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Which resistance training is safest to practice? A systematic review

Journal of Orthopaedic Surgery and Research volume 18, Article number: 296 (2023) Cite this article

Abstract

Background

The combination of resistance training (RT) and aerobic training is believed to achieve the best effects. Several different aerobic training methods have emerged in combination with or as a substitute for traditional RT. This study wished to verify which RT is safest in terms of injury prevalence and incidence. Also, it ascertained the characteristics of the injured subjects, the level of severity of the injuries and what definitions of injuries the available studies use.

Methods

This systematic review followed the PRISMA recommendations and was registered in PROSPERO with the number CRD42021257010. The searches were performed in the PubMed, Cochrane and Web of Science, electronic databases using the Medical Subject Headings terms "Resistance training" or "Strength training" or "Crossfit" or “Weightlifting” or “Powerlifting” combined (AND) with "Injury" or "Injuries" or "Sprain" AND “Incidence” or “Prevalence” AND “Epidemiology” or “Epidemiological” in the title or abstract. The last search was performed on March 2023. To be included in the review, the studies had to be available as full text, be clinical trials focusing on epidemiological injuries of resistance training. There was no time limit for the selection of articles. To assess the quality of the studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used.

Results

The initial literature search resulted in 4982 studies. After reading the titles, abstracts and full text, 28 articles were selected for data extraction. Seventeen investigated the injuries in HIFT/CrossFit, three in powerlifting, three in strength training, three in weightlifting and one in strongman. In addition, one study examined the HIFT/CrossFit and weightlifting. The incidence of injuries presented in the studies ranged from 0.21/1000 h to 18.9/1000 h and the prevalence of injuries was 10% to 82%. In the quality assessment for STROBE, five studies were classified at level A, 21 at level B and two at level C.

Conclusion

This systematic review showed that traditional strength training is the safest RT method, and strongman is the least safe regarding injuries. Few studies have been rated highly according to STROBE. Furthermore, few studies have been published on some RT methods. These two factors make it difficult to generalize the results.

Background

The combination of resistance training (RT) associated with aerobic training is ideal for the best performance [1,2,3]. With the growth of such information and the encouragement for the greater practice of physical exercise, different RT methods have emerged [4,5,6]. Within these modalities, when considering health, well-being and quality of life, there was less concern only with aesthetics or performance gains within the sport [1, 2]. Therefore, studies that evaluate variables related to exercise safety are important [7]. Studies on the incidence and prevalence of injuries are important to identify risk factors within the modality and develop preventive strategies [8, 9]. The comparison between one modality and another is also important for practitioners to choose the best and safest RT method. This study wished to verify which RT is safest in terms of injury prevalence and incidence. Also, it ascertained the characteristics of the injured subjects, the level of severity of the injuries and what definitions of injuries the available studies use.

Methods

Protocol registration

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations [10] and was registered in PROSPERO (ID CRD42021257010). The searches were performed in the PubMed, SPORTDiscuss and Web of Science, electronic databases using the following keywords (Additional file 1): "Resistance training" or "Strength training" or "CrossFit" or “Weightlifting” OR “Powerlifting” AND "Injury" or "Injuries" or "Sprain" AND “Incidence” or “Prevalence” AND “Epidemiology” or “Epidemiological”. The last update of the database search was conducted on March 2023.

Eligibility criteria

Studies were deemed eligible according to the PICOS criteria [10, 11] (Table 1). To be included in the review, the studies had to be available as full text, and be clinical trials focusing on epidemiological aspects of injuries that occurred with RT. There was no time limit for the selection of articles. Literature reviews, case reports, editorials, letters to the editor, technical notes and articles published in languages other than English were excluded.

Table 1 PICOS framework
Full size table

Selection of studies and data extraction

The studies were independently screened by two reviewers (TTS and ESO) for inclusion. Each reviewer studied the title of each article identified through the search, followed by examination of the abstracts. Subsequently, the full text of the articles which passed the previous stages was analysed. Disagreements between reviewers were resolved by a third senior reviewer experienced in systematic reviews and meta-analyses (RO).

