On CrossFit and Risk

Growing up, my mom would often tell me “When I was ten, I broke my ankle taking a giant step in the backyard playing a game of SPUD. Heck, if you can break your ankle taking a giant step, you might as well go out and do something more fun.” Fortunately, she has supported me through many such fun experiences over the years. But, like most parents, she has also instilled in me the fact that there is a certain amount of risk associated with doing just about anything in life. The responsibility falls on each one of us to evaluate and decide how much risk we are willing to take on in order to reap the potential rewards of our actions.

A "risk taker" from a young age, thanks to Mom

A “risk taker” from a young age, thanks to Mom

I have become increasingly familiar with the concept of balancing risks and benefits through my medical training. Though every medication comes with a laundry list of side effects, and there is risk with “going under the knife” for any surgical procedure, these treatments regularly save lives and reduce the burden of disease. Ironically, the hospital – the place to which we go for life-saving interventions – is also one of the most dangerous places to spend time as a patient. Deaths related to medical errors have been reported at 98,000 – 400,000 per year, the upper limit of which would make preventable medical errors the third leading cause of death in the US behind heart disease and cancer. (1-2) Despite ongoing and diligent efforts to improve patient safety, receiving medical care at a hospital is still accompanied by substantial risk. Yet, in times of compromised health, the potential benefits of hospital care still greatly outweigh this risk.

While preparing for my career in medicine, I’ve also spent the past five years involved in CrossFit. Although I am aware of frequent discussions in the media of its “dangers,” my decision to participate in CrossFit is no different than any other—I heed my mother’s advice and work to reasonably mitigate the risks and maximize the benefits. The benefits of CrossFit are incontrovertible: increased work capacity across broad time and modal domains, in other words, increased fitness. Whether measuring fitness with a maximal effort treadmill test or the ability to stand from a seated position on the floor, it is well-established that increased fitness reduces one’s risk of death. (3-5) In fact, having a better level of fitness decreases your risk of death more than controlling other risk factors such as your blood pressure, cholesterol, and blood sugar. (6) Quite simply, performing constantly varied, functional movements at high intensity (aka CrossFit) will result in increased fitness, and therefore better your chances of living a longer, healthier, more functional life.

The story of Pete, a middle-aged member of CrossFit Painesville, exemplifies the positive impact CrossFit can have. After a decade of being overweight and requiring an intensive medication regimen to keep his cardiac risk profile “within normal limits,” Pete walked into his local affiliate to give CrossFit a try. Despite challenging workouts and persistent soreness in the initial weeks, he decided to continue with his training. Eventually the soreness subsided and he became stronger, faster, and learned several new skills – his fitness improved. He went on to lose over 30 lbs and cure his diabetes, hypertension, and sleep apnea. Instead of continuing down a road of worsening chronic disease and more medications with their inherent side effects, he chose to endure CrossFit’s discomforts in order to reap the benefits of a fully functional and medication-free life. Pete’s story is not uncommon – nearly every affiliate around the world is likely to share a similar story about at least one of its members.

Pete before and after starting CrossFit

Pete before and after starting CrossFit

Yes, the risks of participating in a CrossFit program are also undeniable, ranging from soreness (highly likely), to a temporary musculoskeletal injury (less likely), to a catastrophic injury that permanently reduces physical capacity (very unlikely). Although stories of injuries sustained doing CrossFit run rampant on the internet, these same injuries and much worse are seen in our favorite sports and recreational activities. Personally, I’ve had more severe injuries over my years competing in gymnastics than in CrossFit, but no one ever suggested I should stop doing gymnastics. In honor of the glorious winter we’ve just survived, we can also examine the similar examples of skiing and snowboarding. According to CNN, there are about 2-3 injuries from snow sports per 1000 participants per day.(7) When high-profile skiing accidents bring scrutiny to the danger of winter sports, the International Society for Skiing Safety responds appropriately by advocating professional instruction, taking your time, and using correct equipment as ways to decrease the risk of injury. Under these guidelines, over 100 million individuals still chose to take to the slopes in 2013 alone. In comparison, a study published in the Journal of Strength and Conditioning Research, albeit small and with high potential for bias, reports an injury rate of 3.1 per 1000 hours trained using CrossFit.(8) Similarly, joining an affiliate and working with a qualified trainer, adhering to CrossFit’s mantra of “mechanics, consistency, intensity,” avoiding overtraining, and spending time on recovery (hydration, nutrition, sleep, mobility) are important ways to decrease your risk of an injury while still reaping the benefits of CrossFit training. Just as with snow sports, the risks of participating in a CrossFit program should not dissuade responsible participation.

