One of the worst nightmares of any powerlifter is being injured.
We train so hard and put all this time and effort into our pursuit of strength, just to be derailed by stubborn back or knee pain. If you are in this sport long enough, you are bound to be injured at some point.
So how do we manage injuries if you are a powerlifter? Recovering from aches, pains, and injuries requires a careful approach that is primarily focused on long term solutions with short term interventions used as needed.
The Long Long term solutions include:
- Volume & loading
- Exercise selection
- Overall Technique
- Sleep, Nutrition, & External stress
- Amount of Daily Activity
- Mental Approach
Short term interventions include:
- Proper warm-up
- Recovery Tools
- Supportive Equipment
There is no magic solution or one size fits all approach, but rather a holistic approach to managing the variables that affect your recovery and training. Where most people go wrong is they mainly focus on the short term interventions rather than the long term solutions. Let’s first take a look at what is an “injury”, and then dive into what the long term solutions and short term interventions entail.
What Is An Injury? (Overuse vs Acute Injuries)
Before reading on, there must be one thing that we all understand as a fact of injury:
Any injury is a result of a tissue being pushed past its tolerable limits, whether that be from overuse or some acute overload.
Powerlifting injuries fall into the overuse category, as pain builds over time as we continue pushing the tissues past its tolerable limits. Overuse injuries usually start out as a very slight ache or pain but go from being a slight nuisance to being chronic pain that requires us to back off of our normal training.
An acute overload injury, on the other hand, tends to be more traumatic, such as a pec tear or quad tendon rupture. These tissues very well may have already been in the overuse category and pushed so far that acute overload damage occurred, but either way, these injuries are much more significant and require a lot more work to rehabilitate than will be covered in this article.
But, what I will discuss is the ability to hopefully stay clear from acute traumatic injuries by managing your training and recovery adequately from the start.
So how do we manage these injuries?
First and foremost we must take a look at our training as a whole and make the long term adjustments needed to find the tolerable limits that will allow us to train pain-free.
Long Term Solutions
As powerlifters we are in a constant battle of inducing stress upon the body through our training and external activity, while at the same time trying to recover from the training through adequate rest, sleep, and nutrition. Each one of these variables plays a role in the possible development of an injury and the recovery from it, so let’s take a look at the different training and external variables that play a role.
Volume & Loading
As mentioned above, the primary reason an injury occurs is due to a tissue being pushed past its tolerable limits. So, one of the first places we should look at is our training.
To put it simply, are we doing too much?
If there has been a slow build up of pain over time that you would now consider chronic, I would say you should be taking a hard look at your training volume and loading as the possible cause.
What do I mean by volume and loading?
Typically injuries can be pinpointed towards whether it is more volume induced or intensity induced. Does pain occur all the time, or does it occur mainly once you reach a certain weight?
Now it usually is a mixture of both, but we should be mindful of when pain occurs and dictate training adjustments based on that. There are other variables that play into this that we will touch on later, but I have found the solution as simple at times as adjusting someone’s weekly volume from 18 sets to 15 sets, or maybe having them work below 80% of their 1RM for 3-4 weeks before building back up. But it does not always work out that perfect, especially when it has become chronic.
When dealing with chronic pain, we need to take an even more conservative approach.
Think of our training and tissue’s tolerable workload as a bucket that you are filling water. More stress, whether through training or outside of the gym, adds more water to the bucket. Whereas recovery methods help to reduce the water being added. If we train past our capabilities and start to overflow the bucket, we can start to experience pain. Whereas if we train at the correct volume and loading, our bucket is full but with a little bit of room, and we are able to train pain-free.
Typically our goal is to train with just a little bit of room left in the bucket so we can attain maximal results while being pain-free. But if we overflow that bucket for too long not only is there too much water but now the bucket actually starts to get smaller. We can no longer train at our normal tolerable limits, as that doesn’t allow us to get out of pain, so we must drop even further to fully recover. And then once we do recover, we can then work to build that back up.
