Crossfit

It is no secret that the popularity of CrossFit has exploded in recent years. Since it was founded in 2000, it has taken the fitness world by storm. CrossFit workouts (known as WODs or workout of the day) combine elements of high-intensity interval training, Olympic weightlifting, plyometrics, powerlifting, gymnastics, calisthenics (body weight exercise), and strongman exercises. While all CrossFit gyms, or boxes, differ in the structure of the daily workout routine, most consist of a warmup, a skill development segment, the high-intensity WOD, then a cool down. If performed correctly and under the supervision of a knowledgeable, skilled coach, CrossFit offers a variety of physical, mental, and emotional advantages. Not only do individuals get in better shape, but they leave the box each day knowing they gave it their all while surrounded by a close-knit community of friends. However, like other sports and activities, there may be situations that arise that put CrossFitters at risk for injury. Unfortunately, since its inception, CrossFit has been scrutinized for putting people at a higher risk for injury.  Common injuries include shoulder impingement, low back pain, FAI or hip impingement, and various forms of tendinitis.  

Factors that may lead to some of these injuries include: 

• It is difficult in a group training atmosphere for activities to be individualized. As a CrossFit coach and a participant, it is important to consider past medical histories and past injuries that may put a person at risk during certain lifts or aerobic exercises. 
• In early stages, a person may not be accustomed to higher repetitions of exercise, which causes the technique to fall apart due to fatigue. Poor technique has a high correlation with increased risk of injury. 
• EGO: Let’s face it. CrossFit can get competitive when everyone is trying to get the best time, or the greatest number of reps completed for a WOD. Problems arise when a person refuses to modify a lift in order to perform it safely, or when someone pushes through a workout while sacrificing proper technique in the process.  

Common CrossFit Injuries include: 

• Shoulder impingement: The most common CrossFit injury is likely shoulder impingement. This occurs with overhead movement when the tendons or bursa around the shoulder are impinged inside of the joint.  Symptoms include pain in the front and side of the shoulder when moving the arm overhead, or when laying on the affected side. While there can be several causes for shoulder impingement, in regard to CrossFit, the common culprits are excessive stress on the rotator cuff tendons and shoulder instability (weakness of the rotator cuff and surrounding ligaments). Common activities that aggravate shoulder impingement syndrome include the clean and jerk, snatches, kipping pull ups, and dips.  
• Low back pain: With compound lifts such as squats and deadlifts, it is likely that heavy loads will be placed on the low back. If muscle imbalances are present or the lift is not executed properly, it can lead to muscle strains, ligament sprains, or even disc irritation in the low back. Symptoms include tightness and pain that can be described as aching, throbbing, or shooting (possibly into the leg). Extension-based low back pain is often seen with overhead lifts or kipping pull ups, as the low back compensates for other areas of the body, causing it to overarch.  
• Femoral Acetabular Impingement (FAI): Impingement of the hip can be described as abnormal contact between the femur (the long thigh bone) and the acetabulum (the socket of the hip bone where the femur inserts). This results in increased friction with hip movement overtime that can to labral tears. Hip impingement causes pain and stiffness throughout the joint and results in progressive loss of motion if not treated. Popping and clicking occur with hip flexion and rotation. In CrossFit, FAI can occur when a pinching sensation is felt in the hip at the bottom of a squat position.  
• Tendinitis/Tendinopathies: With high impact activities such as thrusters, jerks, snatches, sprinting and jumping, excessive load can be placed on tendons throughout the body. Initially, this will lead to inflammation of the tendon that will progress to stiffness and weakness. Common sites for tendinopathies include the rotator cuff, the elbow, the patella, and the Achilles.  

How can Physical Therapy help? 

A PT will perform a thorough evaluation to determine the structure that is injured or painful, but more importantly why it is injured or painful. Your past medical history will be reviewed to determine any possible underlying causes of pain. The problem is often coming from another non-painful part of the body. For example, shoulder impingement is not simply rotator cuff tendinopathy. Why is the rotator cuff not functioning properly? It can be due to a variety of reasons such as shoulder instability, scapular weakness, tightness in the pecs, cervical and/or thoracic spine.  Your PT will design a treatment program to correct any of these underlying mobility or strength deficits, so your problem doesn’t return once the painful structure is healed. Your PT will also communicate with your CrossFit coach to establish progressions and a plan of care. 

Key Takeaways: 

• TECHNIQUE IS VITAL: When an exercise technique falls apart, injuries usually follow. 
• LEAVE THE EGO AT THE DOOR: Modify workouts to avoid injury. There may be instances where you need to decrease the volume or weight. You may even need to take a break completely from a specific exercise.  
• DO NOT STOP THE FITNESS JOURNEY: If you love CrossFit, PT’s want you to continue CrossFit. PT’s will give you strategies to modify certain exercises, as well as provide corrective exercises to improve mobility, strength, and overall movement patterns!