A 10-Year Analysis of Resistance Training–Related Injuries Treated in Emergency Departments: Are Patterns Shifting With More Participation of Women Over Time?

Abstract

Coffey, K, Pezzullo, L, Nixon, RM, Bolling, J, and Vincent, HK. A 10-year analysis of resistance training-related injuries treated in emergency departments: Are patterns shifting with more participation of women over time? J Strength Cond Res 40(1): e1–e8, 2026—This study reports current sex-related injury patterns associated with resistance training–related data from the National Electronic Injury Surveillance System (NEISS). This retrospective study includes patients seeking care for “resistance training” activity as defined by NEISS, encompassing the use of weight machines, barbells, dumbbells, and kettlebells. The prevalence, type and anatomical site of injuries, and hospital outcome were compared by sex. In total, 15,348 cases were included (20.40% female; 22.8 ± 6.3 years). Females sought care more frequently than males for accidental injuries including fracture (odds ratio [OR] = 1.27 [1.11–1.46]), contusion/laceration (OR = 1.52 [1.37–1.69]) and concussion/internal injuries (OR = 2.45 [2.02–2.97]). Males had 20 and 35% greater odds for reporting to the emergency department (ED) for exertional sprains/strains and dislocations, respectively (both p <0.05). Sites more frequently treated in the ED for females were the head, leg, and ankle/foot (all p < 0.050). The trunk was the most commonly injured site for both males and females (40.5 and 31.1%, respectively). Males had more crush injuries (3.10 vs. 2.20%, respectively) and injuries related to pressing movement (7.20 vs. 3.30%, respectively; p < 0.050). Females had more injuries related to dropped equipment (18.50 vs. 12.10%, respectively), falls (8.30 vs. 5.60%, respectively), and being hit by equipment (6.1 vs. 4.10%, respectively) than males (p < 0.050). Gym environments were the most common injury sites for both sexes. Compared with earlier NEISS data, persistent sex differences exist with injury presentation in the ED, with an increase in concussions/internal injuries in females. Appropriate training regarding set-up and lift execution is critical to minimize these injuries. Prospective tracking that links specific type of lifting activity with specific injuries may provide a better understanding of how to reduce or prevent injuries.

Introduction

Resistance exercise that uses weights, such as weight machines, dumbbells, barbells, and kettlebells, is a popular sport and exercise activity in the United States. Resistance training encompasses formal Olympic, power, Strongman and other strength sports as well as any activity. For instance, resistance training, by this definition, may be second only to walking in popularity among Americans, with 8.9% of Americans aged 15 years and older reporting regular participation (31). Over 25 million Americans used free weights in 2023 (29). Subjects engage in the activity for various reasons, including support of sports activities (6,35), improving or maintaining overall health and functionality (31), reaping psychosocial benefits (28), and for competition (25,30). Many high school and collegiate athletic programs have now incorporated weightlifting into preparatory programs for other competitive sports to increase athletic performance and reduce the risk of injury (12,21,22). The National Federation of State High School Associations reported that participation in high school weightlifting teams (in this case, typically referring to Olympic weightlifting) has increased overall by 9% since 2004–05, mostly because of increased participation among girls (23).

Existing research points to sex differences in both participation and patterns of emergent injury in resistance training. During 2011–15, American men were more than twice as likely to participate in weightlifting than women (70.3 vs. 29.7%, respectively) (31). However, the demographics of subjects have been shifting since this time. For example, the sex distribution of high school weightlifters has changed dramatically, with approximately 18,751 males and 6,095 females in 2005–06, to 18,862 males and 14,001 females in 2023–24 (23). The 229% increase in female participation is an important consideration when contextualizing injury patterns, injury risks, and mechanisms of injury related to the sport. Resistance training injuries are commonly exertional (e.g., sprains or strains) or accidental (e.g., fractures or other injuries from dropped weights or improper use of equipment) (18,26). What is known is that for both men and women, the most common sites for emergent resistance training–related injuries include the trunk and shoulder (3). Sex differences in resistance training injuries have been observed, with females having lower overall acute and recurrent injures particularly with chest and thigh (17). For resistance training injuries treated in the emergency department (ED) during 1990–2010, females had higher odds of presenting with accidental injuries more often related to the foot, whereas males were more likely to experience exertional injuries (defined as sprains/strains) (18,26). Females were more likely to experience lower extremity fractures and foot injuries than males, and males were more likely to experience upper body fractures than females (12,18). For both sexes, the trunk seems to be the most commonly injured region of the body that initiates ED visits (3,26). In an analysis limited to lower-body injuries (2010–2021), there was a significant increase of lower trunk sprains and strains in both sexes (3), with males being more likely to experience lower trunk injuries than females (1). Research to date is limited in its assessment of shifts in these injury patterns over time.

