How to Prevent CrossFit Injuries

An Interview with Gray Cook

Lead Photo Credit: Again Faster

The Progress Killer

The fastest way to halt progress is to injure yourself. And as CrossFit participation rises, so does the number of injuries, no matter how much CrossFit HQ tries to deny it.

How do you keep yourself strong and healthy? We've got just the man to answer these questions.

Meet Gray Cook

Gray Cook

Gray Cook founded Functional Movement Screen (FMS). FMS lays down a fundamental baseline on function (a person's ability to move), and identifies potentially faulty function before it becomes detrimental.

We had the opportunity to speak with Cook about CrossFit, injury rates, and protecting both elite and amateur level CrossFit athletes.

Dr. Rusin: What are your thoughts on CrossFit's incidence of injuries?

Gray Cook: CrossFit has accelerated our exposure to innovative bodyweight and Olympic-type lifting techniques. A lot of people learned about old and new school techniques through CrossFit.

The modern evolution of fitness has been on fast forward, causing some problems to quickly rise to the surface. But I don't think it's a CrossFit problem. The average consumer of fitness doesn't know how best to "consume" those sources of fitness.

CrossFit has just given us a model that could potentially be the vehicle of how we actually change physical education in our country.

When you get big, and you get popular, you must install some systematic approaches so that everything you're doing is sustainable.

Rack Position

Dr. Rusin: What's the most potentially debilitating movement being programmed in CrossFit training?

Gray Cook: The Olympic lifts. Why? Because they require a lot of good movement on the part of the athlete, a lot of great coaching, and an enormous amount of skill and technicality, dependent on the feedback between an athlete and the coach.

If an athlete doesn't have an adequate base of mobility, stability, and skill, the Olympic lifts with the straight bar can be potentially injurious.

Having a technically sound deadlift before progressing into a movement like the clean makes a lot of sense.

The movements that involve both heavy loading and increased bar speed and skill levels are potentially the most dangerous types of movements, but also have the highest ceilings of any lifts out there.

When reps and time become the focus, the assumption is that technique no longer matters. In Olympic lifting gyms, it's always about the technique; the technique is always the bottleneck of limitation.

If we keep the clock in programming, I'd much rather see lifts with far lower technical ceilings as opposed to Olympic lifts. Doing these high loads with ludicrous volumes may determine who's put together and who's going to get hurt.

If you want to do high reps to see how long your technique lasts, that's fine. But there literally needs to be someone standing there to monitor your technique. I'm only interested in how much you can do under good technique.

The coach should control the time based on technical sound movement mechanics, not the other way around where the athlete controls the time with poor technicality with big lifts. This will teach athletes to own their technique.

Dr. Rusin: As a physical therapist, what are the most common types of injuries you see in CrossFit?

Gray Cook: The data says that the number one risk factor for sustaining a future injury is having had a previous injury.

So many athletes are going back to training without having fully recovered from an injury, which is partly the fault of the athlete and partly the fault of the medical system.

It's hard to say that one type of injury happens more often in CrossFit, but rather, the metabolic environment and heavy loading schemes under huge amounts of stress tend to "wake up" old injuries that have been mismanaged in the past by the athlete, rehab specialist, or coach.

Lower backs, shoulders, and knees often take the brunt of the hit when talking about injury rates in CrossFit. But with good mobility, stability, and technique, many of these common injuries can be avoided.

Just look at the work Kelly Starrett has been doing over at San Francisco CrossFit with his athletes.

American Kettlebell Swing

Dr. Rusin: What are your thoughts on CrossFit-style training for athletic development and sport specific performance training?

Gray Cook: Do we use CrossFit-type loading implements and training styles in high performance athletic training? Yes. But we have been for over 100 years.

Tools like the kettlebell can fill in gaps in training in sports performance, even at the highest level like NFL strength and conditioning.

Are sports performance coaches - who already have a great deal of success implementing programs that match the specific needs of the sport - going to stop doing what has been working to bring in CrossFit-style programming? Probably not.

What coaches will gladly introduce are movements popularized by CrossFit that have been battle-tested under some of the most robust metabolic environments in all of fitness.

Many of the exercises we see in CrossFit can be strategically aimed at sports performance and have a great amount of success in the crossover.

Dr. Rusin: If you were to change one thing about CrossFit programming, what would it be.

Gray Cook: CrossFit needs to spend as much time defining the individual's capabilities as they do setting a WOD or a specific all-inclusive workout across the board.

People don't know their own limitations, which sometimes gets them into problems that elevates the unnecessary risk of injury while training.

A lot of people blindly shuffle into these challenging environments not really knowing what they're physically capable of without getting hurt. That needs to be addressed to protect the athletes, and offer some alternatives in programming to match their current functional status.

Dumbbell Swing

Dr. Rusin: Do you believe that CrossFit is potentially the most injurious form of mainstreamed fitness currently practiced?

Gray Cook: It would be very easy for people to assume that, just due to CrossFit's widespread popularity.

