A simple presentation about how to treat CrossFit Athletes from a Physiotherapists / Physical Therapist's point of view. Included are what CrossFit is about, what it is not, some of the effects of CrossFit, What CrossFit Coaches (and athletes) want you to know and some clinical things you can do to help these athletes.

1. A Guide For Physiotherapists
Antony Lo
APA Musculoskeletal Physiotherapist
www.physiodetective.com
CrossFit Level 1Trainer

2. IntroductionTo CrossFit
What Do CrossFit CoachesWant
YouTo Know?
What CanYou DoTo Help CrossFit
Athletes?
Some Case Studies

3. What is Fitness?
“Increased work capacity over broad
time and modal domains”
What is CrossFit?
A methodology that optimizes fitness
“Constantly varied functional
movements performed at relatively
high intensities”
The community that is formed when
doing these workouts together
Source: http://www.crossfit.com/cf-info/what-is-crossfit.html

4. What CrossFit is NOT
New
More dangerous than other sports
A cult (but doesn’t mind if it is)
A fad
Irresponsible
CrossFit Does
Challenge beliefs
Pushes the envelope
Work

5. The Effects Of CrossFit
Physical – improved work capacity over broad
time and modal domains
Social
working out with these people sometimes up to
12 times a week or more means you are like
family.
It is rare, extremely rare to walk into a CrossFit
gym, do your workout and walk out again
without acknowledging someone or someone
having a conversation with you – it is the
opposite of a typical suburban gym.
Psychological – Many, many people use exercise
to relieve stress...at CrossFit, you do that with
your community, your family...you suffer
together

6. CrossFit and Injuries
Mainly typical MSK/Sports injuries
Shoulders, hips, knees, backs, necks
Myofascial – muscle/tendon
Articular – usually cartilage and ligament
Lots of overactive muscle motor patterns
Rhabdo – it happens, it shouldn’t
3.1/1000hrs injury rate (Hak PT et al 2013)
Similar to Oly weightlifting, powerlifting and
gymnastics and less than contact sports
Self reported data – 73.5% had an injury
Only 136 survey respondents
Running has 2.5-33.0/1000hrs
(Videbaek S et al 2015)

7. CrossFit and Injuries
That study...
Smith et al 2013 JSCR 27 (11) 3159-3172
10 weeks CrossFit program
Body Fat % and VO2Max both improved
Claimed 16% injury rate despite NOT checking if
those that couldn’t complete testing were injured
Lawsuit pending with claims of fraud and journal
editor not fulfilling their duties
That injury – Kevin Ogar
107kg Snatch – a relatively easy weight for him
It was supposed to be a triple (3RM)
It was his first rep
Theories?

9. There is CrossFit the GPP and CrossFit the
Sport
Don’t say you love CrossFit because of all the
work it gives you – it is BS
CrossFit patients are the best because they
want to get better
The coach really wants to help...and can
Better communication between physio and
coaches – including a plan for rehab!
Return to CrossFit Goals, not just no pain in
their ADLs
You don’t have to stop training when injured

10. Look at their problem movement!
Understand the movements so you can give
more specific advice
“Scaling” is a real thing – give good
substitution movements
If you want them to change something
(eg:technique), PROVE it is betterYOUR way
Better explanations on how to prevent injury,
not just avoiding the pain
Give appropriate exercises – “clams” isn’t
going to help their knee pain during 5x5 at
80% of their 1RM
Physios should do CrossFit

11. Subjective Examination “extras” to ask
What level of CF do they do?
What are their lifting numbers?
What movements are the ones that hurt?
When in the movement do they get the pain?
How far into the workout?
Pelvic Floor Questions
Stress urinary Incontinence
Pelvic Organ Prolapse
Pelvic Pain
What are their goals for this session?
What do they define success of treatment as?

