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Background: The popularity of incorporating powerlifting exercises in resistance trainingprograms for rehabilitative purposes may be increasing among health care providers.

Objectives: To review and compile the occurrence, safety, and effects of the powerliftingexercises (back squat, bench press and deadlift) in clinical treatment studies of symptomaticphysical and mental health problems.

Methods: Four databases were systematically searched in October 2023. Studies involving atleast one powerlifting exercise, performed by patients with physical and/or mental healthproblems, and investigating outcome measures affecting the health problem of the patients,were included.

Results: The fifteen included studies investigated effects on chronic low back pain, musculo-skeletal pain, anterior cruciate ligament injury, post-COVID-19, chronic fatigue syndrome, hyper-tension, pulmonary hypertension and lymphoedema caused by breast cancer treatment.

Conclusions: Although using powerlifting exercises to treat symptomatic physical and men-tal health problems appears safe, evidence of effectiveness is limited. More research isneeded to determine clinical utility

Background: Resistance training with the barbell back squat (BBS) exercise is practiced in sports, recreation, and rehabilitation. Although extensively debated, it is commonly believed and recommended that maintaining a neutral lumbopelvic alignment during BBS is an important technical aspect that might reduce the risk of injury. There is limited knowledge of how objectively measurable factors affect the extent to which the lumbopelvic region moves into flexion during a BBS.

Purpose: The aim of the study was to investigate the association among anthropometric measurements, range of motion in the hips and ankle joints, lumbopelvic movement control tests, and flexion of the lumbopelvic region during execution of the BBS.

Study design: Observational, cross sectional.

Methods: Eighteen experienced powerlifters and Olympic weightlifters were included and measurements of lumbopelvic movements were collected with inertial measurement units during BBS performed at 70 % of 1RM. Examination of anthropometric properties, range of motion in the hip and ankle joints, and lumbopelvic movement control tests were collected as independent variables. Linear regression analysis was used to investigate which independent variables were associated with lumbopelvic flexion during a BBS.

Results: The linear regression showed that a higher range of motion in ankle dorsiflexion could statistically significantly explain an increased amplitude of lumbopelvic flexion during the BBS. Anthropometrics, range of motion of the hips, and performance in lumbopelvic movement control tests did not show any statistically significant associations.

Conclusions: The results suggest that strength and conditioning professionals and clinicians who instruct and assess lifting technique in the BBS and/or use the BBS to assess performance or as an intervention should recognize that a higher range of motion in the ankle joints might affect lumbopelvic flexion during the BBS. In practice, the value of an individual assessment of lifting technique focusing on the goal of the movement should be emphasized.

Background

Low back and hip pain problems are frequent in powerlifting. There is a lack of information on the specific pain phenotypes and specific impairments in body function associated with these pain problems, as well as how to reach a clinical diagnosis relevant for powerlifters’ pain problems. Therefore, the aim was to develop a comprehensive clinical assessment protocol for pain and function in powerlifters with low back and/or hip pain and evaluate its feasibility for use in further epidemiological or clinical studies of powerlifters.

Methods

The study was conducted in two phases. In phase one, the protocol was developed according to literature regarding musculoskeletal assessment and sports injuries, and in phase two, feasibility was evaluated. Eight powerlifters with low back/hip pain were included in phase two. Four of them were examined independently by two physical therapists, and the other four were examined by one of the physical therapists. The time spent on the examination, whether the physical therapists could reach a clinical diagnosis without adding items to the protocol, and whether the two physical therapists were consistent in terms of the clinical diagnosis, were evaluated.

Results

The protocol was developed including subjective examination, physical examination, and a clinical diagnosis based mainly on signs and symptoms of associated neurophysiological pain mechanisms and the specific impairments in body functions associated with the powerlifter’s pain problem. The protocol met the feasibility criteria. The examination lasted approximately 1 h, no items needed to be added, and both physical therapists were able to make a consistent clinical diagnosis. Visual observation and alteration of movement strategy of the squat/deadlift were thought to be crucial for assessing the powerlifters’ pain problem.

Conclusions

This is the first comprehensive clinical assessment protocol developed to describe powerlifters’ pain problems/injuries with a clinical diagnosis based on the dominating neurophysiological pain mechanism and impairments in body functions. However, before use in larger studies, it is recommended that the protocol be further evaluated by a larger number of physical therapists and powerlifters to evaluate its reliability and whether the content of the protocol should be further expanded.

Objective: To systematically review the literature on the incidence, prevalence, anatomical injury localisation and risk factors in Olympic weightlifting and powerlifting.

