Lowering the Crossfit Injury Rate

Whether you love or hate Crossfit, it is here to stay. I personally LOVE Crossfit. I wrote a blog post in April last year about Crossfit and why injuries occur – you can read it here. I have been consulting with high level and the general Crossfit population for well over a year now. This blog post is about the common issues that I see and how to reduce the injury rate in Crossfit…

Crossfit athletes never cease to amaze me. I love our enthusiasm, determination, encouragement and community. I have seen lives change, bodies change, goals hit and lots of personal bests and records achieved. But as a physio (physical therapist), I have seen the injuries, niggles, plateaus in performance and, let’s face it, when a Crossfitter can’t improve on something they are desperate to improve in, they get frustrated!

To help these people back to their best, I have noticed I have used the same framework over and over. Like everything I do, it isn’t particularly special or “secret” in knowledge…the real secret is in the implementation! So let’s get back to basics…

The Basics – Mechanics, Consistency, Intensity

Keep reading for the love of God! DO NOT SKIP THIS PART!!

I will guarantee you that nearly every Crossfitter I have met knows these concepts or something like it… but knowing it and doing it properly are 2 very different things. It is the reason why you see poor squats, poor barbell technique and, eventually, a plateau in performance.

I am going to break this up into theory and practice because I have seen some pretty limited mobility in athletes that would make me think they shouldn’t be doing anything at all if we got all technical about things!

Mechanics and Consistency

Theory: This is getting the movement right. Every time. Absolutely perfect technique. Your goal should be to execute every single repetition perfectly. That means a perfect squat – now I can confidently tell you now that the average Crossfitter does NOT have a good squat. I have pretty good flexibility, better than most for a big guy, and even my squat is not up to my standards. Getting your technique right is a journey of a lifetime and one which you should think about daily.

Now I am not your coach and to be honest, I don’t want to be. I am a very good Physio and consultant. Your coach is no doubt a good coach. I prefer to work with coaches, not be the coach. Your coach can see things that don’t look right to them. I see things that don’t look right to me. TOGETHER, we address the concerns that we each have. The bottom line is that both I and your coach will give you things to work on. Take these suggestions seriously. Organise a program of mobility and technique practice that you do before and after your WOD.

If you WOD alone, then watch technique videos and video yourself. Something like the Coach’s Eye App is worth the money – you want to see what you are doing. The best athletes in the world ALL need coaches simply because they can’t see themselves in action. Send your video links to me – I will look at them – post them on facebook at www.facebook.com/physiodetective.

Until you can master each exercise PERFECTLY, I do not suggest you go too heavy. If you cannot do more than 80% of your reps correctly and controlled, then the weight is too heavy or the rep numbers are too high for you. You need to swallow your pride and scale the exercise back to a level you can do properly. This is arguably the HARDEST thing to get a Crossfit athlete to do…but it works. My athletes that have scaled back or even completely rested (rare) for a time and have come back stronger and started breaking their old Personal Bests (PBs).

If you allow technique flaws to be practiced over and over at high repetitions, you will be at an increased risk of injury AND it will be harder to change your technique later. It is better to get it right and keep it right.

Practice: Although most people don’t possess a squat that will pass muster with me, I don’t have people only doing half squats all the time (unless they REALLY need to!). You can scale your exercise to a level such that your squat will still achieve the standard but you are really working hard to maintain good form. It might only be an air squat that you can manage.

If you understand the risks of injury, then do the workout at whatever weight you think you should. You can always increase the reps at a lighter weight to get the same intensity or increase the weight with reduced range. You may actually have to do an accessory movement like a lunge instead of a squat. There are ways around your limitations. However, I still recommend that you should be doing more good reps than bad ones – I don’t mean “acceptable” reps, I mean good form at least 80% of the time. Scale your exercise back to a level so you can achieve this.

Ideally, you will have a pre-WOD mobility routine and warm up and a post WOD time to work on your technique and mobility. Consistently working on your weaknesses will allow you to make them strengths. It will take a few months, I won’t lie to you…but if you do this properly and consistently, with good coaching, you will blast through your previous plateau levels and continue to improve.

A Caveat:It is close to the Open season and Regionals. It may not be possible to scale back your training based on what the coaches are trying to achieve. The above suggestions are the ideal but in practice, we are always balancing other issues…this increases the risk of injury but sometimes it raises that risk very slightly compared to the gains that are made. This is something between you and your coach. Again, I am not your coach but will work with your coach. I will go in to bar for you if I think it is dangerous to your health – my patients are my first concern…in the 16 years I have been a Physio, I haven’t had too many problems at all with coaches or athletes in danger 🙂

Intensity

Theory: This is where you increase the effort, the speed, the load. You try to do more reps unbroken than before, a little faster than before with a little more weight than before.

