Saudi Journal of Sports Medicine

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 21  |  Issue : 2  |  Page : 45--50

Injury rate among CrossFit participants and its associated risk factors in Riyadh: A cross-sectional study


Wassim A Aldebeyan1, Bader Aljadaan2, Abdullah Bin Dous1, Mohammad Almashouq3, Noura A Abouammoh4, Abdulaziz Alsubaie1, Abdulrahman Alshahrani3, Hind Alghamdi3, Muath Alsoliman3,  
1 Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia
2 Department of Orthopedic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
3 Medical Students, College of Medicine, King Saud University, Riyadh, Saudi Arabia
4 Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Noura A Abouammoh
Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 4545/145111
Saudi Arabia

Abstract

Background: CrossFit is a form of exercise that incorporates rapid and successive high-intensity movements. This study assesses the rate and risk factors of CrossFit injuries. Materials and Methods: This is an analytical, cross-sectional study that was conducted in four CrossFit affiliates (two for males and two for females) in Riyadh, Saudi Arabia. A validated questionnaire was used to collect the data from CrossFit athletes between January and April 2018. Data collected were incidence, severity, number of injuries, and potential risk factors for injury in the preceding 6 months. Using the SPSS software, data were analyzed using the t-test, Chi-square test, and multivariate logistic regression. Results: Among the 255 participants, 31.37% had an injury during the last 6 months' period. The incidence rate of injury was 3.33/1000 athlete hours. Participants who did not include cool down in their CrossFit workout were significantly more likely to be injured (41.58% vs. 24.68%, P = 0.004). Injured participants reported higher weekly athlete training hours (5.73 ± 3.89 vs. 4.55 ± 2.94, P = 0.008). Most of the participants' injuries were acute and required medical attention (51%). Conclusion: Injury rate among CrossFit athletes in Saudi Arabia is relatively high, especially among those who train regularly and those who do not incorporate cool-down in their CrossFit regimen. Cooling-down after CrossFit activities might help in reducing the rate of injury.



How to cite this article:
Aldebeyan WA, Aljadaan B, Dous AB, Almashouq M, Abouammoh NA, Alsubaie A, Alshahrani A, Alghamdi H, Alsoliman M. Injury rate among CrossFit participants and its associated risk factors in Riyadh: A cross-sectional study.Saudi J Sports Med 2021;21:45-50


How to cite this URL:
Aldebeyan WA, Aljadaan B, Dous AB, Almashouq M, Abouammoh NA, Alsubaie A, Alshahrani A, Alghamdi H, Alsoliman M. Injury rate among CrossFit participants and its associated risk factors in Riyadh: A cross-sectional study. Saudi J Sports Med [serial online] 2021 [cited 2021 Dec 8 ];21:45-50
Available from: https://www.sjosm.org/text.asp?2021/21/2/45/327481


Full Text



[INLINE:1]

 Introduction



Previous studies have supported the argument that high-intensity, single modal exercise with relatively minimal time investment is effective.[1],[2],[3],[4],[5],[6] Although the beneficial effects of extreme conditioning programs were acknowledged, concerns over the possible exercise-related injuries and rhabdomyolysis as a result of following these highly physically demanding programs, such as CrossFit, were raised by the Consortium for Health and Military Performance and the American College of Sports Medicine.

High-intensity intermittent exercise programs, including CrossFit, have many health benefits because of reducing total, abdominal, trunk, and visceral fat.[2],[4] Risk of musculoskeletal injuries among CrossFit athletes may result in extended rehabilitation time, missing work, and may require treatments. The early fatigue resulting from practicing CrossFit can lead to less resistance to subsequent repetitive exercise stress and unsafe execution of movements.[7]

There is much concern regarding the high musculoskeletal injury rates resulting from CrossFit; however, the available data are controversial. Weisenthal et al. reported an incidence of injuries of 19.4%,[8] whereas Hak et al. reported an incidence of 73.5%.[9] Moreover, in a study conducted in Brazil, 31% of the respondents revealed that they had experienced some type of injury while practicing CrossFit.[10]

To date, no studies have investigated the injury rate among CrossFit athletes and the factors that could lead to these injuries in Saudi Arabia. The aim of the present study was to examine the rate, severity, and number of injuries and potential risk factors for injury in the preceding 6 months. The results of this study may be used to assess the safety of CrossFit and to identify the potential factors that put athletes at greater risk of injury in Saudi Arabia.

 Materials and Methods



Setting

Using a simple random technique, four CrossFit affiliates in Riyadh (two for men and two for women) agreed to participate in this study. Three of the included CrossFit affiliates belong to the same company while one of the females' affiliates is owned by a different company. All the four included CrossFit affiliates were recruited from the different areas of the same city. It should be noted that females in Saudi Arabia are less acquainted with CrossFit activities and more likely to visit CrossFit affiliates for regular aerobic exercise.

Subjects

The sample size was calculated using the following formula:

n = Z2 (p[1 − P])/d2

The conventional level of confidence was set at 95%. For this confidence level, the Z-value was set at 1.96. The estimate for P was made using the data from previous study.[10] The calculated sample size was 329.

A total convenient sample of 283 athletes from the included affiliates were asked to participate. Participants were included if they were older than 18 years and had been training at a CrossFit facility and excluded if they had a preexisting injury before practicing CrossFit.

