27 minutes | Oct 27th 2020

Is CrossFit Dangerous? PH167

In this edition of Pursuing Health Pearls, we are going to dive into a question that certainly gets a lot of attention in the media, and that is, “Is CrossFit dangerous?”

Some of the perception that CrossFit is dangerous may stem from how it has been portrayed in the media over the past 20 years. From the early days of CrossFit, it was presented as an extreme exercise program with “Pukie Clown” and “Uncle Rhabdo” as mascots. CrossFit was initially used widely in the training of elite athletes in other sports and for military and first responders, with a tagline of “Forging Elite Fitness.”

In addition, watching athletes compete in the CrossFit Games can also make it difficult for the average person to understand that CrossFit can be for them, too. Seeing these athletes who train for hours each day with a sole focus on becoming the “Fittest on Earth” can make CrossFit seem inaccessible or “too intense” for the average person.

However, over the years these harsh messages have been toned down, and the methodology underneath it all has proven over and over again to be effective at producing health and fitness in people from all walks of life. CrossFit is not just for extreme or elite athletes, it really can be for anyone. Here, we’ll review the available data on CrossFit and injury rates as well as our interpretation of some findings that may help to minimize risk while participating in CrossFit.

 

Some Qualifiers

Before we discuss the research, we have to acknowledge that we still have a relatively small amount of data available on CrossFit and injury rates, although we do have a lot more than we did 10 years ago.

We also have to acknowledge that the studies we do have available have limitations. Many of these studies are retrospective, meaning participants were asked to fill out surveys about past injuries while doing CrossFit instead of tracking the injuries in real time as they happen. As with epidemiological nutrition research, this approach does not always provide the most reliable information.

Finally, we have to acknowledge that there have been a lot of special interests in this research area that can influence how studies are reported, and which studies are published or not.

The biggest example of this was a 2013 study in the Journal of Strength and Conditioning, which is a journal published by the National Strength and Conditioning Association (NSCA).

This study followed 43 participants doing a CrossFit program for 10 weeks and found that they improved aerobic fitness and body composition, but reported an injury rate that was later found to be fabricated. The study was corrected and then retracted completely from the journal. The study was the focus of multiple lawsuits against the lead investigator, Steven Devor as well as the Ohio State University and the NSCA. Steven Devor resigned from his position at the Ohio State University. CrossFit won $4 million in sanctions in a lawsuit stemming from the retracted paper. Judge Janis Sammartino ruled that the NSCA had “deceived and continues to deceive the public and consumers regarding the safety and effectiveness of CrossFit training.” She went on to say in her ruling: “Not only is it clear that the NSCA knowingly and repeatedly resisted producing documents that were irrefutably relevant to this litigation, but the forensic evaluation also uncovered evidence that the NSCA destroyed presumptively relevant documents and engaged in mass deletions across numerous devices during the pendency of this litigation.”

We share this here to demonstrate that the NSCA had motives to deceive the public on the safety of CrossFit training which then influenced the research that was published as well as contributed to bad press perpetuating “CrossFit is dangerous” dogma.

The Research

Now, qualifiers aside, we will discuss what the research we have tells us about injury rates in CrossFit.

An article published earlier this year reviewed all of the studies reporting injury incidence and incidence rates among CrossFit participants. The researchers came up with a total of 14 studies that met their inclusion criteria. Among these studies, the injury incidence ranged from 12.8-73.5% and reported injury rates ranged from 0.27-3.3/1000 training hours. They concluded that these findings would suggest CrossFit has a relatively low injury risk, and we know from this study and others that these injury rates are comparable to or lower than rates of injury in other similar activities such as Olympic weightlifting, distance running, track and field, rugby, or gymnastics.

While most of the studies reviewed were retrospective studies relying on survey data, there was a prospective study done in 2017, where 177 participants were followed for 12 weeks while they did CrossFit and any injuries they experienced during that time were documented. In that study the overall injury incidence rate was 2.1/1000 training hours, which is consistent with the rates from the other studies discussed above.

Overall, the data we have indicates that the risk of injury in CrossFit is relatively low, and not different from other similar sports.

Other Findings

Now that we know injury rates in CrossFit are low and comparable to other similar sports, we’ll discuss other findings that were reported in the research that may be relevant to minimizing injury risk.

The review study discussed above highlighted three important factors associated with injury incidence and incidence rates in CrossFit: 1) training frequency, 2) duration of CrossFit experience, and 3) individuals that compete in CrossFit competitions.

The idea that individuals who compete in CrossFit competitions are at higher risk for injury makes intuitive sense, as they are likely pushing themselves harder and taking more risks in training and competition.

As far as frequency, a study that surveyed over 3000 participants who did CrossFit from 2013-2017 found that the greatest rates of injury were in those who did CrossFit less than 3 days per week compared to those who did 3-5 days or more than 5 days per week. So, doing CrossFit less frequently seemed to be associated with higher risk of injury.

Additionally, this study found that those with less experience had a higher injury rate. The highest rates of injury occurred in the first 6-12 months of doing CrossFit. In other words, the longer participants had been doing CrossFit, the less frequently they reported getting injured.

