Powerlifting/Injuries

Injury Modifications

4 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Knee

Knee issues in powerlifting typically arise from squat-related stress. Common problems include patellar tendinopathy, meniscus irritation, and general anterior knee pain. Most issues respond well to load management and targeted strengthening.

When to Seek Professional Care

  • →Locking or catching in the joint
  • →Giving way or instability
  • →Significant swelling that doesn't resolve
  • →Pain persists beyond 4 weeks despite modifications
  • →History of ACL, meniscus, or other knee surgery
  • →Sudden onset with pop or snap
  • →Inability to bear weight

General Principles

  • •Knee sleeves provide warmth and proprioceptive feedback - use them
  • •Quad strength protects the knee - don't neglect isolation work
  • •VMO (inner quad) weakness is common - target it specifically
  • •Hip strength (glutes) controls knee tracking - strengthen hips
  • •Calf and ankle mobility affect knee loading in squats
  • •Patellar tendinopathy responds to controlled loading, not rest

Contraindicated Movements

Deep squats (below parallel) when symptomaticWalking lunges (uncontrolled knee flexion)Leg extensions through full ROM with heavy weightJumping or plyometrics (moderate+)Sudden direction changes

Recommended Exercises

Terminal knee extensions (TKEs)

3 sets × 15 reps

Strengthens VMO for patellar tracking

VMO-focused leg press (narrow stance, feet low)

3 sets × 12 reps

Targets vastus medialis for knee stability

Step-ups (controlled)

3 sets × 10 reps

Builds single-leg strength with controlled loading

Nordic curls (eccentric hamstring)

3 sets × 6 reps

Eccentric hamstring strength protects the knee

Glute bridges and hip thrusts

3 sets × 15 reps

Strong glutes improve knee tracking and reduce strain

Calf raises

3 sets × 15 reps

Calf strength supports knee function

Ankle mobility work

2 sets × 10 reps

Better ankle mobility reduces compensatory knee stress

Return to Full Training

Criteria:

  • ✓Pain-free through full ROM (squat depth, stairs, kneeling)
  • ✓No swelling after training
  • ✓Full quad and glute strength
  • ✓No catching, locking, or instability

Progression:

  1. 1.Week 1-2: Box squats to tolerable depth, light weight
  2. 2.Week 3-4: Gradually increase depth, moderate weight
  3. 3.Week 5-6: Approach full depth at 70% intensity
  4. 4.Week 7+: Return to full training with ongoing prehab

Lower Back

Lower back issues are common in powerlifting due to the high loads in squat and deadlift. Most issues are muscular strain or facet joint irritation, not disc problems. Training can often continue with modifications while the back heals.

When to Seek Professional Care

  • →Radiating pain down leg (below knee especially)
  • →Numbness or tingling in legs or feet
  • →Weakness in legs (foot drop, difficulty rising from chair)
  • →Bladder or bowel dysfunction (emergency)
  • →Pain persists beyond 4 weeks despite rest and modification
  • →History of disc herniation
  • →Pain that worsens with coughing or sneezing

General Principles

  • •Core bracing protects the spine - never lift without proper brace
  • •Belt use is encouraged when symptomatic - it's a tool, not a crutch
  • •Neutral spine under load is non-negotiable
  • •Address hip mobility - tight hips transfer load to low back
  • •Sleep position matters - support lumbar curve
  • •Sitting less and moving more helps recovery

Contraindicated Movements

Goodmornings at high intensity (moderate+)Stiff-leg deadlifts (moderate+)Rounded back liftingHeavy barbell rows (moderate+)Hyperextensions with weight (moderate+)

Recommended Exercises

McGill Big 3 (bird dog, side plank, curl-up)

3 sets × 10 reps

Evidence-based core stability exercises that protect the spine

Dead bugs

3 sets × 10 reps

Builds core stability while maintaining neutral spine

Pallof press

3 sets × 10 reps

Develops anti-rotation core strength

Cat-cow mobility

2 sets × 10 reps

Promotes spinal mobility and blood flow

Hip flexor stretching

2 sets × 30 reps

Tight hip flexors contribute to lower back strain

Glute activation (bridges, clams)

3 sets × 15 reps

Strong glutes reduce lower back compensation

Walking

1 sets × 20 reps

Best low-back recovery activity - promotes healing

Return to Full Training

Criteria:

