Since High Intensity Functional Training (HIFT) is relatively new, I thought it would be helpful to share my thoughts on this type of training. If you are unfamiliar with this term, perhaps you’ve heard of CrossFit - which is, by and large, the most popular form of HIFT. CrossFitters and non-CrossFitters alike have inspired the content for this article by asking such thought-provoking questions. I am a firm believer of the notion that if you want better answers in life, learn to ask better questions. These are questions virtually every CrossFitter at our physical medicine and rehabilitation center in Carol Stream, Illinois ask upon their arrival .
The 3 Most FAQs Dr. Earl gets asked about CrossFit
Is CrossFit Safe?
This is a loaded question, as there are several factors involved in making the decision for each person. Personally, I believe that CrossFit founder, Greg Glassman, created a movement (no pun intended) around the world by getting relatively sedentary individuals up and moving.
So, in a sense I commend him for creating a cult(ure) within the CrossFit community whereby exercise has become fun and competitive AND for all. Everyone has an entry point into CrossFit and everyone’s potential within the sport knows no bounds.
As with all things, though, there are some inherent risks with CrossFit. Most notably, has been the awareness of certain injuries heightened by CrossFit athletes. For example, a recent study showed the shoulder consisted of 39% of all CrossFit injuries, which was closely followed up by spine injuries at 36%.
For me, though, the question surrounding safety within an exercise-based activity lies in your past medical history, past exercise history, and current physical limitations. Take a former college football player who now works in the financial industry. They would adapt and assimilate quickly into the CrossFit world and would have less of an injury risk (as football strength and conditioning programs similar exercise selection as CrossFit does - such as cleans, jerks, deadlifts, and loaded carries).
On the other hand, if you’re a stay-at-home mom of 4, and want to get into an exercise routine without any background in cleans, jerks, deadlifts and loaded carries, then your entrypoint into CrossFit should be different than the former football player. By mastering the movements first, you can set yourself up for success in the long term. Most CrossFit injuries are a volume issue, after an individual does too much, too soon after doing too little for too long.
How Can I Get Pain Free?
This is another loaded question, one which requires further examination into one’s philosophy in life. Whenever a patient expresses the desire to be “pain-free”, or worse, whenever they were promised to be pain-free by another person, provider or commercial, I cringe a bit deep in my soul.
The reason I respond with such a visceral response to this narrative is because it narrowly looks at the issue at-hand without taking into account how the human body was Created.
One of my favorite discussions with new patients is when the conversation takes a deeper dive into the complexities of pain. Our team of specialist chiropractic physicians takes a more detailed approach when it comes to the conversation around pain. There are words we do not use at our office because they do more harm than good. For example, “weakness” is not spoken here. (That is not a motivational quote, but rather an intentional omission of a word frequently used at chiropractic, physical therapy and orthopedic offices). We refuse to allow our patients to walk out of their first appointment feeling worse about their physical body.
We do this by creating an environment for patients to share their journey and expectations of treatment. We believe that every one of our patients deserves the right to learn more about their pain, suffering, frustrations and, more importantly, the specific steps they can take (either on their own or with us) to change their path.
This includes the conversation about pain. As a healthcare facility in 2022, it is our view, and that which the literature and leading researchers in the field of pain support, that pain is a normal human experience similar to hunger and thirst. We view it as an important signal. We explain it this way to patients, “Imagine the fire alarm goes off in your house. Do you know where the fire is? Do you know how intense the fire is? Do you know what causes the fire alarm to go off? Typically, you would know if you just burnt the bacon in the oven and needed to open a window. I’m not talking about that situation, but rather, the type that wakes you up at 3am out of nowhere. What are your immediate thoughts? GET OUT! With no knowledge of the damage, location, or intensity of the fire - your only instinct is survival.
What if I told you that the pain experience creates the same perception?
Contrary to popular opinion, we do not know the causative tissue in pain experiences. There is a lot we don’t know about the complexities of pain, so we have to be very careful about how we describe it as such with our patients.
Here’s the take home point; we don’t focus on a “pain-free” state, but rather, pain reduction which allows our patients to complete the meaningful activities they desire. Yes, we have permitted runners to run in pain. Yes, we have permitted CrossFitters to deadlift even with a lumbar sprain, disc herniation and a weak core. Dangit! I said we don't use that word!
A quick note about core stability and a weak “core”....
A simple internet search for help with CrossFit injuries, especially the low back, reveals the misinformation plaguing the public. Nearly all of the articles written about low back pain for CrossFitters recommend “strengthen your core”. For over 8 years, I have asked for one example of a scientific paper where the original reference to “weak core” causes low back pain.
I have yet to have one person provide me with an example.
There are anecdotal cases, whereby individuals strengthen their core and voila, their low back pain dissipates. This would be a wonderful example of correlation not equating to causation.
Ice cream sales and crime both rise in summer months. Ice cream sales do not cause crime increases. Increases in crime do not cause ice cream sales to increase. They are correlated, or linked, by one confounding variable - the weather.
When Can I Return to CrossFit?
By now, you’ll appreciate that I don’t have a direct answer to these loaded questions. On one hand, I believe it is important to track your workload and manage your own specific situation properly. I would not recommend purchasing an online program, or following along with a youtube channel’s tips, as they cannot take into account your entire health history, physical limitations, and exercise background. It’s one of the biggest limiting factors for someone to improve, in my opinion, when they anchor their views on recovering from an injury by doing something that worked for someone else!
We are not all equal. We should be treated equally in respect and dignity, but humans are not created equal. My wife has blessed me with four beautiful children, and no matter what the New York Times might suggest, I can never give birth to a baby. Her body was built differently than mine, and as such, it will respond differently to injury. Giving her the same treatment plan as a 60 year old man who just had a total hip replacement would be inappropriate (and insulting to my wife!).
There is good news, though, if you are efforting through with a CrossFit related injury. (Please note: the only difference between effort and struggle is the presence of negative emotion). Your effort is not in vain. A unique, individualized plan of action is exactly what it will take to get you back into CrossFit in no time.
Our office ascribes to the notion of graded exposure. We also enjoy using simple metaphors and analogies to help simplify medical jargon. Imagine, if you will, you have a scab on your knee from when you fell off your bike as a kid. If you were like me, you wanted to pick at that scab day and night BUT didn’t want it to start gushing blood and be forced to restart the healing process. Instead, what I learned to do was to pick at the outermost aspects of the scab. The shallowest parts of the injury were also at the adjacent edges with the deepest portion being directly at the center. By picking at the edges, I started to reveal the healed skin underneath. This also prevented the scab from re-opening and starting all over again. Eventually, the entire scab would be ready to be peeled off.
Recovering from injuries, especially spine (neck and low back) related is best done under the same strategies. By gradually exposing the spine to movements which are safe, we build tolerance of the movements which used to cause aches, pains and tightness. With that being said, once Crossfitters get the slightest reduction in pain, they feel as if they are good to do something full-tilt again. This is equivalent to ripping the darn scab off again too soon. Rather, wait patiently and pick the edges with full body, stability, mobility and mentally challenging exercises. That’s where we come in.
We do this day-in and day-out at our office in Carol Stream. We’ve had hundreds of athletes, including CrossFitters, go through our office’s Pillars of Movement Screen to identify where your starting point is and (more importantly) where we need to get you to in order to get you back to the gym.
If this is something you, or a friend, family member or co-worker need, then here’s what you can do….
Do This Next:
A 4-Year Analysis of the Incidence of Injuries Among CrossFit-Trained Participants