CrossFit Injuries: Are There Really That Many?

CrossFit Injuries

As a Physical Therapist who works in a CrossFit box, I get asked this question a lot. Both by people who are members, as well as outsiders, so I figured it was time to share my thoughts.

If we look at injury rates in CrossFit, a 2017 study by Klimek showed that injury rates are very similar to other popular sports such as soccer, ice hockey, powerlifting, gymnastics, and even, yes, running!

CrossFit Vs. Running

Now I’ve never heard anyone say that running is unsafe or that we should never run, but injury rates for runners have been reported at 2.5-12.1 per 1000 training hours, vs 2.1-3.1 per 1000 training hours in CrossFit. (Moran 2017, Hak 2017, Montalvo 2017, van Mechelen 1992).

CrossFit injuries occur because we are training with increased intensity and load for a longer duration of time. Montalvo found that competitors and those who trained more frequently were more likely to experience an injury. A lot of boxes will program more intense workouts than what @crossfit actually recommends.

With that said we need to look at load and volume management. Tim Gabbet showed a 70% increase in injury risk when training volume is too high or there is a big spike in volume.

Workout Volume

Due to the high volume in many workouts that also require a high degree of technical precision, we tend to see increased injuries as a result of technique errors as well as from a lack of muscle strength/endurance.  I think this is due to the fact that a lot of athletes will train above their maximal recoverable zone, which will allow them to build up strength for a period of time, but eventually catch up with them in the form of a CrossFit injury.

In CF Level 1 classes coaches are taught to compose workouts with a single strength or skill exercise or a metabolic conditioning workout with a 2 days on/1 day off or 5 days on/2 days off schedule.

However most gyms will program a strength component as well as a conditioning component on the same day 6-7 days/week.  This is significantly higher than what CrossFit HQ actually recommends and I believe this puts athletes above their maximal recovery zone and makes them more susceptible to injury.

Common Medical Opinion

If we look at what most medical professionals say when it comes to CrossFit, AKA “Just Stop”, then we shift to the other end of the spectrum and we know that an inactive lifestyle can be associated with higher risks of: Chronic pain, obesity, depression, heart disease, diabetes, shorter lifespan, etc.

I think its pretty obvious which one is better.

Overall, a comprehensive approach needs to be taken to prevent CrossFit injuries. An individualistic approach to volume and load management, technique, and muscle strength/imbalances can have a real positive impact on this sport which has already done a great job encouraging millions to live a healthy, active lifestyle!

If you’re a CrossFitter, live in Washington DC, and have suffered an injury, you don’t have to suffer in pain.  Big League Performance and Rehab is here for you!  We specialize in helping active people like you get back to the things they love to do!

If your interested in talking 1 on 1 with a Doctor of Physical Therapy about what you’ve been dealing with you can email Dr. Mike right here- Contact

4 Keys to Picking the Right Physical Therapist

Being a Physical Therapist in a CrossFit gym has given me a great opportunity to talk to many athletes about the sport as well as current issues they may be having.  It’s always surprising to hear how grateful they are when you spend a couple minutes listening to their situation.  It makes me think what are we, in the medical community, actually doing that no one has been able to answer these questions.

Unfortunately, in the state that Physical Therapy is right now, seeing patients in a one on one environment is very rare.  It’s just too hard to maintain a profitable business with this type of strategy due to insurance reimbursements.  What happens instead, is we move from a patient centered model of care to a therapist centered model of care, where the Physical Therapist  is seeing anywhere from 3-5 patients an hour.  What happens then is the PT will get to spend about 10 minutes per patient before having to move on to the next one, while you get handed off to an assistant, aide, or volunteer.  The PT ends up just running around putting fires out all day, instead of actually getting to listen and talk with you about what’s going on.

As we’re learning more and more about pain.  We’re learning it’s a very complex, multifactorial thing that isn’t always connected to biomechanical factors, other variables such as sleep, diet, and stress also play a role.  These are things your Physical Therapist should be talking about with you and how to manage them.  In the therapist centered model of care, it’s easy for a PT to get caught up in the injury and forget about the whole person.  The focus should always be on you, not just your injured body part!

