Written by the Phoenix Rehab physiotherapy and hand therapy teams. Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H; hand, wrist and elbow sections by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z. Last reviewed 12 October 2026.
Across the weight-training sports, the lower back, the shoulder and the knee are the areas injured most.1 In powerlifters, elbow injuries are more common after age 40.2 Most gym injuries we see build over weeks, when load or volume climbs faster than the tissue adapts, or come from one rep at the end of a set where the position slipped.
The gym is where many of our patients go to get stronger after an injury. It is also where a fair number pick up the next one. If your gym week includes spin classes, the spin class injuries guide covers the knees, back, neck and hands on the bike.
The story we hear goes like this. A new program, a new coach, or a new year. The squat and deadlift numbers climb every week. Then the back is stiff getting out of the car on Monday, or the shoulder clicks at the bottom of the bench, and the plan becomes a deload week. The deload week turns into a month.
Few of these start with one dramatic rep. Most are a load the body had not caught up with, plus a rep late in a set where the back rounded or the elbows flared. Load can be measured and planned, so this is workable.
Gym injuries also hide well. You can train around almost anything. Skip the bench, use the machine, pull with straps. A few months on, the whole program bends around one shoulder. The point of an assessment is to find out what that shoulder can do today, in numbers, and build back from there.
The lifts, and what they load
| Lift | What it loads | What it most often irritates |
|---|---|---|
| Back squat, high-bar and low-bar | Knees, hips, lower back; with a low bar, the shoulders, elbows and wrists holding it | Kneecap pain, jumper’s knee, the hip labrum, low back pain; the inner elbow and the shoulder in low-bar |
| Deadlift: conventional, sumo, mixed grip | Lower back, hips, hamstrings; the groin in sumo; the biceps of the underhand arm in mixed grip | Low back pain, a disc, the SI joint, groin strain, distal biceps tear |
| Bench press and dips | The shoulder at the bottom, the chest, the triceps at lockout | The end of the collarbone (weightlifter’s shoulder), pec strain or tear, the triceps tendon, the biceps tendon |
| Overhead press | The shoulder overhead | Rotator cuff tendon |
| Snatch, clean and jerk | Wrists in the front rack, shoulders overhead, the back in extension, knees | The back of the wrist, the TFCC, shoulder instability after a missed snatch, pars stress fracture in young lifters, jumper’s knee |
| Pull-ups, rows and curls | The inner and outer elbow, the biceps | Golfer’s elbow, tennis elbow, the biceps tendon |
| Shrugs and heavy carries | The neck and upper trapezius | Neck strain |
Every gym injury, by body part
This covers general weight training, Olympic weightlifting and powerlifting. Start from where it hurts. Rows with a link go to the page that covers that injury in full.
| Where | Injury | How gym training usually causes it |
|---|---|---|
| Wrist | Pain on the back of the wrist (dorsal impingement) | The front rack and the clean catch; the wrist bent back under a low-bar squat |
| Wrist | TFCC tear, on the little-finger side | The front rack |
| Elbow | Distal biceps tendon rupture | Heavy lowering, and the underhand arm in a mixed-grip deadlift |
| Elbow | Golfer’s elbow, on the inner elbow | Pulling and curling volume, and gripping a low-bar squat |
| Elbow | Tennis elbow, on the outer elbow | Grip-heavy training |
| Elbow | Triceps tendon pain or tear | Heavy pressing lockout, including the bench |
| Shoulder | Pain at the end of the collarbone (distal clavicle osteolysis, weightlifter’s shoulder) | Heavy bench press volume and dips |
| Shoulder | Rotator cuff tendon pain | Overhead pressing, and holding a low bar |
| Shoulder and chest | Pec major strain or tear | Lowering a heavy bench press |
| Shoulder | SLAP (labral) tear | Heavy overhead work or bench |
| Shoulder | Dislocation or instability | A failed snatch overhead |
| Shoulder | Biceps tendon pain at the front of the shoulder | Bench press, curls and the low-bar squat position |
| Neck | Neck strain or facet joint sprain | Shrugs and heavy carries |
| Lower back | Low back pain from lifting | Deadlifts and squats with the lower back rounding under load, including max-effort attempts |
| Lower back | Slipped disc (lumbar disc herniation) | Heavy lifting with the back rounded |
| Lower back | Pars stress fracture (spondylolysis) | Arching under an overhead bar, in young Olympic lifters |
| Lower back | SI joint pain | Loading one side more than the other |
| Hip and groin | Hip labral tear and hip impingement (FAI) | Deep squat depth |
| Hip and groin | Groin (adductor) strain | Wide sumo stance in squats and deadlifts |
| Pelvic floor | Leaking under load | Bracing under heavy and max loads |
| Knee | Kneecap pain (patellofemoral pain) | Squat volume |
| Knee | Pain below the kneecap (jumper’s knee) | Olympic lifts, jumping and heavy squats |
| Knee | Meniscus tear | A deep squat with the knee twisting |
Not on the list, or not sure which row is yours? That is what the first visit is for.
