How To Prevent The 7 Most Common CrossFit Injuries
CrossFit training is arguably the best way to build your fitness, but like all training methods, there is an injury risk when you step inside of a CrossFit gym.
A recent research study examined CrossFit athletes’ most common injury sites, with the shoulder, spine, and knee being the most frequently injured. (1)
As a performance Physical Therapist specializing in working with CrossFit athletes, I can attest to these findings.
They are typically the sites I help athletes recover from to get back to training.
Another study found that injury prevalence in CrossFit is relatively low and comparable to other sports and exercise programs. (2)
However, knowing the major sites of injury can help you design pre-hab exercises to lower it even further.
Injuries in CrossFit can be challenging because the CrossFit culture is about hard work and pushing through pain.
Thus, your best way to deal with CrossFit-related injuries is to focus on injury prevention by dedicating at least some of your training hours to fortifying your body and increasing your resiliency.
This article breaks down the seven most common CrossFit injuries I have seen as a performance physical therapist and CrossFit coach over the last twelve years.
So that you can reduce your risk of injury and keep training hard in the long term.
What Are the Most Common CrossFit Injuries?
Shoulder Injuries in CrossFit Athletes
Rotator Cuff Strain
A rotator cuff strain is a type of shoulder injury to one or more of the muscles or tendons that make up the rotator cuff in the shoulder.
The rotator cuff consists of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons, which surround the shoulder joint and help stabilize it while allowing a wide range of motion.
When strained, these muscles or tendons become stretched, partially torn, or in severe cases, completely torn.
This can result in pain, weakness, and limited range of motion in the shoulder. The severity of a rotator cuff strain can vary from mild discomfort to significant pain and functional impairment.
Rotator cuff strains are common in both athletes who perform repetitive overhead motions (such as swimmers or baseball pitchers) and in individuals who perform manual labor or activities that stress the shoulder.
Causes
High-frequency shoulder training without adequate rest and sudden increases in weight or repetitions can also lead to this injury.
In CrossFit, this could arise from high-volume overhead pressing or gymnastic movements that the shoulder is not accustomed to.
Prevention
To prevent rotator cuff strains, it’s ideal to warm your shoulders thoroughly before workouts, focusing on shoulder mobility and activating the shoulder stabilizers.
Strengthening the rotator cuff muscles with accessory exercises like dumbbell external rotations and overhead carries helps the cuff to tolerate high workloads.
You also want to avoid increases in workout volume beyond 10% per week, allowing the tissue to adapt to training over time.
Treatment
Immediately after a rotator cuff strain, let the shoulder rest and avoid painful movements.
Shortly after, focus on isometric strengthening exercises for the rotator cuff, such as doorway external rotations.
This helps to strengthen the muscles in a nonaggressive position and can have a pain-relieving effect.
Shoulder Impingement
A shoulder impingement, also known as subacromial impingement syndrome, is a condition where the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space in the shoulder.
This space is located between the top of the upper arm bone (humerus) and the acromion (the bony prominence at the top of the shoulder blade).
In this condition, the tendons get “pinched” or compressed when the arm is raised, particularly above shoulder level.
This can lead to shoulder pain, weakness, and reduced range of motion in the affected shoulder. Shoulder impingement is common among people who frequently perform overhead activities, such as athletes in throwing sports or workers who often reach above their heads.
Various factors can cause shoulder impingement, including the shape of the acromion, bone spurs, or swelling of the bursa (a fluid-filled sac that reduces friction between tissues).
Over time, if left untreated, shoulder impingement can lead to more severe conditions like rotator cuff tears.
Causes
Shoulder impingement often stems from weakness in the rotator cuff muscles and lack of mobility in the shoulder joint and scapula.
However, it may also occur, and poor posture during workouts and overuse of the shoulder in repetitive motions can contribute to this condition.
For example, if the upper back is rounded and the shoulder blade is immobile, the shoulder will have less room to operate.
Prevention
To prevent shoulder impingement, emphasize strength training for the rotator cuff and scapular stabilizer muscles.
Regular shoulder and upper back mobility exercises such as cat-cows and open book rotations are also needed.
Balancing pushing and pulling exercises in training can also help maintain the shoulder’s structural balance.
Treatment
When addressing shoulder impingement, avoid movements that cause pain.
Increase shoulder stability through targeted exercises and improve shoulder and upper back mobility with stretching and a foam roller.
I don’t love foam rolling, but it can be a pivot point for upper back mobilization.
