In sports medicine, our goal is to get our athletes safely back to play. People engaged in CrossFit will get injured, just like any other sport. Our job as clinicians, especially Sports Medicine physicians, are to listen to our athlete, diagnose and get them safely back into the sport that they love. Although there appears to be a negative perception on the injury risk of CrossFit, most are based on sensationalized anecdotes. With an estimated 10 million CrossFitters and over 10,000 gyms across the world, you will likely run into a CrossFit athlete. My hope is with this article, more clinicians can understand the typical injuries of a CrossFit athlete and be able to get them back to play safely and quickly.
Understanding the CrossFit Athlete Most runners when they get injured, do not want to hear, “maybe you should give up running.” Similarly, most CrossFit athletes do not want to hear from their physician, “maybe you should give up CrossFit.” To understand CrossFit injuries, the clinician should understand the sport itself. For example, in running, most injuries are chronic overuse injuries. If you see an injured runner, the clinician should ask about nature and timing of injury, the training regimen leading up to the injury and the athlete’s training goal. Additionally, a clinician should know the types and injury patterns related to running to help the runner get back to the sport he/she loves. Similarly, physicians should understand the pattern and nature of injury as well as how to help the athlete return to play for CrossFit. You can read about the background of CrossFit in my first blog post-“Coming out of the CrossFit Closet.” For this first part of this series, let’s take a look at the research done so far on CrossFit injuries.
CrossFit Injury Research Unfortunately there are not many published peer-reviewed research on CrossFit injuries. However, in the last year, there have been 3 articles helping to understand the nature and rate of injury in CrossFit athletes. The first study looked at US Army Soldiers in a brigade combat team.  Investigators compared injury rates before implementation of CrossFit and other high intensity training (Ranger Athlete Warrior Program, Advanced Tactical Athlete Conditioning Program) versus those non-participants. Bottom line, there were no difference in injury rates among HIT vs. non-HIT participants. In fact, there was a non-statistical DECREASE in injury by 2% in the HIT group. In addition, looking at the data further showed that running more than 16 miles per week was a significant risk factor for injury. This is the only study that looked at documented injury rates from the medical system. There are two other studies, but both of them were survey research, which relied on self-reported injuries. A cross-sectional survey of 386 US participants in a CrossFit affiliate found that 19.4% of athletes suffered an injury over a defined period of 6 months.  This study also found injuries of the lower back, shoulder and knees as common injury patterns. Finally, another study surveyed 132 self-defined participants of CrossFit and found that 73.5% suffered an injury.  Injury was defined as those that prevented an athlete from “working, training or competing.” There was no separation of injuries that led to a physician visit versus those that were self-treated. An injury rate of 3.1 injuries per 1000 training hours were calculated from these self-reports. Common injuries included shoulder, spine and arm/elbow. The really interesting thing about this research study is that it gives an estimate of the true injury incidence (rate). So, how does 3.1 injuries per 1000 training hours compare to other sports? Here’s a table of common sports and estimated injury rates:
Table 1. Estimated Injury Rates for Selected Sports*
|Basketball||1.94-5.7 (per 1000 hrs)|
|Tennis||2.0-20.0 (per 1000 hrs)|
|Soccer||5.0-12.0 (per 1000 athlete-exposures)|
|Football (practice)||4-10 (per 1000 athlete-exposure)|
|Football (games)||36 (per 1000 athlete-exposure)|
|Powerlifting||1.0-4.4 (per 1000 hrs)|
|Running||2.5-5.8 (per 1000 hrs)|
|Olympic weightlifting||3.3 (per 1000 hrs)|
|Gymnastics||5.4-7.96 (per 1000 hrs)|
|CrossFit||3.1 (per 1000 hrs)|
As you can see, CrossFit injury rates are comparable to other sports but less than soccer, football and gymnastics. It is interesting that CrossFit falls right in between the rates for the powerlifting, weightlifting and gymnastics—movements that CrossFit utilizes. Here’s another look at it, from the Washington Post. http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/31/kevin-wares-injury-is-horrible-but-mens-basketball-is-among-the-safer-college-sports/ Despite the inherent limitations of survey research, these studies help inform the nature and rates of injury for health care professionals. Understanding the common injuries from these research studies can help the clinician recognize injury pattern and help the athlete remain active despite their injury or quickly return the competitive athlete to competition. Also, it is important to note that although there were no cases of rhabdomyolysis in these studies attributed to CrossFit, these studies are just too small to determine if rhabdomyolysis is a major issue in CrossFit. Another blog post will touch on the concept of rhabdomyolysis. This concludes part 1 of this blog series on CrossFit injuries. The next post will start dealing with one of the most common injuries in Crossfit—the shoulder.
- Lawuit alleges CrossFit workout damaging. Accessed Aug 30, 2014 at: http://www.navytimes.com/article/20080816/NEWS/808160309/Lawsuit-alleges-CrossFit-workout-damaging
- Grier T, Canham-Chervak M, McNulty V, Jones BH. Extreme conditioning programs and injury risk in a US Army Brigade Combat Team. US Army Med Dep J. 2013 Oct-Dec:36-47.
- 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), 2325967114531177.
- Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. 2013 Nov 22. [Epub ahead of print].
- Epperly T, Fields KB. Epidemiology of Running Injuries. In Wilder R, O’Connor F, Magnum E. Running Medicine, 2nd Ed. Healthy Learning 2014
- O’Connor et al. ACSM Comprehensive Review. Ch. 83. Basketball; Ch. 94. Gymnastics, Ch. 102. Soccer, Ch 106 Tennis.
- Calhoon G, Fry AC. Injury rates and profiles of elite competitive weightlifters. Journal of Athletic Training 1999;34(3):232-238
- Dick R. et. al. Descriptive epidemiology of collegiate men’s football injuries: NCAA Injury Surveillance System, 1988-1989 through 2003-2004. Journal of Athletic Training 2007;42:221-233.