Injury profile in CrossFit practitioners: systematic review

Dominski, Fábio Hech; Siqueira, Thais Cristina; Serafim, Thiago Teixeira; Andrade, Alexandro

doi:10.1590/1809-2950/17014825022018

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 25 (2) • June 2018 • https://doi.org/10.1590/1809-2950/17014825022018 copy

Injury profile in CrossFit practitioners: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

CrossFit is a new form of physical training that has become popular since its inception. This study aimed to analyze the injury profile of CrossFit practitioners through a systematic review. PRISMA recommendations were applied to this systematic review. Electronic search was performed in the databases CINAHL, SciELO, Science Direct, SCOPUS, LILACS, PEDro, PubMed, SPORTDiscus and Web of Science. The methodological quality of the studies was assessed. Ten studies were selected. The prevalence of injuries in CrossFit practitioners ranged from 5 to 73.5%, and the overall injury incidence rate per 1000 training hours ranged from 1.94 to 3.1 injuries. The body region most affected by injuries was the shoulders, followed by the back and the knees. Regarding associated factors, the type of exercise performed and CrossFit training time were related to injuries. Besides that, sex was associated to the prevalence of injuries, with men showing more injuries than women. Age was not related to injury prevalence. It was concluded that the most commonly affected body region among CrossFit practitioners was the shoulders, predominantly in males and with previous injuries, often obtained in other modalities. In addition, CrossFit can be safely practiced by individuals aged 18-69.

Keywords:
Exercise; High-Intensity Interval Training; Wounds and Injuries; Review

		Inclusion	Exclusion
P	Participate	Any individual practitioner of CrossFit	Individuals practicing other forms of physical exercise
I	Intervention	CrossFit	Massages, manual therapy, stretching, alternative therapies, weight training, hiking or running, High Intensity Interval Training (HIIT)
C	Comparison	With healthy individuals or not, with groups of other physical exercises, or Control Group without intervention	-
O	Outcome	Injuries, trauma	-
S	Study	Randomized and non-randomized controlled study	Case studies, review, review with meta-analysis

Author	Sample				Results - Injuries
	n	Sex		Age average (years)	Population	Prevalence (n/%)	Type of injury	Injury rate (every 1,000 hours of training)
	n	Men	Women	Age average (years)	Population	Prevalence (n/%)	Type of injury	Injury rate (every 1,000 hours of training)
Grier et al.²⁰20. Grier T, Canham-Chervak M, McNulty V, Jones BH. Extreme conditioning programs and injury risk in a US Army Brigade Combat Team. US Army Med Dep J. 2013:36-47.	1393	1248	145	26.8	Soldiers	5%	-	-
Hak et al. ²¹21. Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. 2013. doi: 10.1519/JSC.0000000000000318 https://doi.org/10.1519/JSC.000000000000...	132	93	39	32.3	Athletes	97 (73.5%)	-	3.10 injuries
Weisenthal et al.²²22. Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among CrossFit athletes. Orthop J Sports Med. 2014;2(4):2325967114531177. doi: 10.1177/2325967114531177 https://doi.org/10.1177/2325967114531177...	386	231	150	18 to 69	Practitioners	75 (19.4%)	Inflammation, sprain and dislocation	-
Chachula, Cameron, Svoboda²³23. 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. doi:10.3928/19425864-20151119-02 https://doi.org/10.3928/19425864-2015111...	54	40	14	17 to 50	Practitioners	24 (44%)	Joints	-
Huynh et al.²⁴24. Huynh A, Leong KE, Jones N, Crump N, Russell D, Anderson M, et al. Outcomes of exertional rhabdomyolysis following high-intensity resistance training. Int Med J 2016;46(5):602-8. doi: 10.1111/imj.13055 https://doi.org/10.1111/imj.13055...	34	25	9	35.5	Practitioners	12 (35%)	Rhabdomyolysis	-
Sprey et al. ⁶6. Sprey JW, Ferreira T, Lima MV, Duarte Jr A, Jorge PB, Santili C. An epidemiological profile of CrossFit athletes in Brazil. Orthop J Sports Med. 2016;4(8):2325967116663706. doi: 10.1177/2325967116663706 https://doi.org/10.1177/2325967116663706...	566	323	243	31.4	Practitioners	176 (31%)	-	-
Summitt et al.²⁵25. Summitt RJ, Cotton RA, Kays AC, Slaven EJ. Shoulder injuries in individuals who participate in CrossFit training. Sports Health. 2016;8(6):541-6. doi: 10.1177/1941738116666073 https://doi.org/10.1177/1941738116666073...	187	-	-	-	Practitioners	44 (23.7%)	-	1.94 injuries
Aune, Powers²⁶26. Aune KT, Powers JM. Injuries in an extreme conditioning program. Sports Health. 2017;9(1):52-8. doi: 10.1177/1941738116674895 https://doi.org/10.1177/1941738116674895...	247	139	108	38.9	Athletes	85 (34%)	-	2.71 injuries
Montalvo et al.²⁷27. Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective injury epidemiology and risk factors for injury in CrossFit. J Sports Sci Med. 2017;16(1):53.	191	94	97	31	Athletes	50 (26.17%)	More acute than chronic	2.3 injuries
Moran et al.³3. Moran S, Booker H, Staines J, Williams S. Rates and risk factors of injury in CrossFit: a prospective cohort study. J Sports Med Phys Fitness. 2017;57(9):1147-53. doi: 10.23736/S0022-4707.16.06827-4 https://doi.org/10.23736/S0022-4707.16.0...	117	51	66	35	Practitioners	-	Acute and of Gradual start	2.10 injuries

