Musculoskeletal Injuries in Competitive CrossFit Athletes

Abstract

Objective  To identify the most frequent musculoskeletal injuries in CrossFit athletes who participated in a competition in 2017.

Methods  A cross-sectional study conducted through the application of a questionnaire to adult competitors of both genders who participated in a competition in 2017.

Results  Among the participants, 44% reported previous injuries, 67.3% of whom were men. The main types of lesions were inflammations, sprains and contusions. The most affected anatomic sites were the shoulder, spine and knee. Among the injured, 34.4% had a previous lesion at the site; 75.8% were undergoing follow-up with healthcare professionals; and all of them practiced CrossFit 5 times a week with a mean duration of the training sessions 68.2 ± 12.4 minutes and mean rest of 1.7 days a week. The duration of the training sessions was the most significant factor (p = 0.002) for the occurrence of injuries.

Conclusion  The percentage of athletes injured due to the practice of CrossFit was of 44%, with a higher incidence among men. The main type of injury was inflammation, and the most exposed anatomical sites were the shoulder, spine and knee.

Keywords
epidemiology; injuries; musculoskeletal system; physical exercise

Resumo

Objetivo  Identificar as lesões musculoesqueléticas mais frequentes em atletas de CrossFit que participaram de uma competição em 2017.

Métodos  Estudo transversal realizado por meio de aplicação de questionário em atletas adultos, de ambos os gêneros, participantes de uma competição em 2017.

Resultados  Entre os participantes, 44% relataram lesões prévias, sendo 67,3% homens. Os principais tipos de lesões foram inflamação, entorse e contusão. Os locais anatômicos mais afetados foram ombro, coluna e joelho. Entre os lesionados, 34,4% apresentavam lesão prévia no local; 75,8% realizavam acompanhamento com profissional da saúde; e todos relataram praticar CrossFit 5 vezes por semana, com duração média dos treinos de 68,2 ± 12,4 minutos e descanso médio de 1,7 dias por semana. A duração do treino foi o fator mais significativo (p = 0,002) para ocorrência de lesões.

Conclusão  A porcentagem de atletas lesionados devido à prática de CrossFit foi de 44%, com maior incidência nos homens. O principal tipo de lesão foi inflamação, e os locais anatômicos mais expostos foram ombro, coluna e joelho.

Palavras-chave
epidemiologia; exercício físico; lesões; sistema musculoesquelético

Introduction

CrossFit is a training program consisting of alternated high-intensity physical exercises. The high biomechanical and physiological demands associated with CrossFit make it paramount that healthcare professionals know its features.¹-³

Most injuries occur due to the improper performance of movements.³ They can be modulated by individual factors (such as anatomical abnormalities, age, and previous injuries) and the characteristics of the training sessions (including schedule and duration).³,⁴ It is noteworthy that lack of supervision increases the prevalence of injuries.⁵-⁷

Regarding the rate of injuries, Summit et al.⁴ reported 73,5% (3.1 injuries/thousand hours of practice), whereas Weisenthal et al.⁸ identified a rate of 19% (2.4 injuries/thousand hours of training). Sprey et al.¹ showed no significant difference regarding gender, age, anthropometric data, the previous practice of other sports, the duration of the training sessions and their weekly frequency, rest time, and other concurrent physical activities.¹ However, Xavier and Martins³ pointed out that men are 2.9 times more likely to be at risk, and that the chance of injury is 2.7 times higher among those who train for more than 1 hour.³ This same study³ identified overweight/obesity and weekly training frequency as risk factors. The most common injuries are contusion, strain, and tendinopathy; the most injured body parts include the shoulder, spine, and knee.³,⁸-¹²

The present study aimed to identify the epidemiological profile and factors that influence the occurrence of musculoskeletal injuries in participants of a CrossFit competition held in the city of Curitiba, Southern Brazil, in 2017.

Materials and methods

The present is a cross-sectional study approved by the institutional ethics committee (under CAAE 68129117.6.0000.0093) involving adult, regular CrossFit athletes who participated in a competition in October 2017 and signed the informed consent form. The inclusion criteria were age > 18 years, having registered at the competition, and willingness to participate in this research project. The exclusion criteria were age <below 18 years and no registration at the competition.

The sample size was calculated based on the number of participants in the competition (634, including 446 males); the final sample consisted of 333 athletes (207 men) with a 5% error.

As the research instrument, a questionnaire (Appendix 1) consisting of descriptive and multiple-choice questions was developed, which was filled out and returned to the researcher during the competition. We obtained anthropometric data, as well as data pertaining to gender, features of the training sessions, the previous and current practice of other sports, the features of the CrossFit-related injuries, follow-up with a healthcare professional, and use of dietary supplements.

