Is CrossFit Bad for You?

So the main purpose of this blog is to touch on a very delicate subject around injury prevention and incidence amongst Olympic Weightlifting, Powerlifting and CrossFit athletes. I am including the last in here because two Olympic Weightlifting moves are regularly practiced in CrossFit boxes as a way to develop skills and strength, remember this word, skill! If you are reading this and not familiar with those lifts I suggest now it is a good time for you to stop and google: Snatch and Clean & Jerk.

But isn’t Weightlifting and CrossFit bad and dangerous for you? Way too many injuries…

I hear from people that CrossFit causes way too many injuries and so does Olympic Weightlifting. Let me start by saying that perception is flawed. According to the authors of a Systematic Review just published on the British Journal of Sports Medicine (1), injury rates with Olympic Weightlifting and Powerlifting are just the same when compared to other non-contact sports and lower when compared to contact sports. So if you are thinking weightlifting is harmful now you should be reconsidering your participation in soccer, rugby, AFL and so many other well accepted team sports out there. The ones mentioned above are part of the Physical Education Curriculum in most schools in Australia and we are not campaigning against them and nor should we. On the contrary, for many health reasons which are not part of the scope of this blog, activity participation needs to be encouraged in our society.

How about CrossFit then? Well, sorry to disappoint but another two studies that looked into CrossFit reached the same conclusions. When compared to team sports weight lifting (including CrossFit), has a relatively lower incidence of injury (2). One paper in particular states the injury rate in CrossFit to be half of the one seen in Soccer (3). Bottom line, I believe we can all move past that myth and get on with enjoying our chosen sport.

So how can I get into these sports and prevent injuries?

Ok, now we are moving into a maze. Injury prevention and pre-participation screening protocols are a massive topic right now in sports medicine, as a matter of fact, they always have been. If you are a health professional or someone keen on scientific lingo, read: Bahr, R. (2016) Why screening tests to predict injury do not work—and probably never will…: A critical review, who offers more insight into the topic in his research paper (4).

The challenge we face is complex because of various reasons. Individuality is one of them, we all have arms and legs but we are far from being all the same. We move differently, we present with different bone structures, our flexibility is status genetically determined; which I graciously call floppies, stiffies and something in between; the distribution of muscle fiber types is also genetically determined and so forth. Some of these characteristics are changeable to some extent with training whilst others are not. They all collectively impact our abilities to perform certain movements. Injury prevention is also about risk exposure, pure math, greater the exposure the more likely something bad can happen. And then we have good coaching, bad coaching, and no coaching at all. Also external pressures coming from relatives, sponsors, society (aesthetics), the list goes on. Finally, we have SKILL. I will get into this eventually, hang in there.

One of the best strategies to prevent an injury is knowledge. Looking into a paper that investigated injury patterns in CrossFit participants we can get some insights (5). These authors reported that males sustained injury more frequently than females, if you are a male reading this perhaps you may consider quitting showing off.

Shoulder, low back and knees were pointed out as the most common sites in that order; lower back being the most common in powerlifting movements. An interesting conclusion was that the involvement of a trainer was associated with fewer injuries among participants. Oh yeah, that’s right! Good trainers get you doing homework, foundation skills and all those drills you find boring.

At the London Olympic Games in 2012, 61% of the reported Powerlifting injuries were classified as chronic overuse. Shoulders represented 32%, Chest and Elbows 13% each (6). At the London Olympic Games, data from surveillance research reports that Weightlifting was one of the sports with the highest rates (4%) of injury where an athlete had to be absent from training or competition for more than 7 days (7). Now let me put that information into context, considering there were 252 Weightlifting athletes competing in London and that each athlete has 3 official attempts at lifting a given weight x 2 (2 movements Snatch + Clean & Jerk) that is a total of 1,512 lifting attempts across all athletes. Sure some may not have done all the attempts because of injuries or other reasons but I bet this number would still not vary that much. Interestingly, I am not factoring in warm up lifts during competition, something around 10 lifts before going up on stage. Adding up everything we are getting close to 4000 lifts. Should we include lifts done at training?

My point is every lift or attempt made equals 1 exposure or 1 chance of hurting yourself. The higher exposure the greater chances of injury to occur. Hence, high rates of injury need to be looked at considering exposure numbers and not just as a raw number.  Now calm down, other authors also agreed that in Elite Weightlifting the most common injuries are due to overuse and not nasty joint dislocations (8). At the Rio Olympic Games 2016 we had one elbow dislocation; the other injuries were not as severe.

Ok, and how about the Rio 2016 Olympic Games?