But what adds to the difficulty of this is the amount of “water” going into that bucket is always changing based on all the other variables. There is never a time where you will know exactly what the amount is, but rather must take all the precautions you can to make sure the other variables are aiding in the recovery and minimizing added stress.
Related Article: 5 Best Squat Shoes For Knee Pain
When it comes to exercise selection and injuries, I have a general rule: If the achiness or pain stems from a specific exercise that is not your competition squat, bench press, or deadlift, then remove it. If the pain stems from your competition squat, bench press, or deadlift though, then we will need to take a look at the other variables.
Are there certain exercises that are just inherently bad for you?
In my opinion, no.
Everyone is different based on their biomechanics and some exercises just seem to cause some people issues while others feel great. So saying something like “front squats will usually cause knee pain because it requires more knee flexion” is incorrect.
It really just comes down to the individual, but if you find some specific variation or accessory continues to correlate with achiness or pain, simply switch it out for something else. As powerlifters, there are only three movements we are required to do and that is the competition squat, bench press, and deadlift.
Technique can play a large role when it comes to aches, pains, and injuries, but the role is a bit different than most people realize. Many people think that bad technique will cause injuries, but that is not necessarily true.
Remember what I said earlier, in that “all injuries are a result of a tissue being pushed past its tolerable limits, whether that be from overuse or some acute overload”.
The role technique plays is being a primary variable in the level of workload we can handle. The more efficient our form and technique is, the higher the levels of volume and loading we can handle. Efficient technique allows the body to distribute tension and workload efficiently to all the working muscle groups and allows us to expend the least effort to do the most work. So when we improve our technique, we are also improving our ability to handle more training stress.
This is the reason the person at the gym with a form that makes you cringe is not immediately getting injured. Because in some manner they are actually staying within their tolerable limits of workload. This is not to downplay technique by any means though, as it is vitally important to improving strength and long term injury resiliency. The point is that technique alone does not cause injury, but rather dictates your ability to handle more or less training stress.
Sleep, Nutrition, and External Stress
We have covered training variables, but external variables play a huge role in your recovery, with none being more important than sleep and nutrition. As mentioned before, we must take a holistic view to see what causes our aches and pains.
There have been countless times I have had athletes I coach have acute flare-ups of pain while running similar volumes and intensities that they have been working through pain-free for months. But after diving deeper we find that the week of the pain flare-ups they did not sleep very well or maybe they were not able to adhere to their normal diet.
It is well known that how much sleep you get plays a large role in recovery, but the position we sleep in too can make a big difference. I have experienced countless athletes who were experiencing shoulder and back issues and as we dug deeper it could be traced back to how they slept. Maybe they slept on a really bad mattress that caused significant lateral flexion of the spine for all 8 hours of sleep. Or maybe they always slept with one arm outstretched above their head and found they had chronic tightness in that trap that referred pain down to the shoulder. Either way, not only do we need a sufficient amount of sleep, but we also need to make sure how we sleep is correct.
And lastly, while sleep and nutrition are our main forms of recovery outside of the gym, our personal life can pull us in the opposite direction and be an added stressor. With the bucket analogy, we also need to account for external stress outside of the gym such as relationship issues, work problems, and any other external variables that are added stress into our life. We might have everything perfect when it comes to our training and recovery, but then we have a significant life stressor that adds more water to the bucket and starts that overflow. Personal life struggles are going to happen, and we just need to make sure to account for these times of added stress within the variables of our training and recovery.
As mentioned, as powerlifters we are in a constant battle of inducing stress and then trying to recover from it, so if our recovery is hindered we will not be able to handle the same stress that we usually do. So before making any drastic changes to your training, first make sure the recovery variables of sleep and nutrition are maximized.
Amount of Daily Activity
This is a less talked about external variable, but many times I have had this come into play.
