At any time, somewhere in the world, an inadequate sport scientist or deluded therapist is about to initiate another defective study on injury and injury rates in CrossFit.
Let’s face it; if they didn’t tag their post as “CrossFit Injuries ” no one would care, no one would look at it. It would go as un-noticed as it actually deserved.
As CrossFitters, we are fascinated by injury rates but appalled by poor and shoddy sports science and therapy babble. The major problem is this: in CrossFit, as in life, unless there is a fall or an accident, most injuries are simply “the straw that broke the camel’s back”.
Normally, clients tweak their back because they misuse their back all the time. To push this proposition into the light, and to be a bit silly, if a client leaves a sports session, goes to hospital and is diagnosed with cancer, no one seriously suggests that the sport session gave them cancer.
Often, injury reviews make no attempt to correctly trace the aetiology of injury. Often, bad form is a result of constant poor posture, not of failure under fatigue. According to McGill, injury is often the result of a long term misuse and reduction in capacity. The actual activity that brings on a bad back is something as innocuous as brushing your teeth.
But there are lots of issues in studying CrossFit and injuries: what does CrossFit mean? Often, in what passes as the literature, the implication is that injury is a result of high rep induced fatigue. However at CrossFit London, for example, we have gymnastics, periodised strength sessions and Olympic weightlifting sessions, many of which are carried out at ” normal ” speeds.
If I tweak a knee in a back flick landing, at CrossFit London, is that a CrossFit injury?
Let’s explore an injury. One of my recent ones!
I’ve tweaked my right wrist and it hurts. It started the day after I missed a snatch. Is CrossFit to blame? I was training on my own, at a very lazy pace. Was that injury caused by the poor snatch or the fact that my right upper limb always tries to compensate for my left side? Why? Because I’m deaf in my right ear, meaning that I sleep with my left ear on the pillow, which means that for 55 years I’ve slept on my left arm, every night, which has weakened it.
So, was it those factors or the fact that I decided to solidly practice handstand walking for 9 days in a row? Can any of this be laid at CrossFit’s door, apart from the fact that it was CrossFit which inspired me to improve myself?
Hak et al (2013) found that 73.5% of CrossFitters had sustained an injury that prevented them from training (based on an injury rate of 3.1 per 1000 hours trained, just like gymnastics and weightlifting). Weisenthal et al (2014) reported that shoulder, low back and knee injuries were most common. Low backs were commonly injured during power- lifting movements.
Frankly, I’d ask if these people sat at desks or hunched. I see more seating injuriesthan I do deadlift ones.
But, lets follow the line of thought. CrossFitters, allegedly, injure themselves during fatiguing workouts. Doing a lot of work with an eye on the clock is, therefore, wrong.
CrossFitters, at their core, view their workout movements as work. The aim of all work is to relate the work done, with time. How long did it take?
This holds true in academic exams, running, rugby and life. Winning performances consist of doing good work, in a faster time
I’m not so sure about sex.
As we have discovered from life, activity can fatigue. The more emails you write, the more chance of a poor phrase slipping in. Morgan et al, 2009 (not really a report, more an article) Nachemson (1965) and Dreischarf et al. (2016) all observe the possible consequences of lifting with a flexed lumbar spine. I’m surprised sitting hunched at work hadn’t given them a clue. However, GOOD NEWS . There IS money in stating the bleeding obvious.
Overhead arm movements are problematic. Impingement of the rotator cuff muscles can occur if the space between the coracoacromial arch and the humeral head is reduced (Morgan et al 2010). Defective scapular positioning could be to blame (Kibler 1998). The scapulae should retract and tilt posteriorly in order to maintain the subacromial space during an overhead arm movement.
That scapula retraction is affected by the mobility of the thoracic spine and rib cage is once again stating the bleeding obvious, but well done Strunce et al (2009) for writing it up. Years of hunching, texting, peering at computer screens mean that our overhead positions need work.
Therefore, it can be suggested that without good mobility of the thoracic spine no one should risk putting their hands over their head.
No one should stock the upper shelves of your kitchen, no curtain hanging, no singing along to rock groups or holding up your lighter at a Prog Rock gig.
There is a line of thought that demands perfection in movement, without for one second conceding that the pathway to learning good movement is poor movement.
