10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation

froning 1024x682 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation

1) What Crossfit is:

I field emails every day with questions about crossfit injuries.  The biggest complaint I hear from these individuals about other physical therapists is that they don’t understand crossfit.  Obviously, understanding what you’re trying to send your patients back to and what they’ll have to be capable of performing is going to be critically important in the rehab process.

To add to that, the amount of misinformation and bias out there in regards to crossfit is staggering.  I can’t tell you how many times I’ve been wearing a crossfit shirt and I’ll hear negative remarks about crossfit from other therapists who have never even set a foot in a crossfit gym or have any idea of what crossfit even is.  

I was at CSM (Combined sections meeting, a very large physical therapy conference) and one of the presenters named Joe Black made a very interesting statement.  He sends his patients to crossfit after therapy to address some of the problems he found in therapy.  He believes that crossfit can be helpful in the rehab process (With a well designed program I completely agree).  This was a very refreshing statement.  Many therapists hold the completely opposite opinion.  In fact there was a whole presentation at CSM that year talking about the dangers of high intensity programs like crossfit.

After Joe’s statement you wouldn’t believe the gasps from the audience.  They sounded disgusted.  You would have thought that Joe just took off his shirt and looked just like Edward Norton from American History X.

Edward Norton 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation

Obviously there is a lot of negative belief about crossfit in the therapy world.  Crossfit is certainly not a perfect system and I don’t mean to raise it up on a pedestal but crossfit is certainly not the demon it is made out to be.  I really feel that this sentiment is largely based in a lack of understanding of crossfit in general.

To this date there is very little research to objectively measure risk of injury in crossfitters.  However, the research that is out there thus far demonstrates crossfit as about as risky as competitive weightlifting and powerlifting.   In this particular study crossfit demonstrated a 10 times decreased risk of injury compared to recreational running.  (Chris Beardsley puts this information into perspective in his review of this particular study HERE).  If you’re familiar with the research on risk of injury in sports you’ll know that competitive weightlifting and powerlifting is among the safest of sports, contrary to popular belief.  (Meanwhile it’s fine to have 8 year olds bash their heads together in american football, sorry just venting).  Purely recreational running has been shown to be much more risky but physical therapists routinely treat runners to get them back to running without as much negative sentiment.

If you really want to learn more about crossfit (and I really feel you should if you’re seeing the population) then you can find out more HERE.  Visit some of the gyms you’re getting patients from.  Take a few classes, befriend the coaches.  It’s going to make a world of difference for your patients.

2) Crossfit Athletes go to Physical Therapists and Other Rehab Specialists because they want to Return to Crossfit.  

Hammer 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful RehabilitationOne of the fastest ways to drive away and destroy rapport with crossfitters is to tell them what they’re doing is inherently dangerous.  We just spoke before how this isn’t really true and physical therapists already don’t have the best rapport with crossfitters because of the above stated stigmas.  When I introduce myself to crossfit coaches as a therapist I’ll commonly be asked, “what kind of therapist are you?” as if to see if I’m on board with the whole idea of crossfit or not.

My goal as a physical therapist is to give patients the tools to promote longevity in their sports and other recreational activities.  Instead of stating that crossfit will eventually hurt you, let’s figure out how we can keep people healthy.  Not everyone will be able to return to every aspect of crossfit, but we should be trying if it’s reasonable and our patients desire it.

3) Crossfit Has Enormous Benefit to Patients

As therapists we only see the dark side of crossfit.  We see the injuries.  We hear about rhabdo.  We hear biased comments from the strength and conditioning community.   We see the youtube videos.  We start to think that crossfit is a cult of people performing high rep barbell exercises poorly while standing on kettlebells because they aren’t being taught how to exercise properly.  Obviously this isn’t the case.  The crossfit coaches I’ve met have been some of the brightest trainers and are generally very passionate about their jobs.

As a therapist I’m constantly racking my brain to figure out how to get people more active and to engage in better lifestyle decisions.  If you’ve ever been a personal trainer then you can understand just how difficult it is to get people moving more and getting healthy.  Crossfit is making our jobs easier.  It’s espousing all of these things and people are getting pumped about it.

Side Note: For some reason there has always been a social stigma toward people who are making positive changes in their lives.  Why is it a bad thing that people are so excited about fitness?  Shouldn’t we be more concerned about people whose social outlets are riddled with alcohol, drug use and copious amounts of pork roll?  I’m pretty sure drinking alcohol, eating poorly and staying up too late at night is worse then eating paleo, drinking coconut water, working hard and getting to bed early (Even though the latter is less socially acceptable).  We can work with a few injured people.  I’d be much happier to see some more shoulder impingement and less diabetes, heart disease and morbid obesity.

4) Crossfitters Are Not the Typical Patient

madelyn maddy curley female crossfit athlete sweat for it4 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful RehabilitationCrossfitters generally love high intensity, difficult exercise.  They are not afraid to push, it’s usually one of the reasons they are attracted to crossfit in the first place.  Many crossfitters have a background in sports or other forms of high intensity exercise.  If you treat these patients like the 65 year old total knee replacement patient that they’re sitting next to, chances are they will start to doubt what it is you’re doing with them.  I’m not saying we should prematurely throw too much at these patients but if your clinic has nothing but fluorescent dumbbells and your patients are only getting basic therapy exercises, chances are you’re missing the mark, and your patients will feel this way.