Data extraction

The data collected by two authors (TTS and ESO) from the articles referred to the sample size, type of resistance training, incidence and prevalence of injuries, associated factors, severity, and definition of injuries. The American College of Sports Medicine (ACSM) defines resistance training for health and fitness as “a form of physical activity that is designed to improve muscle fitness by exercising a muscle or muscle group against external resistance” [12]. Resistance or strength training is widely performed in contemporary health and fitness environments through the use of equipment such as free weights, sectorized weight machines, plate loaded machines, weighted balls, resistance bands, and body weight resistance equipment [13].

Quality assessment

To assess the quality of the studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used. The scale has a checklist with 22 items that receive scores from 0 (does not meet) to 1 (complies). Depending on the sum of items reached by the study [14, 15] when the study fulfilled more than 80% of the criteria established in the STROBE, the study is considered high quality if 50% to 80% of the STROBE criteria are met [16]. On the other hand, if the considered study met less than 50% of the STROBE criteria, low quality if detected [16].

Results

Search results

The initial literature search resulted in 4982 studies. After reading the titles, 4899 were excluded, leaving 63 for evaluating the abstracts. Twelve studies were excluded at this stage, leaving 51 for further evaluation. 21 were selected for data extraction. Seven investigations were selected searching the references by hand. Eventually, 28 articles were selected for data extraction (Fig. 1).

Fig. 1
figure 1

Flow chart of the literature search

Full size image

Patient demographic

Data from 13.127 RT practitioners were collected. The mean age was 28.7 ± 6.4 years. Their average weekly training was 2 to 6.10 workouts per week. The generalities and patient demographic of the included studies is shown in Table 2.

Table 2 Generalities and patient demographic of the included studies
Full size table

Seventeen studies evaluated the number of injuries in HIFT/CrossFit, three in powerlifting, three in strength training, three in weightlifting, and one in Strongman. In addition, one study looked at HIFT/CrossFit and weightlifting. Overall, the incidence of injuries ranged from 0.21/1000 h to 18.9/1000 h [17, 18] and the prevalence of injuries was 10% to 82% [19, 20]. Within the HIFT/CrossFit, the mean injury was 4.2/1000 h and 52.5%, respectively. In powerlifting, the mean prevalence of injuries was 56.6% and the incidence of 4/1000 h. Strength training studies did not show the incidence of injuries, with a mean prevalence of 12.6%. The only study on strongman reported an injury incidence of 5.5/1000 h and an injury prevalence of 82%. Weightlifting practitioners had 3.2/1000 h of injury incidence and 46.2% of injury prevalence, respectively. The greatest number of injuries were located in the shoulders [21,22,23,24,25,26], followed by the back [27,28,29]. Some studies analysed factors associated with injuries, as well as their severity and cause. Of the 28 studies included, 21 had explicitly defined an “injury” in their methods (Table 3).

Table 3 Injury characteristics
Full size table

Quality assessment

The studies were evaluated using the STROBE Checklist. The range of points acquired by the studies on the scale ranged from 8 [30] to 19 [31,32,33]. Five studies were classified at level A, 21 at level B and two at level C.

Discussion

This study investigates the injury rate among resistance training partitioners. Traditional strength training showed a lower injury rate, unlike Strongman, which was the RT method with the highest injury rate in the selected studies. In general, the reported injuries are of high severity, with shoulders and back being the most commonly affected anatomical areas. The injuries definitions were different between the selected studies.

