Beyond the Aesthetics A Narrative Review of Injury Management in the Pursuit of Muscle Mass in Bodybuilding

Musculoskeletal injuries are common among bodybuilders because of the physical demands of high-volume, high-intensity resistance training. Despite frequent pain or injury, many continue training—often adjusting their routines to accommodate discomfort. Before attributing symptoms to orthopedic causes, it is essential to first screen for medical red flags that may indicate systemic or nonmusculoskeletal issues requiring further evaluation. This narrative review examines the prevalence, risk factors, and injury patterns in bodybuilding, with particular attention paid to the shoulders, lower back, and knees. We explore the roles of training practices, overuse, anabolic-androgenic steroid use, and caloric deficits in injury risk. Given scarcity of evidence-based guidelines specific to bodybuilders, we propose strategies commonly used in other athletic populations to reduce injury risk and support training. These include proper warm-up protocols and targeted modifications to load, range of motion, tempo, volume, and proximity to failure. Periodization and use of blood flow restriction training are also discussed as tools for managing load and mitigating pain. By integrating these approaches, both bodybuilders and clinicians can enhance performance while minimizing the risk of aggravating existing injuries. By applying these strategies, both athletes and clinicians can work toward sustaining performance while reducing injury risk in the bodybuilding population.