If you look at things like rates of female non-contact ACL injuries and the increasing number of concussions in high school football, I may be more concerned about youth sport development programming causing more injuries than CrossFit.

Other fitness professionals have made the same mistakes being made by CrossFit coaches. Sometimes as coaches we get carried away with generating hugely challenging metabolic environments, trying to maximize a training effect, and don't gauge the abilities of the athletes.

Dr. Rusin: How can coaches protect CrossFitters?

Gray Cook: Making sure that every movement programmed into the WOD has workable modifications for athletes that aren't currently of executing a higher level movement without having an increased risk of injury.

This may require the coach to check off whether an athlete can proceed in a WOD on a daily basis as is, or needs to simplify a movement or two.

Knowing the moves that people struggle with, so they don't get into a highly challenging metabolic and time-sensitive environment, with those faulty movement mechanics can do the athlete and sport a lot of good.

Our job as coaches is to expose our athletes to new exercises and new combinations, not necessarily to force feed numeric training packages that may not be appropriate for ones skill set or conditioning level.

If we're looking at CrossFit as another vehicle for adult physical education, controlled exposure to something new is the brilliance of the WOD.

The reason there are coaches at CrossFit is to help each athlete participate by modifying movement at a pace that allows you to be independent and sustain it for tomorrow.

Dr. Rusin: Movement screening is a simple tool used by almost every professional sporting organization. How could FMS fit into CrossFit?

Gray Cook: When you're gaining a new CrossFit consumer, or reappraising the things that have occurred in training, obviously we want to put a metric on movement along with other performance metrics like strength and metabolic capacity.

The movement screen is a little gauge we run in the background to see if your movement dropped below a certain point, and if so, we need to remediate.

I've spoken with Dr. Stuart McGill about this at length, and it comes down to this: Do I coach you or do I correct you?

If you have the physical capacity to do a technique, then doing it right provides both the mobility and stability micronutrients that are behind the things that make you stronger.

But if you have compromised foundational movements, even the best coaches in the world would not persist in coaching that movement.

The screen is meant to pick up potential problems that are going to impede the teaching platform that you're currently standing on. It's important to correct these dysfunctions and at the same time stop loading these faulty patterns.

For a movement pattern that's considered dysfunctional, the best evidence says don't load it.

First, it could become injurious. Second, no good, quick adaptation can occur here because positive physical adaptation is dependent on one thing that nobody tracks, and that's a positive physical response.

Dr. Rusin: Injuries in sport are nothing new. The NFL concussion epidemic became such a problem that the NFL had to take action.

Do you view CrossFit as having that same type of epidemic of musculoskeletal injuries to the point where something needs to be done to address this before it gets out of hand?

Shoulder Pain

Gray Cook: Yeah, probably.

If we can identify that you are broken before you go into a WOD and get hurt, we can help you. That's the whole point. If we start seeing your movement integrity decline, we can implement the proper measures to protect you.

Do you think people just one day have a heart attack, or for five years that cholesterol and blood pressure was going up, the circulation and breathing was going down, and the heart was becoming less harmonic with the rest of the body?

There are so many indicators that can be identified before a problem occurs. Right now, early detection works for many medical issues except for musculoskeletal injuries.

We wait until your friggin' knee hurts, and then you go to a knee specialist who's going to find what? A knee problem. He's never going to tell you that you have a tight hip or a jacked up ankle. He's going to say, you shouldn't have been doing squats, now I gotta scope your knee.

If we could simply baseline movement before we started challenging fitness, we could start to detect potential injuries or pain episodes secondary to training.

Dr. Rusin: You've worked with a lot of different elite level athletes. What sets CrossFit apart?

Gray Cook: CrossFit did something that we were ready for. It combined some bodyweight movements with some weightlifting moves, and combined things like ropes, kettlebells, rings, and barbells into a new and invigorating way to excite people.

CrossFit puts a focus on movement and not weight loss. When people keep focusing on movement and keep getting better, what happens? They lose weight.

Here's the problem, though. Everyone wants to move, but not everyone is capable of moving correctly.

The intake standards in the United States military has dropped five times since 1965 because we couldn't get enough people to serve if we had the same physical standards that our grandfathers passed to get into World War 2.

CrossFit had an amazing solution to a lethargic sedentary society. The problem is, as CrossFit gets bigger we're still generally on a physical decline in Western civilization. The Western mentality is a bit flawed.

The first time you ever saw a clean, you attempted to do the same thing with 45 pound plates on each side of the barbell, not a broom handle like the European athletes learn to do.

That's just Western mentality; we think we're entitled to do any damn move we please just because.

Unfortunately in our current fitness landscape, to keep your clients safe you have to ask the health questions first before the fitness questions. Everyone thinks they can bring a fitness solution to a health problem.

I do think if CrossFit could take the lead on a little more systemization on the front end of screening, we could use them as an example of the future platform of physical education.