Crossfit athletes use kettlebells, barbells and gymnastic rings.  If you’re looking to return these athletes to crossfit then their program should most likely contain these tools.  Crossfit athletes also perform high intensity exercise.  Some of your therapy might end up getting these patients pretty sweaty.  This is the language of crossfit.  I go have a catch with my baseball patients when they’re ready for it.  I take my crossfit patients to the olympic lifting platform when they’re ready for it also.

5) Physical Therapists and Rehab Professionals can be of Tremendous Benefit to these Athletes

Therapists can be of benefit not just for getting these individuals out of pain, but in returning to crossfit, addressing additional issues down the kinetic chain, screening for risk of injury and educating patients about the body and proper biomechanics during exercise.  In my mind this is the same as returning post ACL repair patients back to their sport.  Therapists have a tremendous set of skills and in my opinion, largely undervalue their abilities.

6) Different Crossfitters have Different Goals

Not everyone wants to squat 500lbs or make it to the crossfit games, but some do.  This is one of the first questions I’ll ask these athletes.  Do you want to be competitive?  How competitive?  Do you care about getting really strong?  Is your main goal to be able to play with your kids and keep your body strong and healthy?   This makes an enormous difference in the rehab process.  Often times our biases can get in the way of seeing what our patients really want.  We can’t lump all “crossfitters” into the same boat.  Our therapy should reflect the patient’s goals as an individual.

7) Crossfit is Getting Extremely Popular

One of the potential reasons therapists are seeing more crossfit injuries is simply because more and more people are engaging in crossfit.  I continue to see runners on a daily basis with injuries and I know one of the reasons this is occurring is simply because there are so many runners out there.  This is all the more reason to start learning more about crossfit.

8) Exercise Technique, Programming, Modification and Progression is Pivotal

rorym USAW HBergeron Snatch 830x1024 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful RehabilitationIn my opinion our jobs as therapists is not only to get our patient out of pain but to figure out why they got hurt in the first place and to correct it.  To do this we’re going to have to have some sort of idea of what movements our patients are going to be doing in the gym and what safe technique looks like.  Once someone’s knee pain has died down, let’s load these patients up with a squat and see how it looks.  Shoulders hurt?  What does your press look like? etc etc.

Another thing to think about is the patient’s exercise program.  If your patient has knee pain, are they squatting 4-5 times per week?  Maybe they need to decrease the volume and frequency some.  Crossfit has a lot of shoulder intensive exercise.  Is their crossfit coach programming enough rest and modifying frequency, volume and intensity accordingly?  I spend copious amounts of time developing smart programming for competitive crossfitters that takes these things into consideration that you can learn more about HERE.

Another thing to keep in mind is that every individual will have an optimal dosage of exercise.  Most crossfit gyms attempt to program based on their population.   Keep in mind that crossfit is a group exercise program and not every person will fit the standard program provided by their gym.  Therapists can help patients to learn how to modify the program at their gym and how to bridge back to their normal routine post injury.

Most crossfit gyms also have some sort of progression for new members.  Not everyone who comes through the door is doing muscle-ups, high rep snatches and butterfly pullups on the first day and most people probably have no business trying these things on the first day.  As a crossfit coach and athlete I feel very comfortable teaching my patients better exercise technique and reviewing programming but if you don’t have this knowledge then speaking with the patient’s crossfit coach is going to be very important.

9) Graduated Return to Crossfit is Extremely Important

woman crossfit torrance 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation

We know the reinjury rates are very high for our patients when they return to sport.  We’ve seen great benefit for bridging programs for return to sport.  I regularly prescribe long ball toss programs to my pitchers returning to sport and the Santa Monica PEP program to my ACL patients returning to sport.  Just like these sports we need to bridge our patients back to their sport.  I want to see how my achilles tendinopathy patients tolerate crossfit movements like double unders and box jumps before they go back to the gym and try them on their own.  You can bet there will be a gentle progression of exercises before my patients jump straight back into their previous routine.  I’ll also put my patients through a crossfit workout right in the clinic to see how things shake out in a controlled environment before they’re thrown back in the fire at their own gym.

I get a bit concerned when I see patients return from an injury and jump straight back into their regular programming.  If you don’t have the tools or know how to do this, then speak with their crossfit coach.  I know very little about swimming technique and don’t pretend to.  I’ll communicate with that athlete’s swim coach though to troubleshoot technique and get that patient back swimming in a smart way.  Most crossfit coaches are very passionate about helping their clients and are very open to suggestions from therapists. (We could also learn quite a bit from the coaches)

10) The Entire Kinetic Chain is Extremely Important in Crossfit Athletes

Crossfit emphasizes full range of motion in every exercise.   For example, if someone lacks ankle mobility, hip and core stability, thoracic extension, scapular stability then they’re going to have trouble with some of the basic crossfit exercises like snatch and clean and jerk.  If that athlete has shoulder pain during snatching it could be coming from an ankle restriction.  I like to use the Selective Functional Movement Assessment (SFMA) or Functional Movement Screen (FMS) as well as looking at the basic crossfit movements in order to break down where the problem is coming from and come up with a comprehensive program to treat the patient.

Tools like the FMS and Y-balance tests can also be used to assess risk of injury, identify some issues that might be leading to the patient’s pain and to help direct future treatment.

So there you have it.  I admit I did release a bit of steam with this article but hopefully it was all good information!  Crossfit in general is poorly understood and I don’t think it’s fair to condemn something because we don’t understand it.