To us, this highlights CrossFit’s charter of mechanics, consistency, intensity which recommends first learning the proper movement mechanics, then demonstrating those mechanics consistently (i.e. doing CrossFit at least 3 days per week, for many months and years in duration). Only after demonstrating proper mechanics and consistently practicing those mechanics should the intensity of the workouts be increased. The finding that the highest rates of injury occured in the first 6-12 months of doing CrossFit could indicate that participants are pushing the intensity too quickly before this charter has been implemented.

Other studies have found that males and those with prior injuries are at higher risk of injury.

Studies also find that working with a trainer to coach participants on movement mechanics and guide them through workouts decreases the rate of injury.

As far as sites of injury, the studies we have seem to be pretty consistent in finding that shoulder injuries are most common. Following shoulder injuries are injuries to the lower back and knee. This information suggests that there may be  some movements across the board that we could improve on as a CrossFit community to decrease shoulder injuries. One example of this would be the kipping pull-up. In the past CrossFit participants may have been encouraged to start practicing kipping pull-ups earlier in their journey, but now most trainers would recommend participants being able to perform at least one (or more) strict pull-ups before subjecting the shoulder joint to the high force of a kip.

 

Takeaways

Here we’ll summarize some of our personal takeaways after reviewing the available research:

    • The injury rates in CrossFit are relatively low, and no different from other similar forms of activity
    • We suspect that employing CrossFit’s charter of “mechanics, consistency, intensity” by emphasizing learning good mechanics in the early months of doing CrossFit and doing CrossFit consistently (at least 3 days per week) before adding intensity may be a way reduce risk of injury
    • Working with a trainer to learn the movements and receive coaching through workout will likely reduce injury risk
    • We should be aware that shoulder injuries are most common and do what we can to protect the shoulder joint. Some ideas for this include: 1) requiring strict movements (pull ups, handstand push ups, muscle ups) prior to doing kipping, 2) encouraging proper warm up and prehab/rehab exercises, and 3) making sure the musculature around the shoulder is balanced.
    • Males and those who compete in CrossFit are at higher risk of injury and should be especially cognizant of listening to their bodies when training to reduce this risk.

 

Risks vs. Benefits

Now that we’ve discussed some factors that can potentially influence risk of injury, we will take a step back and look at the big picture of the risks and benefits of doing CrossFit.

We acknowledge that there is going to be some risk of injury with doing CrossFit, just as there is with doing just about anything active. But what are the risks of not doing CrossFit?

We talked about the risks of sedentarism back in Ep 159 of the podcast about exercise. We know that more time spent in sedentary behavior increases the risk of all-cause mortality, cardiovascular disease mortality, cardiovascular disease, type 2 diabetes, and cancer of the colon, endometrium, and lung. A large 2016 meta-analysis study which pooled 16 studies looking at over 1 million people demonstrated that increased daily sitting time and decreased moderate-vigorous physical activity was associated with increased all-cause mortality risk.

So, if you don’t do CrossFit (or any other exercise), your risk of death and a number of chronic diseases goes up.

The potential benefits of CrossFit have also been studied. The research we have tells us that those who do CrossFit have: increased in VO2 max (cardiorespiratory fitness), increased strength, musculature, and endurance, reduced cardiovascular risk factors including decreased blood pressure, and body fat % and increased insulin sensitivity, (1, 2) and higher levels of sense of community, satisfaction, and motivation.

These benefits above have been documented in research studies, but the anecdotal benefits are also hard to argue with. If you know someone who has done CrossFit, you’ve no doubt heard about them. These are the benefits that are harder to put into words, but make you ask yourself, “Do I want to sit on my couch all day for fear of injury, knowing that my sedentary behavior increases my risk of chronic disease and death, or do I want to take the small risk of injury and improve my quality of life by doing CrossFit?”

 

To Sum It Up...

Although CrossFit has been portrayed in the media as dangerous, available research suggests that the risk of injury is no higher with CrossFit than any other similar activity. There are a few things we can do to potentially reduce the risk of injury, which include doing CrossFit under the guidance of a trainer, learning movement mechanics well first (an “On Ramp” or “Foundations” class is a great way to do this), and staying consistent with training by working up to at least 3 days per week.

There are also a lot of benefits to doing CrossFit, including increased fitness, strength, and endurance, decreased cardiovascular disease risk, and increased sense of community and satisfaction. The risks of not doing CrossFit should also be taken into consideration as being sedentary is associated with an increased risk of death overall as well as increased risk of a number of chronic diseases

Every person has to make a decision for themselves about what level of risk to take on with the activities they choose to do. But in our minds, reaping the benefits of CrossFit and avoiding the risks of sedentarism greatly outweigh a risk of injury that is comparable to doing other similar types of activity.

 

Related episodes:

Ep 132 - Healing Through Functional Movement with Dr. Amy West

Ep 159 - Pursuing Health Pearls - Exercise + Why It's So Good For Us

 

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

 

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.

This post was originally published on October 27, 2020.