12. Objective Examination “extras” to do
Find test/retest movements to “prove” success
Watch the movements that cause problems or
get footage of it – Coach’s Eye or Ubersense
Nail down the mechanism of injury and its
contributing factors – telling the person what is
sore won’t satisfy them
*** PROOF that your intervention and
suggestions are worthwhile go a long way with
CrossFitters ***
There is a lot of biomechanical model of pain stuff
out there – resist and go biopsychosocial

13. Treatment “extras” to do
Proof
Avoid passive treatment where possible
Exercises and stretches in functional positions
“Mobility” aids – balls, rollers, bands, gadgets
Mechanics, consistency, intensity
RefineTechnique
Get it reproducible
Add reps/load/time pressure
Rehab plan
Permissible Exercises including scaling
options/suggestions
Specific rehab program
EMAIL the coach!!!

14. Dear Neil, Dear Dave,
Thanks for referring Neil for an assessment about his right elbow pain today
He presented with 6-8 weeks history of right elbow pain with some left elbow I/T symptoms. It hasn't gotten
better with rest.The chiro he saw recently said to rest and she will look at it next time. He has scaled all
the way back to the bar only for weights and pullups are painful. Push ups had some pain/tension too.
From my assessment, I found that neil's nerves on the right were irritated from his neck.This seems to be the
major contributing factor to his pain in the right elbow.
We worked on pullups, strict press, dumbbell press and push ups today. I also did some neural mobilisation
and neck mobilisations (no manipulation this time).

15. Pullups - we scaled it back to feet supported with elbows out, elbow at 45deg and elbows forwards. no pain. No chin raising to
achieve chin over bar.Set a box or stool or plates up so chin is over bar at the top (or kill 2 birds with one stone and set it up
for strictCTB PU)
Strict Press -These were still tension in the right elbow. It may take some time to settle this down (about a week). So long as
there is no pain, I am happy. It will fatigue quickly.Allow the elbows to fly for now and progress towards "proper"
technique later. it is more important that Neil actually just moves and it isn't that heavy so no harm, no foul.
Dumbbell press - best for this was old school dumbbells with wide elbows into a military press.Work in 3-5 sets of 5-15 reps NO
PAIN.The effort should feel equal on both sides. Progress from elbows at 90degABD to 45deg to elbows forwards please
Push ups - long neck setup BEFORE loading up onto hands and toes
Alternate arm and leg swim with scap movements - in push up position - long neck - work on gaining that strength and
endurance to keep your balance.

16. Work bags - set the neck in a long position and try to pull from the back of the shoulder blades instead of letting your arms get
dragged out of the scaps and rounded.You dictate where the bags are, don't let the bags dictate where you are
Neural mobilisations
- i taught you how to roll into and out of the nerve mobilisation on the wall- fingers pointing down, palm on wall, NO
STRETCHING or altered sensation please!
- watch and do this "dance" please - https://www.youtube.com/watch?v=QZlt8bNb07I
Training - you can train in whatever you want that doesn't hurt. ideally there should be equal effort and tension in both arms.
You may find anti-inflammatories useful but if you do take meds, check with your GP or pharmacist first and still treat the
exercise gently...the idea is to retrain the brain to move pain free and meds can help achieve that goal and break the pain
cycle. be sensible in your scaling - if it is 25 pullups in aWOD, maybe do 5 good quality strict or band up so you can do 25 to
get the cardio benefit or do ring rows without pain etc etc. Just keep moving albeit pain free as much as possible please.

17. I would like to see you again in about 1-3 weeks. Come sooner if you are feeling worse or a lot better - if
worse, then I need to do more to settle things down. If a lot better, I would like to progress your exercises
a lot more. If progress is steady, then in 2-3 weeks will be fine.
Thanks again. If you have any questions about training, work, scaling options or anything else, please don't
hesitate to email me.
Cheers

19. Give PROOF
The Neural System is the Key (Performance and Recovery)
“30secs rule”
#tensiontotask
#spreadtheload
Variability is King – Can you do all the variations?
External Cues are best – avoid “activation” cues
Ask about PF symptoms and refer toWH Physios
Believe the RESULTS, not the BS story we make up to
try explain why things happen

20. Posture
Core Activation
Squat
Deadlift
Others?

21. Results are really what matter to the client
All explanations (including mine) are just stories
we make up to try explain a result
Believe the result, not the stories
Do what it takes to get the right result
Challenge your own beliefs about CrossFit and
many clinical beliefs – the results are there

22. www.physiodetective.com – articles and courses
CrossFit.com
Journal.CrossFit.com
Most Popular = mobilitywod.com