Spine Injuries in CrossFit Athletes
Lower Back Strain
A lower back strain, or lumbar muscle strain, is an injury to the muscles or tendons in the lower back area.
It occurs when these soft tissues are stretched beyond their normal range or torn due to excessive force.
This condition typically results in lower back pain, stiffness, and reduced flexibility in the lower back region.
The severity can range from mild discomfort to significant pain that limits movement and daily activities.
Lower back strains are among the most common lower back injuries, especially in athletes who engage in Olympic weightlifting and powerlifting, which involve high-intensity pulling from the ground.
Causes
Lower back strains in CrossFit athletes often result from poor load management during exercises.
As well as improper core bracing during heavy lifting and intense lower back movements like squats and deadlifts.
These factors can put high stress on the lower back muscles and ligaments.
This is a good thing, but midline stability and progressive training is key.
Prevention
To prevent lower back strains, try to avoid sudden, significant increases in workout intensity or volume.
It’s important to consider total training (and non-training) fatigue before near-maximal lifting.
You can also incorporate lower back pre-hab exercises such as Sorensen holds and supermans to strengthen the lower back.
Additionally, you may consider using a weightlifting belt to increase core bracing.
Adhering to deadlift and squat points also puts you in a mechanically advantageous position for lifting.
Treatment
When treating a lower back strain, rest is essential initially to allow the affected area to heal.
While continuing to train as many movements as possible that don’t cause pain.
Incorporating gentle spine mobility exercises can help maintain flexibility.
Soft tissue work, such as massage or foam rolling, can aid in recovery by improving blood flow and reducing muscle tension.
Once you are mostly pain-free, I typically reintroduce training over several days and weeks.
Herniated Disc
A herniated disc, a slipped or ruptured disc, affects the spine. It occurs when an intervertebral disc’s soft, gel-like center pushes through a crack in the tougher exterior casing.
This can happen in any part of the spine but most commonly occurs in the lower back (lumbar spine) or neck (cervical spine).
A disc herniation can put pressure on nearby nerves, leading to various symptoms depending on the location of the herniation.
These symptoms may include pain, numbness, tingling, or weakness in the affected area and sometimes in the limbs associated with those nerves.
The severity of a herniated disc can vary widely, from causing minimal discomfort to significant pain and functional limitations. It’s a common spinal condition that can affect people of all ages.
Causes
Herniated discs often occur due to repetitive spine flexion or rotation motions, especially under load.
Poor load management, such as lifting weights that are too heavy or excessive volume, can also lead to disc issues.
When I herniated my L4-L5 disc, it was a direct result of poor mobility in my hips and a program that had me maxing out every single day.
Prevention
Preventing herniated discs typically involves maintaining proper core bracing and moving as well as possible.
Emphasizing spine mobility and avoiding excessive flexion or rotation of the spine when lifting heavy weights.
Your spine should be able to move while loaded, but this skill needs to be built over time.
Treatment
Treatment for a herniated disc typically begins with varying degrees of rest, but gentle motion, as tolerated, can help avoid spasms.
Gentle spine mobility exercises, such as double knees to chest, cat-cows, and lower trunk rotations, can increase flexibility without aggravating the lower back.
I also try to incorporate a core stability program as soon as possible, moving from table exercises like posterior pelvic tilts to standing core strengthening.
Repeated extensions and sciatic nerve glides can also help depending on how a client presents.
Knee Injuries in CrossFit Athletes
Patellar Tendonitis
Patellar tendonitis, or jumper’s knee, is an overuse injury affecting the patellar tendon. This tendon connects the kneecap (patella) to the shinbone (tibia).
It’s characterized by inflammation and micro-tears in the tendon, resulting in pain and tenderness at the front of the knee, typically just below the kneecap.
This condition is common among athletes, especially those involved in sports that require frequent jumping or repetitive stress on the knee joint.
Causes
Patellar tendinitis, often called “jumper’s knee,” is commonly caused by repetitive movements such as jumping or squatting in CrossFit workouts.
Poor landing mechanics during jumping or running can also exacerbate the stress on the patellar tendon, leading to inflammation and pain.
Prevention
Focusing on strengthening the quadriceps and hip muscles can help prevent patellar tendinitis by preventing compensations when landing or running.
But, the biggest factor is avoiding sudden increases in running or jumping volume.
As a general rule of thumb, a progression in repetition volume of no more than 10-30% per week is sufficient. (3)
Treatment
Treatment for patellar tendinitis typically involves rest to allow the tendon to heal.