I get to watch, weekly, people swim, play football, walk and sit. 98% do so appallingly. The better athlete starts with poor movement and develops. The poor athlete is happy with more poor movement.
I don’t mind sport science hysteria, but the dangerous sports are contact ones; Rugby, boxing, jumping of cliffs with bits of cloth tied around some sticks. See this BBC Article. I should say that I boxed and loved it: I personally don’t like sports that make me focus on a ball then encourage someone to pull my legs away or high tackle me.
Maybe I’m a coward.
I suspect if we really analysed injury, it would correlate with long term poor form. What identifies it is the health drive of the sub group. Casual pub footballers, probably won’t spend the money to see a therapist. The average CrossFitter, passionate about their sport, will see a therapist to get back to fitness asap.
So what is the applicable morality here? If someone moves badly, should we ban them? If you walk poorly, taking 10,000 steps surely has a higher risk factor than lifting a bar 45 times. Sitting for 8 to 12 hours is, surely, more dangerous that a kipping pull up. Running to get a ball and crashing into a team member, or falling off skis, has a real risk of death. Maybe you can tweak a shoulder if you miss a muscle up.
According to my good friend Dale Saran: “You have to accept a risk of injury as a reality of playing a sport, or just living a life. A 100-percent safe exercise has a zero percent chance of getting you fit. It’s you sitting on the couch with a helmet and kneepads on.” I sort of agree, but I’d say “sitting on the couch with a helmet and kneepads on” is the most dangerous thing you can do. Sitting is basically suicide for those who like to do things slowly (and watch TV in the process).
I suspect that mental attitude has a role in all this. Frequently, aggressive people injure themselves. This is from a blog post: “Determined to perform well, he doubled down on his training, working out twice a day, upping his max dead lift to 375 pounds and doing 53 pull-ups at a time. The tough regimen took its toll – tennis elbow, golfer’s elbow, shoulder woes, knee pain, a persistent trick in his neck”
I think aggressive people have always injured themselves.
~So what are we to do? As Crossfit London, the UK’s 1st ever Crossfit affiliate we have a duty to lead the way in this research as,f rankly, those sport scientists that have looked at injury rate in crossfit are not up to the task. Im sure there are great sports scientists out there btw. We intend to carefully record all of our injuries over the next year and review the back ground and nail the aetiology. We will, where possible interview the injured client, the coach and any witnesses.
So if you injure yourself, don’t be surprised if you get a very inquisitive email from me or one the Crossfit London sports injury team.
Just sayin
References
“Consortium for Health and Military Performance and American College of Sports Medicine Consensus Paper on Extreme Conditioning Programs in Military Personnel” Bergeron et al.
http://library.crossfit.com/free/pdf/CFJ_111200_Bergeron_Champ.pdf
Injury Rates and Profiles of Elite Competitive Weightlifters
Gregg Calhoon J Athl Train. 1999 Jul-Sep; 34(3): 232–238
Dreischarf M, Aboulfazl SA, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: a review of in vivo and computational model studies. J Biomech. 2016;49(6):833-45.
Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med.1993;21(4):599-603.
Hak P, Hodzovic E, Hickey B. The nature and prevalence of injury during crossfit training. J Strength Cond Res. 2013; DOI:10.1519/JSC.0000000000000318. [Published ahead of print]
Kibler BW. The role of the scapula in athletic shoulder function. Am J Sports Med.1998;26(2):325-337.
Morgan WE, Feil C. Cross-Fitness injury prevention: Protecting the lumbar disc in squatting motions [online]. California; Dynamic Chiropractic; 2009 [last updated Oct 2009; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54148
Morgan WE, Feil C. The Importance of the Thoracic Spine in Shoulder Mechanics [online]. California; Dynamic Chiropractic; 2010 [last updated May 2010; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54622
Nachemson AL. In vivo discometry in lumbar discs with irregular nucleograms. Acta Orthop Scand. 1965;36(4):426
Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clinical Sports Medicine.1991;10:615-621.
Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230- 236.
Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among crossfit athletes. Orthop J Sports Med. 2014;2(4): 2325967114531177
http://ojs.sagepub.com/content/2/4/2325967114531177.full
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