The total work you perform is based on the time it takes to move the load and the repetitions you do. If the load and reps are the same, then the time taken will determine your intensity. If the Time is set (like a 15mins AMRAP (as many reps/rounds as possible), then the reps and load will determine your intensity.

This is also where everyone, including myself, falls down. We need to ensure we don’t progress too quickly into loads that are unmanageable, rep ranges that have more bad reps than good ones and going so fast that we sacrifice good form for speed.

Practical: I think gaining strength is probably the best way to increase intensity. For example, your Fran time will be a lot better if your 1RM thruster is 70kg vs 40kg. Once you have the strength to do more, you will be able to decrease the time it takes to do it. Then it becomes small goals…take 5 secs off your 400m run during Helen, string together 2 more pullups than you normally can, go unbroken in a set of kettlebell swings, etc etc. During ALL of this, your MUST maintain good form at least 80% of the time. By making your intensity goals just right, you will improve with safety…the trick is not to overdo it so you get injured nor under-do it so you don’t improve 🙂

 

The Four Key Areas

As a physiotherapist (Physical Therapist for you USA readers), I think every joint is important! But the 4 key joints I seem to have to deal with are (in a loose sort of order):

  1. Hips
  2. Shoulders
  3. Ankles
  4. Lower back

The knees, thorax, neck, wrists, elbows and feet round out the list.

Please note: These are the problem regions, NOT the PAINFUL ones!

Quite often people come to me with pain in a region somewhere e.g. the shoulder and they have seen every man and his dog, gotten it massaged, doing lots of rehab, even seen if the neck is the problem… but they get to me and it turns out to be a rib/thorax issue. Just because one region is painful, it doesn’t mean that the problem is there.

I will be devoting a blog post to each of the 4 key areas this month…what to look for and 2 simple exercises you can try to help…please remember that you may have seen these exercises before but it actually in the execution of the exercises that makes all the difference!

I would love to hear what troubles you have had or your favourite exercises for the 4 key areas are – please leave a comment below 🙂

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About Antony Lo
Antony Lo is an APA Musculoskeletal Physiotherapist based in Sydney. His website is www.MyPhysios.com.au. He specializes in the management, treatment and prevention of pain and dysfunction, particularly of the pelvis and ribcage. His sub-specialties include Crossfit and Exercise Performance Optimization, Ante-Natal and Post-Natal Care and difficult cases that have failed treatment elsewhere.

4 Responses to Lowering the Crossfit Injury Rate

  1. Anonymous says:

    Excellent advice, thanks Antony.

    Like

  2. Antony Lo says:

    I have been asked why I say you should do good reps 80% of the time… here is an extract from a Facebook reply that I made…

    So we are doing 10 strict pull ups. Any deviation from perfect, arching of the back, poking of the chin, twisting, etc would be a no-rep. So you try and you do 7 and on your 8th you no-rep (it was a bad one). You rest, do another good one but then you go for the 10th but again, it isn’t a good rep. So you call the end of your set there…by my count, you have 8 good reps, 2 no-reps. That is 80%. The 2 tries count as far as I am concerned from a physio because they involved effort. I would record 8 good reps and 2 failed reps.

    I think the above scenario is a realistic one – have a go or two at getting those struggle street reps out. But if you can’t do it properly, then end it there for safety’s sake and scale the rest of them.

    That is how i got to the “80% of the time” figure…

    Training and competition are different – within reason, do what you need to in comp but if you are doing more bad-form reps than good, you are at serious risk of some sort of injury

    You know when you break a PB like your 1RM snatch? You know it was ugly – your knees buckled a bit, you were off balance in the hole, you struggled to stand it up but you got there…that feeling of achievement is AWESOME right? Mentally, now you know you can lift that weight and you are likely to be able to do it again really soon. But it was what I call “an ugly PB”… if we talk long enough, you will hear me talk of my 1RM’s as ugly or good. My squat clean 1RM is 190lbs (I was at Crossfit Active on a course at the time – bloody pounds!) Anyway, it was a pretty good lift. Some wobbling but fairly clean. I recently did 2 hang squat cleans at 82.5kg – they were clean too… I tend to bail out of lifts if they get ugly. I could probably fight more but it don’t see the point…I need to be able to work as a physio, not lift 2.5kg more. I got a strict ring dip out months ago but it was UGLY. So ugly that my shoulder motor control is still not quite right (it would help if i did more rehab on it!!) So, I don’t do ugly anymore!

    Like

  3. David says:

    Agreed! I’ve pushed melsyf further in the On Ramp classes than I ever imagined I could (or would) .this is definitely a place to check out if you want to challenge yourself, as well as feel proud of what you can accomplish!!!!

    Like

  4. renee says:

    Great Post! Ive had the most trouble with my hips…no trouble elsewhere fingers crossed!

    Like

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