Categorized as: Health & Safety Log

Crossfit Injury rates and Injuries.

At any time, somewhere in the world, an inadequate sport scientist or deluded therapist is about to initiate another defective study on injury and injury rates in CrossFit.

Let’s face it; if they didn’t tag their post as “CrossFit Injuries ” no one would care, no one would look at it. It would go as un-noticed as it actually deserved.

As CrossFitters, we are fascinated by injury rates but appalled by poor and shoddy sports science and therapy babble. The major problem is this: in CrossFit, as in life, unless there is a fall or an accident, most injuries are simply  “the straw that broke the camel’s back”.

Normally, clients tweak their back because they misuse their back all the time.  To push this proposition into the light, and to be a  bit silly,  if a client leaves a sports session, goes to hospital and is diagnosed with cancer, no one seriously suggests that the sport session gave them cancer.

Often, injury reviews make no attempt to correctly trace the aetiology of injury. Often, bad form is a result of constant poor posture, not of failure under fatigue. According to McGill, injury is often the result of a long term misuse and reduction in capacity. The actual activity that brings on a bad back is something as innocuous as brushing your teeth.

But there are lots of issues in studying CrossFit and injuries: what does CrossFit mean?  Often, in what passes as the literature, the implication is that injury is a result of high rep induced fatigue.  However at CrossFit London, for example, we have gymnastics, periodised strength sessions and Olympic weightlifting sessions, many of which are carried out at ” normal ” speeds.

If I tweak a knee in a back flick landing, at CrossFit London, is that a CrossFit injury?

Let’s explore an injury. One of my recent ones!

I’ve tweaked my right wrist and it hurts. It started the day after I missed a snatch. Is CrossFit to blame?  I was training on my own, at a very lazy pace. Was that injury caused by the poor snatch or the fact that my right upper limb always tries to compensate for my left side?  Why? Because I’m deaf in my right ear, meaning that I sleep with my left ear on the pillow, which means that for 55 years I’ve slept on my left arm, every night, which has weakened it.

So, was it those factors or the fact that I decided to solidly practice handstand walking for 9 days in a row?  Can any of this be laid at CrossFit’s door, apart from the fact that it was CrossFit which inspired me to improve myself?

Hak et al (2013) found that 73.5% of  CrossFitters had sustained an injury that prevented them from training (based on an injury rate of 3.1 per 1000 hours trained, just like gymnastics and weightlifting). Weisenthal et al (2014) reported that shoulder, low back and knee injuries were most common. Low backs were commonly injured during power- lifting movements.

Frankly, I’d ask if these people sat at desks or hunched. I see more seating injuriesthan I do deadlift ones.

But, lets follow the line of thought. CrossFitters, allegedly,  injure themselves during fatiguing workouts. Doing a lot of work with an eye on the clock is, therefore, wrong.

CrossFitters, at their core, view their workout movements as work. The aim of all work is to relate the work done, with time. How long did it take?

This  holds true in academic exams, running, rugby and life. Winning performances consist of doing good work, in a faster time

I’m not so sure about sex.

As we have discovered from life, activity can fatigue. The more emails you write, the more chance of a poor phrase slipping in. Morgan et al, 2009 (not really a report, more an article) Nachemson (1965) and Dreischarf et al. (2016) all observe the possible consequences of lifting with a flexed lumbar spine. I’m surprised sitting hunched at work hadn’t given them a clue. However, GOOD NEWS . There IS money in stating the bleeding obvious.

Overhead arm movements are problematic. Impingement of the rotator cuff muscles can occur if the space between the coracoacromial arch and the humeral head is reduced (Morgan et al 2010). Defective scapular positioning could be to blame (Kibler 1998). The scapulae should retract and tilt posteriorly in order to maintain the subacromial space during an overhead arm movement.

That scapula retraction is affected by the mobility of the thoracic spine and rib cage is once again stating the bleeding obvious, but well done Strunce et al (2009) for writing it up. Years of hunching, texting, peering at computer screens mean that our overhead positions need work.

Therefore, it can be suggested that without good mobility of the thoracic spine no one should risk putting their hands over their head.

