PREVALENCE AND LOCATION OF PAIN IN CROSSFITTERS IN A CITY IN THE SOUTH OF MINAS GERAIS

ABSTRACT Introduction: CrossFit was created to develop the physical and motor skills of athletes in all categories, aiming for the physical limit of everyone who practices it, in accordance with their toning capacity. Objectives: Considering that the quest for these limits has resulted in an increasing number of CrossFitter injuries, the objective of this study was to define the levels of pain and the anatomical regions affected among CrossFitters in the city of Alfenas. Methods: The Corlett diagram was used in association with the Visual Analog Scale, which ranges from 1 to 10. Three CrossFit gyms in the city of Alfenas were visited and their CrossFitters were invited to participate in this research. Those who agreed to participate (109) signed the informed consent form. Results: Of the total number of participants interviewed, 86.63% reported having some type of pain in their daily CrossFit routine. Of the total number of respondents who experienced pain, 56.68% were women and 43.32% were men. The three areas that stand out with the highest prevalence of pain were shoulders at 51.37%, the lower back at 44.03%, and the knees at 40.36%. The One-way ANOVA test was applied with p≤ 0.05 and there was no statistical difference between the pain groups (trunk pain, right limb pain, and left limb pain). Conclusion: When we applied the Corlett diagram to verify the degree and anatomical regions of pain in CrossFitters in the city of Alfenas, it was evident that CrossFit is a sport that, by demanding a lot from those who practice it, ends up causing moderate to severe pain, especially in the shoulder, lumbar, and knee regions. Level of evidence II; Retrospective study.


INTRODUCTION
CrossFit is a program created by Greg Glassman in 1995 with the objective of developing the physical and motor skills of athletes in all categories through physical activities of varied intensity to achieve the physical limit of each participant according to their tonic capacity, but which could be harmful to them.CrossFit is based on three distinct types of movement: weightlifting, cyclic (walking and running) and gymnastic (rings and bars) movements.Exercises incorporated into CrossFit, such as gymnastics and Olympic weightlifting, require the correct positioning of joints and vertebrae, which makes the risk of injury to the participants even higher when performed improperly. 1 This training method is divided into three phases.The first is a warm-up based on preparing the body for the subsequent activities.The second phase is where the person's ability is worked and can be varied by learning a new movement or composed of a series of strength exercises.3][4][5][6] This maximum exertion leads to the main types of injuries: contusion, which results from a hard blow to any part of the body; sprain, which is an abnormal stretching of muscle fiber; cramping, an involuntary and painful muscle contraction, and tendinopathy, which is characterized by the loss of tendon function. 1he prevalence of injuries in CrossFitters ranges from 5% to 73.5%.The most affected regions of the body are the shoulders, followed by the back and the knees.Regarding the factors associated with injuries, the type of exercise performed, and the duration of the CrossFit session stand out.Studies have reported an association between sex and the prevalence of injuries, with men suffering a higher number of injuries than women.Age is one of the factors that are not associated with injuries and CrossFit can be safely practiced by people between 18 and 69 years of age. 1 Other data also show that the damage caused by the practice of CrossFit occurs in different magnitudes, which vary by type of exercise.The most common injuries are those that affect the musculoskeletal system. 7owever, there are reported cases of individuals affected by injuries due to the exaggerated intensification of this activity.The implementation of limits on the use of weights may be a critical factor in trying to prevent cases of injury among students actively participating in this modality.In addition, activities compatible with each biotype can be effective in both preventing the triggering of worse damage and promoting the proper practice of the activities.However, there are not enough statistical data in the literature to report the main pain sites individually.
This article seeks to analyze the main pain sites in CrossFitters, thus aiming to expand and improve the amount of statistical data found in the current literature.

METHODS
For this purpose, the Corlett diagram associated with the analog scale for pain ranging from 0 to 10 was used.We visited three CrossFit gyms in the city of Alfenas and invited their members to participate in this study by signing the informed consent form approved by the Institutional Review Board.Interviews of the one hundred and nine CrossFitters who agreed to participate were conducted three days a week from 8:00 to 12:00, 13:00 to 17:00, and 18:00 to 20:00 for a month.No distinctions were made in terms of the body mass index or the participants' length of experience with the modality.The one-way ANOVA test was applied with p≤ 0.05.

