Does CrossFit cause injury or is this just an elitist idea?

CrossFit is a training modality and competition structure formally founded by Greg Glassman in 2000. The original CrossFit gym is in Santa Cruz, California, and the first affiliated gym was CrossFit North in Seattle, Washington; there were 13 gyms by 2005, and today there are more than 13,000. The popularity of this sport has exceeded expectation and due to this meteoric rise, the scrutiny which this methodology has attained is substantial both within the media, research and culturally. CrossFit’s mantra is “Constantly varied functional movements performed at high intensity” (Glassman, 2007), herein lies the most often sited issue; adding in such a wide array of exercises that require the skill and capacity to perform them, is so very vast. Thus the achievement of mastery of any singular component is akin to trying to ride two horses at the same time. The added high-intensity facet alongside a competitive element, supports the belief that those taking part will put themselves at a higher risk of injury during training or competition within this methodology.

All that being said, is it CrossFit as a sport putting people at risk of injury above that of any other recreational and competitive sporting environment?. Elkin, Kammerman, Kunselman, & Gallo, (2019) presented a study whereby a total of 411 participants (122 CrossFit; 289 traditional weightlifting) completed questionnaires about their injury history and the seeking of medical attention. It was ascertained that those following a CrossFit routine were 1.3 times more likely to be injured and 1.86 times more likely to seek medical attention. The study does, however, caveat that “any action that involves the participant using free weights consistently” (Elkin et al., 2019) are to be considered as traditional weightlifting, thus making the parallels reduced in comparability. The cited study has even come under fire by CrossFit themselves who asked for it to withdrawn.

In the interest of pertaining a balanced view of how injury rates in CrossFit relate to that of other sports and activities, the predominant method of research is epidemiological studies via questionnaire; Feito et al., (2018) specifically performed a study with 3049 CrossFit participants and ascertained the participant's injury ratios, 30.5% of participants reported having an injury concerning their CrossFit training. Schneider, Seither, Tönges, & Schmitt, (2006) reported a 5.6% injury rate across the active population in Germany, could it therefore be considered that the injury rate is higher for CrossFit than that other sports? Possibly. However, “46% of all sports injuries in Germany are soccer-related” (Schneider et al. 2006) thus highlighting that possibly soccer carries a higher injury risk than CrossFit. This narrative however, does not lend itself to the media, as that doesn’t sell stories and herein is where the possible issues against CrossFit become sociological/discriminative.

During the assessment of injury ratios within Crossfit the proportion of injuries of the shoulder takes up the vast majority of injuries occurring, this is possibly due to the very high volumes of vertical and shoulder dominant movements that occur during this methodology of training. The aforementioned mantra of “Constantly varied functional movements performed at high intensity” (Crossfit, 2000) would go some way to explaining this too, as the high-intensity level and the nature of the movements including Olympic lifts, Ring muscle-ups, and Kipping style pull-ups, will often take the shoulder joint through a range of movement past what is the physiological norm. Furthermore, the glenohumeral joint is particularly susceptible to levels of fatigue as its stability is dependent upon muscular activation (Paine and Voight 2013).

Throughout the programming of CrossFit, there is also the idea of “benchmark” workouts, these are regarded as the standards and metrics of performance for CrossFit athletes. The completion time of a benchmark workout is used as a metric of assessment to asses progression within the sport. However, the chasing of a faster time encourages the chasing of an outcome over the quality of performance. The benchmark workouts are often included as part of regular training and not neccesarily peaked for within the training plan. With the lack of periodised peaking phases and the chasing of speed over form, it could be postulated that this increases injury chance. However, no more of an increased risk than that of the gym-goer whom constantly attempts a max squat or bench press, without following a training cycle and peaking for such an attempt. A reason as to why this may contribute to injury risk is the lack of specific goals with a very broad range to attempt to improve, without the use of planning for every aspect. The usage of benchmark workouts is not a problem in itself if they fall within a testing phase or peaking phase, as any athlete would do to assess progress in their annual plan and periodization model.

Further to the benchmark workouts within the programming structure of CrossFit, the workouts also have an “RX” level, which is the weights/reps/exercise prescribed at the highest level, with reduced-intensity versions of these workouts, which are classed as “scaled”. This allows athletes to work at their ability or own level. However, due to the competitive nature of the training methodology, most people strive to achieve or attempt the RX workouts. The RX numbers have not been designated to an athlete based on any of their previous numbers, no percentage of 1RM, no RPE set, no RIR. As an example, the benchmark workout “Grace” is 30 clean and jerks for time, therefore the purpose is to achieve 30 clean and jerks as quickly as possible, the RX weight is 135lbs (61kg) for men and 95lbs (43kg) for women. Consequently, if you’re a male and your 1RM clean and jerk is 270lbs (122kg) then you are working at 50% for 30 reps, this is set as the same workout for the male who’s 1RM clean and jerk is 165lbs (75kg), therefore working at 81% for 30 reps. This is not the most pertinent way to develop technique, due to the intensity being very high for the athlete with a lower 1RM and therefore increasing the risk of technique breakdown, encouraging the body to find newer methodologies to solve the movement problem presented to it, increasing injury risk.