No one should stock the upper shelves of your kitchen, no curtain hanging, no singing along to rock groups or holding up your lighter at a Prog Rock gig.

There is a line of thought that demands perfection in movement, without for one second conceding that the pathway to learning good movement is poor movement.

I get to watch, weekly, people swim, play football, walk and sit. 98% do so appallingly. The better athlete starts with poor movement and develops. The poor athlete is happy with more poor movement.

I don’t mind sport science hysteria, but the dangerous sports are contact ones; Rugby, boxing, jumping of cliffs with bits of cloth tied around some sticks. See this BBC Article.  I should say that I boxed and loved it: I personally don’t like sports that make me focus on a ball then encourage someone to pull my legs away or high tackle me.

Maybe I’m a coward.

I suspect if we really analysed injury, it would correlate with long term poor form. What identifies it is the health drive of the sub group. Casual pub footballers, probably won’t spend the money to see a  therapist. The average CrossFitter, passionate about their sport, will see a therapist to get back to fitness asap.

So what is the applicable morality here? If someone moves badly, should we ban them? If you walk poorly, taking 10,000 steps surely has a higher risk factor than lifting a bar 45 times. Sitting for 8 to 12 hours is, surely, more dangerous that a kipping pull up. Running to get a ball and crashing into a team member, or falling off skis, has a real risk of death. Maybe you can tweak a shoulder if you miss a muscle up.

According to my good friend Dale Saran: “You have to accept a risk of injury as a reality of playing a sport, or just living a life. A 100-percent safe exercise has a zero percent chance of getting you fit. It’s you sitting on the couch with a helmet and kneepads on.” I sort of agree, but I’d say “sitting on the couch with a helmet and kneepads on” is the most dangerous thing you can do. Sitting is  basically suicide for those who like to do things slowly (and watch TV in the process).

I suspect that  mental attitude has a role in all this. Frequently, aggressive people injure themselves. This is from a blog post: “Determined to perform well, he doubled down on his training, working out twice a day, upping his max dead lift to 375 pounds and doing 53 pull-ups at a time. The tough regimen took its toll – tennis elbow, golfer’s elbow, shoulder woes, knee pain, a persistent trick in his neck”

I think aggressive people have always injured themselves.

~So what are we to do? As Crossfit London, the UK’s 1st ever Crossfit affiliate we have a duty to lead the way in this research as,f rankly, those sport scientists that have  looked at injury rate in crossfit  are not up to the task. Im sure there are great  sports scientists out there btw. We intend to carefully record all of our injuries over the next year and  review the back ground and nail the aetiology. We will, where possible interview the  injured client, the coach and any witnesses.

So if you injure yourself, don’t be surprised if you get a very inquisitive email from me or one  the Crossfit London sports injury team.

Just sayin

 

References

“Consortium for Health and Military Performance and American College of Sports Medicine Consensus Paper on Extreme Conditioning Programs in Military Personnel”   Bergeron et al.

http://library.crossfit.com/free/pdf/CFJ_111200_Bergeron_Champ.pdf

Injury Rates and Profiles of Elite Competitive Weightlifters
Gregg Calhoon J Athl Train. 1999 Jul-Sep; 34(3): 232–238

Dreischarf M, Aboulfazl SA, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: a review of in vivo and computational model studies. J Biomech. 2016;49(6):833-45.

Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med.1993;21(4):599-603.

Hak P, Hodzovic E, Hickey B. The nature and prevalence of injury during crossfit training. J Strength Cond Res. 2013; DOI:10.1519/JSC.0000000000000318. [Published ahead of print]

Kibler BW. The role of the scapula in athletic shoulder function. Am J Sports Med.1998;26(2):325-337.

Morgan WE, Feil C. Cross-Fitness injury prevention: Protecting the lumbar disc in squatting motions [online]. California; Dynamic Chiropractic; 2009 [last updated Oct 2009; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54148

Morgan WE, Feil C. The Importance of the Thoracic Spine in Shoulder Mechanics [online]. California; Dynamic Chiropractic; 2010 [last updated May 2010; cited 2016 March 23]. URL: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54622

Nachemson AL. In vivo discometry in lumbar discs with irregular nucleograms. Acta Orthop Scand. 1965;36(4):426

Neviaser TJ. Weight lifting: risks and injuries to the shoulder. Clinical Sports Medicine.1991;10:615-621.

Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17(4):230- 236.

Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among crossfit athletes. Orthop J Sports Med. 2014;2(4): 2325967114531177

http://ojs.sagepub.com/content/2/4/2325967114531177.full

 

 

First aid: 1 day, level 2, course

Crossfit London runs an excellent 1st aid course specifically aimed at the gym environment. Ideal for Pt’s, trainers , gym goers and those with  active partners:

CPR, Choking, bleeding,… you name it, you’ll be able to 1st aid it.

At £60, its one of the best value accredited  (NUCO) 1st aid courses around.

Action packed and fun. Well taught!

Click here for details of the next 1st aid course ( and the others that we do)

9 Malcolm Place: Health and Safety Report

This thread will act as our ongoing  maintenance check list and health and safety reporting system.

This builds on the previous experiences and risk reviews carried out at 9 Gales Gardens

The headline observations were  as follows

We need a public risk assessment – one that satisfies the legislation, but one that also means instructors, and trainees understand the risks and what is expected from them.

1) Health of client : in line with current gym management, the client is to assume responsibility for their own health  http://crossfitlondonuk.com/2010/09/the-parq-vs-health-commitment-statement/ )

( the original was amended  20th Sept 2010 from:” Clients must have submitted aPARQ, and if need be, been signed off by their doctor or have signed  a disclaimer” to all clients to follow the recommendations of their health professionals and take responsibility for their own health)

2) Slippery floor (sweat created, drink spills): Instructors to check area safe, clients to manage and observe during the session.

3) Equipment check: weekly, in-depth check by Crossfit LondonUK officers system to be set up, spotting loose screwsbolts, fraying bands/ropes/buckles, etc. A visual inspection before each session by the instructors as part of warm up. Clients to be aware.

4) Running outside the gym (as part of a WOD): The facility opens on to a road – albeit a quiet one, but a road never the less. Emphasise walking in and walking out.

open the door to right  angles, and clients to run towards bethnal green road ( ie turn right). If possible blue gate to be half  closed.

6) First aid: A first aider to be on-site when training is taking place.

7) Instructors to hold insurance cover, Crossfit London to take an interest in such cover.

8) Movement specific warm ups must preceed dense or intense sessions (dense = typical fast CF work out, intense = heavy weight)

9) Client must know the move and be coached. Trainer must offer an adaptation or scaling alternative if required

10) To avoid over-training and possible injury by failure to consentrate, regular trainees must have a week off from training every 12th week (clients to be responsible for monitoring)

11) Trainees must have access to water, and be reminded that they may stop and rest at anytime

12) The dangers of rhabdomyolisis must be emphasized and clients taught to watch for danger signs. Intense eccentric training in dense conditions should not be deployed. (updated 7 August 2012 to include) : no more than 5 negative pull ups in any one session

13) All incidents/suspicions of disrepair, must be written up  in comments below

14) A first aid box is required, to be formally checked every  quarter by a CrossFit Londonofficer.

15) A member of the group must have an active working mobile phone incase of emergencies.( incase instructor has forgotten their one)

All incidents must be writen up below, and  a copy sent to andrew@crossfitlondonuk.com.  the Name of any  individual must be left off the public report here, but be included in the email to Andrew.

on a weekly basis:

All screws on both pull up systems to be checked

1st aid kit audited and restocked ( an audit list will be kept on the cupboard .

Bars to be checked.

Straps of rings and ropes to be checked.

Cleaning is carried out daily.

 

Fire assessment.

Risk assesment, we are fairly lucky in that all of our pricesses do not involve fire. never the less rubber mats and plates could, if hot enough, catch light.

1) no naked flames within the building. None are required, and  there is no smoking

2) no rubbish storage within the gym. the bin is outside.

3)  No flammable liquids to be stored in the gym ( white spirit etc should be be purchased, used and excess disposed off and not stored)

Re escape: we have a front and back fire escape: staff need to pick up the key from the back door to escape from the alley way.

Exits to be kept clear and marked.

Assembly.  opposite the gym.

 

 

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