Introduction
CrossFit has grown rapidly over the past couple of decades, with an increasing amount of CrossFit affiliates emerging (>15,000 worldwide with >5million athletes) (1).
For those who are not overly familiar with what CrossFit is, it is a multi-modal style of training designed to build community and to create well-rounded athletes through improving strength, power, skills, anaerobic and aerobic fitness, to name a few attributes. This is achieved through a variety of training styles, from Olympic lifting to metabolic conditioning, to gymnastics, to more typical strength training. In CrossFit, there are three general categories depending on your level: Rx (equivalent to senior), Intermediate, and Scaled (equivalent to Junior). Given the variety of training modes, high volume, and advanced skill level, it is almost a given that there is going to be a risk of injury associated with CrossFit. However, is CrossFit that much worse than other sports in terms of injury?
CrossFit Injuries – Lets Dive Deeper
A recent systematic review published this year (1) investigated the injury epidemiology and risk factors in CrossFit affiliates. 25 studies were included. There were 12,079 participants (Male n = 6,454, Female n = 4,940, unknown n = 685). The average age of participants in the studies varied from 25.2 to 38.8 years old.
Prevalence and Incidence
In the included studies, there was a wide variety in the reported prevalence and incidence of injury. Musculoskeletal injury prevalence ranged from 12.8% to 73.5% (mean = 35.3%). Injury incidence varied from 0.2 to 18.9 injuries per 1,000 hours of CrossFit.
Nature and Location
Only six of the 25 studies included injury type. Tendinopathies, joint injuries, and muscle strains were the most common injuries reported. For anyone with any CrossFit knowledge, this is unsurprising given the highly repetitive nature or certain movements. Fractures and dislocations were uncommon.
Shoulder injuries were the most common (26%) of all injuries. Again, not shocking given the amount of overhead work involved in CrossFit. It is often for high-level gymnastic work and heavy overhead lifting to be included in a workout where the muscles around the shoulder are pre-fatigued, increasing injury risk.
Spinal injuries were the next most frequent (24%), with lumbar spine injuries accounting for the large majority (80%). This is also quite predictable, with heavy squats and deadlifts, as well as lower-load higher-volume movements in workouts such as ball-slams, burpees, cleans, etc. This may result in the lower back being fatigued and technique being suboptimal, enhancing injury risk.
The knee was the third most commonly injured area (18%). Again, unsurprising given the amount of knee loading which occurs from a combination of
plyometric movements and heavy resistance training at high intensities.
The majority of injuries did not result in significant time-loss, with most injuries resulting in absences of 1-2 weeks (however further information was quite limited – did athletes return to the same level or were they still limited upon return?).
Six of the 25 studies indicated the amount of injuries which required surgery. 8.7% of total injuries in these studies resulted in surgery, with over 50% of these being for the knee joint. However, it is probably likely in some cases that there were previous injuries present and the injury sustained in CrossFit wasn’t the sole reason for surgery.
Risk Factors for Injury
Possible Risk factors for injury in CrossFit were similar to other sports, these included:
Increased participation time (this may be due to higher chronic workloads, and training at higher intensities once you have a good level of technique competence).
Previous injuries ( a well-established risk factor throughout injury epidemiology research).
Weekly training frequencies (higher volumes likely to result in increased injury risk).
Participation in competition (again, likely related to overall training workloads).
Male sex.
Older age (also a well established non-modifiable risk factor in other sports).
Increased BMI (likely higher relative workload).
Poor coach supervision (lack of coach supervision may result in performing highly skilled movements incorrectly).
CrossFit vs Other Sports
Results from this systematic review revealed that CrossFit injury incidence was similar to field sports, such as soccer or rugby (3-4.2 injuries/1000 hours), as well as closely related sports such as weightlifting (2.4-3.3/1000hours) and powerlifting (1.0-4.4/1000hours).
Predictably, CrossFit injury rates were much higher compared to bodybuilding (0.2-1.1/1000 hours). I say predictably as bodybuilding is performed in a highly controlled environment, with long rest periods and less fatigue. However, CrossFit injury rates were lower when compared to Strongman (4.5-6.1/1000hours).
Conclusion
The results of this study should probably be taken with a pinch of salt as the studies reviewed are generally of quite poor quality. However, it is probably the highest quality epidemiology study on CrossFit thus far. There are some outliers which show increased incidence rates, or different possible risk factors, but these are in the minority and require further studies to elucidate findings. It is highly likely the risk of injury and the risk factors will differ depending on your individual history.
What we can probably take from this, is that CrossFit is much safer than a lot of people make it out to be (and could probably be safer if you had a periodised programme – some will already have this). If you go to any CrossFit related video on social media you will see individuals who have never done CrossFit commenting ‘recipe for injury’, ‘he can’t even do a real pull-up’, ‘focus on strict work’ etc., despite the video in question being of a highly athletic individual who likely already has the prerequisite strength and fitness required to perform said movement. Overall, CrossFit is not a particularly high-risk sport, but like all sports where you work at high intensities, with high volume and with highly skilled movements, there is a risk of injury and it is likely going to occur at some stage if you train regularly.
Tips to reduce injury risk in CrossFit
Gradually increase your workload.
Focus on developing technique prior to increasing external load.
Keep a training diary.
If you have current niggles/injuries, modify your training until the issues are resolved.
Have a go to Physio or Athletic therapist who is familiar with your training demands and you as an individual.
If you have previous injuries (e.g. patellar tendinopathy) you may need to be more reserved with your approach to some exercises – in this case modifying the amount of plyometrics (e.g. double unders, box jumps) in your training and spending more time working on isolated strength (e.g. front squats, knee extensions).
Put a large emphasis on your recovery - what you do outside of the gym? (nutrition, sleep etc.).
If you plan on competing, ensure you have a qualified coach to programme for you.
References
1. Ángel Rodríguez M, García-Calleja P, Terrados N, Crespo I, Del Valle M, Olmedillas H. Injury in CrossFit®: A Systematic Review of Epidemiology and Risk Factors. Phys Sportsmed. 2022 Jan 2;50(1):3–10.