I have a lot of fun working with crossfitters and I hope you do too,

Dan Pope DPT, CSCS

P.S. If you enjoyed this article then sign up for the newsletter to receive the FREE guide - 10 Idiot Proof Principles to Crossfit Performance and Injury Prevention as well as to keep up to date with new information as it comes out via weekly emails.

90 Responses to 10 Critical Principles Physical Therapists Need to Know About Crossfit for Successful Rehabilitation

  1. Pingback: Tuesday 12/31/13 - 15 Things I Wish I Knew When I Started CrossFit

  2. Awesome article as always Dan. I’ve been treating several CrossFitters lately (and CrossFit myself) and love it. They tend to be VERY compliant and if you get them better, can talk CFit with them, and make a good impression they will become great referral sources for us.

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  4. Dan,
    As a PT of 16 years I can say that I wholeheartedly agree with all of the above. The general practice of PT has drifted away from the manual and functional roots that I think make it an integral part of patient health/recovery. Last spring I moved my entire practice into a CrossFit box and now exclusively treat athletes, most of them crossfitters. Outcomes are incredible and patient compliance is 100% because these athletes want to return to what they love. I have also progressed from goals based on “everyday life” to using functional movements…..CrossFit movements. I also do A LOT of movement/postural education and preventative interventions. If you can address limitations in mobility or problematic postural stability, then you can reduce or eliminate the risk of injury. I share with people a lot that the patients I love the most are the ones that have no specific complaints. They allow me the opportunity to assess limitations in movement or poor posture and keep them from returning with injuries later. If you can find athletes that will listen, you can tremendously impact their performance!!! Great article and great line of thinking. We need to form our own section in the APTA ;-)

    • Let’s do it Chris! Right now there is definitely some buzz out there with high intensity exercise programs like crossfit. Really cool that you moved into a box, I wouldn’t mind doing the same. Where are you located?

  5. I would love to know about places and people in my area with the same out look as you…. CrossFit is a sport like any other and as safe as we try to be injury happens…. and I hate the answer “If it hurts don’t do it” I swear if I hear it again I’m just going to get up and walk out…. I hope that more and more people open up to up CrossFitters we need/want good help to keep us WODing hard and for a long time…. great blog…. thanks……..

  6. Excellent piece Dan. And I completely agree, as physios we should champion everyone having a movement practice and it’s our job to figure out their needs not discourage them. CrossFitters are BY FAR my favorite clients. Humans should be able to express full movements and not be injured doing it – it’s our job to facilitate and cultivate that.

    Seth

    SethOberst.com

  7. Great Article!

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  9. Didn’t hear that gasp. Guess I wasn’t paying attention.
    Great article. Keep up the good work.

    • Thanks Joe, I enjoyed your talk that day. I guess it wasn’t as much of gasping as much as hushed murmurs.

      • And I do remember meeting you. I’ve got your card around here somewhere. Going to Vegas?

        • Excellent, not this year. Saving up my money and using my continuing education on a few different things this year. Hope to cross paths again sometime in the future.

  10. Dan, Great article! I wish I would have written it! Our field of PT needs to move forward and learn about and study these new sports/unfamiliar areas we are presented with. I opened up a private cash based practice and treat primarily Crossfitters in the area and other recreational athletes. Use the SFMA and FMS religiously as well as manual therapy skills. All of which the local PT’s I know of are NOT doing. They treat athletes like their 65 year old total joint patient. I even had a physician challenge me by saying, “I see a lot of Crossfit injuries. Wouldn’t you agree?” To which I replied, “Not as many Crossfit injuries as I do Runners and Triathletes.” He nodded in thought and ended the conversation. Keep up the great work! Dave

  11. I wish more PTs would read this. I have had issues with therapists in the past because they don’t understand and condemn too quickly. They also treated me like a sedentary potato and did not take the time to explain what they wanted in the exercises they prescribed. These were so called respected professionals, I won’t tell you where they worked ( Cleveland Clinic). Crossfitters and all athletes deserve and demand a high level of care and autonomy. When PTs understand this there will be more mutual respect.

    • I agree with you Joe. I apologize for the subpar care. I’ll also just say that PTs are becoming more and more burdened with patient care because reimbursement decreases and we’re forced to see more patients to make ends meet (Not to mention the mountains of paperwork). A lot of times the therapist would love to be more attentive but they’re forced to see more patients and get bogged down with paperwork.

  12. Claire McAuliffe

    Excellent article and thank you!!! Very helpful indeed!

  13. Great article! My MT/PT didn’t really understand Crossfit beyond the popular mainstream images, but she understood my own range of motion issues and limitations, my injuries and my wish to get back to the box. While my specific exercises were definitely lower intensity and weight, we were working on range of motion and mobility, not strength. She also asked questions and spent the time showing me how to modify and what to do as I went back to Crossfit, as well as how to approach a WOD if I was having issues again, before those issues led to injury. I think she still thought Crossift was maybe “too much” for some people, but like you said, she preferred to celebrate being active and healthy instead of putting down how one gets there.

  14. Hi dan,

    Awesome article. I find that I myself struggle myself sticking to the basics of the healing process with these high intensity athletes for the purpose of keeping them interested (they seem to want to skip 8 steps and get right into the higher weight, higher intensity exercises vs the more simple but more appropriate to the stage of their healing process exercises) Any tips on this regard?? we started crossfit classes last summer (I enrolled myself and very much enjoy it, as well as the discussions with our crossfit trainer), so we at my clinic are starting to see the occasional crossfit injury.

