Squat, bench press, deadlift: how to prevent injuries while powerlifting

In recent years, powerlifting participation rates have shown a sharp increase among men and women of all ages and training levels. Athletes practicing this sport, who compete in separate classes for age, weight, and sex [1], are engaged in performing 3 basic exercises:

• Squat
• Bench press (lying on a flat bench)
• Deadlift (ground clearance)

The squat, bench press and deadlift are fundamental strength training exercises also used by other athletes who practice team sports and individual with the aim of increasing maximum strength, muscle mass and therefore sports performance. During training, powerlifters use sub-maximal loads and are engaged in high training volumes to stimulate hypertrophy and maximum strength.

Powerlifters' workouts

The lifters' workouts are generally almost repetitive, as their attention is focused on the three key exercises mentioned above and, on their variants, and propaedeutic techniques. Scientific studies on powerlifting have examined the incidence of muscle injuries in these athletes. In elite category lifts about 30% of total weightlifting injuries are associated with squatting, while 40% are related to bench press and the remaining 30% to deadlift.

A recent review of the scientific literature published by Bengtsson et al. (2018) [2] examines the associations between muscle weightlifting injuries and the three fundamental exercises for powerlifting. In the following paragraphs, the main results will be reported and discussed.

The three exercises in powerlifting: squatting

The squat is performed starting from an upright position with the barbell resting horizontally on the back of the shoulders. During the movement, the lifter lowers the body by flexing the hip, knee and ankle joints until the fold of the hip is below the upper part of the knees. The lifter then returns to the vertical position by extending the three joints mentioned above.

During the competition, the powerlifter must assume an upright and immobile posture with the knees fully extended and the torso in a vertical position before receiving the "squat" signal from the referee and then starting the execution of the movement. When the ascent phase is complete, the arbiter indicates to the athlete that he/she can put the barbell back on the rack. The main contribution during squatting is given by the hip extensor muscles, hip adductors and abductors, knee extensors and ankle plantar flexors [3].

Bench press

While lying on the bench, the athlete lifts the barbell from the rack and keeps it perpendicular to the body with his/her arms outstretched. The lifter then lowers the barbell towards the chest and then returns it to its starting position with or without a pause in movement when the barbell is close to the chest. During the competition, the two phases of the movement are dictated by the referee's voice signal [1]. Bench pressing is performed with a handle width of no more than 81 centimeters between the index fingers. The main muscles involved during the execution of this movement are pectoralis major, the triceps and the anterior deltoid [4].

Deadlift

The lift requires the lifting of the barbell from the platform until the athlete reaches an upright position. In the first phase of the movement, the lifter bends his/her ankles, knees, and hips. During the competition, the balance is held with the arms straight and raised until the athlete assumes an upright position and the referee does not indicate to proceed with the phase of support of the load. The first muscles to be involved in this movement are the rear extensors of the lower limb [5]. There are two variants of ground clearance: the conventional and sumo styles. In the first, the barbell is held with the hands placed outside the knees, while in the sumo style, the athlete takes a wider and externally rotated stance and the barbell is held with the hands placed inside the knees [6, 7].

The coaches and athletic trainers specialized in this discipline are very interested in the prevention of the risk of injury. Since all three exercises in this sport trigger multiple joints and are subject to high loads, often several times a week, it has been suggested that the risk of injury could be linked to the use of excessively heavy loads, repeated stress without adequate recovery between sessions and/ or a suboptimal lifting technique [8]. In the review by Bengtsson et al. 41 studies are examined, focusing on the relationship between weightlifting injuries and the three exercises included in powerlifting.

In the bench press, weightlifting injuries were reported to the pectoralis major muscle, fractures of the clavicle, ribs, and dislocations of the glenohumeral joint, as well as various tendinopathies. In relation to the deadlift, however, among the most common lesions were muscle tears in the various muscles of the thigh, lumbar lesions and weightlifting injuries to menisci. In addition, the authors have reported this exercise could be related to episodes of spondylolysis, i.e. an alteration of the morphology of the lumbar spine that consists of the interruption of continuity of the vertebral isthmus, avulsions of the ischial apophysis and damage of the thoracolumbar and dorsal vertebral ligaments [9].

Only 3 of the 38 studies analyzed in the review reported non-optimal lifting as the cause of the weightlifting injuries. Finally, the squat, often considered a safe exercise as long as it is performed correctly, has often caused disagreement between researchers, coaches, and athletes on what the correct technique of execution should be, in terms of depth of descent, the width of legs, speed of movement, balance position and direction of gaze. With regard to compression forces, it has been shown that they increase with increasing knee flexion.

In addition, stress on the structures close to the knee joint varies when squatting with knee flexion, hip augmentation and internal rotation of the femur (valgus stress). In addition, attention is paid to the depth of the squat, as a deeper squat causes an increase in the load on the hip and knee joints. Injuries reported in connection with squatting include weightlifting injuries to the quadriceps tendon, lacerations of the anterior cruciate ligament, and tears of the biceps femoris musculature.

1. International Powerlifting Federation. Technical Rules Book [Internet]. 2016. https://www.powerlifting-ipf.com/rulescodesinfo/technicalrules.html
2. 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 & Exercise Medicine 2018;4:e000382.
3. Clark DR, Lambert MI, Hunter AM. Muscle Activation in the Loaded Free Barbell Squat. J Strength Cond Res 2012;26:1169–78.
4. Clemons JM, Aaron C. Effect of Grip Width on the Myoelectric Activity of the Prime Movers in the Bench Press. J Strength Cond Res 1997;11:82–7.
5. Escamilla R, Francisco A, Kayes A, et al. An electromyographic analysis of sumo and conventional style deadlifts. Med Sci Sports Exerc 2002;34:682–8.
6. Escamilla RF, Francisco AC, Fleisig GS, et al. A three-dimensional biomechanical analysis of sumo and conventional style deadlifts. Med Sci Sports Exerc 2000;32:1265–75.
7. Escamilla RF, Lowry TM, Osbahr DC, et al. Biomechanical analysis of the deadlift during the 1999 Special Olympics World Games. Med Sci Sports Exerc 2001;33:1345–53.
8. Lavallee ME, Balam T. An overview of strength training injuries: acute and chronic. Curr Sports Med Rep 2010;9:307–13.
9. Gotshalk L. Sports Performance Series: Analysis of the deadlift. National Strength & Conditioning Association Journal 1984;6:4–9.