PT Classroom - Treating the CrossFit Athlete ׀ by  Bill Lyon, PT, DPT, CSCS

Regardless of your opinion on CrossFit (which can be a heated topic in rehab and strength and conditioning circles), the fact is that it continues to grow very rapidly with new gyms seeming to pop up overnight and every 5 miles. As CrossFit continues to grow and legitimize as a sport on a professional level, those in the rehab community will see injuries come into clinic doors just like any other sport.

A recent study looking at injury rates among CrossFit participants found that the areas most likely to be injured are shoulder, lumbar spine, and knee. In this article, I’ll address 2 common injuries (lumbar spine and shoulder) that I have run into several times in my practice and at the gym, as well as some specific things to assess and correct for each.

Lumbar Spine Strain – With big movements, often heavily loaded, such as squats, deadlifts, cleans, and snatches often making up an important portion of CrossFit athletes’ training, one can see that the potential for overloading the lumbar spine is ever present. Often these injuries seem to lie on one end of the spectrum, or the other, that being either a one rep max attempt that was too much or from a repetitive movement with a lighter weight in a conditioning workout. Treating these patients initially comes much like any other patient that walks in with a lumbar strain, addressing soft tissue concerns, tissue irritability, and potential guarding. Below I’ll highlight some specific things to look at in regards to the CrossFit athlete.

Flexibility and Mobility Deficits – Generally in a well-coached and properly ran CrossFit gym, flexibility and mobility training are heralded as being just important as your strength and conditioning exercises, but in my experience the “common everyday CrossFit goer” doesn’t usually treat it as such. Assessing and treating for significant tightness in gluteals/external rotators, hamstrings, and hip flexors will help to lessen stresses applied to pelvis and lumbar spine during CrossFit.

Gluteal and Hamstring Weakness vs Quad Dominance – So many of the “big movements” in CrossFit should be hip hinge and gluteal driven, but we often see athletes compensating with quads while squatting, lunging, and cleaning. I have personally seen 1RM squat numbers get very high on people who, in all reality, had horribly weak gluteals. Strict strengthening of the gluteals and hamstrings for powerful hip extension is a must.

Aberrant Movement Patterns

This is a biggie that is often limited by the above listed topics and/or poor coaching. Walking into a poorly coached gym and seeing 20 people squatting with knee valgus and rounded lumbar spines is enough to make any rehab professional cringe. I spend a good deal of my time with patients working on squat, lunge, clean, and snatch form with no more than a dowel, PVC pipe, or unloaded barbell. Grooving the proper pattern and technique on these big lifts before adding weight is a must to avoid injury/re-injury in the CrossFit athlete.

Shoulder Impingement: CrossFit often incorporates a large amount of overhead pressing movements (shoulder press, jerk, push press, etc) and forward pressing (pushups, tire flips, ring dips, etc) which can greatly develop the deltoids and pectorals. What we see a lot is very tight anterior chest wall musculature with weak upper back/scapulothoracic musculature. Going into a workout and performing 100 push presses with a kyphosed thoracic spine and protracted/depressed scapulae, it’s easy to see how someone could be predisposed to impingement.

Upper Back Strengthening – working on the ability to upwardly rotate and elevate during overhead movements is crucial. Lower trap and serratus strengthening, as well as upper trap strengthening in an overhead position go a long way toward this goal.

Thoracic Spine Mobility and Anterior Chest Wall Flexibility – So important yet often overlooked is the mobility side of the strength-mobility equation. I tell patients all the time “you can make your muscles strong as a truck, but if you’re fighting your own body’s position and tightness, it won’t make a difference.” Working on static and dynamic stretching to the anterior chest wall, as well as the often over developed lats (due to their effect of scapular depression and GHJ internal rotation) will help to lengthen strong and tight tissues, while manual therapy and self-mobilization techniques will help to “open up” the chest and thoracic spine to gain the needed extension.

In closing, I would like to address a very important take away point from the article looking at injury rats among CrossFit athletes. The study noted that while the injury rate seemed high, it was significantly decreased with coach involvement and guidance on form correction. Much like any form of coaching or training, the result is only as good as the instructions someone is given and the best thing your patient can do to prevent injury is choose a good gym with well-educated and reliable coaches!
 

Last revised: March 18, 2015
by Bill Lyon, PT, DPT, CSCS, USAW-L1