The first step of a thousand miles: CrossFit injury prevention in 2020

22-01-2020 Mirwais Mehrab

Athletes tend to train for all kinds of reasons, such as pleasure and relaxation, competition, to socialize, and for improvement of fitness and health. Besides improving quality of life enjoyment and satisfaction, participation in sports reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, obesity, and diabetes mellitus, etcetera.

Unfortunately, sports participation always carries a risk for injuries. Injuries on their turn, are a potential threat to sports participation and to all mentioned benefits of it. 


I believe three pillars play an essential role in this:

  • You
  • Your coach and box
  • Me (kidding, meaning; medical professionals and researchers)

“Wait, what? Me?’’ – Yes, YOU are responsible for executing safe training standards, moving well, and actually listening to the advice of your coach. Compare it with getting fit. If you’re smart, you will listen to your coach about how to get fit, but you will have to do the workout by yourself eventually to get there. Injury prevention works almost the same! If you repeatedly ignore the technical cues of your coach, or if you participate in competitions every week despite your coach telling you not to; don’t be surprised to be injured almost all of the time. Since I’m not your dad I won’t dwell on your personal responsibilities, instead, I will write about information that might contribute to your ability to stay injury-free, from my point of view.


The role of medical doctors and researchers is that they can conduct studies to gather useful data for injury prevention which can be used for optimal injury treatment and rehab (examples will follow later in this blog). A couple of years ago, I started to investigate injuries among Dutch CrossFit athletes and explored risk factors for injury. At that time, CrossFit injury studies were incredibly limited. A couple of years have passed by and CrossFit injuries are starting to getting more and more attention from both the medical world as in the media. Therefore the purpose of this blog is to provide a brief update on where we stand regarding CrossFit injury studies in the medical and scientific world and what to look for in the upcoming years, which will hopefully contribute to your ‘awareness’ of the subject.


One of the most popular injury prevention models is ‘4-stage-approach’. I will use this model to guide you through the process of how injury prevention strategies are developed step by step through scientific studies and provide a brief update on where we are when it comes to CrossFit injury studies.


The first step of the 4-stage-approach is to establish the extent of the injury problem. Despite that CrossFit training is criticized regularly of having a disproportionate risk of injury, several studies have shown the opposite in the last years: the injury rate (injuries per 1000 hours of training) in CrossFit is comparable with other non-contact and fitness-related sports and is significantly lower than other popular sports in the Netherlands, such as soccer and recreational running. For a very long time, one of the stigmas around CrossFit training was (or is?) that the sport would have a disproportionately high risk of injury. Studies prove otherwise!


The second step is to identify the factors and mechanisms which play a part in the occurrence of injuries: meaning that the factors and inciting events that eventually can lead to an injury should be analyzed. Researchers have explored risk factors for CrossFit injuries. In these studies, injured athletes are analyzed and compared to non-injured athletes. Studies have concluded that short duration (<6 months) of participation in CrossFit training and poorly performed exercises are significantly associated with a higher risk of injury. Higher levels of coaches involvement significantly decrease injury risk. Other potential risk factors for injury are a relatively high training volume, participation in competitions, and athletes with a prior injury. Of course, some of these risk factors are no-brainers but I believe that we need findings from studies to eventually create ‘proven’ injury management strategies.


If you would like to read more about the specifics of this step in my study that investigated injury incidence and patterns among Dutch CrossFit athletes, click here


The third step is to introduce measures that are likely to reduce the future risk and/or severity of injuries and the last and final step is to evaluate the effect of the measures. These preventive measures should be based on findings of the injury studies performed in the first and second step. Until now, these milestones haven’t been reached yet, meaning that no studies are performed regarding the last steps so far.

Nice to know: new injury prevention models also implemented a fifth and sixth step, which focus on understanding the implementation context for injury prevention, as well as continuing to build the evidence base for their efficacy and effectiveness of interventions. For example, if research finds that mobility exercises should be practiced twice a day to reduce injury risk, it is important to know whether athletes are willing and able to do this.


It's pleasing to see that more and more studies are being performed regarding CrossFit injuries, but until now, studies that investigated injuries in CrossFit are still relatively scarce and haven’t been performed with the optimal study designs and sample sizes (number of study participants) yet. The first step has been taken, but the journey of a thousand miles further has just started. 


High-quality studies with optimal study designs and relatively large sample sizes (number of participants) are necessary to identify the mechanisms and etiology of CrossFit injuries. These findings can be used for introducing targeted preventive measures to reduce injury risk. I strongly urge coaches and boxes to establish an approach to injury management and to work closely together with medical professionals!

You, your coach, and me (& colleagues) will have to collaborate to optimize injury management.
We all should be taking our responsibility and face the challenges presented together. Let’s educate ourselves on injury prevention and safe training standards for the better!

Do you want to learn more about the specifics and tactics of injury management for coaches, athletes, and even medical professionals? Keep an eye on the UnScared social media channels for courses regarding this subject: much more will follow soon!

If you have any training related questions, please consult with your coach. If you have any health-related questions, please always consult with your doctor.

Mirwais Mehrab

About Mirwais Mehrab

Mirwais Mehrab is an emergency medicine resident physician and medical researcher. As a former three time weightlifting champion, he also trains CrossFitters and Weightlifters in his notorious training camps and courses. Sports and Health enthusiast, determined to contribute to a fitter and healthier world; one athlete or patient at the time.

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