Within sports, there is a particularity that makes it difficult to characterize an injury. Sport, unlike other contexts, makes the athlete or practitioner continue their training or participate in some competition even with pain or loss of function. Therefore, the simple absence from training or competition cannot always be characterized as an injury [34, 35]. With this in mind, most selected studies characterised the injury as any pain or change in performance within the training modality and exercises performed. Other studies were less stringent, and only considered injuries when the subject did not practice for some time. This agrees with the definition of a sport injury as a pathological process that interrupts training or competition and can lead the athlete to seek medical treatment [36]. There is a perceived difficulty in standardizing the definition of injuries in studies. No matter how difficult it may be, this must include within its definition the inability to perform the sport [34].

Traditional ST presented the lowest prevalence of injuries, at an average of 13%, demonstrating the safety of the practice of traditional ST. The low incidence (< 1/1000 h) indicated the safety of the practice [4]. The safety of traditional ST can also be explained by the different profiles of the training method [37, 38]. While other RT modalities put a greater focus on the task and constant challenge related to performing complex movements at higher intensities, traditional ST mostly focuses on specific muscle contraction [38]. Powerlifting had a low incidence of injury, very similar to HIFT/CrossFit and weightlifting [39, 40]. Powerlifting usually occurs from the high loads used in deadlift, squat and bench press [41]. Using high loads requires excellent technique and reduces the chances of injuries [42, 43]. Most of the studies identified on HIFT/CrossFit, with an average of 4.22 lesions per each 1000 h of exposure. Even with a low average, two studies showed a high rate of injury incidence [18, 44]. Szeles et al. evidenced an incidence of 18.9/1000 h lesions, well above the others [18]. This difference of almost 5 times the mean value can be explained by the different methods used to define an injury. The main justification is the non-standardization of the definition of injury. In this review, for example, seven studies had no definition of injury. Furthermore, many studies have different definitions, which increases the subjectivity of the interpretation [4]. Hak et al. found almost double the prevalence of injuries [45]. In one of the first epidemiological studies of HIFT/Crossfit conducted online, the online questionnaire, depending on how it is disseminated, may be biased towards the target audience of the survey [46, 47], as a study of injuries in a sport can draw more attention to subjects who have already had an injury. Studies with higher injury prevalence often define injuries as any pain or loss of function that makes the subject change training or results in a reduction in training performance. Other studies with lower rates have less stringent definitions with a lower degree of rigidity or no definition at all. This further increases the importance of standardizing the method of studies [48, 49].

The injury rate in weightlifting is similar to HIFT/CrossFit. However, a smaller number of studies were found, which makes it more difficult to consider fewer results as accurate as the HIFT/CrossFit. A systematic review showed values similar to those of this review [50]. The severity of injuries in this study varied greatly, and this may occur because some accidents take place during training [50, 51]. The highest prevalence found in the studies was that of Strongman [52], a sport in which athletes perform with high loads and varied movements. Specific training is responsible for increasing the chances of injury by 1.9 times when compared to traditional ST [52].

Most injuries occurred in the shoulders, followed by the back. These results are in line with previous studies in HIFT/CrossFit, weightlifting and powerlifting [46, 50], given the high loads and large ranges of motion [50, 53, 54]. It is necessary to have good stability of the scapulothoracic complex to allow less overload on the glenohumeral joint. Lower trapezius and serratus anterior activation are critical in overhead movements [47]. A single training method altered the pattern of shoulder and back injuries. Only one of the traditional RT studies verified this and realized that injuries in the lower limbs probably occurred through running and jumping [19]. Most injuries were classified as moderate, but few studies included this variable in their results [27, 52, 55,56,57]. Furthermore, the small number of studies that verified the severity of injuries does not allow generalization of the results. As these sports do not involve a constant change of direction and physical contact, injuries tend to be less severe [47, 58, 59]. Most studies did not find an association between the practitioner's sex and the occurrence of injuries. Previous untreated injuries seem to predispose to new injuries. Some of these RT methods are recent, which makes their practitioners come from other sports with an injury already treated [47, 60]. Individuals who start practising HIFT/CrossFit are 3.75 times more likely to get injured in practice [60]. Athletes with previous shoulder injuries are eight times more likely to injure the area compared to athletes with healthy shoulders [25]. In the practical context, all RT methods seem safe. Strongman reported the highest rate of injuries, but only one study was included in the analysis.

