CrossFit: 73.5% Chance of Getting Injured!

Anyone that has read this site knows I am not a fan of CrossFit. I believe it is the wrong approach to fitness for a number of reasons, but my root reason is the high rate of injuries. When you combine speed + load + volume, bad things happen. Until yesterday I had no idea what the injury rate for CrossFit was. If you would forced me to guess I would have said 20% with maybe 2% of those injuries requiring surgery. I wasn’t even close.

Thanks to Bill Lagakos, PhD (@CalorieProper) for tweeting this study yesterday. From The nature and prevalence of injury during CrossFit training abstract.

An online questionnaire was distributed amongst international CrossFit online forums. Data collected included general demographics, training programs, injury profiles and supplement use. A total of 132 responses were collected with 97 (73.5%) having sustained an injury during CrossFit training. A total of 186 injuries were reported with 9 (7.0%) requiring surgical intervention. An injury rate of 3.1 per 1000 hours trained was calculated. No incidences of rhabdomyolysis were reported. Injury rates with CrossFit training are similar to that reported in the literature for sports such as Olympic weight-lifting, power-lifting and gymnastics and lower than competitive contact sports such as rugby union and rugby league.

I’m sure the CrossFit people can point to flaws in this study, but even if the numbers are overstated by double, triple or quadruple, they are still ridiculously high. Getting in shape should never carry risks of injury or surgery this high.

Is it Bad Form?

A common defense of CrossFit and Olympic Lifting is the belief that injuries are a result of poor form and with good form injuries will not happen. I call this The Myth of the Perfect Rep. To believe that every rep of every set of every workout is going to be flawless is a fallacy. We are human. We are not mechanical. We make mistakes. We lift emotionally. And we age.

Let us set aside that not all injuries occur during the movement, some are slow and accumulative. Excellent form will allow the athlete to progress through lower weights and lower volumes with lower risk of injury. However, as skill and strength increase so does the weight and the volume. The risk of injury still exists only now the stakes are higher.

Your form can be 10 or 50 times better than it was when you started, but it will never be 100% perfect. One enemy of good form is fatigue. Fatigue can be brought on from using too much weight or doing too many reps or having too little recovery. The more skill involved with an exercise, the greater the risks of having bad form. I’ve watched the video where elite CrossFit athlete Kevin Ogar severs his spine at least 10 times. His form looks solid to me. Maybe from a side angle it would be easier to see how this one repetition lead to him being paralyzed from the waist down. Regardless of what went wrong, it was a horrifying injury.

With gymnastics the load is never more than the athletes body weight. With Olympic Lifting, the load is high, but the reps and volume are less. And both those sports have high injury rates. You don’t need to mix speed, skill, load and volume together to achieve a high level of fitness. All you are doing is compounding the risks of getting injured.

Gymnast

Photo by crises_crs

Stay Safe

Of course I have to end this post with the obvious conclusion I reached in my 20 years of weightlifting. The key to fitness is not getting injured. Extreme hardcore protocols do not offer any advantage once you account for injury risk. How do you get strong with minimal injury risk? Do the almost the complete opposite of the CrossFit.

  1. Pick exercises with low or near zero skill requirements, such as machine based weight machines (leg press, pulldown, chest press).
  2. Go slow. Ballistic movements are used to make skilled movements safer and easier. They are counter-productive for zero skill lifts.
  3. Reduce volume.
  4. Increase intensity (or not). With safer exercises, you now have the option of going for an extra rep or spending more time under load without fear of getting hurt.
  5. Allow time for recovery. 1-2 brief workouts a week is all you need.

There it is. It isn’t glamorous, but it works.

Of course what I just described is High Intensity Training (HIT), which is not to be confused with the more popular High Intensity Interval Training (HIIT). After many years and many injuries of lifting the other way, I am now 3+ years into HIT with no injuries and in great shape. The key to winning is first don’t lose. For more info on HIT, read Body By Science for a gym based workout or Hillfit 2.0 for a body weight approach.

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MAS

Critical MAS is the blog for Michael Allen Smith of Seattle, Washington. My interests include traditional food, fitness, economics, and web development.

17 thoughts on “CrossFit: 73.5% Chance of Getting Injured!”