Every once in a while, risks associated with the things we do become real—they exit the realm of statistics and remind us that we are human, as they did for many CrossFit athletes in the case the spinal cord injury sustained by Kevin Ogar in January. Of note, it is important to distinguish the elevated risk assumed by a high-level competitor over that of a recreational athlete. In pursuit of the benefits of high-level competition, we increase our training hours, perform more advanced maneuvers, and more aggressively push the limits of our bodies. Kevin’s accident forced me to pause and realize the risks I assume by competing in a high-level sport, as I’m sure it did most of my peers around the world. But what I can also state with confidence is that none of us has since thrown in the towel. The rewards we reap in the pursuit of peak fitness are too great to abandon for a small risk of a catastrophic event over which we have very little control. In fact, the rewards of improved functional physical capacity are exactly those which best prepare us to endure and recover from such an injury. Kevin continues to do CrossFit today because he understands its importance to his well-being and his rehabilitation. Similarly, after breaking her neck in a car crash, the strength Miranda Oldroyd had developed through CrossFit likely saved her from being paralyzed and also aided her quick and complete recovery. In these cases, the reasons for training functional movements become more obvious – in order to most successfully navigate life, we must build capacity in the movements life demands of us. When injury befalls us, these movements also provide the best rehab for meeting life’s demands.

Kevin Ogar and Miranda Oldroyd using functional movements as rehab

Whether you are taking a giant step, racing down black-diamond slopes, or performing constantly varied functional movements at high intensity, life is dangerous. Everything we do has some associated level of risk and benefit. We walk around every day not knowing the exact level of risk and benefit associated with most of our actions, yet it remains our responsibility to decide what’s worth pursuing. I, for one, see an overwhelming benefit to pursuing increased fitness, despite its risks. The soreness, pain, and even emotional ups and downs I experience in this pursuit are worthwhile knowing that I am preparing my body to surmount any physical task, recover from a catastrophic injury, and live a long, functional life with as few visits as possible to the “oh-so-dangerous” hospital.

______________________________________________________

  1. IOM (Institute of Medicine). To Err is Human–Building a Safer Health System. Washington, DC: The National Academies Press; 2000. http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
  2. James JT. A new, evidence-based estimate of patient harms associated with
hospital care. J Patient Saf. 2013 Sep;9(3):122-8.
  3. Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262(17):2395.
  4. Berry JD, Willis B, Gupta S, Barlow CE, Lakoski SG, Khera A, Rohatgi A, de Lemos JA, Haskell W, Lloyd-Jones DM Lifetime risks for cardiovascular disease mortality by cardiorespiratory fitness levels measured at ages 45, 55, and 65 years in men. The Cooper Center Longitudinal Study. J Am Coll Cardiol. 2011 Apr;57(15):1604-10.
  5. de Brito LB, Ricardo DR, de Araújo DS, Ramos PS, Myers J, de Araújo CG. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2012 Dec 13.
  6. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793
  7. http://edition.cnn.com/2013/01/14/sport/skiing-risks-deaths-injuries/index.html
  8. Hak PT, Hodzovic E, Hickey B. The nature and prevalence of injury during CrossFit training. J Strength Cond Res. 2013 Nov 22

40 responses to “On CrossFit and Risk

  1. Compelling insight Julie! Thank you! I will be forwarding this to my mom who worries herself to bits over my recreational CrossFitting.

  2. Pingback: Thursday, April 17

  3. Pingback: Wednesday, April 16, 2014 : CrossFit Costa Mesa

  4. Pingback: Clever | NCLab

  5. Pingback: CrossFit and Risk | Intrepid Athletics

  6. Very well written and researched. I appreciate having this as a resource that I can share with naysayers!

  7. Pingback: On Crossfit and Risk Vs Reward | Work WODs

  8. or we could shift altogether away from modern medicine and KStar and seek out genuine preventative care. Instead of pharmaceutical care from your PCP or sickness care from a hospital – both of which tend to treat only symptoms. Seek out movement specialists, get assessed and treated where there isn’t a chance that you’ll a) die, or b) only receive medication, as is par for the course of 99% of what we call ‘medicine’ today. Our healthcare system is bankrupting us and yet we are on average sicker than third world countries!

    • That’s all well and good but you’re still going to need modern medicine and the hospital if you ever suffer serious injury. We’re mortal and vulnerable and that’s all there is to it, so I think I have better things to do with my time than lecture someone else on how they handle their own health.

      • Lecture? What’s she’s saying is that increased fitness helps even when you have an injury. She never said medicine and hospitals were not needed for serious injury. In fact she is in the medical field so that would really make no sense if she were saying that.

        It’s your choice how you live your life. Have a serious injury when you are weak and increase your risk of death. Increased fitness only improves life and longevity for us vulnerable mortals. This you cannot deny and therefor cannot deny the goal of the article. Some things need to be said to be understood and she did a fantastic job even if you don’t like or appreciate it.

    • whats wrong with Kstar?

