Injury Prevention in CrossFit
As discussed in a previous article, CrossFit is a very safe sport and exercise modality. But that is not where the story ends. I want it to be even safer. I want myself and others to get even better results. So we can be even healthier, perform better and have even more fun.
So the purpose of this article is to discuss the principles behind injury prevention as they apply to CrossFit, so we can further decrease the risk during participation. These are messages that I have been delivering for many years now, but I recently found a paper that reported some very interesting and specific injury data from CrossFit, which is novel to me. So that was a major inspiration for this piece.
So first, let us discuss some general principles related to injury prevention. Then we will look at the findings of the research paper.
Prevention
This term is usually not meant literally by those who are well informed. It is now used as shorthand for ‘risk reduction’ which is more accurate, but prevention is a familiar term to the public. We unfortunately do not have the ability to prevent things from happening because there are simply too many variables in life to control, and much is still yet to be understood about the human system. This is especially poignant when we are talking about contact sports, where there is one or more other individuals that can have a direct effect on you that is entirely out of your control.
We can however, decrease the risk of many injuries, and in turn their sequelae, with proper training and lifestyle modification.
Preparedness/Preparation
This is not a specific term, and it means exactly what you think it means. At the highest level, being fully prepared for an activity or sport includes having done what you can to reduce injury risk. Let us break preparation down into its components:
General Physical Preparation (GPP)
This is a slightly more specific term that will be familiar to anyone with a background in powerlifting. For athletes in most sports, GPP includes training in the gym, doing some basic cardiovascular training, stretching and other things that have a general health and performance/athletic benefit. They will not necessarily directly make an athlete better at their sport, though often will. What they will do is improve the athlete’s physical abilities, allow the athlete to practice and train more, practice and train harder, and decrease their risk of non-contact injuries which would prevent them from practicing.
For fitness athletes, general preparation will include many of the same things as specific, but done in a different way. Either way, the goal of GPP is to build a ‘base’ of strength/hypertrophy, endurance, power and other qualities that will translate to a higher sport performance. This increased fitness and performance indirectly reduces injury risk, by allowing more sport training and improving overall health. GPP also builds strength and tolerance of muscle, bone, tendons and ligaments, thereby directly reducing risk of injury to those tissues.
Sport Physical Preparation (SPP)
Contrary to the picture that has been painted in the last few decades, sport (specific) preparation is NOT single leg squatting on an unstable surface, or doing box jumps while someone throws a ball at you. It is mostly just practicing your sport. In fact, nothing could be more specific.
Practicing your sport is how you develop the skills (obviously), but also the coordination, the balance, the tolerance for specific joint positions, loads and stresses. Practice is also where you develop situational knowledge, sometimes referred to as ‘IQ’, which is extremely important for not only performance, but avoiding injury. For example, a quarterback scrambling and throwing the ball away instead of staying in the pocket and getting tackled.
Trying to make a weightlifting exercise look more like a sport movement at the expense of load is a huge mistake, and misapplication of the principle of specificity.
As mentioned, in strength and fitness sports, the difference between general and specific is more subtle. The modalities will be mostly the same, but the program variables will be different. For example, variations of the squat, bench press, and deadlift, and lighter, higher rep work would be considered GPP for a powerlifter. But competition style, and heavier squat, bench and deadlift variations would be sport preparation.
For CrossFit there is even more overlap, because pretty much any rep range and time domain (within reason) is on the table. For the most part though, CrossFit is in the 5-20 min duration range, with some max lifts, and occasional longer endurance events. So all of that would be considered sport preparation. Other things, like low intensity cardio, bodybuilding (even this overlaps), lift variations and stretching and mobility exercises being the general preparation. Some of these things are much less likely to be in a CrossFit WOD or competition, so that needs to be considered too (dumbbell bench press for example).
This more specific form of preparation, directly stresses an athlete in the way they will be stressed during competition, but in a controlled and (hopefully) progressive way. Therefore, it allows an athlete to build tolerance to the stresses that will be faced during competition. This includes essentially every body system and tissue.
Now, the recent article:
From Sweat to Strain: An Epidemiological Analysis of Training-Related Injuries in CrossFit®
The researchers surveyed a group of 308 CrossFitters from several different gyms in Germany between 2018 and 2019. The group included recreational and competitive athletes, the majority of them between the ages of 20 and 40.
