Orthopaedic surgeons frequently need to advise their patients on participation in sports and recreational exercise. A common concern with the wide variety of exercise options available remains the risk of injury related to the selected type of exercise.

Chris Durall, DPT, clinical associate professor at the University of Wisconsin (UW)–Stevens Point, has made significant research contributions to the fields of injury rehabilitation and injury prevention. In a 2018 study published in the Journal of Sport Rehabilitation, he compared the injury rates in CrossFit, an increasingly popular fitness option, to more traditional forms of exercise. CrossFit is a form of high-intensity interval training that involves performing varied functional movements.

Boris A. Zelle, MD, FAAOS, an orthopaedic surgeon at UT Health San Antonio and a member of the AAOS Now Editorial Board, interviewed Dr. Durall about those injury findings, as well as Dr. Durall’s research and experience in the field.

Dr. Zelle: Could you tell us a little bit about yourself and the work that you do?
Dr. Durall: I am currently a faculty member for the new doctor of physical therapy (DPT) program at UW–Stevens Point. We are using a competency-based curricular model to develop master-adaptive learners, and it has been tremendously rewarding to see these bright young clinicians rise to the challenge.

My role in the program is to teach the orthopaedic courses, as well as courses on pain science and primary care for physical therapists. Prior to this, I directed the physical therapy clinic at my alma mater, UW–La Crosse, for 18 years. While I was there, I also assisted with the DPT courses in the research curriculum.

Recently, you contributed to some research on injury rates among different types of exercise. Can you tell us a little bit about your study question and the approach that you used?
The critical appraisal of CrossFit injuries versus more traditional forms of exercise was a research project initiated by a student group when I was at UW–La Crosse. Some of the members of our research team were CrossFit practitioners, and CrossFit was somewhat novel at the time.

The team discussed a variety of research-related questions regarding CrossFit and landed on the injury analysis. We did a systematic search of the literature for research on injury rates in CrossFit, although at that time, there were not too many articles available. Data from the best available research were pulled for analysis. The studies that we analyzed used a retrospective cohort design.

What were the main findings of your study?
The main takeaway was that injury rates with CrossFit were comparable to or lower than injury rates with more traditional forms of exercise. CrossFit was specifically compared to injury rates for Olympic lifting, distance running, military conditioning, track and field, rugby, and gymnastics.

Among all CrossFit-related injuries, shoulder injuries seemed more common than in other sports, comprising about 25 percent of all CrossFit-related injuries. Interestingly, CrossFit-related injuries were higher in males than in females. We do not have a conclusive explanation for this finding, but it was also reported that males were more likely to perform CrossFit exercises without supervision by a qualified coach. Although this relationship does not prove causation, we suggest that supervision by qualified coaches may be an efficient way of lowering the risk of injuries when performing CrossFit exercises.

What can we recommend to our patients who wonder about doing CrossFit versus other forms of exercises?
At the time we published our review, the results suggested that the injury risk with CrossFit was more or less similar to a lot of other traditional forms of exercise. Based on our research, a case can be made for recommending appropriate supervision and CrossFit coaching. Individuals with a history of shoulder problems should be particularly cautious when starting CrossFit and should increase the training intensity in a slow and controlled manner.

Where do you see future research in this field?
More papers on CrossFit injuries have been published since our analysis, so there will be an opportunity for an updated review on injury rates. I would like to see CrossFit injury rates compared against rates from other forms of resistance training beyond Olympic lifting.

The studies we had to draw from were mostly based on retrospective data and, as such, were subject to survey bias and lack of randomization. The training programs also lacked uniformity. Hopefully, future studies will overcome these limitations.

Any other insights that you would like to share with the orthopaedic community?
This is more of an affirmation of conventional wisdom than an insight, but for any type of resistance training, I still believe that engaging slowly and gradually is sensible, as is utilizing a qualified coach. There is a painful irony to getting injured doing something that is supposed to improve your health.

By the way, it really impresses me that you and the larger orthopaedic community are keeping tabs on topics like this. Your patients are very fortunate.

Boris A. Zelle, MD, FAAOS, FAOA, is vice chair of research and chief of orthopaedic trauma in the Department of Orthopaedics at UT Health San Antonio. Dr. Zelle is a member of the AAOS Now Editorial Board.

Reference

1. Klimek C, Ashbeck C, Brook AJ, Durall C: Are injuries more common with CrossFit training than other forms of exercise? J Sport Rehabil 2018;27(3):295-9.