Participation in resistance training is increasing among girls and young women, and sex differences in injury are already known to exist. At present, it is not clear how these injury patterns may have shifted in more recent years, and how these data may inform medical preparedness and safety considerations particularly for girls and young women. Hence, the purpose of this study was to update the evidence and expand insight regarding weightlifting injuries treated in EDs during 2013–22 in individuals aged 14–35 years. Our hypotheses are grounded in the possibility that earlier injury patterns reflected differences in the average athlete's level of experience, fitness, and access to training and supervision among females vs. males. As female participation has increased over time, it may be that the average female athlete has become more technically experienced, has better access to (or willingness to seek out) coaching, and/or is more likely to practice resistance exercise in a supervised space such as an organized class or school team. Compared with previously published ED data (26). we hypothesized that: (a) females would experience an overall higher occurrence of resistance training injuries during 2013–22 with more similar distribution to that of males (exertional injuries such as sprains, strains), and (b) females would have similar injury prevalence to males in supervised resistance training settings (school, practice, class) vs. unsupervised settings (home, gym).

Methods

Experimental Approach to the Problem

This was a retrospective epidemiologic study using the National Electronic Injury Surveillance System (NEISS), a database compiled by the US Consumer Product Safety Commission. AS defined by NEISS, patients admitted for “weightlifting” and equipment-related injuries to NEISS participating hospitals were extracted from January 1, 2013 to December 31, 2022. From this point on, the term weight lifting will be replaced by resistance training to better reflect the sport terminology. An estimated 100 hospitals with a 6-bed minimum and a 24-hour operating ED represented a stratified probability sample from which data were collected. A statistical sample weight based on the inverse probability of selection was assigned for each ED, enabling calculations of national injury estimates (NEs) across the US using the NEISS cases. The database was queried for related cases and data were pooled in Excel (Microsoft, Redmond, WA). Variables included age, sex, injury setting and diagnosis, hospital admission status, the location where the injury occurred and narratives providing additional detail of the incident.

Subjects

These data are publicly available and de-identified. The university Institutional Review Board deemed this study ‘non-human' and therefore did not require board approval (IRB determination #NH00046612). Of the available 24,017 cases initially captured related to weightlifting, 15,347 of patients aged 14–35 years (high school-young adult up to the “masters” division) were included to best capture injuries most relevant to the sport (26). The inclusion criteria were as follows: incurred injury due direct result of participating in the activity of resistance training, aged 14–35 years, both sexes, all types of weight lifting sports. Exclusion criteria: aged <14 or >35 years, injured without direct involvement of resistance training-related activity or equipment, or injuries that involved burns, fires, alcohol, or drug use. Furthermore, cases were excluded if the injury occurred in circumstances that were unrelated to weight lifting participation (e.g., tripping on a dumbbell while doing work in a garage, having weight or bar dropped on foot while observing others in training, and experiencing lacerations from a piece of glass present in the resistance training area).