Incorporating ankle mobility exercises and stretching of the calf muscles can help improve overall leg mechanics.
Isometric strengthening exercises for the quadriceps without movement can help strengthen the tendon and provide a pain-relieving effect.
Meniscus Tear
A meniscus tear is an injury to one of the C-shaped pieces of cartilage in the knee joint. The menisci (plural of meniscus) act as shock absorbers between the thighbone (femur) and shinbone (tibia).
There are two menisci in each knee: the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side.
A tear can occur in various patterns and sizes, ranging from small to large, and can be partial or complete.
Common types of meniscus tears include bucket handle, flap, and radial tears. The injury can cause knee pain, swelling, stiffness, and mechanical symptoms like catching or locking of the knee joint.
Causes
During CrossFit workouts, Meniscus tears often result from twisting movements under load or at high velocities.
Deep squats you are not prepared for with excessive loading and high frequency can also contribute to this injury.
Prevention
Preventing meniscus tears involves optimizing ankle and hip mobility to ensure proper movement patterns during squats, pistols, box jumps, etc.
Increasing the strength of the quadriceps, hamstrings, calves, and hip muscles can also provide better support for the knee joint during intense training.
Treatment
Treatment for a meniscus tear focuses on improving ankle and hip mobility and knee stability exercises.
More severe tears may sometimes require medical intervention, including surgery, followed by a structured rehabilitation program.
Hip Injury in CrossFit Athletes
Hip Flexor Strain
A hip flexor strain is an injury to one or more muscles that allow you to lift your knee and bend at the waist.
These muscles, collectively known as the hip flexors, run from your lower back to your upper thigh.
When strained, these muscles can become stretched, torn, or inflamed, leading to pain and reduced hip and upper leg mobility.
Hip flexor strains can vary in severity, from mild discomfort to more severe pain that significantly limits movement.
Causes
Hip flexor strains in CrossFit athletes often result from overuse of these muscles during workouts.
If your warm-up lacks luster, you may leave the hip flexors unprepared for intense activity.
If you are unaccustomed to volume, repetitive sprinting or toe-to-bar movements can also lead to this injury.
Prevention
To prevent hip flexor strains, avoid sudden increases in workload that stress these muscles.
Increase hip flexor strength and endurance through targeted exercises like banded marching and leg raise variations.
Implementing a thorough warm-up routine that includes dynamic stretching for the hip flexors can help prepare these muscles for training.
Treatment
Rest is essential when treating a hip flexor strain to allow the injured muscle to heal.
As you continue to train around the injury, gentle hip flexor stretching can help maintain flexibility but should be done carefully to avoid aggravating the injury.
Hip stability exercises, such as lateral band walking and single-leg RDLs, can strengthen the surrounding muscles and provide better support.
Soft tissue work, such as massage or foam rolling, can help recovery by improving blood flow and reducing muscle tension in the affected area.
Final Thoughts On CrossFit Injuries
If you’ve experienced one of these injuries, I hope this has helped you learn more about how to prevent it in the future.
As you can see, injuries usually result from doing too much, too fast, too soon, and from maintaining proper form while under heavy loads or high-rep Olympic lifts.
CrossFit injury rates are relatively low and comparable to those of other training methods and shouldn’t be considered a higher risk just because the methodology contains high-intensity exercises. (2)
Regardless, by training progressively and moving well, you can significantly decrease your risk of developing the most common injuries found in CrossFit.
But injuries and pain are complex.
Finding a licensed Physical Therapist or physical therapy clinic near you to evaluate and treat your injury thoroughly is vital to returning to the gym safely.
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References:
1. Shim, S. S., Confino, J. E., & Vance, D. D. (2023). Common Orthopaedic Injuries in CrossFit Athletes. The Journal of the American Academy of Orthopaedic Surgeons, 31(11), 557–564. https://doi.org/10.5435/JAAOS-D-22-01219
2. Gardiner, B., Devereux, G., & Beato, M. (2020). Injury risk and injury incidence rates in CrossFit. The Journal of sports medicine and physical fitness, 60(7), 1005–1013. https://doi.org/10.23736/S0022-4707.20.10615-7
3. Nielsen, R. O., Cederholm, P., Buist, I., Sørensen, H., Lind, M., & Rasmussen, S. (2013). Can GPS be used to detect deleterious progression in training volume among runners?. Journal of strength and conditioning research, 27(6), 1471–1478. https://doi.org/10.1519/JSC.0b013e3182711e3c