With that said, these are the 4 things I recommend checking out before you commit to a Physical Therapist:

 

  1. Pick a Physical therapist who will work with you 1 on 1 for an hour.

    • Physical Therapy isn’t unlike any other business. The saying “you get what you pay for”, definitely applies.  It’s very unlikely, you’ll see a business  advertising that they treat 4 people/hour.  Would you go to an accountant that set up 4 different meetings at the same time?  I hope not, because why would it be ok for people to treat your most important asset, your body with less respect than your accountant gives to your tax return.
    • Due to poor Insurance re-imbursements, many clinicians will practice in fee for service type model or accept limited insurances. The reason they do this is out of necessity.  They refuse to sacrifice quality for quantity.
      • Not just Physical Therapists but many physicians, dentists, and chiropractors have also begun to shift to this model of care. This allows them to treat patients, the way they deserve.  Some lady in Iowa who works for Blue Cross, should not be determining how many visits of PT you get!
    • Medical Providers with a true passion for helping other are shifting to this model every day. It’s good for them, and even better for the patient.  You should work with someone that treats you the way they would treat a family member.
    • Understand that you have a choice in the matter, do your own research and choose a PT that you feel comfortable working with.

 

  1. Pick some who performs hands on treatment

    • The act of putting your hands on someone can be very powerful. Sometimes to get the nervous to relax, the best way is just putting your hands on someone.  Think about when you go to the doctor, you wouldn’t like it if they just stood there and said what’s the matter.
    • From my experiences, putting my hands on people has definitely helped them get better quicker. Your PT sessions shouldn’t consist of getting a hot pack, some ultrasound, e-stim, and some dumb leg raises that don’t even make you feel tired.  These are the kind of places that give physical therapy a bad name.  Leave and don’t ever go back!
    • When looking for a PT, a safe bet is someone who performs manual therapy. Other key words are mobilizations, manipulations, as well as soft tissue or fascia techniques such as Active Release Technique.

 

  1. Pick someone who has experience in working with people who are similar to you

    • Pretty easy, if you’re a crossfitter, make sure they’ve worked with crossfitters before. If you’re a runner, make sure they’ve worked with runners before.  If you’re a baseball player, make sure they’ve worked with baseball players before.
    • You don’t want to get attached to a PT that doesn’t understand A) your goals and B) the demands of your goal.
    • If you do CrossFit or Olympic lifting, your PT clinic should have a squat rack and barbells to help prepare you for a return to your sport. Just as if you want to be able to walk up the stairs pain free, they should be able to help you accomplish that as well.
    • Even though, we all have that same sheet of paper from an accredited university, there can be a massive difference in physical therapists. Pick one that understands your sport and your goals.  You should feel comfortable with them and if they tell you to stop doing CrossFit or to stop running, tell them no thank you and kindly get up and leave.

 

  1. Ask your prospective physical therapist, how much they dead lift.

    • This is a recommendation from Kelly Starrett at MobilityWOD. Danny Mattas of Athletes Potential in Atlanta, GA think you should ask them how much they snatch.
    • Realistically, if you’re a crossfitter, your therapist should have knowledge of both. As well as squatting, thrusters, pullups, double unders, etc.  You get the idea, they should be well versed in what you’re trying to do.  If they don’t know what a snatch or a clean is, you’ve definitely gone to the wrong place.
    • Many physical therapists will tell you to stop doing CrossFit. This is like telling a runner to stop running, it just isn’t going to happen.  If you look at injury rates from CrossFit, they’re no different than the rates for running, soccer, and hockey to name a few sports.  No one is trying to end those sports!  Make sure they understand that return to your sport is vital.
    • I’m not saying that they need to be able to deadlift twice their body weight, but they need to be well versed in what you’re trying to achieve.

 

If you’re injured and seeking out a physical therapist, I hope this post helps you.  No matter where you are in the country, you have the right to take these principles and apply them to your search.  Don’t let anyone tell you, you’re resigned to only 1 place whether or not their interests align with yours.

If you’re in the Washington D.C. area and have been struggling with an injury, we can help.  You don’t have to live with pain, no matter how severe or nagging, you deserve to do the activities you enjoy.  We help people just like you get back to the CrossFit gym, back to playing with their kids, and back to waking up pain free every morning!