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Hey Reader,

I hope your week is off to a great start.

How did your training go last week?

My shoulders are still sore from Saturday's Bulletproof Training Program metcon.

The combination of wall balls and KB snatches was a tough one.

This week, we're diving into common injuries I have seen while working with CrossFit athletes and as a physical therapist.

Please remember that this newsletter is meant for educational purposes and may not apply directly to your situation.

If you're frustrated with an injury, I encourage you to get assessed by a physical therapist to get it fixed fast!

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Deep Dive

7 Common CrossFit Injuries and How to Avoid Them

CrossFit is an incredible way to build fitness, but like all training methods, there are risks of injury.

​A recent study examined CrossFit athletes' most common injury sites, with the shoulder, spine, and knee being the top ones.

As a performance Physical Therapist specializing in working with CrossFit athletes, I can attest to these findings.

They are typically the sites I help athletes recover from to get back to training.

Whether you’re a seasoned athlete or just starting, knowing how to prevent these injuries can keep you training hard for longer.

This week, we'll break down the seven most common CrossFit injuries and give you actionable tips to avoid them.

Let’s get into it!

Shoulder Injuries in CrossFit Athletes

Rotator Cuff Strain

Rotator cuff strains occur when the muscles or tendons of the rotator cuff are stretched or torn to varying degrees.

Usually due to overuse, sudden movements, or improper lifting technique over time.

Causes

High-frequency shoulder training without adequate rest and sudden increases in weight or repetitions can also lead to this injury.

Prevention

To prevent rotator cuff strains, it’s ideal to warm your shoulders up thoroughly before workouts, focusing on shoulder mobility and activation of the shoulder stabilizers.

Strengthening the rotator cuff muscles with accessory exercises like dumbbell external rotations and overhead carries helps the cuff to tolerate high workloads..

You also want to avoid increases in workout volume beyond 10% per week, allowing the tissue to adapt to training over time.

Treatment

Immediately after a rotator cuff strain it’s ideal to let the shoulder rest and avoid any painful movements.

Shortly after, focus on isometric strengthening exercises for the rotator cuff, such as doorway external rotations.

This helps to strengthen the muscles in a nonaggressive position and can have a pain-relieving effect.

Shoulder Impingement

Shoulder impingement happens when the upper arm bone (humerus) compresses the tendons of the rotator cuff under a bony prominence of the shoulder blade (acromion).

Causes

Shoulder impingement often stems from weakness in the rotator cuff muscles and lack of mobility in the shoulder joint and scapula.

However, it may also occur, and poor posture during workouts, along with overuse of the shoulder in repetitive motions, can contribute to this condition.

For example, if the upper back is rounded and the shoulder blade is immobile, the shoulder will have less room to operate.

Prevention

To prevent shoulder impingement, emphasize strength training for the rotator cuff and scapular stabilizer muscles.

As well as regular shoulder and upper back mobility exercises such as cat-cows and open book rotations.

Balancing pushing and pulling exercises in training can also help to maintain a structural balance of the shoulder.

Treatment

When addressing shoulder impingement, avoid movements that cause pain.

Increase shoulder stability through targeted exercises and improve shoulder and upper back mobility with stretching and a foam roller.

I don’t love foam rolling but it can be a pivot point for upper back mobilizations.

Spine Injuries in CrossFit Athletes

Lower Back Strain

Like a rotator cuff strain, a lower back strain is an injury to the lower back muscles or tendons where the soft tissues are stretched or torn to varying degrees.

Causes

Lower back strains in CrossFit athletes often result from poor load management during exercises.

As well as improper core bracing when handling heavy weights during lower back intense movements like squats and deadlifts.

These factors can put high stress on the lower back muscles and ligaments.

This is a good thing, but midline stability and progressive training is key.

Prevention

To prevent lower back strains, try to avoid sudden, significant increases in workout intensity or volume.

It's important to consider total training (and non-training) fatigue before near-maximal lifting.

You can also incorporate lower back pre-hab exercises such as Sorensen holds and supermans to strengthen the lower back.

Adhering to deadlift and squat points also puts you in a mechanically advantageous position for lifting.

Treatment

When treating a lower back strain, rest is essential initially to allow the affected area to heal.

While continuing to train as many movements as possible that don’t cause pain.

Incorporating gentle spine mobility exercises can help maintain flexibility.

Soft tissue work, such as massage or foam rolling, can aid in recovery by improving blood flow and reducing muscle tension.

Once you are mostly pain-free, I typically reintroduce training over several days and weeks.

Herniated Disc

A herniated disc involves the bulging of lumbar disc contents into the spinal canal, which can compress nerve roots and potentially lead to pain.

Causes

Herniated discs often occur due to repetitive spine flexion or rotation motions, especially under load.

Poor load management, such as lifting weights that are too heavy or excessive volume, can also lead to disc issues.

When I herniated my L4-L5 disc, it was a direct result of poor mobility in my hips and a program that had me maxing out every single day.

Prevention

Preventing herniated discs typically involves maintaining proper core bracing and moving as well as you can.

Emphasizing spine mobility and avoiding excessive flexion or rotation of the spine when lifting heavy weights.

Your spine should be able to move while loaded, but this skill needs to be built over time.