Procedures

The database was queried for related cases and data were pooled in Excel (Microsoft). Two members of the study team reviewed each of the 24,017 cases to confirm that these were all directly related to participation in resistance training activity. If there was a discrepancy in agreement of the 2 reviewers of a case, a third arbitrated to make the decision for inclusion or not. Variables included ages, sex, injury location, and diagnosis. Clinical narratives associated with each case were reviewed. Two team members were assigned the case narrative review to determine the appropriateness of inclusion into the analysis based on any additional narrative details. Using the definitions and codes from the NEISS manual, the anatomical locations of injury were collapsed into main groups: head (face, mouth, eye, head, neck), arm (shoulder, upper and lower arm), hand and wrist (includes finger), leg (upper and lower leg), ankle and foot (including toes), and all body parts (a NEISS established code). Based on the predefined NEISS injury diagnoses, diagnoses were simplified into 6 groups: exertional injuries such as sprains and strains and accidental injuries such as contusions and lacerations, fractures (stress fracture or acute), joint dislocations, and internal injury/concussion.

Based on available narrative data, the environmental setting in which the injury occurred was classified into 5 general categories: school, practice, class, gym facility, or home. If no details were provided or the setting was labeled “unknown,” it was considered “unspecified.” Although supervision level was not provided directly in the narratives, most U.S. states require certified coaches or trained adult staff to be physically present at all times to actively supervise students in school settings where practices and classes commonly occur. As such, we defined here direct supervised weight lifting settings to be school (when practices, classes occurred) and unsupervised settings were home and the gym/general sports facilities. Language coding was used to identify mechanisms of injury, and keywords included “dropped,” “hit,” “fell” (and “tripped and fell”), “crushed,” “press” or “pressed,” and “pulling.” If resistance training equipment was specified in the narrative, we grouped these into: “barbell” or “bar,” “dumbbell,” kettlebell.” After the first coding process to capture details on environment and mechanisms, 1 reviewer manually reviewed the data capture of the codes to ensure that data were accurate before statistical analysis.

Statistical Analyses

All analyses were performed using SPSS v. 29 (IRB, Armonk, NY). To test our first hypothesis, linear regression models were developed to illustrate trends in injury incidence over 10 years in males and females. The dependent variable was the weighted estimate, and the independent variable was the year. Pearson's Chi-square tests (χ²) were used to determine if the proportions differ by sex for injury type, location, injury mechanism, equipment, and hospital disposition. Phi coefficients (ɸ) were used to determine effect sizes for sex effects on categorical variables; values >0.05 indicate weak effects, >0.10 is considered moderate, >0.15 is strong, and >0.25 are strong effects (2). Cohen's d values were used to determine effect sizes of sex difference in continuous variables such as age; values were classified as small (0.20), medium (0.50), and large (0.80) (5). Binary logistic regression was used to clarify the sex differences in injury type and to estimate the odds ratio (OR) and associated 95% confidence interval (CI) for the location and type of injury, where males were the reference. To test the second hypothesis, χ² test was used to test whether the proportions of injuries differed by weightlifting setting between sexes. The level of statistical significance was established at p < 0.05 for all tests.

Results

Patient Characteristics

A total of 15,348 patients (3,140 females and 12,208 males) between the ages of 14 and 35 years sought treatment at participating NEISS EDs between January 1, 2013, and December 31, 2022, met the criteria for this analysis. Table 1 provides the characteristics of this group. Overall, females represented 20.5% of the population. A total of 1.90% more males than females were younger than 18 years (p = 0.030). The proportions reported were different between sexes (p < 0.050).

Table 1.

Characteristics of the sample population.^*

	Males	Females	ES	Males	Females
				NE	NE
Cases	12,208	3,140		483,231	125,353
Age (y)	22.76 ± 6.30	22.93 ± 6.31	0.030	—	—
<18 y (n, %)†	3,509 (28.70)	841 (26.80)	0.018	137,638	33,174
Race (n, %)†
Asian	258 (2.10)	51 (1.60)		9,624	2,133
African-American	2001 (16.40)	504 (16.10)		77,220	19,913
Caucasian	4,453 (36.50)	1,239 (39.50)		186,430	51,291
Other	766 (6.30)	157 (5.00)	0.033	30,173	8,513
Other/not specified	4,730 (38.70)	1,189 (37.90)	0.040	177,457	45,692

^*Values are raw scores (NEISS cases) and national estimates (NE).