When ascertaining the injury risk compartively between activities, there are issues concerning the use of epidemiological studies, that being the complete multifactorial nature that occurs and the lack of control over the subjects and lifestyle interventions. Within the analysis of injuries in sport there are so many contributing factors from lifestyle, training history, injury history, technique, genetic predisposition, age, gender (females more predisposed to ACL injuries, and laxity within the glenohumeral joints) that can all influence the injury risk of an athlete. These multifactorial influences are displayed in Figure 1. (Bahr and Holme 2003) this image is adapted from original work by Meeuwisse (1994). Highlighting that the sport or training methodology is only one piece to this puzzle.

Figure 1. illustration of the multifactorial nature of injures in a sport. (Bahr and Holme 2003)

From a coaches perspective a predominant and founding ethics rule in sports medicine and coaching alike is the obligation to the athlete to protect the athlete from harm in both the long and short term (Dunn et al. 2007). For that reason the training methodology used should be minimising the injury risk, this is where an observed cultural issue within CrossFit starts to occur. The majority of CrossFit injuries happen in the general regime of training, as it is the competitive environment that is sought and desired by athletes, coaches and box owners alike (Simpson et al. 2017). Conversely within most other sports the majority of injuries normally occur in the realm of competition and not in training (Nagle et al. 2017). Training in itself is the medium by which an athlete becomes prepared to perform at their optimum for their competitive event, whether that be the weekly Saturday afternoon soccer match or the more infrequent athletics or powerlifting competitions. Injuries will occur in sport, but the main focus of training should be to reduce injury risk and improve performance, as opposed to the chasing of numbers/performances in training. In competition it is more acceptable for the athlete’s risk-reward ratio to be skewed, that being the outcome of getting injured in competition may seem worth it if winning is the outcome, vs training where being injured inhibits the ability to compete (Chen, Buggy, and Kelly 2019). In training and strength culture upon social media, CrossFit appears to be the butt of a lot of jokes and ridicule for its perceived levels of injuries it instigates, and the apparent disregard for proper form by some coaches and CrossFitboxes within the sport. For instance “what do you call a failed mediocre athlete with injured shoulders?.....a crossfitter” (A.Willis, personal communincation, October 17, 2019); the reasons as to why this cultural thought process is around is not too apparent nor well researched. A notable idea that the sport has grown out of nowhere and made vast sums of money and allowed some athletes to be professional, whereas other strength sports like strongman and even more so powerlifting, it is extremely rare to be professional, as the sponsorship and media coverage is not there; thus it may come from a source of jealousy or that as a sport they are style over substance.

To surmise the literature would state that CrossFit as a training methodology is no more inherently dangerous than playing Soccer in terms of the chances of getting injured, and there does appear to be an unfair scrutiny placed upon the CrossFit community. However, some very simple measures could ensure a more well-rounded and thought out programming and loading structure, which would reduce injury risk further, allowing it to be a longer-term training methodology. This includes that of reducing the number of movements placing the greatest stress on the glenohumeral joint and saving the maximal loading/repetitions for competitions.

Word count: 1638

References

Bahr, R., & Holme, I. (2003). Risk factors for sports injuries—A methodological approach. British Journal of Sports Medicine, 37(5), 384–392.

Chen, Y., Buggy, C., & Kelly, S. (2019). Winning at all costs: A review of risk-taking behaviour and sporting injury from an occupational safety and health perspective. Sports Medicine - Open, 5.

Dunn, W. R., George, M. S., Churchill, L., & Spindler, K. P. (2007). Ethics in sports medicine. The American Journal of Sports Medicine, 35(5), 840–844.

Elkin, J. L., Kammerman, J. S., Kunselman, A. R., & Gallo, R. A. (2019). Likelihood of injury and medical care between crossfit and traditional weightlifting participants. Orthopaedic Journal of Sports Medicine, 7(5).

Feito, Y., Burrows, E. K., & Tabb, L. P. (2018). A 4-Year analysis of the incidence of injuries among crossfit-trained participants. Orthopaedic Journal of Sports Medicine, 6(10).

Glassman, G. (2007). Understanding CrossFit. Crossfit Journal, 56, 1–2.

Hak, P., Hodzovic, E., & Hickey, B. (2013). The nature and prevalence of injury during CrossFit training. Journal of Strength and Conditioning Research, Publish Ahead of Print.

Klimek, C., Ashbeck, C., Brook, A. J., & Durall, C. (2018). Are injuries more common with crossfit training than other forms of exercise? Journal of Sport Rehabilitation, 27(3), 295–299.

Meeuwisse, W. H. (1994). Athletic injury etiology: Distinguishing between interaction and confounding. Clinical Journal of Sport Medicine, 4(3), 171.

Nagle, K., Johnson, B., Brou, L., Landman, T., Sochanska, A., & Comstock, R. D. (2017). Timing of lower extremity injuries in competition and practice in high school sports. Sports Health, 9(3), 238–246.

Paine, R., & Voight, M. L. (2013). The role of the scapula. International Journal of Sports Physical Therapy, 8(5), 617–629.

Schneider, S., Seither, B., Tönges, S., & Schmitt, H. (2006). Sports injuries: Population based representative data on incidence, diagnosis, sequelae, and high risk groups. British Journal of Sports Medicine, 40(4), 334–339.

Simpson, D., Prewitt-White, T., Feito, Y., Giusti, J., & Shuda, R. (2017). Challenge, commitment, community, and empowerment: factors that promote the adoption of crossfit as a training program. The Sport Journal, 21.

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).