Author	Factors associated with injuries	Results	Factors not associated with injuries
Grier et al.²⁰20. Grier T, Canham-Chervak M, McNulty V, Jones BH. Extreme conditioning programs and injury risk in a US Army Brigade Combat Team. US Army Med Dep J. 2013:36-47.	a) Sex and body mass index	a) Risk of injury greater for men with BMI classified as overweight or obese	-
	b) Smoking	b) Risk of injury greater in smokers compared to non-smokers.	-
Weisenthal et al.²²22. Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among CrossFit athletes. Orthop J Sports Med. 2014;2(4):2325967114531177. doi: 10.1177/2325967114531177 https://doi.org/10.1177/2325967114531177...	a) Sex	a) Men presented more injuries than women (53 against 21)	Age, participation time, training session time, training days per week
	b) Type of exercise	b) The shoulder was more injured in gymnastic movements and the lumbar was more injured in powerlifting movements
	c) Supervised by professional	c) The rate of injury significantly decreased with the involvement of the instructor
Chachula, Cameron, Svoboda²³23. 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. doi:10.3928/19425864-20151119-02 https://doi.org/10.3928/19425864-2015111...	a) Prior injury	a) Practitioners with prior injury are 3.75 times more likely to suffer an injury related to CrossFit	Age
	b) Type of exercise	b) Participants realize that exercises like deadlift and kettlebell swing aggravate lumbar injuries, jumps intensify knee pain, and pain in the shoulders and elbow are accentuated due to ring dips	CrossFit experience
	b) Type of exercise		Participation in classes with professional supervision
Sprey et al.⁶6. Sprey JW, Ferreira T, Lima MV, Duarte Jr A, Jorge PB, Santili C. An epidemiological profile of CrossFit athletes in Brazil. Orthop J Sports Med. 2016;4(8):2325967116663706. doi: 10.1177/2325967116663706 https://doi.org/10.1177/2325967116663706...	a) Training time	a) Practitioners of CrossFit since 6 months (35%) showed higher injury rate, with 70% compared to practitioners with less training time	Sex and age group
Summitt et al.²⁵25. Summitt RJ, Cotton RA, Kays AC, Slaven EJ. Shoulder injuries in individuals who participate in CrossFit training. Sports Health. 2016;8(6):541-6. doi: 10.1177/1941738116666073 https://doi.org/10.1177/1941738116666073...	a) Type of exercise	a) Practitioners considered gymnastic exercises as the main cause of injury (25 of 46 total injuries).	Age, number of resting days
Aune and Powers²⁶26. Aune KT, Powers JM. Injuries in an extreme conditioning program. Sports Health. 2017;9(1):52-8. doi: 10.1177/1941738116674895 https://doi.org/10.1177/1941738116674895...	a) Training time	a) The incidence rate of injury among athletes with less than 6 months of experience was 2.5 times higher than that of athletes with more than 6 months of experience	-
	b) Type of exercise	b) Squat cleans, ring dips, overhead squats and push presses were more likely to cause injury
	c) Equipment type	c) Exercises performed with bars resulted in more injuries
	d) Prior Injury	d) Athletes with prior shoulder injury are 8.1 times more likely to injure the shoulder compared to athletes with healthy shoulders
	b) Excessive effort and inadequate technique	e) Athletes reported that 35% of injuries occurred due to overexertion and 20% due to improper technique in the execution of the exercises
Montalvo et al.²⁷27. Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective injury epidemiology and risk factors for injury in CrossFit. J Sports Sci Med. 2017;16(1):53.	a) Participation and training time	a) The injured athletes presented more participation time (in years) and weekly time of CrossFit practice compared to non injured	Age, sex, size of CrossFit class, number of trainers, years of structured physical activity, and participation in competitions
	b) Physical activity aside from CrossFit	b) Athletes with physical activity practice aside from CrossFit were 2.3 more likely to injure themselves
	c) Stature	c) Injured athletes presented greater stature compared to non-injured
Moran et al.³3. Moran S, Booker H, Staines J, Williams S. Rates and risk factors of injury in CrossFit: a prospective cohort study. J Sports Med Phys Fitness. 2017;57(9):1147-53. doi: 10.23736/S0022-4707.16.06827-4 https://doi.org/10.23736/S0022-4707.16.0...	a) Sex	a) Highest rate of injury found in men who had injury in last 6 months	-
	b) Type of exercise	b) Weightlifting exercises were the most cited as cause of injury: squat, deadlift, overhead press and Snatch.	-