For the most part as humans, we typically have the same day to day and week to week activity. In training we do not typically have large fluctuations week to week in volume and loading, nor do we normally have large fluctuations in the activity within our daily life outside of the gym. As a coach I am not having my athletes track everything they do outside the gym, which is a bit extreme, but a question I will ask if we do see a flare-ups of pain is if they did anything outside the norm in their daily life.
For example, it is not uncommon to find that a couple of days before the squat session where the pain occurred that they may have done something a bit more stressful in their daily lives that they weren’t accustomed to. Maybe they went hiking with the family or helped their brother move into a new apartment on the 3rd floor. It seems so insignificant at the time, but if these activities are inducing stress upon the knee that requires recovery, then that is changing that levels of their tolerable workload within the gym.
Another scenario is a more long term change in daily activity. Maybe you had a desk job and have now switched to something requiring more manual labor. You then start experiencing aches and pains while performing the same program you always had. The issue now is that the program was built around your previous daily activity, not your current activity, and most likely needs to be adjusted to account for these changes.
We as powerlifters tend to dramatize any and all injuries we have. Any signal of pain and we immediately jump right to panic mode and expect the worst. The mind is very powerful and I have seen countless times, including within myself, that this overdramatization creates higher levels of pain due to our hypersensitivity to the area and internalization of the injury being worse than it is. I’ve seen powerlifters who thought they bulged a disk and could barely move, then miraculously feel better the day after going to the doctor and finding out it was just a minor strain.
We should also be mindful that most aches and pains are not necessarily “injuries”, as the word injury is used very loosely in the powerlifting community. If you want your body to feel perfect every single day, you probably shouldn’t compete in a sport where the goal is to push your body to the extremes of lifting a maximal weight. We are going to have aches and pains, but the majority of the time these are not going to greatly affect training or require time off from working out. Most “injuries” are not injuries at all, but rather increased inflammation that is producing pain signals that are higher than our normal liking. So be careful in jumping straight to the word “injury”, as it tends to have negative connotations that entail a more severe issue than you likely have.
We need to be very careful to not self-manifest more pain through our negativity and panic towards the situation. This is easier said than done, but when experiencing pain you should immediately try to resort to positivity versus negativity.
For example, “It hurts to barbell squat but belt squats feel great”.
Focus on what you can do versus what you cannot, and focus on the improvements during the recovery process versus constantly being down on yourself because you aren’t squatting as much as you were 3 months ago.
Short Term Interventions
So you have addressed the long term solutions, but what can we do on a daily basis to make minor improvements that can translate to our training?
This is where short term interventions come into play. Unfortunately, this is where most start though, as people are always looking for an easy fix, but there isn’t one. It doesn’t mean these short term modalities do not have their use though. On a session per session basis, there are definitely things we can do to limit achiness and pain to make training more manageable. We just have to understand that these do not fix the issue, but rather creates comfort and confidence within an individual training session that allows us to still be able to perform at a high level.
Proper Warm Up
A proper warm-up is vital to prepare the body for the demands we place upon it in the sport of powerlifting. If someone is not properly warming up, that will be an immediate priority to address, but not without simultaneously addressing what was mentioned above within long term solutions.
So what is a proper warm up? As a coach, I have found this to be very hard to answer, as it is highly individual and truly just depends on what the athlete feels they need to comfortably lift heavy weight. For some, this may be a pretty extensive process and for others fairly simplistic. We have a great article that I would highly recommend checking out, as it gives a good synopsis of where to start when it comes to warming up (How to Warm Up For Powerlifting: Step By Step Guide).
I do have a couple go to’s that I feel can make a positive difference though.
1. Stationary Bike
First and foremost, the single best warm-up tool I have found for powerlifters is an Airdyne or stationary bike. Starting your workout on the bike for around five minutes can make a big difference in just getting the body warm and blood flowing.