Design: Updated systematic review, PROSPERO registration (CRD42022382364).

Data sources: Four databases (PubMed, Embase, SPORTDiscus and Web of Science) were searched on 19 February 2024.

Eligibility: Reports assessing injury incidence and prevalence in Olympic weightlifting and powerlifting, published between January 2015 and February 2024, were included in addition to reports from a previous systematic review. The ‘Quality Assessment Tool for Observational Cohort and Cross-sectional Studies’ was used to assess methodological quality.

Results: Of 1765 screened records, eight new reports were found, resulting in 17 reports in the review. 12 reports covered weightlifting and seven covered powerlifting, with two of the reports included in both categories as they addressed both sports. In weightlifting, the period prevalence of injuries during competitions was 10.7%–68%, the incidence was 2.4–3.3 injuries/1000 hours of training, and the most common injury sites were the knee, lower back, shoulder and hands/fingers. In powerlifting, one report showed a point prevalence of 70%. Injury incidence was 1.0–4.4 injuries/1000 hours of training, and the most common injury sites were the lower back/pelvis, shoulder and elbow/upper arm. Both sports showed a high prevalence of pelvic floor dysfunction (eg, urinary incontinence) among females (50%) compared with males (9.3%).

Conclusions: This updated systematic review supports the conclusions of previous reviews and shows new findings that pelvic floor dysfunction is very common in both sports. Due to the distinctly different study designs and settings, further direct comparisons between sports were difficult. In weightlifting, reports mainly focused on injuries during competitions. In powerlifting, injury incidence was low, but injury prevalence was high when defining injury as a painful condition that impairs training/competition.

Objectives: To measure lumbopelvic movement control in powerlifters with and without low back pain (LBP).

Design: Quantitative Cross-sectional.

Participants: Twelve powerlifters with LBP and 28 powerlifters without LBP.

Setting: Powerlifters were recruited in nine different cities and filmed while performing a movement control test battery.

Main outcome measures: Lumbopelvic movement control test battery consisting of seven tests, with a possible score between 0 and 13. The tests were rated by a physical therapist blinded to the group allocation and comparisons of the frequency of current/incorrect tests between groups were calculated.

Results: There was no statistically significant difference in the movement control test battery between the powerlifters with LBP (Median = 7.0, (2–11)) and powerlifters without LBP (Median = 6.0, (1–10)) (P = 0.59). There were no statistically significant differences between groups when the individual movement control tests were analyzed separately.

Conclusions: The lack of significant differences between groups indicates that performance in lumbopelvic movement control test might not be associated with LBP in powerlifters. More studies on associations between LBP and movement control and other body functions are needed to guide assessment and treatment of powerlifters with LBP and for investigation of possible risk factors for LBP in powerlifters.

Chronic low back pain (CLBP) presents a significant challenge in healthcare, re-quiring effective tools for rehabilitation and assessment. This study explores the use of virtual reality (VR) for assessment of physical function in patients with CLBP, and investigates how movements and tasks can be designed for assessment purposes. The focus is on physiotherapists' perceptions of using VR regarding task design, feasibility, and user experience. We conducted three design workshops with physiotherapists and HCI researchers, and designed three VR applications that we evaluated with six physiotherapy students. The study provides valuable insights into participants' perceptions and highlights promising and challenging aspects of using VR in physiotherapy assessment. We found the approach to be useful and have potential. However, additional focus is needed on task design, measures of physical function, and designing for body size diversity. This study lays the groundwork for designing physiotherapeutic assessment of patients with CLBP.

Research on risk factors and injuries in powerlifting has so far only been studied through cross-sectional/observational studies. In other sports, training load has been prospectively investigated and shown to influence injury risk. However, no method to quantify training load in powerlifting exist. The purpose of this study was to assess the feasibility of a novel standardized method for prospective recording of training load and injuries. The study was conducted in two phases with eight powerlifters initially included in each phase respectively. In Phase 1, the powerlifters registered training load and injuries throughout four weeks and answered a feasibility questionnaire. Based on the results from the questionnaire, updates to the training and injury log were made and the powerlifters in Phase 2 used the updated version to log four weeks of training. Training load and injuries were reported consistently which made calculations on training load and injury incidence possible. The participants reported rate of perceived exertion as difficult to assess and report. However, 9/12 powerlifters stated that they could the training and injury log for a period of at least six months. In conclusion, this standardized training and injury log seems to be a feasible method to quantify training load and injuries in powerlifting. The method could be used in further prospective studies on training load and injuries in powerlifting and in clinical practice.