^†Different distributions between males and females at p < 0.05. ES = effect size, ɸ for age, and Cohen's d for age.

Injuries by Year

Figure 1A, B depict the NE values for total injuries and sprains/strains by sex over 2013–22. Annual incidence of injuries and sprains/strains alone were reduced for men over the 10 years (p = 0.620), but these did not reach statistical significance (p = 0.520). For females, the regression lines indicated a slight elevation in injury incidence for injuries overall, but a small reduction in annual sprains/strains during this period. For both males and females, the lowest injury incidence occurred during the 2020 pandemic year.

Figure 1.

National estimates (NE) for total weightlifting and related equipment injuries during 2013–22. NE are shown by sex.

Injury Prevalence and Location

Sprain/strain and other specific injury prevalence are shown in Table 2. Women had significantly lower odds of sprains and strains (p < 0.001, OR = 0.80; 95% CI = 0.73 to 0.87) than men. For other injury types, females presented to the ED with fewer dislocations. However, the OR for females to incur fractures and contusions and lacerations were 1.27 (95% CI, 1.11–1.46) and 1.52 (95% CI, 1.37–1.69), respectively (both p < 0.050). Women were more likely to experience concussions and internal injuries than men (p < 0.001; OR 2.58; 95% CI, 2.31–2.87). There were no sex differences in the proportion of wrist and hand injuries.

Table 2.

Sprains and strains and other injuries related to weight training expressed as cases and by NE.^*

	Males	Females	p	ɸ
	(n = 12,208)	(n = 3,140)
Exertion-related
Sprains and strains (n, %)	4,305 (35.50)	950 (30.30)	<0.001	0.043
NE values	172,933	38,585
OR [95% CI]	Reference	0.80 [0.73–0.87]	<0.001
Accidental and other specific injuries
Fracture (n, %)	958 (7.80)	307 (9.80)	<0.001	0.028
NE values	37,805	13,404
OR [95% CI]	Reference	1.27 [1.11–1.46]	<0.001
Dislocation (n, %)	273 (2.2)	44 (1.40)	0.003	0.024
NE values	10,211	1,800
OR [95% CI]	Reference	0.65 [0.45–0.86]	0.004
Contusions and lacerations (n, %)	1,580 (12.9)	580 (18.50)	<0.001	0.064
NE values	64,117	22,435
OR [95% CI]	Reference	1.52 [1.37–1.69]	0.004
Internal injury and concussion (n, %)	287 (2.4)	175 (5.60)	<0.001	0.076
NE values	10,446	7,337
OR [95% CI]	Reference	2.45 [2.02–2.97]	<0.001

^*OR [95% CI] for injury are presented, with males as reference. NE = national injury estimates; OR = odds ratio; CI = confidence interval.

The injury locations are presented in Table 3 and summarized in Figure 2. The trunk was the most commonly injured body part for men (40.10%) and women (31.10%). Compared with males, females had significantly lesser OR for trunk injuries (p < 0.001; OR 0.66; 95% CI, 0.61–0.72) and arm injuries (p < 0.001; OR 0.68; 95% CI, 0.61–0.76). However, females demonstrated 39.20% greater odds for head injuries, 24.70% greater odds for leg injuries, and 2.5 times the odds of an ankle and foot injury (p < 0.001; OR 2.58; 95% CI, 2.31–2.87). Location was not specified in 250 cases for men and 56 for women. Figure 3 provides available details of the potential mechanisms involved in the injury extracted from narratives. Females had more injuries involving being hit by equipment, falling and dropping equipment (all p < 0.050). Males had nearly twice the injuries associated with a press motion compared with females (p < 0.050). Females had more injuries involving bars or barbells (15.9 vs. 13.8%), kettlebells (0.80 vs. 0.10%), and dumbbells (3.40 vs. 2.00%; all p < 0.050) than males.

Table 3.