    • What is your beef with Kelly Starrett? He is a big proponent of not going the usual medical/pharma route. I think you’d honestly be hard pressed to find people with more knowledge about how the human body moves and should move. Maybe reading you wrong?

  9. Reblogged this on Not the fat kid in gym class anymore… and commented:
    The amazing Julie Foucher’s thoughts on Crossfit and risk. Great insight!

  10. Pingback: Risk vs Reward

  11. Pingback: April 18, 2014 | CrossFit Bear

  12. Pingback: Risky Business | WODservations

  13. Pingback: CrossFit SAC | Saturday 4/19

  14. Pingback: I can’t say it better | Ruya CrossFit

  15. I used crossfit as a rehab as well…more like I couldnt stay still and had to do something, so like any other person I went to the gym!
    http://instagram.com/p/W-V9VVvs0Q/
    https://www.facebook.com/photo.php?v=3093011859803&set=t.513789565&type=3&theater

  16. I really enjoyed your article.I need advice though.Here in South Africa the doctors do not know crossfit or the injuries and I have had major inflimation in both my knees that causes me to not be able to do squads or burpees for weeks at a time.Both times were caused by burpees.Any advice maybe?

  17. There are several problems with your views. Trying say that medical error is the third leading cause of preventable death is completely ridiculous. Also even if the risk is that high normally there is no choice in the matter. Fix the aneurysm or die. Very simple. Your comparison to skiing is also skewed. The risks of a sport like skiing are very obvious. You don’t have to be an expert to realize the high risk of hitting a tree without the proper skills. There is no debate fitness is integral in overall heath and we’ll being. The problem with crossfit is the risk is not obvious. There are also many more normal ways to achieve the same goal. Crossfit is also a fad. It takes a weekend to get certified. The risk of improper instruction is very high among traditional and we’ll understood methods of fitness. That being said crossfit isn’t necessarily bad for you it just has a higher risk associated that can’t be avoided simply by comparing it to medical malpractice.

  18. Playing Sunday morning softball (America’s pastime) I was part of an
    ordinary play that left a man paralyzed from the neck down… risks are everywhere… you can get hit by a bus on your way to work… a little common sense goes a long way…

  19. Pingback: On CrossFit and Risk | Entrenador Ricardo

  20. Crossfit does not injure people. And, you can not argue the health benefits of training. But.. trainers that train and load movement patterns that clients do not have the ability to perform, because of lack o skill or physical limitations or injury or even fatigue … that is what injures people. There is always risk but the trainer and client need to work together to minimize that. Training needs to follow a proper progression. Not doing so is like not following dosage instructions on medication.

  21. Pingback: WEEKLY UPDATE: APRIL 21ST-APRIL 27TH | CrossFit S3 | Strength Speed Stamina

  22. Pingback: CutThroat CrossFit WOD 4/21/14 |Back Squats, Sled Drags, Rev Ball Toss

  23. Pingback: 4/21/14 1 REP MAX DAY!!! | CrossFit Sonora

  24. Pingback: On CrossFit and Risk | CrossFit 7220

  25. Pingback: The Monday Morning Roundup XIV: Protein Quality and more – Vitality Sciences LLCVitality Sciences LLC

  26. Pingback: Tuesday April 22, 2014 | Crossfit Draper

  27. petermatthewshaw

    Reblogged this on Pete Shaw Strength and commented:
    “The doctor of the future will give no medicine, but will instruct in the care of the human frame, in diet,and in the cause and prevention of disease” – Thomas Alva Edison (1847-1931)
    That is the quote that reads on Julie Foucher’s ‘About’ page. I told myself that I would only ‘reblog’ on this website if I had no other choice. Julie Foucher leaves me no choice. Not only is this world class CrossFit athlete starting a career in medicine, but she boasts some serious writing skills. In this article, Julie Foucher outlines an issue that haunts the world of CrossFit – the element of RISK. Enjoy.

  28. Pingback: Thursday 140424

  29. Pingback: 250414 Risk Vs. Reward | Good Times CrossFit

  30. Pingback: 25 April 14 - Crossfit Silver Spring

  31. Pingback: ACF 4/25/14 | Auburn CrossFit

  32. Hi Julie,

    Have you been forced to miss any exams to compete? How did your school deal with that? I’m a first year at UT SOM San Antonio and my administration has stated that they won’t permit me to miss an exam in order to compete at Regionals. Any experience there?

    Thanks,
    Thomas

    • Hi Thomas,
      I have been fortunate because my program does not have exams, so I have only had to miss a few classes to compete. I am very grateful that my school is so supportive. All I can say is to try to explain the situation and if you have an advisor or mentor who can advocate for you that helps too. I’m sorry this isn’t much help, but best of luck to you in both school and CrossFit!

      Julie

  33. Pingback: Life is full of risks – so why is CrossFit so dangerous?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s