Bodybuilding Injuries: Pec and Biceps Tears, Shoulder, Back and PED Risks

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Last set of bench, the one you told yourself would be a new best. The bar comes down a little fast, you feel something give at the front of your shoulder, and the spotter grabs the bar. Every lifter knows someone with a story like that, from the teenager in a high school weight room to the masters competitor prepping for a local show and the pros on the Olympia stage. Bodybuilding is actually one of the safer strength sports when it comes to injuries. But it has a few serious ones worth knowing by name, and a set of health risks that come not from the barbell but from drugs and extreme contest-prep habits. This page covers both, honestly.

This page is general information, not medical advice. If you’re hurt, see a sports medicine doctor, physical therapist (PT) or certified athletic trainer (AT). For the bigger picture of the sport, start at our bodybuilding hub.

How common are bodybuilding injuries?

Less common than in most sports. A German study of 71 competitive and elite bodybuilders (Siewe and colleagues, 2014) found about 0.24 injuries per 1,000 hours of training, which the authors called low compared with powerlifting, Olympic weightlifting and strongman, and minimal next to team and contact sports. The catch: 45% of the athletes reported pain or symptoms while training, often pain they trained through without stopping. Most injuries were in the shoulder, elbow, lower back and knee, and athletes over 40 were injured more often.

The injuries to know by name

Pec tear (pectoralis major tendon rupture)

The classic bodybuilding injury. The American Academy of Orthopaedic Surgeons (AAOS) says it usually happens under an eccentric load, typically on the way down in a heavy bench press, and it is most common in men between 30 and 60. AAOS lists anabolic steroid use as a risk factor alongside heavy weightlifting. The signs: a pop or ripping feeling, sudden pain and weakness, pain with pushing, bruising on the chest and upper arm, and a chest that looks uneven (one nipple can sit lower than the other). AAOS notes surgical repair is often recommended and works best soon after the injury, and that full activity takes at least 6 months, with full strength sometimes taking a year or more. So don’t “wait and see” for weeks: get checked quickly.

Biceps tear at the elbow (distal biceps rupture)

This one happens when the elbow is forced straight against a heavy load: a deadlift with a mixed grip, a heavy curl or row that gets away from you. AAOS says men over 30 are most at risk, and that smoking and both corticosteroid and anabolic steroid use are linked to weaker tendons. Signs include a pop at the elbow, swelling and bruising at the front of the elbow, a bulge higher in the upper arm, a gap you can feel at the front of the elbow, and weakness turning the palm up. Timing matters here too: AAOS says repair is ideally done in the first 2 to 3 weeks; after that, a more complex reconstruction may be needed. Most people who have surgery get back nearly full strength and return to heavy activity after about 4 to 6 months.

Shoulder and tendon problems

Pressing, lateral raises, dips and flyes add up. A common result is irritation of the rotator cuff tendons (impingement or tendinitis). AAOS describes pain at the front and side of the shoulder, pain at night, and pain when reaching overhead. First steps are usually rest, changing the exercises that hurt and physical therapy; recovery can take weeks to months. The same overuse pattern shows up at the elbow and knee: an ache that builds over weeks, worse at the start of a session. Ignoring it is how many lifters turn a few weeks of modified training into months.

Low back

Squats, deadlifts, rows and heavy leg presses load the lower back. AAOS says most activity-related back pain is a muscle strain that settles within days to a few weeks. Get checked promptly for the warning signs it lists: weakness in the legs, numbness or tingling down to the foot, back pain with fever, chills or unexplained weight loss, and, as an emergency, loss of bladder or bowel control.

The health risks that don’t come from the barbell

This is the part of bodybuilding that’s easy to scroll past and too important to skip. We don’t recommend any of the drugs below, and nothing here is a how-to. It’s what medical research says about the risks.

Sudden cardiac death in competitive bodybuilders

In 2025 the European Heart Journal published a study of 20,286 male bodybuilders who competed in IFBB events from 2005 to 2020 (Vecchiato and colleagues, University of Padova). The researchers found 121 deaths at an average age of just 45, and 38% were sudden cardiac deaths. Professional bodybuilders had more than five times the risk of sudden cardiac death of amateurs. Autopsies often showed thickened, enlarged hearts and coronary artery disease, and some toxicology reports showed anabolic drugs. The lead author pointed to the combination of extreme training, rapid weight loss with severe dieting and dehydration, and the widespread use of performance-enhancing substances. A follow-up study of 9,447 female bodybuilders, published later in 2025, found 32 deaths at an average age of 42, with sudden cardiac death the leading cause (31%).

Anabolic steroids

The National Institute on Drug Abuse (NIDA) lists high blood pressure, heart attack, stroke and artery damage among the effects of anabolic steroid misuse, along with liver tumors and blood-filled liver cysts that can rupture, shrinking testicles, low sperm count and breast growth in men, and a deeper voice and body-hair growth in women. It also describes aggression and mood changes, and says depression during withdrawal is the most dangerous withdrawal symptom because it can lead to suicide attempts. NIDA notes that about a third of people who misuse steroids become dependent. In a 2017 Circulation study of experienced male weightlifters, long-term steroid users had weaker heart pumping function and more coronary artery plaque than non-users, and the plaque rose with lifetime use. Teens are especially at risk: NIDA describes long-lasting changes in the developing brain. Steroids are also linked to the tendon tears above.