Background:  Maintaining neutral spinal alignment is considered important when performing the barbell back squat exercise. Since male and female lifters may differ in injury location it is important to examine whether they differ in spinal alignment during the back squat.

Objectives:  The study aimed to quantify the spinal alignment in the upper and lower lumbar spine during the barbell back squat exercise in male and female lifters. Secondary aims were to compare alignment during the back squat to standing habitual lumbar spine alignment and determine whether male and female lifters differ in these aspects.

Study design:  Observational, Cross-sectional.

Methods:  Competitive power- and weightlifters were recruited and performed three repetitions of the barbell back squat exercise using a load equivalent to 70% of their one-repetition maximum. Spinal alignment and range of motion were measured using inertial measurement units placed on the thoracic, lumbar and sacral spine. Data was presented descriptively and comparisons between men and women as well as spinal alignment in four different positions were done with a factorial repeated measures analysis of variance.

Results:  Twenty-three (14 males, 9 females) were included. During execution of the squat, spinal alignment adjustments in the lumbar spine were made in all three planes of movement, compared to the start position, in both male and female lifters. Compared to their standing habitual posture, all lifters adjusted their upper lumbar spine to a less lordotic position when in the start position of the back squat (standing upright with the barbell on their back). Only male lifters assumed a less lordotic alignment in their lower lumbar spine in the start position compared their habitual posture.

Conclusions:  Adjustments of spinal alignment, predominantly in the sagittal plane, are made during execution of the back squat in both male and female lifters. Further, lifters adopt a less lordotic alignment with a heavy barbell on their upper back, more so in male than female lifters. In conclusion, it seems that spinal alignment changes noticeably during the barbell back squat.

Level of evidence:  3

Background: A neutral spinal alignment is considered important during the execution of the deadlift exercise to decrease the risk of injury. Since male and female powerlifters experience pain in different parts of their backs, it is important to examine whether men and women differ in spinal alignment during the deadlift.

Objectives: The purpose of this study was to quantify the spinal alignment in the upper (thoracolumbar, T11-L2) and lower (lumbopelvic, L2-S2) lumbar spine during the deadlift exercise in male and female lifters. Secondary aims were to compare lumbar spine alignment during the deadlift to standing habitual posture, and determine whether male and female lifters differ in these aspects.

Study Design: Observational, Cross-sectional.

Methods: Twenty-four (14 men, 10 women) lifters performed three repetitions of the deadlift exercise using 70% of their respective one-repetition maximum. Spinal alignment and spinal range of motion were measured using three inertial measurement units placed on the thoracic, lumbar and sacral spine. Data from three different positions were analyzed; habitual posture in standing, and start and stop positions of the deadlift, i.e. bottom and finish position respectively.

Results: During the deadlift, spinal adjustments were evident in all three planes of movement. From standing habitual posture to the start position the lumbar lordosis decreased 13° in the upper and 20° in the lower lumbar spine. From start position to stop position the total range of motion in the sagittal plane was 11° in the upper and 22° in the lower lumbar spine. The decreased lumbar lordosis from standing habitual posture to the start position was significantly greater among men.

Conclusions: Men and women adjust their spinal alignment in all three planes of movement when performing a deadlift and men seem to make greater adjustments from their standing habitual posture to start position in the sagittal plane. Level of Evidence 3.

The aims of the study were to evaluate the relative and absolute variability of upper (T11-L2) and lower (L2-S2) lumbar spinal alignment in power- and weightlifters during the deadlift and back squat exercises, and to compare this alignment between the two lifting groups. Twenty-four competitive powerlifters (n = 14) and weightlifters (n = 10) performed three repetitions of the deadlift and the back squat exercises using a load equivalent to 70% of their respective one-repetition maximum. The main outcome measures were the three-dimensional lumbar spinal alignment for start position, minimum and maximum angle of their spinal alignment, and range of motion measured using inertial measurement units. Relative intra-trial reliability was calculated using the two-way random model intraclass correlation coefficient (ICC) and absolute reliability with minimal detectable change (MDC). The ICC ranged between 0.69 and 0.99 and the MDC between 1 degrees-8 degrees for the deadlift. Corresponding figures for the squat were 0.78-0.99 and 1 degrees-6 degrees. In all participants during both exercises, spinal adjustments were made in both thoracolumbar and lumbopelvic areas in all three dimensions. In conclusion, when performing three repetitions of the deadlift and the squat, lumbar spinal alignment of the lifters did not change much between repetitions and did not differ significantly between power- and weightlifters.