CrossFit "PreHab"

Quite often, other physicians and practitioners ask me about CrossFit.  Specifically, the dangers of CrossFit and also where I think it is going as a health and physical fitness endeavor.  Both of these questions have the same answer.

On a weekly basis I see at least 10 or 12 patients who regularly 'do CrossFit'.  Of these, approximately 75% have an injury that they think may have been associated with their CrossFit activity.   Most of the time, as I explain to my patients, the specific act of CrossFit does not cause the injury, it merely brings their weakness to the surface and they get injured by doing something that they have not done very often and thus can not do very well.  Out of a full week of life they are doing these challenging CrossFit movements, that are out of their norm, at most 4-6 hours.  This equates to about 3-4% of their weekly activities of daily living.  No matter how careful you are, how great the exercise/movement is for you, and/or how great of a coach you have, doing something mildly to significantly challenging for only 3-4% of your week means that you will not be very good at it and thus your risk of injury is increased.
Our lives of sitting more than we want, using "iObjects" (phone, computer, tablets, etc.), and not being as consistently active as we would like (or nearly as active as our grandparents) has put us all way 'out of balance' in terms of health and especially fitness.  It is a constant struggle for all of us to maintain a base level of health and fitness in our busy/successful/over worked/under recovered/couple of  kids/compromised nutrition lives.  If we go into our favorite CrossFit box in this 'out of balance' condition and get "better, faster, stronger" over a period of time, we end up being better, faster, stronger, yet still out of balance.  This equates to an increased risk of getting injured, because no matter how heavy our 1RM deadlift, we are still out of balance and that is what causes injury.
 Which leads us to what we do here at SODO Health & Performance.  We take our patients through, what we now refer to as, CrossFit PreHabilitation (CrossFit PreHab).
 As opposed to rehabilitation AFTER an injury occurs, the goal is to PREvent the injury through focused specific exercises that address weak areas that might otherwise result in injury upon undertaking CrossFit, or any other number of physical activities.   Unfortunately, it does not appear to be effective enough to simply incorporate some 'warm-up' or 'joint-prep' movements/light activities prior to a CrossFit WOD.  Because we are already starting out in a deficit or 'out of balance', we need to put significant time and effort into re-balancing ourselves before we, or as we, start to undertake the challenging demands of CrossFit.  Yes, this means a return to some isolation exercises targeted at strengthening weak areas, weak biomechanical functions, and/or weak functional capacities.
The majority of injuries I see in CrossFit members here at SODO H&P, are most effectively treated with specific therapeutic exercises AWAY from their regular CrossFit WODs.
In addition, more and more, I am having individuals come to see me for homework to balance out their weak areas AS they are starting CrossFit.  Many of them still have existing membership to a 'globo-gym' and this works perfect for doing 2 days per week of PreHab while ramping up/into 3 days of CrossFit.  After a couple of months, they transition fully (5-6 days per week) into CrossFit and are able to maintain their physical fitness 'balance' with the incorporation of some of their specific PreHab exercises into their warm-up before class.  By prescribing specific PreHab homework we have seen a significant reduction in injuries from CrossFit as well as other challenging workouts and exercises regimens that our patients/athletes undertake.
A great deal of the PreHab programs center around our focus on the Fulcrum -> Lever -> Sport continuum.  In order to do sports, you need good strong levering ability, and in order to have good strong levering ability you need to have durable fulcrums to support them.  Not a strong core, but strong fulcrums of the body, specifically durable scapulo-costal fulcrums and durable lumbo-pelvic-hip fulcrums (the subject of other blog posts here).

For CrossFit to have longevity, keeping people able to participate is paramount.  We have found that this is achieved through decreased injuries associated with CrossFit.  An injured member/athlete will cancel their membership and go find something else.  Pain free members/athletes stick with it over the long term and have better results.