    • Ha! That’s pretty funny. I hear you there. I think it’s better then the opposite (Not having your patients follow any HEP whatsoever despite continuous nagging). I tend to give a bit of what they want with a bit of what they need. I also find a lot of things to work on which are at a bit of a higher intensity and match what they expect (ie: some easy kettlebell exercises for low level shoulder injury). I almost always find some issues down/up the kinetic chain as well with these athletes where you can be a bit more aggressive with therapy along with the more basic exercises.

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  16. a guy name anthony in new york

    Some good pts but come on! cross fit is dangerous and foolish, what’s next, toe shoes ?? lol
    As a PT i tell my patients, you want to go do crossfit, go for it, don’t come back here. you might as well start smoking a pack a day too while you’re at it.

  17. I don’t work out at a crossfit gym/box but am into working out, recreational sports and am a licensed PTA and have focused on outpatient ortho as my work setting- I agree with this article completely, however i’m 100% certain there are really bad crossfit instructors out there just as there are really bad PT’s or PTA’s, MD’s, etc… The key is working with someone who 1- knows their stuff and 2- is passionate about it. The number of bad healthcare/fitness professionals i’ve met or worked with over the years amazes me.

    • Great points. Just some anecdote but having been involved with regular personal training for years and crossfit coaching as well I can say I’ve seen a lot of passionate crossfit coaches with a thirst to be educated and help clients with their goals safely.

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  19. Awesome article. I couldn’t say it better myself!
    As a CrossFit coach and DPhty student in Australia, I am constantly having to deal with the entire faculty and student body opposing CrossFit a training modality. CrossFit is sneered at and used as the ‘what not to do’ standard…
    Little do they realise, CrossFit can be such an effective and safe method of training. Whether they agree with CrossFit or not, they need to realise people will engage in activities they enjoy and receive benefits from – irrespective of their physiotherapist’s thoughts or recommendations!
    Thanks again for the article, a great read and shared online for all to benefit!

    • Thanks Taya! Glad to hear others with the same thoughts. It is a bit of a shame to see such negative sentiment. I was pretty lucky to have a supportive faculty at my program.

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  21. Fitness is about well being and good health. Fitness and pain, or fitness and injury are both oxymorons. If an activity causes you pain or injury, repetitively and chronically despite education or rehab, maybe you shouldn’t be doing it. Even if you really really like to do it. It’s not about comparing the rate of injuries in one activity (crossfit) to the rate of injuries in another (distance running).

    I’m a physical therapist. I’ve been to the crossfit gyms. I’ve gone to the workouts. Met the trainers and observed them at work. Competitive weightlifting as a sport is highly technical and anyone getting into it knows in order to maximize their lifting efficiency they must work on precision in their form. I think the problem is less that physical therapists know/understand crossfit, but more that “crossfitters” lack knowledge about this sport. It’s not just a recreational lift that you do to “maintain” your physique. And shouldn’t be used for college athletes in off season conditioning unless it is treated like the highly technical activity it is. Lifting as a supplement to a sport should enhance performance on the court or in the field, it should never be the direct cause of pain/injury. For example, in Olympic weightlifting the power squat is used. There’s no evidence that states this form will “blow out your knee,” but it’s also used for a one repetition max, not repetitive training (which during my crossfit encounters all people were focused on was getting their best number of repetitions and during my college athlete days was what the coaches were mainly concerned about). I don’t doubt there are amazing strength and conditioning coaches out there that have an enormous amount of knowledge about weight lifting, I can’t say that a high percentage of them are crossfit trainers though.

    At any rate, as a physical therapist it is my job not to judge what you love doing, but to get you back to doing what you love doing. I am not for crossfit but I know plenty of friends who are into it and I will continue to support them. I just think it’s sad that in general, “sports related injuries” have become accepted as almost an occupational hazard. I reiterate that fitness is about well being and good health. There shouldn’t be a fine print.

    • Nice perspective DK, I like what you have to say. One point where I will disagree with you is that sport has been historically a test of who can handle the stress and excel. As competition grows, the demand for more and smarter training arises. Think of young weightlifters and gymnasts in Russia and Asia. Throw these young individuals into the fire and see who doesn’t get burned. Even at the collegiate sports level in the US the athletes who can handle the stress and not get injured are the ones who are usually more successful. Crossfit seems to have made the decision to make their brand more oriented toward competition as opposed to just general fitness. I really feel that we can get people to high levels of fitness with low risk of injury but when you are training for something competitively it becomes a flirting session between success and injury. Seeing the large amounts of volume/intensity/frequency that the top level crossfit athletes are putting in, it’s similar to an olympic athlete training for the olympics.

    • How as a physical trainer can you say that “Fitness and pain, or fitness and injury are both oxymorons”?

      …aren’t fitness and pain/injury your career?

      • Not sure what you’re trying to say here. The name of the site has to do with trying to get people to be able to enjoy fitness without pain. Pain is a part of life but can be minimized with smarter choices.

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  23. Wow. To dk, thank you for contributing intelligent, clear, and thoughtful insight to the issue at hand. To djpope, I am eternally grateful that you were not my PT when I needed one. You come off as quite brainwashed, and frankly – dumb – in your writing. Please. No exercise trend (and Crossfit, is, indeed, a trend) is THAT ethereal and perfect. So, runners and triathletes are apparently neo-morons? I’m sorry, but, I learned nothing from this article.