  1. You don’t have to be a CrossFit person to realize the problems with an online questionnaire (self-selection anyone?). That said, I’m completely with you that if you want to gain/maintain strength with a lower risk of injury, CrossFit is not your best choice!

  2. Great post….but I anticipate some comments coming your way from “the community”

  3. It is as evident as it is often missed. Nonetheless, people the world over forget, time and again, that getting injured is one of the red-flag signs that a fitness program has failed.

  4. As I begin this comment I realize that I will come across as an apologist for “the community”. Please understand that’s not my intent. However, it appears that the authors of the study were comparing the injury rate in CrossFit to the injury rate in sports, not fitness activities in general. Reading the injury data in that light, CrossFit may actually compare favorably to other sports. This article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941297/ provides injury rates for various collegiate sports. Figure 5 in that article suggests that all collegiate games and most practices have a higher injury rate than the self-selected CrossFit sample, many of whom are college age or slightly older. Since a typical CrossFit class is about 1 hour long I’m equating “per 1000 hours” to “per 1000 athlete exposures” here.

    Most parents would not think twice about signing their children up for youth soccer, but children’s soccer has an injury rate per 1000 player-hours of “from 0.6 to 19.1 per 1000, depending on the level of play”. http://pediatrics.aappublications.org/content/105/3/659.full. Soccer’s injury rate could be significantly higher than a well coached “CrossFit Kids” class at the local “box”.

    My point is that there’s a bit of an apples and oranges comparison here. Seen as a fitness endeavor CrossFit may indeed be unduly risky compared to HIT. Seen as a sport, CrossFit isn’t that much more dangerous than other sports.

    And, in fact that is what CrossFit is becoming – a sport – though it does not market itself as such. Ultimately the thing for which I blame CrossFit is not the injury risk, but rather its promise of “forging elite fitness”. That tag line is rather misleading and encourages the uninformed to look to it for something that it is not.

  5. @Geoff – Good comment, especially your last paragraph.

    What I would be interested in seeing with the injury data is the severity of the injury. I’ll do another post on this topic specifically, but I imagine the severity of injury is greater when there is more speed and more weight, regardless of the sport.

  6. I was a member of a Crossfit gym for 4 years. First couple of years were awesome. It was like the old team workouts in wrestling practice. Character builders. Grueling physically & mentally, but your overall athleticism and grit grew over time. My body looked and performed amazing. The programming was simple and beautiful. Then the games training took over. Even after my gym resigned their Crossfit membership, they still programmed for the games. Multiple WODs every workout. Then the programming changed to only challenge the fittest of our gym and to prepare them for the games. I saw people falling off of ropes, boxes and pull up bars. I never felt energized by the workouts anymore. The coaches delighted in destroying people and preaching paleo/zone nutrition + beer. When I moved to the coast I looked at several gym’s websites to see their WOD programming. Every single gym had games style programming. Eventually I settled on a basic Art Devany inspired routine. I do miss the gym fellowship and nice physique, but I can’t stand the bizarre programming and cult like behavior.

  7. I don’t do CrossFit, but I do reference their site once a week to perform their WOD on one of my workout days.

    From what I’ve done (about 10 ~ 12 WODs so far), I agree that there are many aspects of CrossFit that could lead to breakdowns in the program (more complexity = more opportunities for problems right?). However, I feel that as a whole CrossFit can be about as safe as any other sport (competitive or casual). The key problems IMO are linked to the competitive nature and a “devil may care” attitude towards the associated risks that some members bring to the table.

    For example, I’ve been doing deadlifts and back squats for 6 months now, at 65lbs (10 lbs per side with the barbell’s 45lb). Till this day, I’m still finding the 65lbs to be doing something for my strength and I’m still spotting ways to improve my technique and lifts.

    CrossFit in contrast has new comers go through a few classes of the induction, and then they’re thrown into the WOD (even though it is a scaled workout). If form is crucial to ensure maximal power utilization and safety, I sincerely wondering how anyone with a few lessons under their belt can appreciate the effectiveness or ineffectiveness of their forms – and they’re doing KB swings & snatches, thrusters, snatches, clean & jerks… all of which incorporate technical forms. For many YouTube CF workouts, form seems to take a secondary priority to speed and numbers – check Jason Kaplan’s sub-2 minute Fran.