Conclusions

Traditional strength training is the safest RT method, and Strongman is the least safe regarding injuries. The anatomical sites with the highest rate of injuries are the shoulders and the lumbar region. Study methods need to be better standardized to prevent discrepant and heterogeneous results.

Availability of data and materials

The data that support the findings of this study are available from Thiago Teixeira Serafim, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Thiago Teixeira Serafim via e-mail.

Abbreviations

RT:

Resistance training

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

MeSH:

Medical Subject Headings

ACSM:

American College of Sports Medicine

HIFT:

High-intensity functional training

ST:

Strength training

References

  1. Saeidifard F, Medina-Inojosa JR, West CP, Olson TP, Somers VK, Bonikowske AR, et al. The association of resistance training with mortality: a systematic review and meta-analysis. Eur J Prev Cardiol. 2019;26:1647–65.

    Article  PubMed  Google Scholar 

  2. Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11:209–16.

    Article  PubMed  Google Scholar 

  3. Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004;36:674–88.

    Article  PubMed  Google Scholar 

  4. Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47:479–501.

    Article  PubMed  Google Scholar 

  5. Medicine AC of S. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364–80.

  6. Kraemer WJ, Ratamess NA, French DN. Resistance training for health and performance. Curr Sports Med Rep. 2002;1:165–71.

    Article  PubMed  Google Scholar 

  7. Hafner M, Yerushalmi E, Stepanek M, Phillips W, Pollard J, Deshpande A, et al. Estimating the global economic benefits of physically active populations over 30 years (2020–2050). Br J Sports Med [Internet]. 2020;54:1482–7.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Oliveria SA, Christos PJ, Berwick M. The role of epidemiology in cancer prevention. Proc Soc Exp Biol Med. 1997;216:142–50.

    Article  CAS  PubMed  Google Scholar 

  9. Syed A, Talbot-Smith A, Gemmell I. The use of epidemiological measures to estimate the impact of primary prevention interventions on CHD, stroke and cancer outcomes: experiences from Herefordshire, UK. J Epidemiol Glob Health. 2012;2:111–24.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev England. 2015;4:1.

    Article  Google Scholar 

  11. Frandsen TF, Nielsen MFB, Lindhardt CL, Eriksen MB. Using the full PICO model as a search tool for systematic reviews resulted in lower recall for some PICO elements. J Clin Epidemiol. 2020;127:69–75.

    Article  PubMed  Google Scholar 

  12. American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687–708.

  13. Hurley KS, Flippin KJ, Blom LC, Bolin JE, Hoover DL, Judge LW. Practices, perceived benefits, and barriers to resistance training among women enrolled in college. Int J Exerc Sci [Internet]. 2018;11:226.

    PubMed  PubMed Central  Google Scholar 

  14. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12:1500–24.

    Article  PubMed  Google Scholar 

  15. von Elm E, Altman DA, Egger M, Pocock SJ, Gøtzsche P, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.

    Article  Google Scholar 

  16. Mataratzis PSR, Accioly E, de Padilha PC. Deficiências de micronutrientes em crianças e adolescentes com anemia falciforme: uma revisão sistemática. Rev Bras Hematol Hemoter. 2010;32:247–56.

    Article  Google Scholar 

  17. Feito Y, Burrows EK, Tabb LP. A 4-year analysis of the incidence of injuries among crossfit-trained participants. Orthop J Sport Med. 2018;6:1–8.

    Article  Google Scholar 

  18. Szeles PRDQ, Costa TSD, Cunha RAD, Hespanhol L, Pochini ADC, Ramos LA, et al. CrossFit and the epidemiology of musculoskeletal injuries: a prospective 12-week cohort study. Orthop J Sport Med. 2020;8:1–9.

