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CrossFit: An Overview and Considerations for Physical Therapists

 

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CrossFit: An Overview and Considerations for Physical Therapists

Holli McClendon, SPT

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Project Development

CrossFit is a topic that I first began hearing about during my exercise and sport science studies as an undergraduate, but it didn’t become relevant to me until entering physical therapy school. Through my interactions with my peers and physical therapists I met in outpatient settings, I realized that there is a lot of contention surrounding CrossFit within the physical therapy profession. For the majority of my time as a student, I had adapted a commonly held view of CrossFit as the notorious sport that produces injured recreational athletes for physical therapists. It wasn’t until beginning to participate in CrossFit myself that I saw another side – physical therapists who view CrossFit as a beneficial wellness and fitness tool, and who even become employed through CrossFit boxes to work with their participants. Because of the “love or hate” relationship I saw between CrossFit and physical therapists, I wanted to create a professional education project providing an evidence-based introduction, overview and considerations for physical therapists and physical therapy students who are unfamiliar with this sport.

Background

CrossFit is a fitness regimen founded by Greg Glassman in 2000 that is now considered one of the most popular and rapidly growing sports in the United States.1,3,5,11  It started with a single “box” (as it is called by the CrossFit community) and has grown into an empire of over 13,000 worldwide affiliates with up to 4 million people using the free “workout of the day” (WOD) for their physical training.13  Public acknowledgement as a legitimate sport is generally considered to have been achieved in 2011 after a significant Reebok sponsorship and ESPN coverage of the CrossFit Games.1  While CrossFit long has been popular with servicemen and women including military personnel and firefighters, participation by recreationally active adults and adults looking to improve their fitness is rising.4

Statement of Need

Along with the popularity, injury rates due to CrossFit have also risen.  It isn’t uncommon for CrossFit boxes to have an employed in-house physical therapist, or at least one that they contract with or frequently communicate with.  Studies of injuries related to CrossFit currently estimate that the rate is similar to that of gymnastics, Olympic weightlifting and power weightlifting.7,15  Because typically the goal of the rehabilitation process for patients injury from CrossFit is to return to the CrossFit environment, it is important for healthcare providers to understand the business and training principles of CrossFit as well as injury prevention and screening methods that are relevant to the type of training encouraged in CrossFit workouts.  Physical therapists are in a unique position to become a bridge between healthcare recommendations and specific communities where individuals spend time, work and play – such as CrossFit boxes.  In addition to direct interventions, a major role of physical therapists in the prevention of injury and disability and the promotion of wellness and fitness, according to the APTA, is to provide education and collaborative consultation to individuals and communities that are at-risk.12

Products

With the goal of providing a resource that physical therapists and students can consult and read as their time allows, I wrote a scholarly paper that provides an evidence-based overview of CrossFit and factors that are particularly important for physical therapists to consider when working with patients who either currently or plan to participate in CrossFit or a CrossFit-like fitness regimen. The history, training philosophy and business philosophy of CrossFit are explained in detail to provide an idea of the programming and intensity of the exercise being performed, and to give therapists information that will help their patients pick a box with discretion (as not all boxes are created equal). Injury rates of CrossFit compared to other sports and risk factors for injury are reviewed. An overview of literature on the potential benefits of CrossFit is provided. The chronic adaptations to the type of programming used by CrossFit can include decreased resting heart rate, decreased body fat percentage, decreased fasting insulin and improved hyperglycemia, increased release of catecholamines and growth hormones, and skeletal muscle adaptations such as improved mitochondrial capacity.2,10,14  Behavioral and psychological variables can also be positively influenced by CrossFit, such as increased exercise adherence and increased motivation due to intrinsic enjoyment of exercise.6,8,9  Finally, methods for screening for abnormal movement are reviewed, which include the Functional Movement Screen, Y Balance Test, and a detailed overview of squat technique (the most fundamental movement of CrossFit).

I have also created a PowerPoint geared toward physical therapists to review the information found in my paper as a presentation. One of my personal goals is to improve my public speaking skills, and I plan to present to a group of clinicians at my upcoming clinical rotation as an in-service, which is in an outpatient sports setting. To accompany this presentation, I created an evaluation form for the listeners to fill out afterwards. This will provide me with valuable information regarding the relevance and usefulness of my topic, as well as feedback on my speaking skills to help me grow as a professional.

The summary of my feedback will be collected and posted on this page following this presentation.

