The number of athletes participating in CrossFit continues to increase year after year. In 2007 only 250 affiate gyms existed whereas that number now totals to over 10,000.. With an increased number of athletes training at a high level and pushing their bodies to its physiological limits, there is an inherent increase in number of injuries. You likely have heard people express concerns over the injury rates and risks of CrossFit. In a recent study in the Journal of Strength and Conditioning, it was demonstrated that the injury risk is 3.1/1000 training hours. To my knowledge, this is the only peer reviewed article looking at injury rates in CrossFit, but the sample size was relatively small and may not be representative of participants as a whole. Never the less, compare this to injury rates of other sports; Running 2.5-30/1000 hours for marathon runners depending on experience, volume, pace; American Football 8/1000 hours; alpine skiing 8/1000 hours or 2-4/1000 skier days; and soccer ranging from 0.6-19.1/1000 hours with MLS rate being 6.2/1000 hours. Based on these numbers, it would appear that the injury rate in CrossFit is actually less than many other sports, and thus the increase in number of injuries has more to do with the increased number of participants and less with the safety of CrossFit as a sport. However, I think there are certain aspects of CrossFit that increase the risk of injury to its participants. It has been my experience that the vast majority of injuries are occurring in athletes that have been participating in CrossFit for 6-18 months. These athletes have participated long enough that they are not watched as closely by the coaches, yet they continue to load up heavy weights and push themselves to their limits performing highly skilled movements which are not automatic motor programs. Also we see form being sacrificed to squeak out another rep in this population. In these individuals that have been doing CrossFit for 6-18 months we typically see low back and knee injuries more common with barbell movements and shoulder injuries seem to be more prevalent with gymnastic style movements.
With the vast majority of CrossFit injuries being neuromusculoskeletal in nature, there is no healthcare provider better prepared to treat this athlete population as their primary provider or entry in to the healthcare system than physical therapists. Physical therapists have the ability to address overuse injuries as well as treat acute injuries and screen for additional red flags that may require referral. With many of the practicing physical therapists at the Doctorate level or with many years of experience in practice, their schooling and experience includes extensive examination, evaluation and red-flag screening training.
A Virginia Mason Medical Center study examining the “Old versus New approach” in managing low back pain, showed lower total health care costs to back pain treatment with standardizing a path with direct access to a physical therapist. The study found less wait times for appointments, MRI utilization dropped from 15.4% to 10%, and only 6% of people lost time from work saving their employers thousands of dollars in healthcare costs and productivity.
CrossFit athletes, especially at the top level, train at the same frequency and intensity as other professional athletes. However, instead of having a full sports medicine support team, they are left with the decision to self manage via self mobilizing on lacrosse balls, purchasing expensive modalities and stretching with bands or to do their best at negotiating through the health care system, deciding who to see when and how often. More often than not, these injuries and impairments can be corrected more efficiently and effectively through a detailed sport specific examination determining the pain generating tissue, movement or strength impairments and then a subsequent focused intervention of manual therapy and specific exercise based on the exam findings. Specifically in the Crossfit athlete, we see movement patterns dominated by global muscles while lacking the important stabilizer muscles As physical therapists we have a trained eye for these motor patterns and can quickly pick up faulty movements like scapula dyskinesis or being Quadriceps dominant at the bottom of a squat. We then have the ability to deconstruct this movement even more detailed to determine if the impairments are secondary to joint restriction (local or afar), muscle weakness or motor programming.
Too often these athletes are mishandled within the medical community. They end up under the care of individuals who are ignorant to the biomechanics and demands of the sport and are either told to “stop doing Crossfit” or worse treated despite the lack of understanding seen as great money makers. Neither of these scenarios is beneficial to the athlete. You wouldn’t see a trainer or team doctor in the NFL that has no clue about the demands of football or simply tell the athlete to stop playing football.
Some of the best athletes I have worked with have been professional CrossFit athletes, but the vast majority of individuals participating in CrossFit are doing it for health and fitness. It is important for the athletes to understand this difference, and understand that modifications during a workout are ok. As a therapist with a good understanding of biomechanics, physiology and the goals of CrossFit exercises, we can help to suggest appropriate modifications. In addition, the nature of all sports includes the risk of injury. Some injuries will require surgery, while others will just need relative rest. All too often, athletes are challenging their healthcare team on when they can go back to full participation and what can they do in the meantime. Who better to help the athlete through what they can and can’t do while recovering from injury than a physical therapist. It has been shown that if athletes feel that their therapists have a strong understanding of their sport and are working to maximize their participation safely, they adhere to restrictions. CrossFit athletes are no different. By utilizing the knowledge of tissue stress during various positions and understanding the movements of CrossFit, we are able to come up with suggested programming to discuss with the athlete and coaches to maximize participation. With this approach, it has been my experience that CrossFit athletes are extremely appreciative and receptive to physical therapists and the skilled care they provide.
Utilizing physical therapists as primary care healthcare providers for neuromusculoskeletal conditions has been shown to be safe, cost effective and maximizes outcomes. With the vast majority of CrossFit injuries being neuromusculosekletal in nature, physical therapists with their extensive knowledge of movement science and biomechanics should be the provider of choice. However, it is imperative that physical therapists take the time to fully understand the sport of CrossFit and its athletes in order to maximize good outcomes and to build rapport. Lets get away from the blanket statement of “stop doing CrossFit” and take the time to understand the sport, put together a medical team that cares with a physical therapist as primary point of contact and find the safest way for athletes to proceed given the current lack of substantial research on injuries in CrossFit.