[Brandon is a student at the University of Mount Olive majoring in Exercise Science. He is currently an Athletic Development Intern at Athletic Lab.]
CrossFit is an exercise phenomenon that has sparked interest in many people and gyms across the nation. CrossFit was designed with the goal to, “build a program that would best prepare trainees for any physical contingency-prepare them not only for the unknown but for the unknowable as well” (Glassman, 2007). This sounds pretty good, right? It gets even better with the fact that CrossFit offers competitions on a reginal, national, world scale, and of course on a personal scale.
As with any form of exercise there will be some downsides to a program; for CrossFit this is the gained reputation for its tendency to cause injuries. The reasons for injury in CrossFit are often a combination of poor technique combined with heavy loading. The overuse of a muscle can also lead directly to injury in an individual. Common injuries include but are not limited to the following: shoulder, low back injuries, knees, wrist, elbow, neck, chest, and foot injuries (Weisenthal, Beck, Maloney, DeHaven, & Giordano, 2014). Shoulder and low back injuries consume the majority of CrossFit related injuries.
The common injuries of the shoulder include subacromial impingement, labrum tears, and rotator cuff tears (see Figure 1, 2, & 3 for common injury sites). The shoulders are mostly injured due to a result of a gymnastic movements performed during training (Weisenthal, Beck, Maloney, DeHaven, & Giordano, 2014). Examples of gymnastic movements commonly seen in CrossFit would be muscle ups and pull ups. A technique commonly performed during muscle ups and pull ups is “kipping” which if done incorrectly can severely damage the upper body extremities. As stated by Glassman, “Kipping is a transference of movement first generated in the horizontal plane, to the vertical plane, where momentum and a perfectly timed pull from the back launch the athlete forcefully upward” (2005). As you can read from the description this movement involves precise timing while moving in multiple planes. To avoid injury, beginners should avoid kipping until they have the prerequisite strength to perform a pull up. The shoulder joint has the greatest range of motion compared to all other joints in the body. However, this means the shoulder is also the least stable joint in the body. When hanging from the pull up position it is extremely important that the muscles around the shoulder are engaged to avoid heavy loading of the shoulder’s ligaments. Strict pull ups require the muscles around the shoulder to be engaged. The momentum from kipping gives way to engage less of the shoulder’s muscles, but not engaging these muscles can be very dangerous for the supporting ligaments of the shoulder.
Another common injury seen in CrossFit would be a low back injury. The spine is made up of bones called vertebrae. The lower back is referred to as the lumbar region of the spine. Between each pair of lumbar vertebrae are an intervertebral disc and a pair of cartilaginous endplates where the vertebrae and disc meet. Weisenthal, Beck, Maloney, DeHaven, and Giordano, point out that, “Low back (injury) is mostly seen as a result of power lifting movements” (2014). This makes sense because, if poor technique is performed during these movements you are directly putting strain on the lower back which in turn can lead to pain. Keep in mind that maintaining good technique becomes harder as the number of repetitions increases. It is not wise to continue a lift if technique is suffering because of fatigue. “Vertebrae can shear or break after forceful extension when finishing the pull of an exercise like the deadlift” (Durall & Manske, 2005). “Disk injuries mostly occur when the spine is flexed” (Durall & Manske, 2005). Deadlifts and good mornings are examples of exercises that may cause lumbar flexion. It is much safer for the lower back to remain extended throughout these lifts. “End plates always run the risk of injury due to excessive loading and compression of the spine” (Durall & Manske, 2005). The likelihood of injury to the end plates is decreased by gradually increasing loads to encourage tissue adaptations over time (Durall & Manske, 2005). Effective means for supporting the structures of the low back would be to strengthen the assisting muscles. The assisting muscles would be those that work to help with the movement, in this case, it would be advised to strengthen the abs and glutes along with the lower back muscles (Figure 5).