    Article  Google Scholar 

  19. Surakka J, Aunola S, Nordblad T, Karppi SL, Alanen E. Feasibility of power-type strength training for middle aged men and women: self perception, musculoskeletal symptoms, and injury rates. Br J Sports Med. 2003;37:131–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Feito Y, Burrows E, Tabb L, Ciesielka KA. Breaking the myths of competition: a cross-sectional analysis of injuries among CrossFit trained participants. BMJ Open Sport Exerc Med. 2020;6:1–9.

    Article  Google Scholar 

  21. Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among crossfit athletes. Orthop J Sport Med. 2014;2:1–7.

    Article  Google Scholar 

  22. Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective injury epidemiology and risk factors for injury in CrossFit. J Sport Sci Med. 2017;16:53–9.

    Google Scholar 

  23. Feito Y, Burrows EK, Tabb LP. A 4-Year analysis of the incidence of injuries among crossfit-trained participants. Orthop J Sport Med. 2018;6:1–7.

    Article  Google Scholar 

  24. de Szeles PRQ, da Costa TS, da Cunha RA, Hespanhol L, de Pochini AC, Ramos LA, et al. CrossFit and the epidemiology of musculoskeletal injuries: a prospective 12-week cohort study. Orthop J Sport Med. 2020;8:1–9.

    Article  Google Scholar 

  25. Aune KT, Powers JM. Injuries in an extreme conditioning program. Sports Health. 2017;9:52–8.

    Article  PubMed  Google Scholar 

  26. Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sport Med. 2017;47:479–501.

    Article  Google Scholar 

  27. Moran S, Booker H, Staines J, Williams S. Rates and risk factors of injury in CrossFitTM: a prospective cohort study. J Sports Med Phys Fitness. 2017;57:1147–53.

    Article  PubMed  Google Scholar 

  28. Larsen RT, Hessner AL, Ishøi L, Langberg H, Christensen J. Injuries in novice participants during an eight-week start up crossfit program—a prospective cohort study. Sports. 2020;8:1–12.

    Article  Google Scholar 

  29. Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res. 2010;468:1635–48.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Tawfik A, Katt BM, Sirch F, Simon ME, Padua F, Fletcher D, et al. A Study on the incidence of hand or wrist injuries in CrossFit athletes. Cureus. 2021;13:3–10.

    Google Scholar 

  31. Strömbäck E, Aasa U, Gilenstam K, Berglund L. Prevalence and consequences of injuries in powerlifting: a cross-sectional study. Orthop J Sport Med. 2018;6:1–10.

    Article  Google Scholar 

  32. Larsen RT, Hessner AL, Ishoi L, Langberg H, Christensen J. Injuries in novice participants during an eight-week. Sports. 2020;8:1–12.

    Article  Google Scholar 

  33. Elkin JL, Kammerman JS, Kunselman AR, Gallo RA. Likelihood of injury and medical care between CrossFit and traditional weightlifting participants. Orthop J Sport Med. 2019;7:1–8.

    Article  Google Scholar 

  34. Timpka T, Jacobsson J, Bickenbach J, Finch CF, Ekberg J, Nordenfelt L. What is a sports injury? Sports Med. 2014;44:423–8.

    Article  PubMed  Google Scholar 

  35. Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med. 2013;47:495–502.

    Article  PubMed  Google Scholar 

  36. Micheo W, Sánchez LA. Rehabilitation in musculoskeletal and sports injuries in older adults. Geriatr Rehabil. 2018;80:161–8.

    Article  Google Scholar 

  37. Dominski FH, Serafim TT, Siqueira TC, Andrade A. Psychological variables of CrossFit participants: a systematic review. Sport Sci Health. 2021;17(1):21–41.

    Article  PubMed  Google Scholar 

  38. Dominski FH, Matias TS, Serafim TT, Feito Y. Motivation to CrossFit training: a narrative review. Sport Sci Health. 2020;16:195–206.