SARMs, diuretics and insulin

• SARMs (selective androgen receptor modulators) are sold online as “safer” alternatives. The FDA says they are not approved drugs, that life-threatening reactions including liver injury have occurred, that they may raise the risk of heart attack and stroke, and that their long-term effects are unknown. They are banned in tested sport.
• Diuretics (“water pills”) are used before shows to look drier. They can throw off the body’s potassium and sodium and drop blood pressure; a published case describes a bodybuilder hospitalized with dangerously low blood pressure and high potassium after diuretic misuse, and potassium problems can disturb the heart’s rhythm. They’re on the World Anti-Doping Agency’s prohibited list.
• Insulin misused for muscle gain can push blood sugar dangerously low (hypoglycemia), which can cause seizures, coma and death. The British Journal of Sports Medicine published a case report on exactly this danger in a bodybuilder.

Extreme dehydration in peak week

Many competitors cut water and sodium in the last days before a show. An evidence review of natural bodybuilding prep (Helms and colleagues, 2014) says dehydration and electrolyte manipulation can be dangerous and may not even improve appearance, and a 2021 peak-week review found little evidence for these common practices. Dehydration also raises the risk of heat illness and muscle breakdown (rhabdomyolysis). If someone feels faint, confused, has chest pain or a racing or irregular heartbeat, or passes dark, cola-colored urine, that’s an emergency: call 911. More on safe show-day habits in Show Day.

Prevention: train for the long game

• Respect the lowering phase. Pec and biceps tears happen under heavy eccentric load. Control the descent, use a spotter or safety pins on heavy presses, and keep true max attempts rare.
• Don’t train through pain that changes how you move. Nearly half of bodybuilders in the German study trained with pain. Swap exercises, reduce load and get it looked at before it becomes a tear.
• Warm up and progress gradually. Add load in small steps; see bodybuilding training for how volume and progression work.
• Extra care after 40. Injury rates were higher in older athletes, and tendon tears are most common from the 30s on.
• Stay off PEDs, and be honest with your doctor if you have used them. A physician can check blood pressure, blood work and your heart without judgment.
• Recover like it’s part of training: sleep, food and rest days. See bodybuilding recovery.

Gear many lifters use

Gear won’t prevent a tear, and none of it replaces good programming or rehab. Many lifters still keep a few things in the bag: a belt like the Gymreapers Quick Locking Belt for heavy squats and deadlifts (learn to brace without one first), stiff Gymreapers 18″ wrist wraps for heavy pressing, and a 7 mm sleeve like the Rehband RX Knee Sleeve for leg day. More choices in our guides to the best knee sleeves and wrist wraps.

When to see a sports medicine doctor, PT or athletic trainer

• Right away (emergency, call 911): chest pain, fainting, a racing or irregular heartbeat, confusion, or dark cola-colored urine with severe muscle pain; loss of bladder or bowel control.
• Within days, not weeks: a pop with bruising or a change in shape at the chest or elbow (pec and biceps repairs work best early), sudden weakness lifting or turning the arm, or back pain with numbness down the leg.
• Soon: shoulder pain that wakes you at night, tendon pain that keeps coming back, or any side effects you think might be linked to a substance you’ve taken.

A sports medicine physician diagnoses and orders tests (and can refer you to an orthopedic surgeon or cardiologist); a physical therapist builds the rehab and the path back to heavy training; a certified athletic trainer works with many school and college athletes. For the food side of staying healthy through a prep, see bodybuilding nutrition and supplements.

Bodybuilding injuries: FAQs

Is bodybuilding dangerous?

The training itself is relatively safe: about 0.24 injuries per 1,000 hours in one study, lower than other strength sports. The bigger dangers at the competitive level are drug use and extreme dieting and dehydration, which researchers link to a high rate of sudden cardiac death among pro bodybuilders.

How do I know if I tore my pec?

AAOS lists a pop or ripping feeling (often during the lowering part of a bench press), sudden pain and weakness, bruising on the chest and arm, pain when pushing, and a chest that looks uneven. See a doctor quickly: repair tends to work best soon after the injury.

Do steroids cause tendon tears?

AAOS lists anabolic steroid use as a risk factor for both pec tendon tears and distal biceps tears, and says steroids are linked to muscle and tendon weakness. In a 2023 case series of six bodybuilders with pec tears, three were using anabolic steroids when the tendon tore.

Are SARMs safer than steroids?

No safe version has been shown. The FDA warns that SARMs are unapproved, have been linked to life-threatening liver injury, may raise the risk of heart attack and stroke, and have unknown long-term effects. And when researchers tested 44 products sold online as SARMs, only about half contained what the label said; many held other unapproved drugs.

Is cutting water before a show safe?

Evidence reviews of bodybuilding prep say dehydration and electrolyte manipulation can be dangerous and may not improve how you look on stage. Our Show Day page covers a safer approach.

Where can I get help if I want to stop using steroids?

Start with your doctor; stopping can bring withdrawal symptoms, including depression, so it’s best done with medical support. In the US, the SAMHSA National Helpline (1-800-662-4357) is free and confidential, and if you ever have thoughts of harming yourself, call or text 988.