They collected information about types and locations of injuries sustained during the period of the study. This is the first study I have seen with this level of detail on CrossFit, so this was pretty interesting. Table 3 below shows the most injurious movements. The box jump was by far the most injurious single movement accounting for 21 out of 146 incidents. 20 of the 21 incidents were, however, leg wounds (scrapes).
The most common types of injuries were sprains and strains (25.8%), wounds (23.3%), contusions (5.8%) and fractures (2.9%).
50% of injuries did not require medical treatment, and only 8.2% of injuries required surgery, half of which were lower leg wounds from box jumps.
55% of injuries occurred during the middle of the workout, and about 25% during single modality training (heavy lifting, gymnastics practice).
Given these statistics, what should we do to minimize the injury risk? One very simple solution stands out; soft plyo boxes. This alone would reduce injury risk (based on this sample) by almost 14%.
Because gyms are unlikely to replace all of their boxes based on this study that they have never heard of, we should list a few more options.
Pacing
Coming out too hot at the beginning of the workout appears to be even worse than you might have thought. It seems like it is increasing your risk of injury (middle of the workout), in addition to making the workout subjectively much more difficult. Try to pace workouts at 70-80% of the pace you think you can hold, then around halfway, you can speed up if you paced it too slow. This will allow you to get through the first half or more, with much less fatigue and therefore decreased risk of injury. This will also result in a lower relative effort than coming out hot and slowing down due to fatigue. All of that benefit, and you might even finish faster too, though this should not be the goal of every workout.
Proper load progression (barbell, gymnastics)
It can be tempting to push near or to your limit every time you are in the gym, especially if you enjoy the training, or do not train very often and feel relatively fresh when you get there. Working to a max barbell lift or complex every time one is programmed is a bad idea which is supported by the data presented. Focus on improving your technique with relatively light weights, and add weight only if it is no longer a sufficient challenge to complete with good technique.
The same goes for gymnastics. Try not to always push right to your limit doing the very hardest progression. Leave some effort in the tank to avoid making mistakes that lead to injury. Progress will take longer the more advanced you become. This takes a great deal of patience.
Expanding the time horizon of progression is perhaps the best reason to keep a training log. It will be effectively impossible to remember what weight you used for a single lift after a few months. Then you will not know what weight you should be using or if you are progressing.
Technique/coaching
This ties into the previous point nicely. Your coach is a very important part of this process. Ask them questions! Ask them how to improve your technique, and if it is a good idea to add weight to the bar or move onto the next gymnastics progression. It is not necessarily the technique that is going to get you hurt, but the technique is a good indicator of whether you have the ability to do the task (or a more difficult one). And as we have discussed, preparation is really what injury prevention is all about.
The authors of this and other studies found that less experience in CrossFit was associated with greater injury risk. They also noted “athletes engaged in competitions, indicative of higher training volumes, exhibited lower susceptibility to injuries.”
This makes sense given what we have discussed previously. More preparation via more training (volume), and longer training history (higher skill and knowledge) is associated with lower injury risk. But before you run off and immediately double your training volume, this increase needs to happen gradually to allow the body to adapt. This process will take months and years, not a few days. Patience.
One last note from the authors:
“Furthermore, training at an official CrossFit® box, high quality of coaching and other protection gear such as grips could lower risk of injury.”
The first point is interesting, and I am actually not quite sure what to make of it. I will reserve interpretation for now. The last point is obvious to me, but others may be unaware of some of the options for protective equipment. Gymnastics hand grips are pretty much essential in my opinion. Unless you don’t mind losing skin off your hands. A weightlifting belt is very helpful for performance, and probably does offer some protection as well, mainly with WODs that have heavy deadlifts for higher reps.
That is all for now. Much more to come on this subject.
Have fun and stay safe!
References
Lenz JE, Szymski D, Krueckel J, Weber J, Krieger F, Karius T, Meffert R, Alt V, Fehske K. From Sweat to Strain: An Epidemiological Analysis of Training-Related Injuries in CrossFit®. Open Access J Sports Med. 2024 Aug 9;15:91-100. doi: 10.2147/OAJSM.S469411. PMID: 39139214; PMCID: PMC11321354.