    • Hey AL,

      Not sure why you feel I’m brainwashed. Also not sure why you think I’d be a poor therapist. I never stated crossfit was perfect and am not sure why you feel this way (Have you even read the entire article or anything else I’ve ever written?) I am constantly being critical of all aspects of fitness. If you don’t believe me read my series on kipping pullups and watch my interview at crossfit HQ discussing the risks of a traditional crossfit exercise. I never mentioned any negative statements against runners/triathletes and routinely treat this bunch. I’m equally happy about people being excited about these sports as crossfit/strongman etc. If you didn’t learn anything from the article atleast it stimulated you enough to respond and atleast that I’m grateful for. If you feel you get nothing from this site I’d suggest not reading or commenting again.

    • Brainwashed? Hardly. Dan is one of the brighter young physical therapists out there (and you have to trust me on that one–I’m in a pretty good position to make that judgment).

      CrossFit is like anything else out there: It’s a tool. Whatever “trend” there is out there that you are following–dry needling, laser, Grafton, et cetera, whatever (and I’m pretty sure that something you are doing is following a trend)–it is still just a tool. To dismiss any form of exercise completely is shortsighted. You call Dan “brainwashed.” I’ll not play that game but there are some descriptive terms that come to mind for you.

      HIIT will be the foundation of most good fitness and sports performance programs within 10 years. And if you don’t know what HIIT is, then you don’t belong in this conversation.

      What will be around until well after your career is over are therapeutic exercise and manual therapy techniques.

      • Thanks for sticking up for me Joe. I agree with you. Lots of negative sentiment toward higher intensity exercise. I guess the fear is that technique falls apart and injury ensues.

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  26. Great article Dan, glad to see you are doing so well out there!

  27. You just became my new favorite Therapist! Great Read! Thanks!

  28. Good article and some great points are made, especially #4.
    This definitely opens the door to take a different approach when talking to Crossfit clients and how to educate them. I think there are a few misconceptions/ poor stigmas on both what PT’s do and what Crossfit is all about.

    First off I would like to state that I am a PT and a personal trainer/ strength coach. As both, my job and goal was/is to keep my clients out of harm’s way and not only get them stronger , and help them lose weight and achieve the typical goals you often hear, but more importantly get them moving pain free and without any limitations, both “functionally” and recreationally. With that being said, physicals therapy as a profession, unfortunately has a bad rap.
    Between the decreased reimbursement rate and loads of documentation we are forced to see more pts and therefore spend less time with our current patients.
    On the hand, PT has become synonymous with a warm up on the bike, elliptical / treadmill, followed by 3sets of 10 using therabands, with the same exercises throughout the course of rehab. BORING!!! It’s no wonder why people do not progress and don’t like going to PT. That is on us. We are supposed to be getting our pts back to what the enjoy and hopefully even functioning better than before.

    On the Crossfit side of things, yes its new, its fun, there’s camaraderie, and competition, I can see how people are drawn to it. But performing numerous repetitions of Olympic-style lifts, explosive exercises and other anaerobic exercises with a Tabata like rest: work load ratio can only spell one thing: injuries. While CrossFit has been a huge platform to get people moving and excited about exercising, (which is great!), I think it is done at the expense of the consumers health. Granted there are great CrossFit coaches/ trainers out there, but I’ve seen first hand both in the CrossFit settings and in rehab setting what the competitive mentality of Crossfft does to individuals. Often this leads to some sort of injury, torn labrum, L/S HNP, or ankle tendonapathy. This does not lead to a referral to a medical professional, but rather an excuse like, “ My coach said he’ll modify the exercise until I heal.
    In my experience I feel Crossfit is becoming like a “rehab” setting for some, and that’s understandable considering that PT has become boring ( for the most part). Patients who have suffered multiple shoulder dislocations, should not be performing kip-ups/ muscle ups and snatches. If these CrossFit experts truly new the mechanics of movement and of the body they wouldn’t allow clients to perform them. The risk far exceeds the reward, which in my experience is not properly conveyed to the clients, and that is where the negative stigma comes from.

    Like any sport- baseball, football, swimming, ect. CrossFit comes with risk, if nothing else through the shear repetitive nature. However, after a certain age, certain type of injury, or multiple injuries one should stop or know his or her limits. Yes, CrossFit is a sport/ competition, but how many 40 year old professional athletes are there? Very few if any. That’s where the line needs to be drawn. People need to realize that , ike everything this is not meant for most.
    In the end, there is a lot to learn on both a PT and CrossFit trainer’s side. Crossfit is going to continue, and its our job as professionals in the fitness injury to truly learn what CrossFit is about and make the changes necessary to, either keep our clients healthy, or return them to what ever goal they may have. This will only happen if both physical therapists as a whole make more of a stance/ effort to be well versed in not only CrossFit lifts, but exercise techniques, variations, progressions, regressions and Periodization schemes as a whole.

    For Crossfit trainers, It would be wise to try and link up with a health care professional that understands you business and client’s needs. First is ask people you know if they have gone or know someone who has gone to a PT that is well versed in orthopedics manual therapy and exercises.
    Some credentials and experience to look for or ask when you meet this professional are: does this individual poses his CSCS. Though not the be all end all it is the gold standard certification to hold in the fitness industry, which hopefully they have experience and knowledge of correct lifting techniques and progressions. Also ask if the professional utilizes the FMS, SFMA, as these screens and assessments look at movement patterns, as a whole, not just isolated muscle actions. Lastly ask what who and what leaders in the fitness/ rehab industry do they follow or connect with, as this will give in great insight to the professionals philosophy.