NEISS case number and percentage of injuries at each body location for females and males.^*

	Total	Male	Female	p	ɸ
	(N = 15,345)	(n = 12,208)	(n = 3,140)
Head	1715 (11.2)	1,276 (10.50)	439 (14.00)	<0.001	0.045
OR [95% CI]		Reference	1.39 [1.24–1.56]	<0.001
Trunk	5,915 (38.5)	4,939 (40.50)	976 (31.10)	<0.001	0.078
OR [95% CI]		Reference	0.66 [0.61–0.72]	<0.001
Leg	714 (4.7)	542 (4.40)	72 (5.50)	0.014	0.020
OR [95% CI]		Reference	1.25 [1.05–1.49]	<0.001
Arm	2,896 (18.9)	2,438 (20.00)	458 (14.60)	<0.001	0.056
OR [95% CI]		Reference	0.68 [0.61–0.76]	<0.001
Wrist, hand	2073 (13.5)	1,669 (13.70)	404 (12.90)	0.345	0.010
OR [95% CI]		Reference	0.93 [0.83–1.05]	0.239
Ankle, foot	1729 (11.3)	1,094 (9.00)	635 (20.20)	<0.001	0.114
OR [95% CI]		Reference	2.58 [2.31–2.87]	<0.001

^*OR [95% CI] for injury are presented, with males as reference. NEISS = National Electronic Injury Surveillance System; OR = odds ratio; CI = confidence interval.

Figure 2.

Prevalence of injury by sex. Values are expressed in percent.

Figure 3.

Specific mechanisms involved in the injury description. Values are expressed in percent.

Setting of the Injury

Any information available from the narratives was categorized to identify patterns regarding the setting where the injury occurred. Although 41% of cases did not include specifics for injury setting, Table 4 provides the available data. Females incurred injuries more frequently in a school, class, or gym setting than males, but fewer injuries in “practice” settings (all p < 0.050).

Table 4.

Setting of injury.^*

	Males	Females	p	ɸ
	(n = 12,208)	(n = 3,140)
School	610 (5.00)	218 (6.90)	<0.001	0.035
Practice	106 (0.90)	15 (0.50)	0.027	0.018
Class	160 (1.30)	108 (3.40)	<0.001	0.066
Gym/sports facilities	2,552 (20.90)	810 (25.80)	<0.001	0.048
Home	291 (2.40)	83 (2.60)	0.400	0.007

^*Values are NEISS cases and percentages. NEISS = National Electronic Injury Surveillance System.

Treatment and Disposition

Most cases were treated in the ED and discharged (96.50% females, 95.70% males). A total of 291 cases of males (2.40%) and 52 cases of females (1.70%) were treated and admitted. The remainder of the cases were treated and transferred, held for observation, or left without being seen. Only 1 fatality occurred (33-year-old man who had a myocardial infarction in the ED) and 1 case was not specified.

Discussion

These findings update the existing evidence related to resistance training–related injuries treated in ED during 2013–22 among individuals aged 14–35 years. The main findings of this study were that musculoskeletal injury prevalence decreased for men over 10 years for total injuries and sprains/strains alone. The distributions of injuries were different between sexes, with females incurring more head, leg, and ankle and foot injuries than men, with more of these as fractures, contusions and lacerations, and internal and head injuries. Being hit or experiencing equipment drops and falls were more common in females than males during this time frame. Despite 2,862 more females in this dataset than earlier NEISS data (26), our findings indicate persistent sex differences with injury presentation in the ED. Moreover, females experienced more injuries in school, class, and gym settings than males. As such, our hypotheses were not fully supported by these data.