Acknowledgements

I would first like to thank my advisor, Dr. Mike Gross, PT, PhD, FAPTA, for his guidance and feedback, for his support of my atypical topic, and for being understanding of the stresses of life that made this project challenging but rewarding journey. Next, I would like to thank my two amazing committee members: Phil Caraher, DPT, MS, CSCS, USAW, PES, CES has been so generous with his time. As it turns out, there aren’t a whole lot of physical therapists with specific interests in Olympic weightlifting. Phil responded to an email from a PT student he had never met before, allowed me to observe him coach a youth weightlifter on the way to Nationals, and provided great ideas and guidance for my project. Jasmin “Jessie” Risen, PT, MPT, ATC first introduced me to the world of school-based PT in my second clinical rotation and truly demonstrated quality of care and compassion that I aspire to as a therapist. After a road bump late in my project, Jessie filled in as my committee member and gave me fantastic feedback and support. Finally, thank you to my classmates, friends and family who provided support and stress relief during this process!

 

References:

For a full list of the references used for my project, click here.

  1. Bellar D, Hatchett A, Judge LW, Breaux ME, Marcus L. The Relationship of Aerobic Capacity, Anaerobic Peak Power and Experience to Performance in CrossFit Exercise. Biology of Sport. 2015; 32(4): 315-320.
  2. Boutcher SH. High-Intensity Intermittent Exercise and Fat Loss: Review Article. Journal of Obesity. 2011; doi:10.1155/2011/868305.
  3. Chachula LA, Cameron KL, Svoboda SJ. Association of Prior Injury with the Report of New Injuries Sustained During CrossFit Training. Athletic Training & Sports Health Care. 2016; 8(1): 28-34.
  4. Fainaru-Wada M. CrossFit’s Big Growth Fuels Concerns. ESPN. http://espn.go.com/espn/otl/story/_/id/11262964/crossf-explosive-growth-fuels-safety-concerns. July 27, 2014. Accessed April 16, 2016.
  5. Glassman G. Foundations. CrossFit Journal. http://journal.crossfit.com/2002/04/foundations.tpl#featureArticleTitle. April 1, 2002. Accessed April 16, 2016.
  6. Gremeaux V, Drigny J, Nigam A, Juneau M, Guilbeault V, Latour E, Gayda M. Long-term Lifestyle Intervention with Optimized High-Intensity Interval Training Improves Body Composition, Cardiometabolic Risk, and Exercise Parameters in Patients with Abdominal Obesity. Am J Phys Med Rehabil. 2012; 91(11): 941-950.
  7. Hak PT, Hodzovic E, Hickey B. The Nature and Prevalence of Injury During CrossFit Training. Journal of Strength and Conditioning Research. 2013; doi:10.1519/JSC.0000000000000318.
  8. Heinrich KM, Becker C, Carlisle T, Gilmore K. Hauser J, Frye J, Harms CA. High-intensity Functional Training Improves Functional Movement and Body Composition Among Cancer Survivors: a pilot study. European Journal of Cancer Care. 2015; 24: 812-817.
  9. Heinrich KM, Patel PM, O’Neal JL, Heinrich BS. High-intensity Compared to Moderate-intensity Training for Exercise Initiation, Enjoyment, Adherence, and Intentions: An Intervention Study. BMC Public Health. 2014; 14: 789. Doi: 1186/1471-2458-14-789
  10. Little JP, Gillen JB, Percival ME, Safdar A, Tarnopolsky MA, Punthakee Z, Jung ME, Gibala MJ. Low-volume High-intensity Interval Training Reduces Hyperglycemia and Increases Muscle Mitochondrial Capacity in Patients with Type 2 Diabetes. J Appl Physiol. 2011; 111: 1554-1560.
  11. O’Hara RB, Serres J, Traver KL, Wright B, Vojta C, Eveland E. The Influence of Nontraditional Training Modalities on Physical Performance: Review of the Literature. Aviation, Space, and Environmental Medicine. 2012; 83(10): 985-990.
  12. Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability. American Physical Therapy Association. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/PTRoleAdvocacy.pdf#search=%22About physical Roles in prevention in the promotion of health wellness fitness%22. June 3, 2015. Accessed April 19, 2016.
  13. Price K. No Sign of CrossFit Boom Slowing Down. Pittsburg Tribune Review. http://www.iclubs.com/more-news/no-sign-of-crossfit-boom-abating.html. July 20, 2015. Accessed April 16, 2016.
  14. Shing CM, Webb JJ, Driller MW, Williams AD, Fell JW. Circulating Adiponectin Concentration and Body Composition Are Altered in Response to High-Intensity Interval Training. Journal of Strength and Conditioning Research. 2013; 27(8): 2213-2218.
  15. Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury Rate and Patterns Among CrossFit Athletes. The Orthopaedic Journal of Sports Medicine. 2014; 2(4): 1-7.

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