    I could continue, but I’ve rambled long enough.
    Dan thanks for the posting. This is exactly the type of content that needs to be discussed and debated in the fitness and rehab world to further advance us as an industry and profession.

  29. Good article and some great points are made, especially #4.
    This definitely opens the door to take a different approach when talking to Crossfit clients and how to educate them. I think there are a few misconceptions/ poor stigmas on both what PT’s do and what Crossfit is all about.

    First off I would like to state that I am a PT and a personal trainer/ strength coach. As both, my job and goal was/is to keep my clients out of harm’s way and not only get them stronger , and help them lose weight and achieve the typical goals you often hear, but more importantly get them moving pain free and without any limitations, both “functionally” and recreationally. With that being said, physical therapy as a profession, unfortunately has a bad reputation.
    Between the decreased reimbursement rate and loads of documentation we are forced to see more patients and therefore spend less time with our current patients.
    On the other hand, PT has become synonymous with a warm up on the bike, elliptical / treadmill, followed by 3sets of 10 using therabands, with the same exercises throughout the course of rehab. BORING!!! It’s no wonder why people do not progress and don’t like going to PT. That is on us. We are supposed to be getting our patients back to what they enjoy and hopefully even functioning better than before.

    On the Crossfit side of things, yes it’s new, it’s fun, there’s camaraderie, and competition. I can see how people are drawn to it, but performing numerous repetitions of Olympic-style lifts, explosive exercises and other anaerobic exercises with a Tabata like rest: work load ratio can only spell one thing: injuries. While CrossFit has been a huge platform to get people moving and excited about exercising, (which is great!), I think it is done at the expense of the consumers health. Granted there are great CrossFit coaches/ trainers out there, but I’ve seen first hand both in the CrossFit settings and in rehab setting what the competitive mentality of CrossFit does to individuals. Often this leads to some sort of injury, torn labrum, L/S HNP, or ankle tendonapathy. This does not lead to a referral to a medical professional, but rather an excuse like, “My coach said he’ll modify the exercise until I heal.”
    In my experience I feel Crossfit is becoming like a “rehab” setting for some, and that’s understandable considering that PT has become boring (for the most part). Patients who have suffered multiple shoulder dislocations, should not be performing kip-ups/ muscle ups and snatches. If these CrossFit experts truly knew the mechanics of movement and of the body they wouldn’t allow clients to perform them. The risk far exceeds the reward, which in my experience is not properly conveyed to the clients, and that is where the negative stigma comes from.

    Like any sport- baseball, football, swimming, etc. CrossFit comes with risk, if nothing else through the shear repetitive nature. However, after a certain age, certain type of injury, or multiple injuries one should stop or know his or her limits. Yes, CrossFit is a sport/ competition, but how many 40 year old professional athletes are there? Very few if any. That’s where the line needs to be drawn. People need to realize that, like everything this is not meant for most.
    In the end, there is a lot to learn on both a PT and CrossFit trainer’s side. Crossfit is going to continue, and it’s our job as professionals in the fitness injury to truly learn what CrossFit is about and make the changes necessary to, either keep our clients healthy, or return them to what ever goal they may have. This will only happen if physical therapists as a whole make more of a stance/ effort to be well versed in not only CrossFit lifts, but exercise techniques, variations, progressions, regressions and periodization schemes as a whole.

    For Crossfit trainers, it would be wise to try and link up with a health care professional that understands your business and client’s needs. Firstly, ask people you know if they have gone or know someone who has gone to a PT that is well versed in orthopedics, manual therapy and exercises.
    Some credentials and experience to look for or ask when you meet this professional are: does this individual poses his CSCS. Though not the be all end all, it is the gold standard certification to hold in the fitness industry, which hopefully they have experience and knowledge of correct lifting techniques and progressions. Also ask if the professional utilizes the FMS, SFMA, as these screens and assessments look at movement patterns, as a whole, not just isolated muscle actions. Lastly ask who and what leaders in the fitness/ rehab industry they follow or connect with, as this will give in great insight to the professional’s philosophy.

    I could continue, but I’ve rambled long enough.
    Dan thanks for the posting. This is exactly the type of content that needs to be discussed and debated in the fitness and rehab world to further advance us as an industry and profession.

    • Thanks for the post Brandon! I agree with you totally. Documentation and being forced to see more patients with less time for each individual totally sucks. People spend hundreds of dollars on their cars, personal tainers etc. but therapy is considered undervalued and seen as something that should be covered under insurance. Meanwhile people want gold standard care and expectations are unrealistic. I do wish that more people were open to seeing therapists as a sort of check up to see what’s moving well and what isn’t for their bodies. Of course we’ll spend the money once we get hurt but not before.

