The NEISS dataset uses only data from ED visits, which not only predisposes to underrepresentation of the true incidence of weightlifting-associated injuries, neglecting visits to urgent care and outpatient clinics, but also likely underrepresents the prevalence of soft tissue injuries, given that MRI is not frequently performed in the ED. Additionally, this study is unable to determine the number of exposed athletes within each age group, and therefore we are unable to comment on the relative participation or injury rates. These limitations should be considered when interpreting the findings and designing future research.
Conclusion
Our study showed that sprain/strain and fracture/crush/avulsion were frequent upper extremity weightlifting injuries, often secondary to drop/crush injuries and overhead movements. Pediatric athletes were more likely to sustain finger and drop/crush injuries, whereas shoulder injuries affected all adult age groups. The low proportion of geriatric weightlifters suggests that this population may underuse a sport effective in combating osteoporosis. These insights into overall and age-specific injury patterns can help shape evidence-based recommendations to reduce the overall injury burden and promote safe resistance training.
Footnotes
Final revision submitted September 15, 2025; accepted September 16, 2025.
The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