The common ones, in more depth
The lower back: deadlifts and squats
What it feels like. A stiff, sore low back after heavy pulls or squats, worst bending forward and getting out of the car. Sometimes the pain spreads into the buttock or down the leg.
What is usually going on. Most of it is a strain of the back muscles and joints when the spine rounds under load, often on the last reps of a set. The deadlift version is covered in lower back pain from deadlifts. In the squat, the pelvis tucking under at the bottom or the hips rising first out of the hole puts the back in the same position, covered in lower back pain from squats. Leg pain with pins and needles or weakness points to a disc or a nerve root, covered in slipped disc.
What we measure. Back extensor endurance in seconds, your hip hinge with a dowel along the spine, hip range, nerve tension tests, and which loads and positions bring it on.
What you can do now. Keep moving and keep walking. Train the lift at a load you can move with the same back position every rep, with pain no more than mild during the set and settled by the next morning. Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.
The shoulder at the bench
What it feels like. Pain at the top of the shoulder, on the bony point at the end of the collarbone, at the bottom of a bench press or a dip. Or pain at the front of the shoulder, or overhead.
What is usually going on. Heavy bench and dips load the joint where the collarbone meets the shoulder blade. Repeated often enough, the end of the collarbone becomes irritated, and lifters call it weightlifter’s shoulder. The full picture is in bench press shoulder pain. Front-of-shoulder pain is often the biceps tendon. A pop at the bottom of a heavy bench with bruising across the chest is a different problem, covered in pec strain and torn pec.
What we measure. Tenderness at the joint, pain when the arm crosses the body, rotation strength on each side, the bench depth you tolerate, and shoulder blade control.
What you can do now. Narrow the grip, shorten the range with a floor press or a board, drop dips for a few weeks, and keep pulling.
Knee pain when squatting
What it feels like. Pain at the front of the knee, around or behind the kneecap, at the bottom of a squat and on stairs. Or pain at the bottom of the kneecap with jumps and Olympic lifts.
What is usually going on. Squat volume loads the joint behind the kneecap, and Olympic lifts and jumps load the tendon below it. Depth, stance and bar position all change that load, and both problems are covered in knee pain when squatting. A twist at the bottom of a deep squat that leaves the knee catching is the meniscus.
What we measure. Single-leg squat control, thigh strength on each side, the depth you reach before pain, and tendon pain on a decline squat.
What you can do now. Squat to a box at the depth that stays comfortable, slow the lowering, and cut volume before cutting load. Keep training the thigh. Complete rest rarely settles kneecap or tendon pain.
The elbow: grip, curls and the pop
Elbows, wrists and hands are seen by our hand therapy team.
What it feels like. Pain on the inner elbow on pull-ups, curls and the low-bar squat grip, or on the outer elbow with grip-heavy work. Less often, a pop at the front of the elbow during a heavy deadlift or a slow lowering.
What is usually going on. Inner elbow pain is usually golfer’s elbow, and outer elbow pain tennis elbow: tendons asked for more than they can take for now. A pop at the front of the elbow, with bruising or the biceps bunching up the arm, can be a distal biceps tendon rupture. The underhand arm of a mixed-grip deadlift is the classic case. Pain at the back of the elbow at the top of a heavy press is the triceps tendon.
What we measure. Grip strength in kilograms on both hands, pain on resisted wrist and finger movements, and elbow and forearm range.
What you can do now. Cut curl and pull-up volume, change grip width, and use straps on heavy pulls while the tendon settles. A pop at the front of the elbow goes to a doctor the same day.
Wrists in the front rack
What it feels like. Pain across the back of the wrist in the front rack or the catch of a clean. Pain on the little-finger side of the wrist when the bar sits in the hands.
What is usually going on. If the shoulders and upper back cannot get the elbows high, the wrist bends further back to hold the bar and takes the load. A low-bar squat bends the wrist back under the weight too. Back-of-wrist pain is covered in wrist pain. Little-finger-side pain is often the TFCC.