    Any one day I do a scaled CrossFit WOD, I’m shattered, and there are CrossFitters who not only do it at the RX level, they also do it more than once a day sometimes.

    The competitive atmosphere is good to get people to push through their limits, but our limits are completely different, and personal physiological limits are there for a reason. Your body is telling you that based on its current state, it might be able to go a some more, but gong far beyond those limits is dangerous. An overly competitive box will make people ignore those limits to their own detriment. The CrossFit Games (which I love following) further fuels that fire.

    Sure, Rich Froning, Ben Smith, Jason Khalipa are amazing athletes capable of things that many won’t be able to achieve on a regular day… but before you try to snatch that 300lb barbell, try to remember that there is only one 3 time reigning champ in CrossFit, and he may represent an outlier in the world. In contrast, there’s only one of you, and we still can’t download our brains into a new body yet.

  8. I recently went to a gym where I hadn’t had a trainer before and he told me that I had to push past the pain and all the usual movie cliche quotes. I said that I was not a professional athlete so there really wasn’t a need or urgency for me to stress out. I could tell by the look on his face he thought I was a “quitter”. But what was i quitting?

    That is something I’ve never understood. So many people have goals that are somewhat meaningless in the larger picture, whether it is running a 5k or marathon. Who said that is THE distance that makes you a man or whatever? And so much of training is competitive where not only is there no prize but there is no race! I think it is largely based on people’s need to be acknowledged because they aren’t talented or attractive or rich or whatever success measure is being measured against. Usually you get the “pushing yourself/see your limits/personal growth”, all tripe. I believe it has nothing to with the physical and everything to do with the mental acknowledgement from others.

  9. @thomas – Yes. Our culture is more concerned with the “demonstration of fitness” versus fitness itself.

    CrossFit is the perfect example. Technical moves performed quickly and at high volume levels “demonstrate” fitness in a way that expose the athlete to greater risks which unfortunately pulls them away from true fitness, which is not defined as a point in time when you were 28 and invincible.

    My definition of fitness has a much longer time horizon.

  10. @thomas @mas

    I think that there is also some aspect of bro trainers treating random people who never lift like experienced lifters.

    Should exercise be entirely without discomfort?

  11. @Matthew – Depends how you are defining “discomfort”. If the discomfort is from having a compromised form brought on by either fatigue or lack of skill in the movement, then yes it should be avoided. If however, the discomfort is directed at muscle fibers in a safe path of movement with no risk of injury, then discomfort is desirable.

  12. A way that data was collected just make me smile! 😀 And I am pretty sure no competitive athlete would go with your inglamorous workout. It works for what? you forget to mention. I understand you think that wheightlifters are fit? Well, they aren´t very fast, are they?

    I think you see what you see (or want to), and not every box is the same, I am in Spain and I havent seen fitness “demonstration” yet. And no doubt there are idiots in every sport, at least I´ve seen in basketball, fooball (soccer), light atletics and even squash.

    I really enjoy some articles you have written, but this is just stupid. Can you define “true fitness”? But, please, do not write an article about it. I am pretty sure I will disagree with you… 😀

    P.S. I am actually a squash player with very little envolment with Crossfit and not considering myself in a comunity at all.

  13. @Janis – When the average person models their workout off of outliers (competitive athletes) it often leads to injury. My message is you can get fit, maybe not elite, without taking the risks that lead to high rates of injury.

    We already covered how the data collection was flawed. But the fact CF has a high rate of injuries is no secret.

    I did make an error. I meant to say “demonstration of strength”, not “demonstration of fitness”.

  14. The self-selected data, says that CrissFit compares similarly with powerlifting :

    “Injury rates with CrossFit training are similar to that reported in the literature for sports such as Olympic weight-lifting, power-lifting and gymnastics and lower than competitive contact sports such as rugby union and rugby league.”

    So a fitness program that incorporates power lifting and Olympic lifting has similar injury rates? And you’re using that as evidence that it’s bad?

    Seems more like you are being dishonest in your conclusion and that you have a serious axe to grind.

  15. @All – Closing comments on this post. The data selection used in the study was not ideal, so we don’t know the true rate of injury. I strongly suspect is still way too high, but I can’t back that up. I’ll keep doing Slow HIT and you CF people can rock on with your kipping pull-ups and high volume Oly lift sets. We will see in 20 or 40 years who picked a program.

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