CrossFit-related injuries included physical complaints severe enough to require medical intervention for diagnosis and treatment; those requiring a change in the duration of the duration, intensity, or form of the training sessions for more than two weeks; or those leading to interruption of the training sessions or of other activity for more than one week. The investigators did not ask about the injury diagnosis, and they were available to clarify any doubts from the participants regarding what was considered a CrossFit-related injury.

The categorical variables were expressed as relative frequencies followed by their respective 95% confidence intervals (95%CIs), and the continuous variables, as mean and standard deviation values. The Fisher exact test for qualitative variables identified differences between strata. The quantitative variables deemed non-normal by the Shapiro-Wilk test were evaluated using the Mann-Whitney test, and the statistical analyses were performed using the Prism statistical package (GraphPad Software, San Diego, CA, United States), version 6.0.

Results

A total of 346 athletes were willing to participate in the research; their mean age was of 28.6 ± 7.49 years. Table 1 shows the anthropometric data. Most participants (33%) had been practicing CrossFit for more than 24 months, predominantly (65%) for 60 minutes per session (Table 2).

Table 1
Anthropometric data regarding CrossFit athletes (N = 346)

	Male	Female
Gender (%/absolute number)	61.9%/214	38.1%/132
Weight (average)	81.44 kg	61.90 kg
Height (average)	1.77 meters	1.64 meters

Table 2
Characteristics if the training sessions, rest days, and motivation to start practicing CrossFit

	Male (n = 214)	Female (n = 132)
Time of practice (months)
3–6	9.8%	7.6%
7–12	20.1%	18.9%
13–18	16.4%	28%
19–24	20.6%	12.9%
> 24	33.2%	32.6%
Number of training days per week
2–3	10.8%	15.9%
4–5	52.8%	47%
6–7	36.4%	36.4%
Duration of the training sessions (minutes)
30	0.5%	0%
45	3.7%	1.5%
60	56.5%	79.5%
75	22.9%	11.4%
> 90	16.4%	7.6%
Rest days
0–1	41.6%	48.5%
2–3	57%	47%
4–5	1.4%	3%

We observed 153 lesions (44%), 67.3% of them in males. Among the injured athletes, 33% had had previous lesions at the site. The most common injury was inflammation, and the most affected anatomical sites were the shoulder, the spine, and the knee (Table 3).

Table 3
Frequency and distribution per age group, gender, injury type, anatomical region, and postlesion management among the injured group

CrossFit-related injury
Total	153/346
Injuries per age group
18–29 years	46.8%
30–40 years	40.5%
41–50 years	35.4%
Injuries per gender	Male	Female
	48.1%	37.9%
Type of CrossFit-related injury*
Fracture	7.8%	6%
Contusion	19.4%	12%
Sprain	22.3%	18%
Inflammation	68.9%	78%
Dislocation	9.7%	2%
Rupture	5.8%	4%
Other	1.9%	0%
Postlesion management*
Seeking medical assistance	70.9%	72%
Changes in training (duration, intensity, or characteristics for more than 2 weeks)	47.6%	50%
Stopping CrossFit or any other activity for more than a week	14.6%	6%
None of the above	3.9%	4%
Other	0%	2%
Number of CrossFit-related injuries
1	56.3%	56%
2	29.1%	34%
3	5.8%	8%
> 3	6.8%	2%
Injured body part*
Shoulder	56.3%	48%
Spine	25.2%	26%
Knee	19.4%	32%
Wrist	15.5%	12%
Elbow	4.9%	6%
Abdomen	3.9%	0%
Neck	2.9%	6%
Leg	2.9%	2%
Ankle	2.9%	2%
Thorax	2.9%	0%
Calf	1.9%	8%
Pelvis	1.9%	2%
Thigh	1.9%	0%
Foot	1%	0%
Hand	0%%	2%
Hip	0%%	2%
Other	2.9%	4%
Existence of a previous lesion at the same injured site	35%	30%

• Note:
• ^*
  More than one alternative could be selected.

Table 4 shows the comparison between the injured and non-injured groups.

Table 4
Comparative analysis of CrossFit-related injuries and multiple variables

Variable	Injury		p-value
	Yes (n = 153)	No (n = 193)
Female gender	32.7%	42.5%	0.075
Male gender	67.3%	57.5%
Practice of another sport	41.4%	36.8%	0.436
Previous injury	34.4%	0.0%	0.548
Follow-up with healthcare professionals	75.8%	75.5%	1.000
Use of dietary supplements	79.7%	79.6%	1.000
Weekly frequency of the training sessions	5.0 ± 1.1	5.0 ± 1.1	0.963
Duration of the training sessions	68.2 ± 12.4	64.5 ± 10.3	0.002
Rest days	1.7 ± 0.7	1.6 ± 0.8	0.778

A total of 75.8% of athletes was followed-up regularly by healthcare professionals, mainly dieticians. Dietary supplementation was frequent, reported by 79.8% of athletes, especially women (Table 5).

