Preventing Injuries for Competitive CrossFit Athletes

This article uses the available current research on the subject of CrossFit Injuries and provides a series of shoulder injury prevention exercises.

Background

I had been in the group of people skeptical of CrossFit, but then I got a few regular CrossFit clients. They explained to me that CrossFit should be considered a ‘sport’, and not a workout. With this in mind, I started to get interested in the sport, and began working with local boxes.

There are many rumors about the ‘high rate of injuries’ in CrossFit, but I wanted to dig into the real research and come up with some concrete data to develop a prevention plan.

This article is written for CrossFit coaches and athletes. It is based on ‘CrossFit Overview: Systematic Review and Meta-Analysis’ (source).

In my research, I found that total injury rates were similar, BUT injuries by body part do not match other sport statistics.

The one statistic that stood out was that over 25% of CrossFit injuries involved the shoulder.  In a study of 182,000 sports injuries, upper extremity injuries including arm, elbow, wrist and hand, total a percentage of only 18-21%. (source) This is a significant difference.  Let’s take a look at the research.


What the Research Says

The Meta-Analysis: Most Relevant Findings

  1. Training Volume is Inconsistent depending on the gym and weekly WODs (source)
  2.  Injury rates increase the longer an athlete participates (source)
    1. 23% injury rate under 6 months
    2. 35% injury rate over 6 months
    3. 45% injury rate more than 2 years
  3. ”24% of practitioners had suffered at least one shoulder injury in the last 6 months.” (source)
    1. Shoulder Injuries were about twice as common as low back and knee injuries; and 25% of total injuries.
    2. Causes:  improper form (33%), too heavy weight (12%), fatigue (18%), previous injury (33%)
    3. Reported Primary Causes of Injury: 
  4. ”This study found a prevalence of exercise addiction of 5% in CrossFit. Exercise addiction is more prevalent in young practitioners (below 30 years) and in males. It is associated with high exercise volumes and negative exercise attitudes that might lead to negative consequences such as injuries and loss of social relations.” (source)

CrossFit Injuries: What Specialists Have to Say

I selected these out of the top web searches because I thought that these articles had the most relevant and helpful information.

  1. The Barbell Physio: CrossFit Maximal Recoverable Volume : ”Something we discuss at length in my course “Advanced Concepts in the Clinical Management of the Fitness Athlete” is the amount of volume most boxes program compared to the volume that is suggested in the CrossFit Level One Seminar. In the CFL-1 most workouts are taught to be composed of a single strength/skill element OR a metabolic conditioning workout. With a 2 days on, 1 day off schedule OR a 5 on, 2 off weekly schedule. In contrast to that, most gyms program a strength AND a conditioning workout each day, 6 days per week. The weekly volume that most gyms program is significantly higher than what CrossFit HQ suggests and I believe often puts athletes exceeding their maximal recoverable volume.”
  2. BreakingMuscle.com: Understanding Shoulder Anatomy and Thoracic Mobility : Discusses the interdependence of thoracic mobility, proper scapular movement, rotator cuff muscle strength, and biceps strength.  Any dysfunction in one can be the cause of pain and dysfunction of the other.  A preventative program should focus on developing all of them.
  3. CAMPT: Physical Therapy Exercises for CrossFit Shoulder : The focus of this article is developing lat and pectoral flexibility, and the development of rotator cuff and scapular stabilization strength.
  4. Arrow PT: Internal Rotation Mobility and When to Cue, ‘Shoulder Blades Down’ : This article discusses the importance of upward-internal rotation of the shoulder during press movements. This, in combination with a compressed rib cage, which avoids excessive extension of the thoracic spine, can improve overhead-lifting form, which can prevent back and shoulder injuries.
  5. Youtube Video of Internal Rotation Exercises : This is a series of internal rotation exercises.  The last one which incorporates the cervical spine is a great stretch to improve shoulder mobility.

Summary

The most important statistics to note are the greater risk of injury the longer one does CrossFit. This indicates that coaching may be excellent at the beginning. But at a certain point, I believe that athletes are treated differently based on their experience, expectations, or upcoming competitions. Based on the research and professional articles, I believe that the following are the main causes of injury:

  1. Lack of Rest: WODs may not incorporate enough rest days, or they incorporate a strength AND conditioning focus on the same day, which is not recommended by CrossFit HQ.
  2. Over-use: Athletes may have a sudden increase in volume. For example, an athlete may start practicing ‘kipping’ or ‘double-unders’ daily to improve form. And this may result in an over-use injury.
  3. Competition Prep: Competitive athletes are more likely to be injured. This may be due to rapid increases in training volume before competitions, and/or skipping rest days.
  4. Lack of Supervision: As athletes become more experienced, they will push their limits with less trainer supervision. (It is not uncommon that athletes with perfect lifting form regress to terrible form by the end of their competition or workout.)
  5. Exercise Addiction: Young male athletes are at risk of increasing volume too fast if they suffer from exercise addiction.

Action Plan for Coaches

  • Rest Days on either 2:1 or 5:2 schedule. Consider limiting athletes to only 5 training days per week. Encourage other cross-training activities.
  • Avoid training the same exercise/technique daily.
  • Progressively increase volume in preparation for competitions.
  • SUPERVISE athletes, no matter their skill level. Especially when increasing weights.
  • Watch for Fatigue: notice poor form towards the end of workouts.
  • Monitor young male athletes for excessive volume increases and negative emotions about fitness.

Prevention Exercises for ‘CrossFit Shoulder’

 

Stretches:

For Overhead Press: Downward Dog pressing the chest through the shoulder window to stretch the serratus anterior.

For Overhead Press: Lat Stretch on a box.

Cues:

For Overhead Press: Compress Ribs before press to avoid excessive thoracic/lumbar extension

For Overhead Press: Shrug your shoulders at top to engage upper traps, rotating the scapula upward.  (source)  (KEEP IN MIND that this is a warm-up cue. It may not apply completely while using full weights depending on the lift. It is meant to teach your body to activate the upper traps, and allow your scapula to rotate upward at the end of overhead press movements. Consult your Olympic lifting coach as needed.) 

Before Pull-ups and Muscle-ups:  warm-up with the pull-up+ exercise.

Exercises:

For Overhead Press: Wall Pinky Press with band.

For Overhead Press: Overhead single-arm dumbbell Lunges (endurance for thoracic/lumbar/scapular positioning)


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