STROBE criteria	Title and Abstract	Introduction	Methods	Results	Discussion	Other information	Total Score (%)	Classification
Studies	Title and Abstract	Introduction	Methods	Results	Discussion	Other information	Total Score (%)	Classification
Grier²⁰20. Grier T, Canham-Chervak M, McNulty V, Jones BH. Extreme conditioning programs and injury risk in a US Army Brigade Combat Team. US Army Med Dep J. 2013:36-47.	0/1	1/2	4/9	4/5	3/4	0/1	12 (54.5%)	B
Hak et al.²¹21. Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. 2013. doi: 10.1519/JSC.0000000000000318 https://doi.org/10.1519/JSC.000000000000...	1/1	1/2	4/9	5/5	4/4	0/1	15 (68.1)	B
Weisenthal et al.²²22. Weisenthal BM, Beck CA, Maloney MD, DeHaven KE, Giordano BD. Injury rate and patterns among CrossFit athletes. Orthop J Sports Med. 2014;2(4):2325967114531177. doi: 10.1177/2325967114531177 https://doi.org/10.1177/2325967114531177...	1/1	2/2	7/9	4/5	4/4	0/1	18 (81.8)	A
Chachula, Cameron, Svoboda²³23. 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. doi:10.3928/19425864-20151119-02 https://doi.org/10.3928/19425864-2015111...	0/1	2/2	6/9	3.5/5	4/4	0/1	15.5 (70.4)	B
Huynh et al.²⁴24. Huynh A, Leong KE, Jones N, Crump N, Russell D, Anderson M, et al. Outcomes of exertional rhabdomyolysis following high-intensity resistance training. Int Med J 2016;46(5):602-8. doi: 10.1111/imj.13055 https://doi.org/10.1111/imj.13055...	1/1	1/2	3/9	3/5	3/4	0/1	11(50)	B
Sprey et al.⁶6. Sprey JW, Ferreira T, Lima MV, Duarte Jr A, Jorge PB, Santili C. An epidemiological profile of CrossFit athletes in Brazil. Orthop J Sports Med. 2016;4(8):2325967116663706. doi: 10.1177/2325967116663706 https://doi.org/10.1177/2325967116663706...	1/1	2/2	6/9	4/5	4/4	0/1	17 (77.2)	B
Summitt et al.²⁵25. Summitt RJ, Cotton RA, Kays AC, Slaven EJ. Shoulder injuries in individuals who participate in CrossFit training. Sports Health. 2016;8(6):541-6. doi: 10.1177/1941738116666073 https://doi.org/10.1177/1941738116666073...	1/1	1/2	3/9	3/5	3/4	0/1	11 (50)	B
Aune, Powers²⁶26. Aune KT, Powers JM. Injuries in an extreme conditioning program. Sports Health. 2017;9(1):52-8. doi: 10.1177/1941738116674895 https://doi.org/10.1177/1941738116674895...	1/1	1.5/2	6.5/9	4.5/5	2/4	0/1	15.5 (70.4)	B
Montalvo et al.²⁷27. Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective injury epidemiology and risk factors for injury in CrossFit. J Sports Sci Med. 2017;16(1):53.	0/1	2/2	6/9	4/5	3/4	0/1	13 (59)	B
Moran et al.³3. Moran S, Booker H, Staines J, Williams S. Rates and risk factors of injury in CrossFit: a prospective cohort study. J Sports Med Phys Fitness. 2017;57(9):1147-53. doi: 10.23736/S0022-4707.16.06827-4 https://doi.org/10.23736/S0022-4707.16.0...	0/1	1/2	8/9	2/5	3/4	0/1	14 (63.6)	B

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[1] Corresponding address: Fábio Hech Dominski - Rua Pascoal Simone, 358, Coqueiros - Florianópolis (SC), Brazil - ZIP Code 88080-350 - E-mail: fabio.dominski@udesc.br- Telefone: (48) 3664-8677