2. Muscle Activation
From there, I typically like some type of antagonistic muscle activation/integration drill. For instance, in the case of achy knees, this would be the hamstrings. Achy knees many times are exacerbated by tight quadriceps, and the activation and warming up of the antagonistic muscle group has been shown to relax the opposite muscle without decreasing performance.
There is a variety of recovery tools, including foam rolling, deep tissue massage, myofascial release, lacrosse ball release, contrast bath/showers, hydrotherapy, cryotherapy, dry needling, ultrasound, e-stem, Graston, and much more.
This is the section where people really get it wrong in my opinion.
Can these recovery tools help? Yes.
But I can confidently say they will not fix your aches and pains, but rather create comfort that decreases pain and can allow short term relief. These recovery tools can generally be summed up within 3 potential benefits:
- Perceived decrease in tightness (foam rolling, deep tissue massage, myofascial release)
- Decrease in acute inflammation (cryotherapy, contrast bath/showers)
- Increased blood flow to the affected area (dry needling, ultrasound)
While these can be effective short term interventions, they are typically relied upon as the “fix” to aches and pains rather than an aid.
I can say from experience that I relied on these tools way too much, and I find more and more that it was more my perceived confidence in them at the time that created the improvement rather than any actual physiological change. With that being said though, I still use some of these modalities to this day, but as a supplement to the long term solutions and to a significantly lesser degree.
Doing 20 minutes of foam rolling during my warm up and weekly deep tissue massages are a thing of the past for me, and I feel better than ever since taking my primary focus off that and placing it upon the adjustments to my training, sleep, and nutrition.
Supportive equipment can be a great tool for powerlifters in helping to preserve their bodies long term, and you probably won’t find too many people not using a belt, knee sleeves, and wrist wraps nowadays due to the many benefits (check out our Best Knee Sleeves For Powerlifting article).
A belt helps to increase abdominal activation and provide an external cue to brace against, which helps improving core stability during the squat, bench press, and deadlift. Knee sleeves provide compression and support for the knee, they create sustained “warmth” around the knee throughout the workout, and they can possibly have slight benefits for strength due to the increased tension at high degrees of knee flexion. And, wrist wraps help to support the wrist joint during heavy low bar squat and bench press, where otherwise they may take a bit of a beating.
All of these tools can help to provide added support for our body allowing for an improvement in strength, but the reason they are not included in long term solutions is they often times can be overused.
I have a general rule of thumb, and that is if one of my lifters cannot warm up to at least 50% of their 1RM without pain while not wearing any supportive equipment, then we need to make adjustments to their training and/or recovery. We need to make sure to not use this equipment as a crutch that masks any potential issues, but rather just like all other short term interventions, use it as an aid in our training.
Lastly, I have found instances in particular with knee sleeves that they are actually causing the pain. It is more commonly known that tight knee wraps can aggravate the knees due to the extreme compression, but also there are times when the compressive forces of some of the thicker knee sleeves can do the same. I’d argue this is due to some structural difference at the knee joint in that specific lifter, as for most knee sleeves will be beneficial, but I have seen this scenario enough to know that it is something powerlifters do need to be aware of.
Very much like the recovery tools mentioned, supplementation tends to be an “easy fix” people reach for when dealing with pain.
The primary issue I find is there are very few, if any, supplements that have been shown to actually help with aches and pains, at least with the actual healing process. What supplements can do though is help with the inflammation and pain, but I say that with caution as inflammation is one of our body’s natural response mechanisms to help in the healing process. Inflammation is usually viewed as a negative thing, but in the sense of our body’s ability to heal it is positive.
If you have been in the powerlifting game for a while, I am sure you have that friend who requires high doses of ibuprofen before every session. And, for a lifter’s longevity, that is a dangerous game to play. Not only because it is masking the real issue, but there is also a good amount of research showing the negative effects that high doses of certain anti-inflammatories can have on protein synthesis.