Let me start by saying all Elite level athletes put a lot of time into their preparation not only pre-competition but throughout their entire lives. So the results you see are a direct reflection of years of blood sweat and tears devoted to achieving their physical best. What can we learn from them? There is no magic! At elite level, any athlete that improves their lifting weight for more than 10% per year puts himself or herself under heavy surveillance from the International Weightlifting Federation (IWF) doping control for the use of performance enhancing substances.

Back to our reality here, most people out there are doing this for fitness and personal enjoyment. Therefore you need to train SMART, a very common acronym that most physios are familiar with. It stands for:

Specific;

Measurable;

Achievable;

Realistic;

Timely.

Your training goals must follow that rule. Be specific about your needs. Have you ever looked at your hip mobility and anatomical barriers? What is your shoulder mobility like? How about your Thoracic Spine extension range? How good is your squat form with a bar overhead at full depth? What is your core strength like? It is a great idea to start answering those questions by measuring results.

Next, can you actually change what you’ve measured? For instance, one’s hip mobility may be restricted to a certain degree due to an anatomical characteristic. Is it possible to work around it and move in a different way or not? If yes, how realistic would that be? Are you prepared to commit and dedicate time to achieve a needed change that will directly impact your ability to perform a squat for instance? Or are you not that serious about it and just want to have some fun with this? Answering those questions will take you a long way when planning your training.

The last step from SMART is time. Once you reflected on what needs to be done you need to establish a timeframe for that to happen and start working towards your goals. Heads up, a good coach would take you through those steps and help you along the way and that is why we have data saying get a good coach and suffer less injuries. Basically do your homework, if it was given by a coach or physio it does not matter.

Speed, technique and control are also paramount. If you ever believed that “muscle up” weights over your head is the same as Olympic Weightlifting you are far off the mark. Can you guess what those athletes have that most human beings don’t? SKILL. The dictionary defines skill as: “an ability that has been acquired by training”. Also from the dictionary, training: “activity leading to skilled behavior”. There are no shortcuts if you want to do this injury-free.

Now don’t go out there training every day like mad after realising you need to improve your skills. Remember your training must be SMART, which includes rest days. Did I mention that the majority of the CrossFit injuries, according to good quality research, are overuse injuries? Be clever about it.

By now you are 100% sure of where I am going with this. You hear people saying CrossFit is bad for you. Well, if you are patient enough to work on your foundation skills and build yourself up with guidance and using common sense, you should be just fine. However if you want to turn up in the gym or CrossFit box and “muscle up” weights with no planning, please take my business card and thank me later.

Happy exercising!

Bruno Rebello (APAM)

Physiotherapist

1. Aasa, U., Svartholm, I., & Andersson, F (2016). Injuries among weightlifters and powerlifters: A systematic review. Retrieved October 09, 2016, from http://bjsm.bmj.com/content/early/2016/10/04/bjsports-2016-096037
2. Keogh, J. W., & Winwood, P. W. (2016). The Epidemiology of Injuries Across the Weight-Training Sports. Sports Med Sports Medicine. doi:10.1007/s40279-016-0575-0
3. Sprey, J. W., Ferreira, T., Lima, M. V., Duarte, A., Jorge, P. B., & Santili, C. (2016). An Epidemiological Profile of CrossFit Athletes in Brazil. Orthopaedic Journal of Sports Medicine, 4(8). doi:10.1177/2325967116663706
4. Bahr, R. (2016). Why screening tests to predict injury do not work—and probably never will…: A critical review. British Journal of Sports Medicine Br J Sports Med, 50(13), 776-780. doi:10.1136/bjsports-2016-096256
5. Weisenthal, B. M., Beck, C. A., Maloney, M. D., Dehaven, K. E., & Giordano, B. D. (2014). Injury Rate and Patterns Among CrossFit Athletes. Orthopaedic Journal of Sports Medicine, 2(4). doi:10.1177/2325967114531177
6. Willick, S. E., Cushman, D. M., Blauwet, C. A., Emery, C., Webborn, N., Derman, W., . . . Vliet, P. V. (2015). The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days. Scand J Med Sci Sports Scandinavian Journal of Medicine & Science in Sports. doi:10.1111/sms.12554
7. Engebretsen, L., Soligard, T., Steffen, K., Alonso, J. M., Aubry, M., Budgett, R., . . . Renström, P. A. (2013). Sports injuries and illnesses during the London Summer Olympic Games 2012. British Journal of Sports Medicine Br J Sports Med, 47(7), 407-414. doi:10.1136/bjsports-2013-092380
8. Fry, A. C., Calhoon, G., Stone, M. H., Weiss, L. W., Li, Y., & Cantler, E. L. (1998). Injury Rates And Profiles Of Elite Competitive Olympic-Style Weightlifters. Medicine & Science in Sports & Exercise, 30(Supplement), 53. doi:10.1097/00005768-199805001-00298

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