Among CrossFit athletes, Tennis Elbow and Golfer’s Elbow seem to be a common scourge — (Not to mention various other injuries to the wrist, shoulder, back and knees.)
CrossFit-related injuries are well-known and frequently discussed in the fitness and rehab / Physical Therapy communities, in fitness-related blogs and forums AND even specifically explored in medical studies.
What Is It About This Form Of Strength Training That Puts One At Risk For Injury?
Is there something inherent about the CrossFit style of working out and weight lifting that predisposes one to a much higher risk of injury?
I know I may take some heat for this. I’m sorry CrossFitters, but I have to say it looks the answer is undoubtedly, yes!
And I hope this post helps shed some light on the issue, (especially if you’re one of my Tennis or Golfer’s Elbow student/members who does CrossFit!)
In this study of over 3000 CrossFit Athletes, surveyed between 2013 and 2017, found that 30.5% experienced an injury over the previous 12 months related to their CrossFit training.
Injuries to the shoulders (39%), back (36%), knees (15%), elbows (12%), and wrists (11%) were most common for both male and female participants. Making the elbow the 3rd most-frequently injured area.
A 4-Year Analysis of the Incidence of Injuries Among CrossFit-Trained Participants
The Problem With CrossFit, According To An Elite Athlete
In this video, Chris Heria, a functional fitness athlete and trainer, explains and demonstrates the problems with the CrossFit approach to fitness and strength training.
My Three Key CrossFit Critiques
#1. Ignoring Pain And Fatigue
CrossFit is classified as an Extreme Conditioning Program, which by definition means pushing past pain and fatigue and routinely working to the point of exhaustion — even vomiting.
Now, don’t get me wrong, that level of extreme exercise may be acceptable and necessary for military special forces and other elite groups (Skills for extreme situations requires extreme training)…
But is it appropriate (or safe) for someone who was sitting on the couch yesterday, with 50 extra pounds around their midsection and no exercise conditioning at ALL?
“Ever since it emerged, with its high-intensity weights and non-stop pace, CrossFit’s been dogged by safety fears.”
“‘It can kill you,’ Glassman [CrossFit’s founder] said in a 2005 New York Times story. ‘I’ve always been completely honest about that.'”
The CrosFitt cartoon mascots embody this mentality to a “T”
One is a character called “Pukie The Clown” (See image below.)
The other is a sketchy dude named “Uncle Rhabdo” where Rhabdo is short for Rhabdomyolysis, a rare condition that extreme exercise can put one right in the crosshairs for.
Rhabdomyolysis can occur when muscles are pushed to such an extreme degree they begin breaking down, and the cellular structure of the muscle ruptures.
This is damaging enough for the muscles, (it can result in permanent muscle damage) but when those cellular proteins hit the bloodstream they can quickly overwhelm the kidneys, which must filter them out, causing acute kidney failure — and death, in severe cases.
Apparently, pushing oneself to the point of total exhaustion, blood sugar depletion / “bonking,” vomiting, loss of bladder control — And even muscle damage and “Going Rhabdo!” is a point of pride among some of the more extreme CrossFitters!
Sure, some pain and “healthy fatigue” from a good, hard workout is perfectly fine for healthy, reasonably fit people.
And the intense burning sensation in muscles that are being strength trained hard (but safely) is perfectly normal — and desirable, at a certain level (although not everyone should be working out at this level.)
But if you’re feeling pain in your joints or tendons, or unusually sharp, sudden, stabbing pains in your muscles, it’s a clear sign that you’re either injuring yourself or are at risk of injury if you keep going.
#2. Sloppy Technique
One of the core tenets of CrossFit seems to be the practice “explosive repetitions,” as in doing as many repetitions as possible in a given, short period of time.
AND with little or no consideration for proper form and level of progression, essentially:
Speed + High Intensity + Sloppiness = Injury
As, Chris Heria explains and demonstrates in the video above, if you work out this way, you will never progress to higher levels of ‘functional strength.’
Functional strength? CrossFit, pays much lip service to being a functional approach to fitness, but I have to question whether some of these exercises bear resemblance to what could be considered “functional” in the real world.
If you watched the video, you will have an image in your mind of what is, apparently, one of CrossFit’s fondest exercises:
The Kipping Pull Up
It involves what starts out looking like an ordinary pull up — It is nothing of the kind.
The person swings their legs violently forward at the beginning of the pull up, and the momentum of the return, posterior swing of their legs is used to help them execute a partial pull up, where the chin apparently does not need to come anywhere near the bar, much less over it.
Then comes the really scary part, in my view: No attempt is made to control the descent, (no emphasis seems to be put on the ‘Eccentric’ part of the exercise.)
The person looks like they just fall or flop back to the starting position, with no control, which puts tremendous force on all the joints of the upper extremity: Shoulders, elbows and wrists.
Because it results in such an extreme, sudden deceleration at the bottom of the pull up, with sudden reversal into the next repetition (which is then repeated as quickly as possible with as many reps as possible.)
It’s one thing if you’re training to be a trapeze artist — THAT could be a functional application of this crazy pull up technique!
For anyone else, who doesn’t need to swing from a trapeze bar, it’s a recipe for shoulder / Rotator Cuff damage, and wrist and elbow injuries, including, of course, Tennis and Golfer’s Elbow.
#3. Difficult Exercises That Overload The Wrist Muscles
CrossFit, as the name implies, takes a cross-training approach to fitness, mixing and matching exercises and varying the WOD or Workout Of The Day at CrossFit gyms across the country.