      As far as the comment about crossfit being all about tabata, high rep oly etc etc that’s not really true. The second point you make really is though. What you do in a crossfit class is based on the coaching/programming. I just had an in depth convo with the head coach at the gym I go to crossfit KADA. Workouts are catered toward the individual. We discussed a particular woman with morbid obesity and a long history of low back pain. Coach was using extremely modified functional exercise at a pace where the client could keep technique sound (far from the typical snatch till your labrum tears idea). Long story short she went to a doc who diagnosed her with a herniated disc and said not to do crossfit. Now she’s back to her sedentary lifestyle because a doc thought crossfit wasn’t safe(when the best thing for her is probably just to get her moving properly) There are good and bad people in every profession and crossfit is no exception. Knowing where you’re sending your patients to is key. I’ve had several patients get hurt going to personal trainers as well (A big trend in the training world is the high intensity tabata type training that’s almost exactly the same as what you’d see in a crossfit class anyway)

      Great tips for finding a good PT too.

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  32. I wish this was the response of PT’s and doctors I have seen, but I have been to a handfull and have not found this response at all. I have not been able to get shoulder impingement and patellofemoral (sp?) pain under control (though it is much improved) and have been begrudgingly out of the box for over a year. Part of that is because I don’t know how to go from exercises made for 65-year-olds (I’m 25) back to a high-intensity regime, and I don’t trust that my PT exercises are adequately equipping me to do so. How can I find a PT that understands CF, crossfitters, and how to help patients transition back to crossfit?

    • Sorry to hear you haven’t found a good PT Andrea. Where are you located?

      • I’m in the Sierra Foothills (east of Sacramento) half of the week and half of the week at grad school in Berkeley.

        • Ya, sorry Andrea I don’t think I know of any PT places out there. Maybe ask some of the local crossfit gyms who they use?

        • Why don’t you try contacting Kelly Starrett who is a PT and owner of San Francisco CrossFit. He should be able to refer you to someone near you.

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  36. The feeling I’m getting from this article and from reading the responses is not that physiotherapists or physical therapists (as they call them in the U.S.) don’t understand Crossfit, but rather Crossfitters don’t understand PT.

    It’s no secret that many Crossfitters have never set foot in a gym before doing Crossfit, or if they had, did not actually work out long or hard enough to actually require PT. Friends of mine who do/did Crossfit typically come from sedentary childhoods and were not “jocks” in high school. Anyone who played sports in school or college or who played soccer, swam, etc while young or even older will most likely have been referred for PT at some point.

    The point I’m trying to make is that Crossfitters always get up in arms about how their “sport” is misunderstood by professionals in the medical and physio fields yet most of the misinformation is caused by Crossfitters who believe posts in forums or have drank the Glassman koolaid.

    • Hey Mike, interesting point. Care to elaborate about the misinformation in forums or what Glassman Koolaid is? Not sure that i fully understand you.

  37. After reading this article, I have to say how LUCKY our entire box is because we have a Chiro with office space inside our box, AND he is a certified CF level 1 coach. He fixed a 30-year back problem and worked with my coaches to program WODs for me until I was ready to start lifting heavy again. Lately, it seems like I am having a PR at every WOD! I am 53 years old and will never stop going to CrossFit. For me, we focus on range of motion, core strength, and proper form. I have found that with a healthy back, I am able to attend classes five or six days a week. If I feel tired, my coaches will give me a WOD that doesn’t involve heavy weights. I have never felt any pressure to do anything my body didn’t feel ready to do. I have no interest in competing and see this form of exercise as the magic pill to provide me with a healthy and high quality of life as I age.

    Last comment on the perception of CF being a cult. If you call supportive, friendly people engaged in healthy behaviors a cult, count me in every time!

  38. Well I wish I sort of agree…but also disagree. I am in PT for a 95% tear in my rotator cuff and also a tear in my labrum. The “box” and trainer I was going to were supposedly the best. A winning competitor and veteran of teaching…I thought I was in good hands. Unfortunately as someone who had seldom worked out in her life at 44…I trusted her. Excited to use her new pullup bars…she put us up on the bar to try kipping pullups with only a 5 minute warmup. I actually felt my shoulder tear. I am now in for a long recovery. My 17 year old son is scheduled for an MRI for the same thing. My Chiropractor, Ortho, and my PT LOVE Crossfit. Increased business they all will admit it. I think Crossfit is great for seasoned athletes and if you have a trainer who will babysit you. Unfortunately they will not turn people away because that is how they make $. Let’s face it… they just can’t supervise you close enough when there is over 20 people in the class. If you are a newbie…Crossfitter and can’t afford one on one….Crossfitter beware!!!!

    • Thanks for the post Laurene. I think it’s important to know that some people definitely do get hurt while doing crossfit. Hopefully we can put in some systems to prevent these things. I find two ends of the spectrum (obviously with some beliefs in between). Some that believe that crossfit exercises are very dangerous and others that believe that the risk is completely minimal. It’s important that we see the injuries and try to prevent them! I also just want to say that this isn’t the norm and there is a risk of injury in any activity. I can’t tell you how many injuries I see who woke up with something abnormal or something slowly began giving them pain while doing something as easy as walking.

    • Laurene,

      I started with a great coach in an awesome box. There are good and bad Crossfitters just like there are good and bad Physical Therapist’s, Athletic Trainers, Personal Trainers, RN’s, MD’s et al.

      dj, Koolaid in reference to Glassman is easily explained by anyone who does their history. If that isn’t enough, I recently went to a continuing ed class in one of the first boxes in the US…very successful box. First words out the owner’s mouth were…”we’re not like the typical CF Box…we do….” There was no need to explain that to me but it speaks volumes about how far CF has strayed from its roots.