Treatment

Treatment for a herniated disc typically begins with varying degrees of rest, but gentle motion as tolerated, can help avoid spasms.

Gentle spine mobility exercises, such as double knees to chest, cat-cows, and lower trunk rotations, can increase flexibility without aggravating the lower back.

I also try to incorporate a core stability program as soon as possible, moving from table exercises like posterior pelvic tilts to standing core strengthening.

Repeated extensions and sciatic nerve glides can also help depending on how a client presents.

Knee Injuries in CrossFit Athletes

Patellar Tendinitis

Patellar tendinitis is an inflammatory condition of the patella tendon, which connects the knee cap to the shin bone.

Causes

Patellar tendinitis, often called "jumper's knee," is commonly caused by repetitive jumping or squatting movements in CrossFit workouts.

Poor landing mechanics during jumping or running can also exacerbate the stress on the patellar tendon, leading to inflammation and pain.

Prevention

Focusing on strengthening the quadriceps and hip muscles can help prevent patellar tendinitis by preventing compensations when landing or running.

But, the biggest factor is avoiding sudden increases in running or jumping volume.

As a general rule of thumb, a progression in repetition volume of no more than 10% per week is sufficient.

Treatment

Treatment for patellar tendinitis typically involves rest to allow the tendon to heal.

Incorporating ankle mobility exercises and stretching of the calf muscles can help improve overall leg mechanics.

Isometric strengthening exercises without movement for the quadriceps can help strengthen the tendon as well as provide a pain-relieving effect.

Meniscus Tear

Meniscus tears occur when the meniscus cartilage (a shock-absorbing tissue between knee bones) tears and causes pain.

Causes

During CrossFit workouts, Meniscus tears often result from twisting movements under load or at high velocities.

Deep squats you are not prepared for with excessive loading and high frequency can also contribute to this injury.

Prevention

Preventing meniscus tears involves optimizing ankle and hip mobility to ensure proper movement patterns during squats, pistols, box jumps, etc.

Increasing the strength of the quadriceps, hamstrings, calves, and hip muscles can also provide better support for the knee joint during intense training.

Treatment

Treatment for a meniscus tear focuses on improving ankle and hip mobility and knee stability exercises.

More severe tears may sometimes require medical intervention, including surgery, followed by a structured rehabilitation program.

Hip Injury in CrossFit Athletes

Hip Flexor Strain

Like the other types of strains mentioned above, hip flexor strains involve torn muscles or tendons in the hip flexor to various degrees.

Causes

Hip flexor strains in CrossFit athletes often result from overuse of these muscles during workouts.

If your warm-up lacks luster, you may be leaving the hip flexors unprepared for intense activity.

If you are unaccustomed to volume, repetitive sprinting or toe-to-bar movements can also lead to this injury.

Prevention

To prevent hip flexor strains, avoid sudden increases in workload that stress these muscles.

Gradually increase hip flexor strength and endurance through targeted exercises like banded marching and leg raise variations.

Implementing a thorough warm-up routine that includes dynamic stretching for the hip flexors can help prepare these muscles for training.

Treatment

Rest is essential when treating a hip flexor strain to allow the injured muscle to heal.

As you continue to train around the injury, gentle hip flexor stretching can help maintain flexibility but should be done carefully to avoid aggravating the injury.

Hip stability exercises, such as lateral band walking and single-leg RDLs, can strengthen the surrounding muscles and provide better support.

Soft tissue work, such as massage or foam rolling, can help recovery by improving blood flow and reducing muscle tension in the affected area.

Final Thoughts On CrossFit Injuries

If you’ve experienced one of these injuries, I hope this has helped you learn more about how to prevent it in the future.

As you can see, injuries usually result from doing too much, too fast, and too soon.

Progressive training and moving well are your best defenses against pain in the gym.

But injuries and pain are complex.

Finding a licensed Physical Therapist to evaluate and treat your injury thoroughly is vital to returning to the gym safely.

If you need help now, I encourage you to book a free consultation or reply to this email so we can discuss how I can help you!

If you have questions about this week's deep dive or want a topic covered, reply to this email and let me know!

Read more about preventing or treating injuries in CrossFit (LINK)

This Week's Training

Day 1 - 8/19/2024 A) Strict Pull-Up - 20X1; 3 x 2.2; rest :15 btw clusters and 2’ between sets (progress load) B1) Top Down Alternating Dumbbell Press - 20X1; 3 x 10e; rest 1’ and move to B2 (progress load) B2) Ring Row - 20X1; 3 x 12-15; rest 1’ and move to B3 B3) Prne IYT - 2010; 3 x 10 each way rest 1’ and move to B1 (progress load) C) MAP 7 Mixed Aerobic Work For time @ sustained effort 12 Min AMRAP 8 Bar-facing burpees 20 Wall balls 20/14# 12 Push press 95/65# View Training Week

Be sure to snap a pic of your training and tag @WillMurtagh_DPT on social!

This week's Blog Post

5 CrossFit Recovery Nutrition Tips To Boost Performance In this article, we’re diving deep into five powerful CrossFit recovery nutrition tips that can help you bounce back faster and train harder. Read now

Before you go, here's how I can help you

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Talk to you soon, Reader

Dr. Will Murtagh, PT, DPT, MS, CSCS, CISSN Physical Therapist | Remote Fitness Coach