If there were supplements that I would possibly recommend, the two I know of that have had legitimate backing in research to aid in decreasing inflammation, without the same negatives effects as ibuprofen, is turmeric/curcumin and fish oil. Both have been shown to have anti-inflammatory benefits with little to no drawbacks. I have used both and found benefit but used them as a supplement to the long term solutions that are the primary focus when addressing pain.
Real Life Examples Of How To Manage Injuries
So after reading all of this, you might be wondering how to actually apply this. Information is great, but how does this play out in a real-life scenario?
Every situation is an individual case, so to give an exact template that everyone could use would be very difficult. Instead, let’s use examples of 8 lifters — 7 that I have coached and then 1 being myself, who experienced some form of pain and the steps that were taken to fix their issues.
This lifter was experiencing achiness in both knees over a 6-8 week span. It was getting borderline of being chronic, and we adjusted volume and intensity but did not see much change. We continued to experiment with different variables, and the fix ended up being the removal of belt squats as an accessory movement and the addition instead of more unilateral work (single leg). Most likely the continued movement pattern of the squat through not only his barbell movements but also accessory movements was causing this achiness. So once we removed that and adjust the movement pattern to unilateral loading, within two weeks the achiness was gone.
This lifter was experiencing chronic right QL (quadratus lumborum) pain on the squat and the deadlift. Whenever I have a lifter with a QL issue that is biased to one specific side, the first thing I look for is a lateral shift in their movement. In the case of this lifter, she displayed a prominent lateral shift to the right on both squat and deadlift. This shift was very intensity specific, and at a certain % of her 1RM on each lift it would start to become prominent. To fix this, we made some adjustments to form and bracing to improve her pelvic position, as the shift was accompanied by an anterior pelvic tilt. But the primary solution was to train below her threshold of form breakdown for the majority of her squat and deadlift work, and then slowly try and raise the ceiling of her form breakdown. After 6 months of slowly progressing on intensity, she is now able to hit maximal loads without the same shift present and is experiencing zero pain.
This lifter had just competed in a meet and was now starting into a more volume intensive training block. As each week progressed his knees started to ache a bit more, and from an outside perspective the issue may seem obvious. This block was more volume intensive so he was experiencing some flare-ups from the added stress. But, before jumping to this conclusion I always first address recovery and came to find out this lifter’s sleep and nutrition had really fallen off and was very inconsistent. So before adjusting the program, I had him put an increased emphasis on recovery and after two weeks of improved sleep and nutrition the pain decreased and his knees were feeling much better.
This lifter was experiencing chronic shoulder pain from the bench press. I had just started coaching him and would classify his bench press style as a “heave” and “tuck”. He was over-tucking his elbows and dumping the bar onto his chest while lifting his head up off the bench and going into thoracic flexion. Instead, I had him vastly change his bench press set up to achieve a more depressed, retracted, and stable shoulder position. We worked on using his legs to drive back and fold his upper traps into the bench, resulting in him elevating his rib cage. We also internally rotated his grip position a bit more to help keep a more stacked joint position between the wrist and elbow. He went from barely being able to bench twice a week without significant pain to now benching 3 days a week and not really feeling much fatigue.
This lifter had been working with me for over 3 years, so we had a really good idea of what training he could tolerate. In the past, he had some history of patellar tendinitis, but we were able to get it under control and it had not been an issue for a while. But after a slight plateau I increased his total weekly squat volume by 2 sets, so nothing drastic but enough to produce a slight uptick in training stress. At first, he did fairly well, but after about 4-5 weeks he started having some slight pain in his patellar tendon again. It continued to get worse after another couple weeks, so the decision was easy to drop those 2 extra sets and go back to his prior weekly volumes that we knew he could tolerate fine. Sure enough, after about 3 weeks the pain was gone and he has not had an issue since. I then made adjustments to the absolute and relative intensities instead to adjust training stress and that worked great to break the plateau while keeping him feeling healthy.
