TRAINING WITH AND THROUGH INJURIES

Perhaps one of the most talked about aspects of CrossFit is the potential danger it presents and the supposedly higher rate of injuries incurred though CrossFit style training. Let us try and put this to rest once and for all, before we beat it like the proverbial dead horse over and over some more. I know it seems hypocritical for me to even suggest such a notion, albeit sarcastically, as I once again open this can of worms for further discussion. However, I promise you I will focus this post more on training through and around injuries and not on a defense of the safety inherent in performing functional movements (you know the very same ones found intrinsically in our DNA).

One of the most common questions circling the gym immediately prior to a workout is what can be done to scale or modify the WOD. Generally speaking this is not an attempt to find the easy way out, but rather is an attempt by one, if not multiple participants, to determine what can be done to accommodate their current situation. Typically this "situation" is some form of an injury.

Now let's make sure we address the idea that acute injuries are very different from chronic injuries:

Acute injury is a sudden injury that is usually associated with a traumatic event such as a fall or accident. Your body will subsequently undergo, often negative changes, in the immediate aftermath of this incident. A traumatic impact can cause your bone to crack, muscles to tear or ligaments to snap. You will likely experience a sudden sharp pain that is often severe, there is often times immediate swelling and even cold purple regions in your body that indicates a lack of proper blood circulation in that injured part. Almost all of us have missed at least one box jump, need I say more?!

Chronic injuries can be also called overuse injuries. Like the name suggests, such injuries are usually caused by the overuse of a particular part of your body either through sports or exercises. They develop slowly and last a long time. Initially the symptoms of such injuries are mild compared to acute injuries and the pain they cause can be minimal. This often leads to a false sense of security, which in turn prompts a person to ignore the injury and carry on with their activities. Over time, the symptoms will likely build up and cause more problems. Some common symptoms of chronic injuries include experiencing pain whenever you engage in sporting activities, swelling and constant aching even when you are otherwise immobile. In other words, chronic injuries are lifestyle threatening as they restrict you from participating in many things. Some examples of chronic injuries are stress fractures, tendonitis and tendinosis.

After 12 years of existence CrossFit has been featured in numerous articles, blogs and even television shows. Although the coverage has often been relatively impartial there still seems to be a deeply held belief that CrossFit is inherently dangerous at best and even deadly at worst. I'm not going to go down the rhabdomyolysis path during this post, I will save that for another time as it is a fairly meaty subject worthy of its own attention.

Constantly varied, functional movements delivered at a RELATIVELY high intensity sounds like an oxymoron right? Well it is not. Needless to say you can have your cake an eat it too when it comes to CrossFit but only if you are smart about. 

Constant variety does not imply randomness. To be random something must be "proceeding, made, or occurring without definite aim, reason, or pattern." This would preclude us from ever being able to measure, test and retest ourselves in an effort to measure our progress. While yes we must be prepared for the unknown and unknowable we can prepare for such using systematic and progressive overloading principles found in any basic exercise physiology textbook. The devil is in the details and the art is found in how we apply such principles in a fun and challenging context.

Functional movements, as mentioned earlier, are those movements found in our original DNA. Movements like running, jumping, climbing, squatting and lunging are just a few of these examples. Oh and yes we do "pick things up and put them down," but we do so with a purpose and with an assurance that what we do in the gym will have an appropriate functional analog in nature as well, for we are looking to improve our lives outside the gym as well as inside it. 

I intentionally highlighted the word "relatively" as a precursor to the notion of high intensity because this is where this tend to get dicey. Seen the CrossFit Games on TV? Good because that is not CrossFit, that is in fact the CrossFit Games. Even CrossFit HQ defines The Games as being distinct from CrossFit itself. It has been suggested that this spectacle of fitness is reserved exclusively for the upper one half of 1% of people/athletes participating in CrossFit. This is not to suggest that performing some of these workouts is not possible, and they are most certainly often a fun and good time. It is to suggest that this is not often where we should look for examples of what CrossFit is, especially if you are new to this style of exercise. Instead you need to find an affiliate with qualified coaches, a long track record of delivering a quality product and an atmosphere that feels warm and embracing. You should also look for a program that caters to multiple fitness levels and experience levels and you should make sure that there is always appropriate scaling and modifications available to meet your current needs and demands. What is intense to one is not necessarily to another and everyone needs just the right dose to get the most out of what they put in. Fitness cannot be dictated to anyone, it can be facilitated and the onus for the rest falls squarely on head of each person. 

My friend Anthony Roberts has looked into the research and found that the incidence of injury in CrossFit was 3.1 injuries reported per 1000 hours of training. This was found to be similar in rate to sports such as Olympic Weightlifting, powerlifting, gymnastics and even lower level contact sports such as rugby. http://romanoroberts.com.mx/the-nature-and-prevalence-of-injury-during-crossfit-training-study/  

All that being said I do not currently know one active, or even semi active, person that has not gotten hurt at some point and had to train with, through or around some sort of injury. Chances are the longer we participate in something the more likely we are to get injured at some point. This is where one's true character is often revealed. It is easy to be motivated when we feel good and we can do everything, but when we have to struggle or persevere a little bit that is when we find out how badly we really want something be it competitive or otherwise. It takes fortitude, mental toughness, and discipline to train through injuries. By now we have all heard the saying, "When the going gets tough, the tough get going." Although this may at times seem cliche there is some real substance to this notion.

