CrossFit Injuries: Causes, Symptoms, Treatment and Exercises

CrossFit is a branded fitness regimen that incorporates components from high-intensity interval training, olympic weightlifting, powerlifting, plyometrics, gymnastics, calisthenics, as well as other types of exercise and sport.

It is a strength and conditioning workout that contains a variety of functional movements performed at a high intensity level. Functional movements are movement sequences (typically involving multiple joints and multiple planes of movement) that mimic actions performed in real-world situations such as squatting, pushing, pulling, and lunging.

CrossFit is practiced in gyms affiliated with, and officially endorsed by, the CrossFit brand called “boxes”, and typically consists of daily workouts referred to as “WODs” or “Workouts Of the Day”. A typical CrossFit class lasts an hour including a warm-up, strength or skill development segment, the high-intensity “Workout of the Day”, and a cool down or mobility session. CrossFit gyms use a variety of equipment including barbells, dumbbells, kettlebells, gymnastics rings, ropes, pull-up bars, jump ropes, medicine balls, boxes, resistance bands, machines (bikes, rowing, ski erg), and various mats.

What are Common Injuries Experienced by People who Participate in CrossFit?

CrossFit injuries occur often because the workout regimen involves movements which can put considerable strain on the body, especially when paired with heavy weights, high repetition, and most importantly a lack of preparation. Lifting weights that are too heavy for your current level of conditioning can cause a breakdown in technique, and the high load combined with poor form can lead to injury. High repetition workouts causing you to push beyond fatigue can also disrupt your technique resulting in injury. The most common injuries in CrossFit involve the back, shoulders, knees, and hands/wrists.

Low back injuries

Low back injuries, including disc herniations, muscle strains, and ligamentous sprains, are often caused by repetitive strain, excessive weights, and/or poor mechanics. Some combination of these factors can lead to excessive stress being placed on certain tissues, resulting in injury.

Shoulder injuries

Lacking shoulder strength or mobility while trying to perform complex movements puts crossfitters at risk of shoulder pain from muscle (including rotator cuff) strains, tendonitis and labral tears. Some CrossFit exercises (like military presses and kipping pullups) place very high loads on the shoulder joint, and require a high level of strength and stability to be performed correctly. Overuse without sufficient rest, or acute high loads without sufficient preparation can result in injury.

Knee injuries

The most common knee injuries in CrossFit are meniscus tears, ligament tears, tendinopathies, and patellar (kneecap) injuries. Jumping, deep flexion (bending), twisting, and pivoting movements in CrossFit workouts put stress on the knee structures. Meniscus injuries often occur when the knee is in deep flexion (ie. with squatting) especially under excessive load. Ligaments (most commonly ACL and MCL) and tendon (most commonly patellar tendon) injuries often occur with jumping or twisting/pivoting movements. The good news is that your body can tolerate all of these loads when properly prepared – and these movements can be great for developing strength and resilience in your joints, you just have to ensure you’re not doing too much too quickly.

Wrist injuries

CrossFit workouts include a lot of weight lifting and pretty much anything you do will include some sort of load being applied to the wrist. Pain can arise from the irritation of one or more of the many structures in your wrist – it’s quite a complex joint with many moving parts. Wrist injuries may result from a single trauma or from repetitive loading with movements such as the clean and press, handstand pushups, burpees, and kipping pullups.

How can a Physiotherapist, Chiropractor or Massage Therapist help with CrossFit Injuries?

If you have sustained an injury while working out, it is imperative that you get assessed by a healthcare professional to properly diagnose your ailment and help guide you through the appropriate treatment. Based on a thorough assessment your health care professional will develop an individualized treatment plan to restore physical function and get you back into the gym. They may use manual therapy techniques such as joint mobilizations and soft tissue release to help with restoring joint range of motion and muscle flexibility. Your therapist can assist with pain management through the use of therapeutic modalities, acupuncture, dry needling, and taping and/or bracing. A personalized exercise program may be developed to restore flexibility and strength, and work on motor control and movement mechanics to help get you back to doing your favorite workouts safely and without pain.

Warm up Routine to use Before Participating in CrossFit

To help prevent injuries, your warm up routine should be catered to target the structures that will be put under the most stress. A Good warmup will involve mobility exercises (dynamic stretches), as well as body weight or light weight versions of the movements you will be performing under load in the WOD to focus on technique. There are many different variations of exercises that might be appropriate for this. See below for some examples.

Some examples of dynamic stretches/mobility drills might include: dynamic calf stretches, deep lunges, deep squats, deep lunge with rotation (often referred to as the world’s greatest stretch), leg swings, hinges (think Romanian Deadlift but without loads – both single and double leg version), cat-camels, thread the needles, as well as shoulder and wrist circles.

Some examples of body weight or light weight resistance exercises might include: bird dogs, glute bridges (single leg or two legged), lunges, squats, hollow holds for the core, planks (both on elbows and on hands), banded shoulder lateral raises or front raises, and banded rotator cuff exercises (such as internal and external shoulder rotations, and banded cross body chops).

If you are unsure about which of these you should be doing, are unsure how to perform some of these, or are feeling a bit overwhelmed by having to do all this prep work just to take one CrossFit class, talk to an expert. You can start by asking your CrossFit coach, or for a more personalized and detailed approach, ask your physiotherapist or chiropractor and they will be able to guide you.

What to Look for when Choosing a CrossFit Gym to Avoid Injury

1. Attend a CrossFit gym that provides coaches/trainers who supervise, correct technique, and are attentive to participants
   Know your strengths and weaknesses and talk to your coach about scaling your WOD to best fit your needs and the fitness goals of the workout.
2. If you are new to CrossFit, attend an extensive fountains program to introduce the skills and lifts that are essential to CrossFit workouts. It is important to learn your fundamentals early to reduce bad habits and poor technique.
3. Focus on form. If you are performing reps to fatigue incorrectly, you are putting yourself at risk for injury.
4. Work on mobility drills regularly since flexibility is important for CrossFit workouts. For example, you need good thoracic spine mobility to perform overhead lifts to reduce your risk of a shoulder injury, and adequate ankle and hip mobility to perform a proper deep squat.
5. Incorporate accessory strengthening exercises (ie. rotator cuff and core strengthening) to reduce the risk of injury.
6. Make sure you get proper rest and recovery time. Most of us underestimate just how important this is – this is one of the most important factors in injury prevention.
7. See a physiotherapist or chiropractor to perform an assessment and determine your strengths and weaknesses. They can educate you on how to improve your performance.

References:

1. Alekseyev et al. Identifying the Most Common CrossFit Injuries in a Variety of Athletes. Rehabilitation Process and Outcome 2020;9