Some are lower-body focused and some target the muscles of the upper body…
However, there are (what looks to me to be) a disproportionate number of exercises that involve intense gripping and/or a great deal of grip control in order to stabilize the weight in question.
Kettle Bells being the primary example of this.
(But also Rings and TRX, which we’ll get to)…
The amount of wrist/grip control required to maintain control of a Kettle Bell while doing an exercise is much greater than for other weights/dumbbells and barbells.
This puts a lot more demand on the forearm muscles: The Wrist and Finger Flexors and Extensors, which are the “grippers” and wrist-control muscles.
And these are the muscle groups involved in Tennis Elbow (Wrist and Finger Extensors) and Golfer’s Elbow (Wrist and Finger Flexors.)
Is this inherently a bad thing? No.
If you train at the right intensity and progress at the right rate — AND allow enough rest time between workouts for recovery — Then you may be fine.
(Of course this kind of pacing, patience and restraint is not what CrossFit is about.)
We could also make a distinction between the original, ‘Russian’ style of Kettlebell swings, and the ‘American / CrossFit’ style.
The American Style, involves swinging the kettlebell all the way over ones head, which is apparently necessary to count as a rep in CrossFit competition, whereas, in the Russian style, the Kettlebell is raised only to shoulder height.
See this article by Tony Gentilcore, of Cressey Sports Performance, for more on this specific topic:
Why I Dislike The American Kettlebell Swing
TRX, Gymnastic Rings and similar equipment
TRX is a workout system, involving straps with handles, upon which a large variation of body-weight exercises can be performed.
Some of these exercises, while looking cool and exciting, require enormous amounts of core and shoulder stabilization strength in order to execute with good form.
Who cares about form!? I can hear you heckling! (If you’re a tried and true CrossFitter.)
Naturally, the way we get better, stronger and more stable is to challenge the weakness and instability with an exercise that requires it…
But, again, we can only progress incrementally. No one can make quantum leaps by heaping on WAAAY more weight or difficulty.
Something tends to be the weak link in the chain that just can’t take that much challenge.
When it comes to something like a TRX “pushup” it’s often a lack of shoulder and Rotator Cuff strength and stability.
And that lack of stability in the shoulder is going to be compensated for — Almost guaranteed — by over-gripping, shall say, “DEATH gripping” the handles…
OR just compensatory tension in the Wrist And Finger Flexor and Extensor Muscles.
(Again, the Tennis and Golfer’s Elbow muscles.)
Take a look at the image above, (click the little GIF “play button” in the lower-Left corner to see the looping GIF video.)
You can see the arms of the Woman athlete shaking at the point of full elbow extension in the TRX “pushup” — This is an indication of how much effort is required to maintain stabilization.
Again, not inherently a bad thing, just know your limits, don’t push too hard too fast, and increase the difficulty in measured, steady increments to avoid overload!
Thoughts On CrossFit From Other Sources
Here’s a blog post from Dr. Sarah Haran, a highly-credentialed Physical Therapist in Seattle – and a CrossFit enthusiast, herself, which got me thinking about CrossFit injuries, in the first place.
Seattle PT discusses Elbow “Tendonitis” among Crossfit enthusiasts
Elbow pain in CrossFit athletes is not uncommon and most typically it is related to overuse of the forearm muscles.
We can see joint irritation from hyperextension or poor catching positions with Olympic lifting or gymnastics movements.
However, in the clinic, I mostly treat elbow injuries that we would as athletes call elbow tendonitis. Dr. Sarah Haran, Arrow Physical Therapy, Seattle, WA.
Elbow Tendonitis in CrossFit Athletes — Arrow Physical Therapy
Here’s one competitive-level CrossFit Athlete, Amanda Allen, who overcame a Tennis Elbow injury in a relatively short time, and her advice to those in her predicament, is:
“Don’t buy into the belief that Tennis Elbow has to last for years. Don’t leave it untreated. Don’t wear yourself down so that your body is in a catabolic state of inflammation and breakdown.”
I certainly agree with and champion the idea of not “buying in” to beliefs about how long Tennis Elbow may or may not take to heal – Lightning fast, miracle-cure style – OR tortoise-slow, for that matter!
(No one knows how long yours will take. It depends on what you do and don’t do and dozens of factors – some within your control – and some utterly beyond it.)
And here are some things you can do to take matters into your own hands:
- Learn more about Tennis Elbow — (The typical explanation and standard “treatments” will send you off on a wild goose chase, chasing symptoms and missing the real cause) Dozens of free videos and articles here at Tennis Elbow Classroom to help you!
- Discover the right and wrong ways to treat it — Here’s a good overview of the principles of treatment and exercise from my perspective: Tennis Elbow Treatment Strategies Compared
Exercise Principles for Tennis Elbow Rehab - Consider enrolling in my free course, ‘Tennis Elbow 101’ to learn more about the basics — Learn more about it and sign up here: Free ‘Tennis Elbow 101’ Course OR check out my premium self-help programs, if you need the best self-help treatment program available (see below)
Here’s where you can learn more, if you’re interested:
Learn To Treat And Heal Your Own Tennis Elbow Or Golfer’s Elbow At Home With This Video Program
You’ll get instant access to a complete VIDEO program designed by a professional therapist to help you take charge and break your vicious cycle of pain and frustration!…I’ll be your personal tutor guiding you through step-by-step video lessons, where you’ll get the therapy techniques, key stretches and essential exercises you need to treat and recover from your injury at home. (Without any special equipment.)
Tennis Elbow sufferers: Learn more about the program here
Golfer’s Elbow sufferers: Learn more about the program here
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