Female injuries comprised 20.5% of the current data set compared with 16.50% of the previous analysis, consistent with increased female participation (26), although a lack of directly corresponding participation precludes measurement of the risk of injury relative to participation. Among injured patients, males were more likely than females to experience exertional injuries. Female OR for exertional injury (sprains and strains) remains lower, at 0.80, compared with males, whereas fractures, contusions and lacerations, and concussions are elevated in the range of 1.27–2.45. Males incurred injury nearly twice as often during pressing motions; pressing motions are involved in several key lifts across resistance training disciplines (bench press, shoulder overhead press). It has been suggested that exertional, compressive loads may have been excessive for traditionally non–load-bearing joints like the shoulder (17). Moreover, some evidence shows that male resistance trained athletes report that 18–35% of their injuries were because of “overly heavy loads” or “too vigorous” intensity (7,34). Overall, male and female exercise preferences continue to differ, including layout of the training facility, type of exercise performed (machines, free weights), and proximity to training next to males (32,33). Injuries may have taken place while the subject was exercising near weight equipment, but was not, herself, using weights: the narratives do not always provide enough detail to judge whether the weight equipment was “involved” rather than “in use.” Another possibility is that education is lagging behind participation shifts. Depending on resistance training discipline and level of experience, female lifters may face barriers to important safety knowledge such as how to choose an appropriate amount of weight, lift with proper form, and safely fail a lift. These errors may contribute to acute injuries. Alternatively, a proportion of females may select suboptimal resistance loads (9), report higher set repetition structure, and use of multiset programs (27), which may offset injury risk altogether or contribute to chronic issues over time. As overall participation in resistance training–related activities continues to rise, an increased level of instruction and supervision may be needed in gyms and fitness centers with resistance training equipment to address this gender gap in weight lifting safety, particularly for those new to the activity. Certified strength and conditioning specialists offer critical guidance on strength program design, implementation, modification of volume, and safe execution of lifts. As such, these qualified professionals can help minimize sport injury or mitigate injury risk (24). Health care practitioners who recommend strength training for its health benefits should consider doing so while connecting patients with appropriate safety information, or with qualified professionals or instructors to ensure appropriate biomechanical technique and training loads—particularly among adolescents (8).

Although more females participated in resistance training activity compared with years prior, the injury pattern by anatomic location has not become more similar to that of males over time. We observed over twice as many head injuries, 3.70% more trunk injuries, and 6.3% fewer ankle/foot injuries in women than men from 2002 to 2005. Quatman et al. (26) reported that 36.9% of male injuries and 27.40% of female injuries were to the trunk. In the present study, the trunk remains the most commonly injured body part across both sexes presenting to the ED, with prevalence at 38.5% in our current data. In other studies and reviews, trunk injuries have been identified as the most common site or among the most common sites in gym subjects (11,14,16). Although it is reasonable to surmise that trunk injuries may broadly represent the spine, the trunk term actually encompasses a wide range of locations in the trunk itself and may not necessarily include the spine. Notably, the narrative data revealed that general terms of “lumbar,” “thoracic,” and “cervical” accounted for 14.40, 3.20, and 0.20% of the cases, the “lower back” and “upper back” comprised 17.50 and 3.30% of cases, and the pelvis and sacrum comprised 0.20 and 1.70% of cases. “Chest” and “abdomen” were involved in 26.80 and 1.30% of trunk injuries. Therefore, these trunk locations may reflect a variety of injury mechanisms involving both soft and bony tissues. Unfortunately, these data do not provide consistent narrative granularity to determine whether the patients are becoming injured with specific types of resistance training, such as powerlifting or bodybuilding, strongman, or general training for health and duration of training sessions. These details could improve the interpretation of our findings because each type focuses on different movements and training strategies. These differences include resistance loads, rest periods, and variations of free-weight equipment use or positioning. Systematic reviews have shown wide variation in injury prevalence by lifting activity type (16–90%), and these differences were attributed to training approaches across the strength training type (17). For example, some approaches focus on maximal weight lifts from a few exercises only, others involve explosive lifts from the floor to an overhead position, some consist of high-intensity rapid succession lifts and power movements. whereas others focus on regular high-intensity single-joint or multijoint exercises to induce hypertrophy for aesthetics. Each approach carries different injury risks. Training session time is related to injury type; recent data show that longer gym sessions compared with shorter (>2 hours vs. <1 hour) were associated with strain/muscle rupture/tear, dislocation, and subluxation (14).

