If you ask any CrossFitter about CrossFit, they will tell you how much they love it, how much it has changed their life, how they’ve improved and benefited over time, and how they just cannot get enough. However, as a physical therapist, one of the most common conversations I have with people – patients, other practitioners, friends, those who do CrossFit, those who don’t – is: “Is CrossFit Safe?” In fact, when I am talking to people who are not fully educated about CrossFit, it is less of a question and more of an assumption: “Isn’t CrossFit really dangerous?”
When we see injuries in the clinic that are related to CrossFit, we need to consider the fact that CrossFit is a growing trend in fitness right now and there is a very large pool of people who are participating. The American College of Sports Medicine’s Health and Fitness journal has recently cited CrossFit as one of the “hottest” new trends in fitness. According to Forbes, CrossFit is one of the fastest growing sports in America. As such, in heath care, we may be seeing a lot of CrossFit related injuries. However, this is due, in part, to the fact that there are so many people who are partaking in CrossFit. In the US alone, there are over 5000 CrossFit gyms (about 7000 worldwide), and over 209,000 people worldwide signed up for the 2014 CrossFit Open competition (http://games.crossfit.com/about-the-games). (CrossFit’s growth is demonstrated in the fact that in 2011, when the Open debuted, there were around 26,000 people registered. In 2012, just shy of 70,000 and in 2013 138,000 athletes signed up for the Open. (http://www.tabatatimes.com/how-fast-are-the-crossfit-games-growing-the-numbers-tell-the-story/))
Dr. Gary Chimes of Lake Washington Sports and Spine refers to what he calls the ‘Denominator Effect’. What needs to be taken into account is not the number of injuries that we see, but the number of injuries related to an activity divided by the number of people doing that activity. He also notes that we must consider how much the activity might be benefiting individuals who are participating and who are not injured. (http://lakewass.blogspot.com/2013/07/thoughts-about-crossfit-denominator.html) Remember that as health care providers, we see the individuals who have been injured, not the folks who are having success in the sport.
Additionally, the risks of CrossFit appear to be primarily orthopedic. Unlike martial arts, football, or soccer, there is a very low risk of athlete-to-athlete contact, which could lead to head injuries. There is also a very low rate of cardiac related danger. In comparison, it has been cited that there is risk of sudden cardiac death in marathon runners: most studies show that there is one sudden cardiac death for every 100,000 marathon runners. At this time, there are no known deaths related to CrossFit workouts. Finally, there is little to no risk of athletes developing eating disorders as is often seen in sports of dance, diving, or distance running, likely because using proper nutrition to fuel workouts is also part of the culture of CrossFit.
In the case of CrossFit, there has only been one small study done on injury rates. Researchers at Cardiff University in Wales found an injury rate of 3.1 injuries for every 1000 hours trained. They conclude that injury rates with CrossFit are similar to those reported in the literature for sports such as Olympic weightlifting, powerlifting, and gymnastics. It should be noted here that in this study, none of the injuries reported included rhabdomyolysis. Let’s keep in mind that rhabdomyolysis is not unique to CrossFit and is the result of inappropriately applied intensity in a workout.
Velocity of movement and fatigue are two important factors to consider in their impact on injury. The most common CrossFit injury that I see in my practice is a shoulder injury occurring in an experienced CrossFitter performing several repetitions of a high level movement (such as an overhead Olympic lift or a kipping pull-up) for time. This is when typically good technique breaks down. Because he is against the clock and suffering from fatigue, this athlete loses the discipline to maintain good form, and sacrifices musculoskeletal health for a faster time. If one’s technique during these fast movements breaks down because of fatigue, the efficient and correct motor pattern that has been trained will no longer be utilized. Instead, the body will call on alternate patterns to perform the movement, thus stressing tissues not designed to be used in that fashion. It is up to coaches to spot this and athletes to prevent themselves from getting caught up in this problem.
The overall take away here is that, yes, there is a risk to CrossFit when an athlete is willing to sacrifice form for a time on the board. However, there really is no evidence to suggest that CrossFit is any more dangerous than other activities. An environment, which encourages athletes to perform their best, despite the risks of doing so, exists in any sport. In my opinion, I feel that the positives of CrossFit certainly outweigh the risks. Correct form, proper programming, good coaching, and ensuring that new athletes go through a beginner’s series to learn how to be a successful CrossFit participant are crucial elements in keeping CrossFit safe for our athletes!
Sarah Haran DPT, OCS Seattle Physical Therapist