    Article  Google Scholar 

  39. Strömbäck E, Aasa U, Gilenstam K, Berglund L. Prevalence and consequences of injuries in powerlifting: a cross-sectional study. Orthop J Sport Med. 2018;6:1–10.

    Article  Google Scholar 

  40. Keogh J, Hume PA, Pearson S. Retrospective injury epidemiology of one hundred one competitive oceania power lifters: The effects of age, body mass, competitive standard, and gender. J Strength Cond Res. 2006;20:672–81.

    PubMed  Google Scholar 

  41. Bengtsson V, Berglund L, Aasa U. Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift. BMJ open Sport Exerc Med. 2018;4:1–8.

    Article  Google Scholar 

  42. Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50:273–80.

    Article  PubMed  Google Scholar 

  43. Wilk M, Gepfert M, Krzysztofik M, Golas A, Mostowik A, Maszczyk A, et al. The influence of grip width on training volume during the bench press with different movement tempos. J Hum Kinet. 2019;68:49.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Teixeira RV, Dantas M, De MDG, Gantois P, Aidar FJ, Dantas PMS, et al. Retrospective study of risk factors and the prevalence of injuries in HIFT. Int J Sports Med. 2020;41:168–74.

    Article  PubMed  Google Scholar 

  45. Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during crossfit training. J Strength Cond Res. 2013;1:1–9.

    Google Scholar 

  46. Dominski FH, Siqueira TC, Tibana RA, Andrade A. Injuries in functional fitness: an updated systematic review. J Sports Med Phys Fitness. 2021;5:673–83.

    Google Scholar 

  47. Dominski FH, Siqueira TC, Serafim TT, Andrade A. Injury profile in CrossFit pratitioners: a systematic review. Fisioter e Pesqui. 2018;25:229–39.

    Article  Google Scholar 

  48. Itri JN, Bakow E, Probyn L, Kadom N, Duong P-AT, Gettle LM, et al. The Science of Quality Improvement. Acad Radiol [Internet]. Acad Radiol; 2017 [cited 2021 Sep 12];24:253–62.

  49. Lohr KN. Rating the strength of scientific evidence: relevance for quality improvement programs. Int J Qual Health Care. 2004;16:9–18.

    Article  PubMed  Google Scholar 

  50. Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51:211–9.

    Article  PubMed  Google Scholar 

  51. Kerr ZY, Collins CL, Dawn CR. Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007. Am J Sports Med. 2010;38:765–71.

    Article  PubMed  Google Scholar 

  52. Winwood PW, Hume PA, Cronin JB, Keogh JWL. Retrocpective injury epidemiology of strongman ethletes. J Strength Cond Res. 2014;28:28–42.

    Article  PubMed  Google Scholar 

  53. Wilk KE, Obma P, Simpson CD, Cain EL, Dugas JR, Andrews JR. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther. 2009;39:38–54.

    Article  PubMed  Google Scholar 

  54. Tooth C, Gofflot A, Schwartz C, Croisier J-L, Beaudart C, Bruyère O, et al. Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review. Sports Health [Internet]. Sports Health; 2020 [cited 2021 Sep 14];12:478–87.

  55. Tafuri S, Salatino G, Napoletano PL, Monno A, Notarnicola A. The risk of injuries among CrossFit athletes: an Italian observational retrospective survey. J Sports Med Phys Fitn. 2019;59:1544–50.

    Google Scholar 

  56. Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JWP. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011;32:703–11.

    Article  CAS  PubMed  Google Scholar 

  57. Calhoon G, Fry AC. Injury rates and profiles of elite competitive weightlifters. J Athl Train. 1999;34:232–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Serner A, Mosler AB, Tol JL, Bahr R, Weir A. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. Br J Sports Med. 2019;53:158–64.

    Article  PubMed  Google Scholar 

  59. Mack CD, Kent RW, Coughlin MJ, Shiue KY, Weiss LJ, Jastifer JR, et al. Incidence of lower extremity injury in the national football league: 2015 to 2018. Am J Sports Med. 2020;48:2287–94.