RESULTS
Of the total number of interviewees from the three gyms in the city of Alfenas, 83.65%, of whom 43.32% were men and 56.68% were women, reported having some type of pain while performing CrossFit. .Figure 1 below compares all participants in terms of the pain related to CrossFit training, divided into two groups: participants without pain, those who had no discomfort during their daily CrossFit routine, and participants who reported pain in any isolated or associated region related to the day-to-fay practice of CrossFit..
Figure 2 shows the total number of participants, those with pain, and those without pain by sex.
As shown in Figure 3, the locations where people experienced pain are divided into: pain exclusively in the upper limbs (UL), including shoulders, arms, elbows, forearms, wrists, and hands; pain exclusively in the lower limbs (LL), including thighs, knees, legs, ankles, and feet; pain in the trunk, including the head, neck, cervical region, upper back, middle back, and lower back, also known as the lumbar region, as well as the pelvis or hip; and mixed, denoting participants who reported simultaneous pain in more than one region.
In Figure 4, the mixed category, which included 71.56% of the participants, was further divided according to the number of occurrences, where the percentage was higher as the number of the interviewees who reported pain in a specific region increased.
According to Figure 5, when evaluating the number of occurrences in limbs, the right and left regions of each region of the Corlett diagram were compared and represented as approximate percentages.These percentages are relative to the total number of participants.The same individual may have pain on both sides and each side was counted separately.
Figure 6 shows a comparison of the top three regions affected in the total population.Figure 7 shows that the trunk region was also divided into parts according to the Corlett diagram: the neck, representing the muscle structures of the neck; the cervical region, representing the structure of the cervical spine; the upper back, representing the muscular region from the first thoracic vertebrae; the middle back, between the lumbar region and the end of the thoracic vertebrae; the lower back or region; and the pelvis, representing the hip region on both sides.

DISCUSSION
Figure 1 shows that only 13.77% of the 109 interviewees did not report discomfort during their day-to-day CrossFit routines.However, different data were found by Minghelli, where 108 (40%) of the 270 participants experienced discomfort over the course of a year, and 80 (29.62%) had discomfort for up to six months of training, totaling 188 individuals affected.Claudino reported that 74% of CrossFitters had some type of injury during 1000 hours practicing this modality, and 50.85% had an injury related to training, 64.48% of whom required medical attention to deal with the injuries. 10When comparing works in the literature, a higher than 50% chance of developing some type of discomfort was observed, whether due to the sport's high demand for physical effort, to improper performance of the technique or positioning of the body, to the failure of the participants to seek help from the coaches, or even the negligence of the coaches themselves in supervising students during the activities. 9,1omparing CrossFit to other activities, like traditional bodybuilding, we see that both the percentage of pain and risk of associated injuries are substantially higher.In a study of 80 bodybuilders conducted by Soares, only 20% presented some type of injury related to the sport.When compared with traditional bodybuilding, CrossFit has a 1.3 times greater chance of causing injury or pain.In addition, 34.81% of the bodybuilders experienced pain, as compared to 50.85% of the CrossFitters. 10n a study of manual work activities, such as construction assistant work, that evaluated 183 participants over 18 years of age from 13 different states in the United States, 78% experienced work-related pain. 12This number is very similar to the 74% of CrossFitters in Claudino's study and the 86.23% in the present study.This is due to the high loads of physical effort demanded in the practice of CrossFit and the search for surpassing limits promoted by the AFAP (as fast as possible) and RFT (rounds for time) culture that stimulates the participant to be increasingly faster and perform the greatest possible number of exercises, which are not necessarily executed with quality, harming several muscles and joints.
As shown in Figure 2, there was a .95%greater incidence of pain in women, due in part to the greater number of female participants.

Figure 2 .
Figure 2. Number of occurrences by sex.

Figure 5 .
Figure 5. Number of occurrences by limbs.