Injury risk was lower in both sexes in supervised settings vs. unsupervised settings. For the cases that included information on the setting where the injury occurred, only 23.60% of male injuries and 27.6% of female injuries occurred in supervised settings. This is consistent with prior data which suggests that resistance training activity performed in supervised settings carries a lower risk of injury than unsupervised, particularly among young weightlifters (3). A concerning finding from our analysis was the relatively high proportion of concussions in females. Of note, our secondary χ² analysis revealed that 40% of these occurred in gym facilities. Future prospective tracking of the types of activities leading to these injuries is the logical next step, with commensurate development of enhanced instruction protocols and/or risk management to reduce risks common to both sexes.

There are limitations that deserve comment. The data reported here are limited to injuries that were reported during visits to U.S. ED. With the rapidly rising popularity and availability of urgent care medical facilities (13), it is probable that many resistance training injuries were treated at facilities outside of the hospital and therefore not captured in this data set. It is also unknown how many resistance training injuries sustained by young adults in the United States have gone untreated because of aversion to health care settings, lack of insurance coverage, and lack of awareness of the injury's seriousness. Although these data set provided a good sample size to analyze sex differences in resistance training injuries, it is unknown if the data are truly representative of the adolescent and young adult sport population in the United States. The dataset does not specify whether the resistance training activity was of a specific subset of activities, such as power lifting, bodybuilding, or training for health reasons. Moreover, we did not have consistent details regarding the specific setting for all accidental injuries. There is also some anatomical ambiguity: In the NEISS dataset, “trunk” refers to injuries affecting any tissues of the body from the esophagus to the pelvis, excluding the shoulders. Although this makes it a broad category, injuries to the trunk are comparatively less common in other sports reported in the NEISS, such as water polo (10), tennis (4), and American football (19), so this prevalence is pertinent to report. These are considerable limitations, particularly when interpreting sex differences in injury patterns and related mechanisms. Future studies should carefully document the type of lifting performed, the action involved, the training experience of the lifter, and the presence of safety spotters. Thorough research of these injury patterns in the future will also guide efforts to make the weight training space safe for both males and females. Resistance training injures among females aged 14–35 years seem to have increased modestly over time compared with earlier studies. Despite this growth, young women are less likely than young men to experience exertional injuries, but more likely than young men to experience most types of accidental injuries. The trunk is the most commonly injured site with resistance training across both sexes. Finally, supervised settings seem to carry a lower risk of weightlifting injuries than unsupervised settings across both sexes. Education regarding proper set-up and execution of lifts is critical to minimize these injuries. Prospective tracking that links specific type of lifting activity (e.g., powerlifting, bodybuilding) with specific injuries may provide a better understanding of how to reduce or prevent injuries in the future.

Practical Applications

There are several practical applications of this work. First, the relatively high proportion of trunk and ankle/foot injuries for both males and females indicates the need to implement methods to lower these risks that connect the kinetic chain. Certified strength professionals can help athletes modify program content to optimize core strength and dynamic stability along the kinetic chain. Determination of deficits in volitional muscle contraction, isometric muscle endurance, stabilization, and movement patterns can be followed by multiplanar training of the muscles involved in load transfer, stabilization, and mobilization can support lifting motion (15). These muscles may include but are not limited to the hip abductors/adductors and rotators, glutes, abdominis, obliques, and multifidus. Second, professionals who work closely with female and developing strength athletes need to create or provide better education on correct spotting methods and overhead lifting technique to help reduce head and internal injuries, especially among females. Education can consist of hands-on workshops, small group seminars in the training space, or short videos, so that these individuals acquire a strong understanding of safe lifting, accidental injury avoidance (e.g., drops, falls), and of being an effective support for others in a strength training environment. Third, in gym facilities (where the injury rate was highest among all settings), safety could be enhanced with more direct supervision by trained staff in active lifting areas. Staff can have immediate and direct benefits for spotting, correcting form if deficits are observed, ensuring use of barbell collars, enforcing safe methods of returning loaded barbells or weights to original positions after use, and reducing distractions in active areas that could lead to tripping or falls.