What we measure. How far each wrist bends back, grip strength, forearm rotation, and the shoulder and upper back range the front rack needs.
What you can do now. Hold the front rack on the fingertips, or use straps or a crossed-arm rack. Narrow the low-bar grip only as far as the shoulder allows. Wrist wraps are a short-term support while the range comes back.
Hip and groin
What it feels like. A pinch deep in the front of the hip at the bottom of a squat, or pain on the inner thigh in a wide sumo stance.
What is usually going on. At full depth the thighbone meets the rim of the hip socket, and in some hips that contact irritates the labrum. A wide stance under heavy load strains the inner thigh muscles, covered in groin strain.
What we measure. Hip bend and rotation on each side, squat depth before the pinch, and inner-thigh squeeze strength.
What you can do now. Find the stance width and toe angle that let you reach depth without the pinch, and narrow the sumo stance for a few weeks. A hip that locks or catches needs a doctor’s opinion.
Training styles, and what each one loads
The lifts are the same in any gym. The way they are programmed is not, and each style below tends to load one joint before the others.
HIIT and bootcamp classes
A 45-minute class of burpees, jump squats, lunges and mountain climbers loads the Achilles, the calf and the tendon below the kneecap, often at the pace of the class rather than your own. We see Achilles tendon pain and calf strains in the weeks after starting a new class, and jumper’s knee from box jumps. Burpees and planks put body weight through a bent-back wrist, and the ache on the back of the wrist is usually a tendon, covered in wrist tendonitis.
We test single-leg calf raises to fatigue on each side and hop control. At the wrist, we test how far each wrist bends back under body weight.
Severe muscle pain and swelling with dark, cola-colored urine after an unusually hard class can be exertional rhabdomyolysis. Go to the emergency department now.
Functional training and kettlebells
The kettlebell swing is a hip hinge done fast and for many reps. When the hips stop driving and the back starts lifting, the low back takes the load, the same pattern as lower back pain from deadlifts. Turkish get-ups and overhead carries hold the shoulder overhead for a long time, and we see rotator cuff irritation from them.
In cleans and snatches the bell flips over the hand and lands on the back of the forearm, and the wrist bends back under it. We see bruised forearms and back-of-wrist pain from this.
We test the hinge with a dowel along the spine and shoulder rotation strength overhead. At the wrist, we test range and grip strength in kilograms.
Olympic weightlifting
The snatch and the clean and jerk load the shoulders holding the bar overhead and the low back arching under it. They also load the wrists in the front rack and the catch, covered in the wrist section above, and the elbows locking out overhead.
At the elbow, we see pain at the back of the joint when the jerk or snatch is caught with the elbow pushed past straight. A missed snatch can take the shoulder out of joint, covered in shoulder dislocation and instability. Less often, a missed lift dislocates the elbow, covered in elbow dislocation. In teenage lifters, one-sided low back pain on arching can be a pars stress fracture.
We test overhead shoulder range and rotation strength, and back pain on a one-leg backward lean. At the wrist, we test extension on each side.
Powerlifting
The bench press loads the end of the collarbone and the front of the shoulder at the bottom of the lift, covered in bench press shoulder pain. The wrist takes the load when the bar sits back in the palm.
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In the low-bar squat, the elbows and inner forearm pin the bar, a common source of golfer’s elbow in squatters. The low back takes over when the hips rise first, covered in lower back pain from squats.
The deadlift loads the low back, covered in lower back pain from deadlifts. It also loads the grip, and the underhand arm of a mixed grip is the classic setting for a distal biceps rupture. We test grip in kilograms on each hand. At the shoulder and back, we test rotation strength and the hinge and squat at a load you can repeat.
Calisthenics
Body-weight training puts the whole body through the hands. Handstands and push-ups hold the wrist bent far back under full body weight, and the back of the wrist is where it shows, covered in wrist pain. Handstand work is also covered in gymnastics injuries.
Muscle-ups and dips pull and press through the elbow, and we see golfer’s elbow on the inner side and triceps tendon pain at the back. At the bottom of a deep dip the shoulder is pressed down and forward, the same load as a deep bench, and we see the end of the collarbone and the biceps tendon irritated by it.
We test wrist extension under load and grip. At the shoulder, we test range and pain at the bottom of a dip.
Rowing machine
Each stroke is a leg drive, a back swing and an arm pull, repeated 20 to 30 times a minute. When the legs tire, the low back rounds at the catch and does more of the pulling, covered in lower back pain when bending.