So now that you have a better understanding of the injury mechanics behind these two problematic areas let us get into some general tips that will help prevent these injuries from occurring. Whether you are new to CrossFit or a veteran to the sport it may be wise to have a trainer present when you train. Trainer involvement in a workout has been shown to reduce the likelihood of injury during CrossFit training (Weisenthal, Beck, Maloney, DeHaven, & Giordano, 2014). I would first suggest a proper warm up/cooldown with any exercise. Warm ups are important for getting your mind and body prepared for the strenuous activities you will experience during CrossFit. I commonly see people spend proper time on their warm up however cooldowns seem to take a back burner to exercise. This should not be the case however because a proper cooldown can assist the body of removing the waste and buildup of lactic acid. An effective cooldown is going to help relieve symptoms of muscle soreness, as well as, aid in the speed of recovery by renewing blood flow to the muscles. Alongside a cooldown, it is especially important to allow the body to have “rest” days. The body needs time to heal and adapt to the stresses that are put on it during a workout. Every time we work out we are creating microscopic tears to our muscles and this is what causes us to feel soreness a day or two later. Without proper rest, a muscle cannot repair the microscopic damage. It becomes fatigued and overused which can directly lead to injury.
Other less common things thought of to prevent injury would be proper range of motion, sleep, and hydration. Having the proper mobility to perform various lifts will help reduce the chance of injury. It is not good to force your body into positions it is not ready to handle, this is why you should be sure to train mobility to all of the muscles to prevent putting them in unsafe positions.
Next, we move onto sleep, most people do not get an adequate amount of sleep needed at night to allow the body to recover properly. During our sleep is where the majority of our muscle recovery process takes place…ensure you are getting at least eight hours! Studies have “found that hours of sleep per night are a significant independent risk factor for injury. Adolescent athletes (15.2 ± 1.5 years) who slept on average\8 h per night were 1.7 times more likely to have had an injury compared with athletes who slept for more than 8 h” (Nédélec, Halson, Abaidia, Ahmaidi, & Dupont, 2015). You may not be an adolescent athlete, but your sleep is still just as important if you plan on continuing or starting CrossFit.
Last but not least, we move on to hydration, our bodies, after all, are mostly composed of water. Water is the basis for all physiological and metabolic processes; we are basically useless without it. This means it affects our ability to perform at higher intensities for longer periods of time; as well as, our ability to recover quickly. Having good hydration will have positive impacts on the brain, heart, lungs, kidneys, and muscles. Comparatively, being dehydrated can and will reduce endurance, strength, and muscular response. This makes staying hydrated unequivocally important for optimal performance. The American College of Sports Medicine recommendations for hydration pre, intra, and post workout is as follows:
- Drink 16-20 fluid ounces of water or sports beverage at least four hours before exercise.
- Drink 8-12 fluid ounces of water 10-15 minutes before exercise. Consuming a beverage with sodium (salt) and/or small meal helps to stimulate thirst and retain fluids.
- Drink 3-8 fluid ounces of water every 15-20 minutes when exercising for less than 60 minutes.
- Drink 3-8 fluid ounces of a sports beverage (5-8 percent carbohydrate with electrolytes) every 15-20 minutes when exercising greater than 60 minutes. Do not drink more than one quart/hour during exercise.
- Drink 20-24 fluid ounces of water or sports beverage for every one pound lost after a workout. The goal is to correct losses within two hours post workout.
Overall, when performing any form of exercise, especially a high demand workout like CrossFit, you should be ensuring you are putting your bodies needs first, keeping an eye out for how your body is feeling, and responding to the demands you are placing on it. With the proper mindset, tenacity, and trainers you should be able to lower your chances of injury during CrossFit.
Durall, C. J., & Manske, R. C. (2005). Avoiding lumbar spine injury during resistance training. Strength and Conditioning Journal, 24(4), 64-72
Glassman, G. (2007). Understanding crossfit. The CrossFit Journal, 56, 1-2.
Glassman, G. (2005). The kipping pull-up. The CrossFit Journal, 32, 1-3.
Hak, P. T., Hodzovic, E., & Hickey, B. (2013). The nature and prevalence of injury during CrossFit training. The Journal of Strength & Conditioning Research. Advance online publication. doi:10.1519/JSC.
Nédélec, M., Halson, S., Abaidia, A., Ahmaidi, S., & Dupont, G. (2015). Stress, sleep and recovery in elite soccer: A critical review of the literature. Sports Medicine, 45(10), 1387-1400
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), 1-7