This lifter also had chronic QL pain, and we tried everything. I adjusted volume and intensity, we made some significant form changes, but no matter what we did he just seemed to have random occurrences of pain flare-ups. These flare-ups really didn’t correlate with anything so at least within his training and recovery, it didn’t quite make sense, until I asked him what position he slept in each night. He immediately moaned and said his mattress was terrible and he always feels contorted and uncomfortable when he sleeps. Fast forward 2 months later and a new mattress, and he has zero pain and we haven’t had an issue since.
This lifter was experiencing achy knees and I was fortunate enough that he was a fairly self-aware lifter and noticed that in particular the days after sumo deadlifts they felt the worst. He was on a 2 day a week frequency for squat and deadlift, but on different days. So, in reality, he was going through some knee flexion based movement 4 days a week and was seeming to not get adequate recover between these days. So the first change I made was to have him squat and deadlift on the same day, and that, fortunately, was the only change I needed to make. He immediately felt better and has never had an issue since.
Lifter H (myself):
I suffered from chronic quad tendinosis to the point that the swelling of the tendon was so bad that it looked like I had a horn on the top of my knee cap. For 2 ½ years, I tried everything I thought might work (short term interventions mostly) to no avail. I tried to manage my volume and loading but I could not be accountable to myself. As soon as I thought I was feeling good I would immediately jump to heavy loads and would re-aggravate the issue.
It was not until I started working with Quinn Henoch, a renowned physical therapist, that I was able to completely heal and become pain-free once again. What he did was fairly simple. He brought me down to a loading level and movement that I could perform pain-free and then we slowly built up over a 5-month span.
I had to start with 10lb tempo goblet squats, as at the time that was the limit of what I could do without pain. With each successive session, we increased the loading until I could squat the bar pain-free. Then we started slowly adding load to the bar until months down the road I was able to squat completely pain-free without limitations. It sounds simple, but it was a grueling process.
Just like with strength, each session in this rehab process was not a perfectly linear progression of improvement. Some days I had to drastically cut the weight to stay pain-free, sometimes even to the point that the only thing I did for the day was 90-degree isometric leg extension holds. But sure enough, I would come back to the next session feeling better and resume the progression forward. It was a long process, but in hindsight, 5 months of rebuilding was nothing compared to the previous 30 months of debilitating pain.
If you are a powerlifter or decide to become a powerlifter in the future, aches and pains are something that you are going to come across. If this occurs, your primary focus should be to look at the holistic picture of your training to find the best way to reduce stress and improve your recovery through variables such as total workload, exercise selection, technique, sleep/nutrition, daily activity, and your attitude.
Be wary of your favorite social media influencers promoting the new best recovery technique. If you noticed, most of the short term interventions linked back to you buying something, and there is a reason for that. The long term solutions were free changes you could make to your training and recovery. Whereas the majority of the short term “fixes” required you to pay for something. This is fitness marketing 101, and the products and services that make money are going to be the ones that are highly advertised as the “fix”. Instead, be patient, continue to be positive, and understand that powerlifting is a process that requires a long term outlook for improvement and recovery.
About The Author
Steve Denovi has 10+ years of experience working with clientele from all walks of life and currently specializes in working with powerlifters and their pursuit of strength. He has his MBA in Marketing but found himself after college following his passion within the fitness industry. Steve now coaches athletes all across the USA and takes a special interest in helping to mentor new coaches and providing content to help educate the strength community.
Krentz, J., Quest, B., Farthing, J., Quest, D., Chilibeck, P. 2008. The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training. Applied Physiology Nutrition Metabolism. 33(3): 470-475.
Miranda, H., Mde, M., Paz, G., Costa, P. 2015. Acute effects of antagonist static stretching in the inter-set rest period on repetition performance and muscle activation. Research Sports Medicine, 23(1): 37-50.
Paz, G., Maia, M., Whinchester, J., Miranda, H. 2016. Strength Performance Parameters and Muscle Activation Adopting Two Antagonist Stretching Methods Before And Between sets Performances. Science & Sport. 31(6): 173-180.