Pain on the side of the chest after long rows is often a muscle, covered in intercostal muscle strain. Pain at one spot on a rib that keeps building over weeks of rowing can be a rib stress fracture, and is worth seeing a doctor about soon. At the wrist, squeaking pain on the thumb side of the forearm a few centimeters above the wrist is intersection syndrome, covered in wrist tendonitis.
We test the back position at the catch and rib pain on a deep breath. At the wrist, we test tendon pain on resisted movement.
Return on tests, not dates
Each lift comes back when the measures say so, not when the calendar does.
- Pain during lifting. No more than 3 out of 10 during the set, and settled by the next morning.
- Back. Back extensor endurance back to your own baseline, then the hinge at 70% of your previous working weight with the same position on every rep.
- Shoulder. Rotation strength within 90% of the other side, and full bench range at working weight with no top-of-shoulder pain the next day.
- Knee. Single-leg squat control and thigh strength within 90% of the other side, then full depth.
- Elbow and wrist. Grip within 90% of the other hand, and the front rack or the low-bar grip held without pain.
- The order. Technique weight first, then working sets, then heavy singles last.
This is Stage 4, Return & Perform, of The Phoenix Recovery Protocol. When rehab hands over to training, our physiotherapists run rehab-led strength and conditioning so the program carries on with the same measures. Pain is the first thing to leave. Strength is the last to train and recover.
Is this normal?
Usually expected: muscle soreness 24 to 72 hours after a hard day or a new lift, on both sides, easing once you are moving.
Worth getting checked: pain on one side, at one spot, that is there at the start of the next workout, that makes you change a lift to avoid it, or that is still there after a deload week.
When to see a doctor first
- Call 995 for chest pain, collapse or fainting, breathlessness out of proportion to the effort, or a sudden, severe headache during a heavy lift.
- Go to the emergency department now if your urine turns dark brown or cola-colored with severe muscle pain or swelling after a hard workout, which can be exertional rhabdomyolysis. Also if back pain comes with numbness between the legs or new problems passing urine or stool, or a shoulder looks out of place after a missed lift.
- See a doctor the same day for a pop at the front of the elbow with bruising or a change in the shape of the biceps, which can be a distal biceps tendon rupture. The same for a pop at the chest with bruising, covered in torn pec, and a pop at the back of the elbow with weakness straightening the arm.
- See a doctor soon for pins and needles or weakness down an arm or a leg, a knee that swells after a twist, locks or gives way, one-sided low back pain on arching in a teenage lifter lasting more than two weeks, or night pain that does not change with position.
Questions people ask
What are the most common gym injuries?
Across the weight-training sports, the lower back, the shoulder and the knee are the areas injured most, and powerlifters also list the elbow among their most frequent injury sites. Most gym injuries build over weeks as load climbs faster than the tissue adapts, or come from one rep where the position slipped.
Why does my shoulder hurt at the bottom of the bench press?
Pain on the bony point at the top of the shoulder at the bottom of a bench or a dip is often weightlifter’s shoulder, an irritated end of the collarbone. Front-of-shoulder pain is often the biceps tendon. A narrower grip, a shorter range such as a floor press, and dropping dips for a while reduce the load.
What does a pop at the front of the elbow when lifting mean?
A pop at the front of the elbow during a heavy deadlift or a slow lowering, with bruising or the biceps bunching up the arm, can be a distal biceps tendon rupture. The underhand arm of a mixed-grip deadlift is the classic case. It needs a doctor the same day.
When can I lift heavy again after a gym injury?
Each lift comes back when the measures say so, not on a date. Pain stays mild during the set and settles by the next morning, strength is tested against the other side, and the lift returns in order: technique weight first, then working sets, then heavy singles last.
Where are you with this right now?
1. It is settling on its own
If it eases week by week while you train around it at lighter loads, you are on the right road. Bring the lift back in steps, lighter and slower first, then working sets. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles on a deload and comes back as the weight goes back on. You have dropped a lift, changed your grip or stance to dodge it, or you spend the first part of every workout warming up one joint. That pattern is usually a strength and load problem, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review is three visits over three weeks with the same therapist.
3. You have had surgery, or you have a date
A pec repair, a distal biceps repair, a shoulder stabilization, hip arthroscopy or a lumbar microdiscectomy each has a shape, with protected weeks before the barbell comes back. See the Hip Arthroscopy Recovery Program, the Lumbar Microdiscectomy Recovery Program, physiotherapy after surgery and the recovery programs. All of it runs on the four stages of The Phoenix Recovery Protocol.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is limiting the lift, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479-501.
- Siewe J, et al. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011;32(9):703-711.
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