  • ✓Pain-free through full ROM (flexion, extension, rotation)
  • ✓Can complete all daily activities without discomfort
  • ✓Core stability restored (passing McGill tests)
  • ✓No pain during or after 2 consecutive light sessions

Progression:

  1. 1.Week 1: Light movement patterns, no loading
  2. 2.Week 2: Empty bar/light weights, rebuild volume
  3. 3.Week 3: 50% of working weights
  4. 4.Week 4: 70% of working weights
  5. 5.Week 5: 85% of working weights
  6. 6.Week 6+: Return to normal with ongoing core work

Pec Tear

Pectoralis major tears are serious injuries that occur primarily during bench pressing, especially when the bar is lowered too fast or bounced off the chest. Complete pec tears are surgical emergencies - delay in repair worsens outcomes. The pectoralis major inserts on the humerus and is maximally stressed during eccentric loading (lowering the bar) with the arm in external rotation and extension (bottom of bench press position).

Red Flags - Seek Immediate Care

  • ●Pop during bench with immediate chest deformity - COMPLETE TEAR, seek orthopedic evaluation within 24-48 hours
  • ●Asymmetric chest appearance after injury - likely complete tear
  • ●Bruising tracking down inner arm - indicates significant tear
  • ●Significant weakness in horizontal adduction - evaluate for tear
  • ●Surgical repair within 2-3 weeks has best outcomes - don't delay

When to Seek Professional Care

  • →Any suspected pec tear (pop, deformity, bruising)
  • →Significant weakness after bench injury
  • →Pain not improving after 2 weeks
  • →Any red flag symptoms

General Principles

  • •Complete pec tears need surgical repair within 2-3 weeks for best outcomes
  • •Delay in diagnosis/surgery significantly worsens surgical outcomes
  • •If you felt a pop and have asymmetric chest appearance, seek evaluation ASAP
  • •Controlled eccentric (lowering) is safer than bouncing
  • •Don't ego lift - use appropriate weight

Return to Full Training

Shoulder

Shoulder injuries in powerlifting typically arise from bench press and overhead work. Common issues include rotator cuff strain, impingement, and AC joint irritation. The goal is to maintain training while protecting the shoulder and allowing healing.

When to Seek Professional Care

  • →Pain persists beyond 2 weeks despite modifications
  • →Weakness or giving way
  • →Pain at rest or difficulty sleeping
  • →Numbness or tingling in arm
  • →History of dislocation or instability
  • →Audible pop with onset of pain
  • →Visible deformity or significant swelling

General Principles

  • •Shoulder health requires balanced pushing and pulling (2:1 pull to push ratio)
  • •Warm-up extensively before pressing - rotator cuff, scapular muscles, thoracic spine
  • •Grip width affects shoulder stress - narrow grip reduces ROM and stress
  • •Never bounce or heave the bar - control is essential
  • •Back tightness and leg drive reduce shoulder load in bench

Contraindicated Movements

Wide grip bench press (when symptomatic)Behind the neck pressUpright rowsDeep dips (below parallel when symptomatic)Heavy overhead pressing (moderate+)

Recommended Exercises

Face pulls

3 sets × 15 reps

Strengthens external rotators to balance heavy pressing

Band pull-aparts

3 sets × 20 reps

Activates rear delts and mid-back for shoulder health

External rotation work

3 sets × 15 reps

Directly strengthens rotator cuff for bench stability

Scapular push-ups

3 sets × 15 reps

Improves scapular control for better bench setup

Thoracic spine mobility

2 sets × 10 reps

Improved thoracic extension reduces shoulder stress

Rear delt work

3 sets × 15 reps

Balances anterior deltoid dominance from pressing

Return to Full Training

Criteria:

  • ✓Pain-free through full ROM (external rotation, flexion, horizontal adduction)
  • ✓Full strength in warm-up weights
  • ✓No pain during or after 2 consecutive sessions
  • ✓Adequate rest completed (1-2 weeks at mild, 4+ weeks moderate)

Progression:

  1. 1.Week 1: Warm-up weights only, rebuild volume
  2. 2.Week 2: 70% of working weights, close grip
  3. 3.Week 3: 80% of working weights, gradually widen grip
  4. 4.Week 4: 90% of working weights, normal grip
  5. 5.Week 5+: Full training with maintenance prehab