    Article  PubMed  Google Scholar 

  60. Chachula LA, Cameron KL, Svoboda SJ. Association of prior injury with the report of new injuries sustained during CrossFit training. Athl Train Sport Heal Care. 2016;8:28–34.

    Article  Google Scholar 

  61. BM W, CA B, MD M, KE D, BD G. Injury Rate and Patterns Among CrossFit Athletes. Orthop J Sports Med. 2014;2.

  62. Alekseyev K, John A, Malek A, Lakdawala M, Verma N, Southall C, et al. Identifying the most common CrossFit injuries in a variety of athletes. Rehabil Process Outcome. 2020;9:117957271989706.

    Article  Google Scholar 

  63. Toledo R, Dias MR, Souza D, Soares R, Toledo R, Lácio M, Vianna J. Joint and muscle injuries in men and women CrossFit® training participants. Phys Sportsmed. 2021;50(3):205–11.

    Article  PubMed  Google Scholar 

  64. Cheng TTJ, Mansor A, Lim YZ, Hossain Parash MT. Injury incidence, patterns, and risk factors in functional training athletes in an Asian Population. Orthop J Sport Med. 2020;8:1–6.

    Article  Google Scholar 

  65. Escalante G, Gentry CR, Kern BD, Waryasz GR. Injury patterns and rates of Costa Rican CrossFit® participants-a retrospective study. J Rom Sport Med Soc. 2017;13:2927–34.

    Google Scholar 

  66. Mehrab M, de Vos R-J, Kraan GA, Mathijssen NMC. Injury incidence and patterns among dutch crossfit athletes. Ortopaedic J Sport Med. 2017;5:1–13.

    Google Scholar 

  67. Little RMD, Paterson DH, Humphreys DA, Stathokostas L. A 12-month incidence of exercise-related injuries in previously sedentary community-dwelling older adults following an exercise intervention. BMJ Open. 2013;3:1–6.

    Article  Google Scholar 

  68. Kim JS, Park HS, Oh SS. An analysis of the characteristics of sports activities and injury experiences of leisure sports participants. J Exerc Rehabil. 2018;14:407–12.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PAFH, Aubry MJ, et al. Sports injuries during the Summer Olympic Games 2008. Am J Sports Med. 2009;37:2165–72.

    Article  PubMed  Google Scholar 

  70. Raske Å, Norlin R. Injury incidence and prevalence among elite weight and power lifters. Am J Sports Med. 2002;30:248–56.

    Article  PubMed  Google Scholar 

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Acknowledgements

None.

Funding

Open Access funding enabled and organized by Projekt DEAL. No external source of funding was used.

Author information

Authors and Affiliations

  1. Physiotherapy Nucleus Orthopedic Trauma of Health and Sports Science of the Santa Catarina State (UDESC), Florianópolis, Brazil

    Thiago Teixeira Serafim, Eliton Stanley de Oliveira & Rodrigo Okubo

  2. Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy

    Nicola Maffulli

  3. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, England

    Nicola Maffulli

  4. Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG, England

    Nicola Maffulli

  5. Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany

    Filippo Migliorini

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  2. Eliton Stanley de Oliveira
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  3. Nicola Maffulli
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  4. Filippo Migliorini
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Contributions

The authors TTS and ESO performed the data extraction and contributed to the writing. NM, RO and FM performed the writing of the manuscript, as well as for the refinement of data interpretation. All authors agree with the final version of this study. All authors read and approved the final manuscript.

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Correspondence to Filippo Migliorini.

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Serafim, T.T., de Oliveira, E.S., Maffulli, N. et al. Which resistance training is safest to practice? A systematic review. J Orthop Surg Res 18, 296 (2023). https://doi.org/10.1186/s13018-023-03781-x

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  • DOI: https://doi.org/10.1186/s13018-023-03781-x

Keywords

  • Resistance training
  • Injury
  • Strength training
  • High-intensity functional training
  • Weightlifting

Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X