      When you can buy a “certification” in a weekend of training, you really need to consider the strength of the certification. Most people don’t, they truly think they are qualified movement specialists when they know little. There are great trainers and average trainers but a weekend certification in anything isn’t a solid basis for a great business.

      Ashleigh, I hope your PT was a personal trainer or some other type of therapist…they don’t sound very bright.

      My prediction…CrossFit will continue to thrive and Medical Professionals who work to cultivate relationships will either grow or decrease their business by helping CF owners, participants and wannabe’s.

      • Good points Pete. I know Glassman has really upset many people in the past and have read some of these statements myself. I was curious to what he was specifically referencing.

  39. A hearty AMEN to all of the above. Not only do I absolutely send my patients who are Crossfitters back to CF when they’re ready, and encourage non-crossfitters to try it; but CrossFit has also made a significant positive contribution to my practice as a physical therapist. Learning to judge movement faults as a CrossFit coach has opened my eyes to movement faults that can cause dysfunction and pain more than anything in PT school.

    • Thanks for the comment Eli. I really enjoy working with crossfitters and think crossfit and any fitness/recreational activity is definitely something to recommend to patients.

  40. Great article, your point of view is very refreshing! I’ve done PT multiple times for sports related injuries and most likely will need to do it again soon for my first “crossfit related” injury. A therapist I previously saw told me she would not treat me for any crossfit injuries if I started participating in the sport, it’s good to know I will be able to find a therapist who cares about what I want to rehab for and won’t judge and lecture me!

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  42. Excellent article Dan. While going through DPT school I was also interested in Crossfit as I joined a box to get an insiders perspective into what the whole craze was about. Did I irritate my rotator cuff? Yes. Did I have a great time doing it? Absolutely. This is EXACTLY why we as PT’s should do our jobs, stop speculating, get out in the community and learn what our patients are doing. A collaborative approach with Crossfitters and trainers alike will only change the current landscape of fitness in a positive way. We tend to forget that we are educators, but also need to be educated ourselves. I will even go out on a limb (with you) and say that the vast majority of PT’s are in strong opposition of Crossfit have never participated in a WOD, or probably never been under a barbell in their lives.

    Paul Caudillo, DPT, CSCS

    • I agree Paul. Therapy school doesn’t teach the most effective ways to train in the gym etc. I agree with you and really believe we could learn a thing or two from trying some of the activities our patients are partaking in.

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  44. I own a PT practice with more than 20 PTs on board. When I started doing Crossfit myself I was astounded by the criticism and disdain my team had for it, what made it worse was that they knew nothing about it other than what they had heard through the grapevine. I immediately arranged for my whole team to do a foundation course as part if their professional development, and gave 3 of them to develop some screening and progression protocols to help get an injured crossfitter back into Crossfit while taking a prevention approach by addressing other mobility and stability issues. Now 8 of my therapists are Crossfitters and the whole process has been great. There is nothing worse than a cynic with no better plan. To all the PTs who vocally dis Crossfit, if you think its broke stop talkin about it, make damn sure you understand it and get involved to fix what you see is wrong. You’ll likely end up eating your words!!!
    After all, what’s harming more people throughout the world, morbidity associated with inactivity or Crossfit?

    • Thanks for chiming in Brendon. I agree with you wholeheartedly and also like the point about inactivity. Better to be in an ortho’s office then a cardiologist’s. (Although I’m still in favor of smart fitness)

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  46. Chris Manfredi, LMT, MS, MBA

    Great post! I’m glad you’re taking a look at cross fit in your domain. I wholeheartedly agree with your assessment, but mine is slightly different.

    I am a licensed massage therapist doing about 40 hours of strict hands on work on clients every week. I’m currently at about 6000+ hours of manipulation on the body as LMTs are always on. I specialize in deep tissue, trigger point/NMT, Thai, and various sports massage. Most of my clients are athletes (marathon, power lifters, cyclists, football, etc.) or weekend warrior types who need relief not only from their jobs but from their fitness routines. I am also into fitness, a former military member, active surfer, yoga enthusiast, swimmer, and cross trainer. So that’s my specs.

    I will be blunt. My worst clients with the most potential for injuries are my Crossfit clients. Bar none; it’s not even close. Most of these clients have come in with minimum flexibility, tons of pain, and horrible discomfort. I barely touch them, and they are in agony. It’s embedding itself into muscle memory as well, and when they leave the box, that memory comes with them into the office.

    I advise all of them that in order to do Crossfit, you must balance it with an even heavier dose of low impact stretching or exercising (Yoga, piliates, swimming), thermotherapy (hot tubs, hot towels, saunas), and self massage helping aids (foam rollers, tennis balls) to break through issues. Good nutrition and rest are also vital.

    Now not every Crossfit client are like this. Maybe only 90% are. The others are resting when they can, stretching always, working on their flexibility, and paying strict attention to form. They don’t push themselves needlessly to weights they know they shouldn’t go to. They use Crossfit as a means to fitness and not the end.

    I think we need to advise anyone looking to take up Crossfit that you must act like an athlete to be one. You need adequate rest. You need days off. You need stretching, acute cooling, and consistent heating.

    You can have it all, a healthy Crossfit body and flexible, lithe frame. But if you don’t watch yourself in the box, you will cause catastrophic damage to yourself. This is what I see as an LMT, and I hope it can make an impact.

    Thanks

    Chris

    • Thanks for the post Chris. I agree with you and think there are several excellent coaches and athletes doing exactly what you recommend.

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