So let us walk through how we should approach an injury, be it acute or chronic.

FIRST: Let's determine how we may have incurred the injury and then clearly identify what movements specifically cause pain or discomfort.

SECOND: Let's get real! If the pain in your shoulder is bad enough that you cannot lift your arm then we need to consider going home or at least sitting out today's WOD and consider possibly working on some form of mobility or recovery. You can come to the gym and do something but let's be smart and find the right something to do. If the pain is not that bad but we simply want to avoid further strain then you need to get to the gym a little earlier, warm-up a little more than usual and discuss what modifications and/or scaling might need to be employed to get you through the WOD. All WODs are infinitely scalable and modifiable. Our needs never change just the means to which we achieve our ends.

THIRD: Rest, Rest and Repeat! Although this is probably common sense it often gets lost in translation. Admittedly we are all very committed to our fitness endeavors, some of us even border on obsessive/compulsive and that's ok too. Sometimes the only remedy is a few days off. While it might turn into a few weeks depending on the situation, this rest period is huge when it comes to getting healthy again. During this time you can research your injury. Just do not become a hypochondriac and diagnose yourself with every disease and mental disorder under the sun, that will not help. Seek out others who have experienced the same injury and pick their brain a little bit to see what helped them and how. Focus on recovery. Get out your foam roller and lacrosse ball and start addressing those adhesions. The caveat here is to make sure you understand your injury and any potential repercussions to using these tools on swollen areas or inflamed tissues. You may also ned to visit a health care provider such as a chiropractor or massage therapist.

FOURTH: As soon as reasonably possible start working range of motion. Most injuries will not necessarily hurt through an entire range of motion. Try and identify what your pain free range is and use it. Scale your WODs and pick alternate movements that work for you, but as always discuss these adjustments with your coach to make sure everything is copacetic.

FIFTH: Avoid creating new injuries. This can happen when you start to create new imbalances based upon your new training approach. Try not to do too much of any one thing and continue to use that constant variety principle. Use this time to address you core strength (we could all probably use some extra focus here) and little things like balance training and even mental training.

SIXTH: Do not limit your research just to muscle groups. Include movements, and how they affect each other. There are an incredible amount of angles, movements, and resistance methods to target nearly every muscle regardless of what is hurt. It takes creativity and educated experimentation. If your hand or forearm is broken, you can loop a band around your elbow/tricep and perform handless rows. Figuring out ways to rig bands and bars around a power rack will surprise you with how diverse you can train your body even with injuries. Even performing the same movements but with a different “groove” or tempo can be outstanding, especially if the injury was suffered performing that movement.

SEVENTH: Try and get an idea on when it is ok to push it a little bit more in your training. If you want to get back to your pre-injury level then you will need to push it a little at some point. Obviously this will be a nuanced path so take your time and be deliberate. Start by getting back a full range of pain free motion. Once established you are clear to start adding weight back into the movement. It is okay to be cautious at first but just remember that trying to hard not to get re-injured is a good recipe for getting injured again. We have all heard about being in the zone right? The idea is that when you feel good and are performing optimally you do not have to think too much or try to hard at what you are doing, instead it comes naturally and freely. The same applies here, if you are too tense or too hesitant moving heavier weights again you are likely going to move in a stunted abnormal manner that will likely get you hurt all over again. Eventually you will need to find the guts to push harder again.

EIGHTH: Never stop learning! The definition of insanity is doing the same thing over and over again expecting a different result. So every time you get hurt, use it as a learning opportunity. Figure out why you got hurt and try not to do the same thing that got your hurt. Really analyze what happened or went wrong. Was the weight too heavy? Were you not as focused on form as you should have been? Were you benching again before you had recovered from your previous session? Understanding how you got one injury will also help you avoid future unrelated injuries. Train smart and stay healthy.

At the end of the day just remember there is no quick fix, i.e. a cortisone shot. Although this may provide some relief and can be an very necessary component to our recovery it is not going to fix things at a fundamental level. For the vast majority of us, we work out for fun or because we are committed to a certain level of health. We are not professional athletes, nor for the most part even competitive amateur athletes. Our priorities in our lives are different from a pro-athlete and therefore our priorities in the gym should be also.

Your mission in the gym is to get stronger, fitter, and healthier for the long haul. Training through pain and skipping recovery will not get you to that place. You can do it in the short-term, but it will come back to haunt you in the form of continued injuries, arthritis, chronic pain and more.

Think about the people in the gym who have the best form and put up the best numbers. They are the people who put in the work day in and day out, not the people who try to muscle through things. Treat your injury recovery the same way. Take the time necessary to heal properly; it will serve you in both your performance and your quality of life for years to come.