I've been using red lava rock for about...10 years plus - maybe much longer because I can't recall not using it. I have a huge mess of java fern growing on a cave made out of 3 large hunks of the stuff. Algae and other things grow on lava rock, snails love it, and I have better water quality in tanks where I have established lava rocks with plants growing over it than I do in tanks without just plants and other rocks.
Personally, I think it becomes the FW equivalent of live rock. I always keep it beneath the HOB outflow which keeps water moving over and through the rock.
As for injuries, I don't know that I've ever seen an injury that led me to think - gee, that was caused by the lava rock. My clown pleco cleans it and has no problems...and so have (over the years) - otos, various shrimp and cories who same around and over it cleaning. I've also kept scaleless fish such as kuhli loaches who hung out, crawled over, and around the lava rock with no problems.
YMMV,
Eric