Spinal and Paraspinal Injuries from Weightlifting in Minors: A 20-Year National Analysis
A comprehensive national study analyzing 20 years of emergency department data reveals that while resistance training remains generally safe for adolescents, spinal and paraspinal injuries continue to occur, most commonly from squats and deadlifts, highlighting the importance of supervision, proper technique, and structured training programs.
SCOLI
A comprehensive national study analyzing 20 years of emergency department data reveals that while resistance training remains generally safe for adolescents, spinal and paraspinal injuries continue to occur, most commonly from squats and deadlifts, highlighting the importance of supervision, proper technique, and structured training programs.
Study Overview
This study, published in World Neurosurgery, analyzed pediatric spinal and paraspinal injuries associated with weightlifting using the National Electronic Injury Surveillance System (NEISS) database from 2004 to 2023. The goal was to characterize the incidence, injury patterns, and exercise-specific mechanisms of weightlifting-related spinal injuries among minors in the United States.
Over the two-decade study period, the analysis estimated 53,017 national pediatric emergency visits related to spinal or paraspinal weightlifting injuries, averaging roughly 2,650 visits per year. Muscular strains accounted for 64% of all cases, with 63% of those strains involving the lumbar (lower back) region. Squats (46%) and deadlifts (30%) were the most commonly implicated exercises.
Key Findings
Overall Injury Trends
Despite the growing popularity of youth resistance training over the last two decades, annual injury rates did not significantly increase over time. This is an encouraging finding and may reflect improved supervision, increased access to certified strength and conditioning professionals, better education around lifting mechanics, and more structured athletic training programs at the school and club level.
Most Common Injuries
Muscular strain was by far the most common injury type, accounting for nearly two-thirds of all cases. Most injuries involved the lumbar spine and paraspinal musculature, underscoring the biomechanical demands placed on the lower back during compound lifts. By comparison, neurologic and structural spinal injuries, including disc herniation, radiculopathy, and vertebral fracture, were uncommon, each representing less than half of one percent of cases.
Exercise-Specific Findings
Among injuries where a specific exercise was identified, squats led at 46%, followed by deadlifts at 30% and bench press at 8.1%. Olympic lifts, rowing exercises, pull-ups, and machine-based movements accounted for smaller proportions of injuries.
Patient Demographics
The average age of injured patients was 15 years, and 84% of cases involved males. Injuries skewed heavily toward older adolescents, a pattern that likely reflects increasing participation in resistance training during the high school years as well as social pressures surrounding physique and athletic performance.
Injury Distribution
By Injury Type
| Injury Type | Percent of Injuries |
|---|---|
| Muscular Strain | 64% |
| Unspecified Back Pain | 25% |
| Sprain | 6.2% |
| Muscle Spasm | 2.0% |
| Contusion | 1.0% |
| Sciatica | 0.4% |
| Disc Herniation | 0.3% |
| Vertebral Fracture | 0.3% |
| Radiculopathy | 0.3% |
By Exercise
| Exercise | Percent of Exercise-Specific Injuries |
|---|---|
| Squat | 46% |
| Deadlift | 30% |
| Bench Press | 8.1% |
| Leg Press | 2.3% |
| Bent-Over/Seated Rows | 2.1% |
| Clean and Jerk | 1.7% |
| Weighted Pull-Ups | 1.5% |
| Power Cleans | 1.3% |
Mechanisms and Biomechanics
Squats were the leading exercise associated with injury. The movement places significant biomechanical demands on the lumbar spine and paraspinal musculature, particularly when lifting technique deteriorates under heavy loads. Common contributors include excessive load selection (often described as “ego lifting”), loss of spinal alignment, poor core stabilization, and fatigue-related breakdown in form.
Deadlifts generated the second highest number of injuries and are known to produce large compressive and shear forces on the lumbar spine. Biomechanical studies cited in the paper suggest that improper posture or excessive loading may increase stress on spinal structures and paraspinal musculature, especially in lifters whose technique has not yet been refined under supervision.
Although bench press is primarily considered an upper-body exercise, injuries during bench press may involve excessive lumbar arching and the spinal stabilization demands of pressing heavy loads from a supine position.
Safety Context
The findings should not discourage youth resistance training. When properly supervised, resistance training has been shown to improve athletic performance, increase bone mineral density, enhance body composition, and reduce overall injury risk in young athletes. The absence of an increasing injury trend despite rising participation suggests that coaches, trainers, schools, and gyms may be successfully implementing safer training environments and emphasizing proper mechanics.
Clinical Implications
For coaches and trainers, the data reinforce a familiar message: emphasize proper form before adding weight, use progressive loading strategies, monitor fatigue and lifting mechanics throughout a session, and build core stabilization and mobility into the program. Discouraging “ego lifting” (particularly in adolescents whose technique is still developing) remains one of the most actionable steps to reduce injury risk.
For healthcare providers, lumbar strain is by far the most common presentation and is generally self-limiting with conservative care. Clinicians should nevertheless maintain awareness of rare but serious neurologic injuries and consider the long-term spinal health implications when counseling adolescent athletes about training loads and progression.
Limitations
NEISS captures only emergency department visits and likely underestimates the total incidence of weightlifting-related spinal injuries, since many minor strains are managed in outpatient settings or self-treated at home. Injury narratives in the database also varied in specificity, and information about training experience, supervision quality, and exact lifting loads was not consistently available.
Conclusions
Weightlifting-related spinal and paraspinal injuries in minors are relatively uncommon compared with the large number of adolescents participating in resistance training nationwide. Most injuries are muscular strains involving the lower back, with squats and deadlifts representing the most commonly implicated exercises. Importantly, injury rates did not significantly increase over the 20-year study period despite rising participation in youth resistance training, suggesting that improved supervision and training practices may be helping mitigate injury risk.
The findings support continued youth participation in resistance training while emphasizing the importance of proper technique, appropriate weight selection, progressive programming, and professional supervision.
Study Information
- Title: Spinal and Paraspinal Injuries from Weightlifting in Minors
- Authors: Benjamin J. Carnovale, Raj S. Lavadi, Janam B. Patel, Rohit Prem Kumar, James Mooney, Manan J. Shah, Michael M. McDowell, David K. Hamilton, Nitin Agarwal
- Institutions: University of Pittsburgh School of Medicine; University of Pittsburgh Medical Center; VA Pittsburgh Healthcare System
- Publication: World Neurosurgery (2026)
- DOI: 10.1016/j.wneu.2026.124961
Topics: research
