Yet another reason for athletes to desist from using anabolic steroids: according to a major review of upper extremity injuries associated with strength training, use of these drugs is linked with several of the more serious types of injury, including triceps tendon rupture and rare neuropathies - damage to the peripheral nerves.

Of course strength training athletes are most likely to use anabolic steroids. But, as the authors point out, 'in addition to their multiple systemic adverse side effects, anabolic steroids seem to play a role in soft tissue injuries about the upper extremity...These reports support other findings suggesting that anabolic steroids predispose patients to tendon injury. Animal studies suggest that anabolic steroids cause collagen fibres in tendons to dissociate, become dysplastic and weaken.'

Although strength training used to be the preserve of competitive athletes, the growing public interest in health and fitness - not to mention the current obsession with body image - is rapidly incorporating the discipline into general fitness programmes for all ages of both sexes. Thus, strength training injuries are likely to become increasingly common. One of the purposes of this review is to draw attention to preventive strategies that emphasise proper strength training techniques.

Of particular concern to the authors are the risks of strength training injuries - particularly of the forearm and wrist - to younger athletes. They report on two cases of forearm fractures in adolescent weightlifters, both involving loss of control over free weights. 'These cases strongly support the need for expert supervision of children and adolescents during strength training activities,' they point out. 'This supervision should include avoiding competition among the young athletes and strictly prohibiting maximal lifts.'

Others needing supervision in the form of a 'spotter' include those performing lifts such as the incline bench press, the flat bench press and the behind-the-neck press. 'The spotter should provide a hand-off of the weight to begin the exercise and should help the athlete control the release of the weight back into the rack after the exercise.'

The authors conclude that: 'Most injuries sustained during strength training are mild strains that resolve with appropriate rest. More severe injuries include traumatic shoulder dislocations; tendon rupture of the pectoralis major, biceps and triceps; stress fractures of the distal clavicle, humerus, radius and ulna; traumatic fractures of the distal radius and ulna in adolescent weightlifters; and compressive and stretch neuropathies.

'These more severe injuries are usually the result of improperly performing a strength training exercise. Educating athletes regarding proper strength training techniques serves to reverse established injury patterns and to prevent these injuries in the first place.'

Clin Sports Med 2001 Jul 20(3) pp481-90