Table 5
Professional follow-up and use of supplements by CrossFit athletes

	Male	Female
Regular follow-up with healthcare professionals	75.2%	75.8%
Healthcare professionals (yes as previous answer)*
Dietitian	75%	72.5%
Physiologist	11.3%	5%
Personal trainer	17.5%	14.9%
General practitioner	21.3%	13.9%
Physician nutrition specialist	16.9%	19.8%
Physical therapist	11.9%	5.9%
Other	13.1%	12.8%
Use of dietary supplements	76.2%	85.6%
Supplements (yes as previous answer)*
Whey protein	90.8%	86.7%
Branched-chain amino acids (BCAAs)	50.3%	53.1%
Albumin	5.5%	5.3%
Casein	5.5%	5.3%
Creatin	41.1%	46.9%
Thermogenic compounds	17.8%	22.1%
Other	22.1%	18.6%
Supplement prescription by healthcare professional	76.1%	77.9%
Which healthcare professional?*
Dietitian	50.3%	61.1%
Physician, except physician nutrition specialist	6.1%	3.5%
Physician nutrition specialist	10.4%	8%
Personal trainer	1.2%	0%
Other	0.6%	0%

• Note:
• ^*
  More than one alternative could be selected.

Discussion

Studies⁸ report high injury rates in CrossFit due to the repetitiveness and intensity of the exercises; however, other studies⁹ deny this hypothesis because of the high level of supervision and instruction during training. The present study showed an injury rate of 44%, higher than the 31% reported by Sprey et al.¹ The fact that the sample of the present study consisted only of competitive athletes explains this difference. The rates are similar to those of other sports with analogous movements (such as weightlifting and gymnastics).²,⁹ In comparison to team sports, such as soccer, the percentages are lower (57% to 61.8%).¹,¹⁰-¹³

In the present study, the most common injuries were inflammation, sprain, and contusion, contrasting with data from the study by Xavier and Martins,³ who observed mainly contusions. Male athletes had more injuries, which agrees with the literature.¹³ On the other hand, female athletes are more careful about seeking instructions from their coach, weight overload, the frequency of training sessions, and exercise performance.⁸,⁹

Most injuries (46.8%) occurred in the youngest athletes (18 to 29 years old), who tend to perform exercises with higher loads or repetitions due to greater impulsiveness and exhibitionism. In addition, the injury rate was indirectly proportional to age; those between 41 to 51 years old presented fewer lesions (35.7%), indicating that they may be more cautious when performing movements or they may have a better technique.

The duration of the training sessions was significant, and those who trained for longer suffered more injuries. We believe intense fatigue and lower concentration lead to erroneous movements that precipitate lesions. Consistent with the literature, 54% of the injuries affected the shoulder, 25% occurred at the spine, and 24% involved the knee.³,⁸

The greater demand for dieticians (73.9%) compared to physicians (18.4%) may reveal more attention to the intake of food and dietary supplements (aiming at achieving a body with good esthetic quality) rather than comorbidities.¹⁴-¹⁸ Women take more supplements, probably to perform the same training pattern as men or to change their body image.¹⁸

These findings indicate the need to monitor, quantify and regulate the individual training load^{2 16} to minimize excesses and damages to physical, psychological, and social health.¹⁸ Sports injuries are multifactorial, and their prevention remains the best treatment.¹⁹,²⁰

The present study had limitations, since the information was obtained from a single competition and was dependent on the participant's memory and understanding of the concept of injury. In addition, factors such as physical and emotional stress may influence the correct completion of the questionnaire. Future epidemiological studies should focus on larger sample sizes and a high number of competitions, in order to obtain more heterogeneous and representative populational outcomes to identify other associated risk factors.

Conclusion

In total, 44% of the athletes presented CrossFit-related injuries, including 48% of men and 38% of women. The most common injury was inflammation, and the most injured anatomical sites were the shoulder, spine, and knee. The only variable significantly associated with such injuries was the duration of the training sessions (p = 0.002).

• Work carried out at the Medicine program of the Universidade Positivo, Curitiba, PR, Brazil.
• Financial Support
  The authors declare that the present study did not receive financial support from public, commercial, or non-profit sources.

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Publication Dates

• Publication in this collection
  17 Mar 2025
• Date of issue
  2024

History

• Received
  20 Oct 2019
• Accepted
  14 Mar 2022