Data collection tool

A survey was developed and used to collect the data on these variables. It was based on a similar study by Montalvo et al. and was modified to meet the purpose of the present study.[11] Content validity was established through review by two certified Level I CrossFit coaches and one orthopedic surgeon. Subsequently, the survey was piloted, and changes in terminology were made to the questions based on feedback from experts and the piloted group. The survey was conducted using the Arabic language as it is the first language spoken by the Saudi population. An English version was kept for those who do not understand Arabic. Back translation was performed to preserve the meaning.

The survey was composed of three parts. The first part included questions related to the athlete's participation in CrossFit, including length of participation (months), frequency of participation, and warm-up and cool-down performance. The second part focused on CrossFit injury history within the last 6 months. Questions targeting type of injury were used to determine the mechanism (acute versus chronic onset). Questions targeting severity of injury focused on the changes that athletes had to make to their training because of injury and the treatment that they received following the injury. Finally, the third part included questions related to the athlete's background, including their fitness level before beginning CrossFit, general physical activity, and participation in CrossFit competitions, in addition to demographic and biometric information.

Data collection

Data collection was carried out at the CrossFit affiliates between January and April 2018, by the researchers, who visited the CrossFit affiliates on 29 random days, during the day or night, to distribute questionnaires and explain the study to attending athletes. Coaches at the affiliates were approached for assisting the researchers in recruitment and data collection. Athletes were chosen in a simple random approach. The researchers kept records to avoid interviewing the same participant. All records were kept confidential. Upon submission, each survey was reviewed for completion.

The study was approved by the Research Ethics Committee at King Saud University based on declaration of Helsinki, 1964 (Ref. No. 17/0992/IRB), and written informed consent was obtained from each participant.

Injury rate

Injury was defined as any physical damage to a body part that caused a person to miss or modify one or more training sessions or hindered activities of daily living. The injury rate was calculated by estimating the total weekly athlete training hours reported and then multiplying it by 26, the number of weeks in 6 months. The injury rate was then recorded as the number of injuries/1000 athlete training hours.[8]

Statistical analysis

After coding, data were analyzed using the Statistical Package for the Social Sciences (SPSS 22; IBM Corp., New York, USA). Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as percentages. T-test was used for continuous variables, and Chi-square test was used for the categorical variables. Multivariate logistic regression was used to assess the risk factors for CrossFit injuries. P <0.05 was considered statistically significant.

 Results



A total of 255 CrossFit participants completed the survey (209 men, 46 women). The response rate was 90% (255/283). Participant characteristics are presented in [Table 1]. The mean age of the sample was 28.17 years, mean height was 173.16 cm, and mean weight was 79.10 kg. No missing data was reported.{Table 1}

Injury epidemiology

Of the 255 participants, 80 (31.37%) sustained a total of 109 injuries during CrossFit participation in the last 6 months. Among those, 31 reported more than one injury over that period. Most injuries were acute (66/109), while the rest were chronic (43/109). About half of the injuries required participants to seek medical treatment (54/109), 42 were treated using self-administered therapy, and the remaining injuries required no therapy at all (13/109).

Risk factors for injury

The injury rate was estimated to be 3.33 injuries/1000 athlete training hours. Only a few characteristics differ between injured and uninjured athletes [Table 1]. Compared to the uninjured group, the injured group had a significantly higher average number of weekly athlete training hours (4.55 vs. 5.73; P = 0.008), and had an almost significantly higher duration of CrossFit participation (9.27 vs. 12.56; P = 0.051). Weekly athlete training days, weekly athlete exposure, class size, number of coaches per class, years of physical activity, age, height, and weight did not differ between the two groups in the unadjusted analysis.

Participants who included a cool-down period in their workouts had a significantly lower incidence of injury (24.68%) compared to those who did not include a cool-down period (41.58%; P = 0.004) [Table 2]. However, warming-up, in addition to participation in CrossFit competitions, fitness level before beginning CrossFit, whether practicing CrossFit for fitness, and physical activity outside of CrossFit were not associated with injury. No gender differences in the number of injuries were identified.{Table 2}

In the adjusted analysis, odds ratio was statistically adjusted to incorporate cool-down period first then again using number of weekly training hours. Participants who did not include a cool-down period in their workout regime had increased odds of being injured (adjusted odds ratio [AOR] =2.32, confidence interval [CI]: 1.34–4.02) [Table 3]. Moreover, higher number of weekly training hours was slightly associated with higher odds of injury (AOR = 1.12, CI: 1.03–1.23).{Table 3}

 Discussion



The current study aims to examine the injury rate among CrossFit athletes and its associated risk factors. CrossFit injury prevalence was found to be 31.37%, with an injury rate of 3.33 injuries/1000 athlete training hours. The number of injuries is significantly associated with the average number of weekly athlete training hours and whether they included a cool-down period.

A previous study reported an injury rate of 3.1 injuries/1000 h of CrossFit participation.[9] Another study, published in 2017, found an injury rate of 2.3 injuries/1000 athlete training hours. 11 Previous studies have shown the prevalence ranging between 19.4%, as reported by Weisenthal et al., and 31%, as found by Sprey et al.[8],[10] The higher injury rate reported in this study is likely due to the lower average number of years of physical activity, with an average of 4.51 years in this study as compared to 17.74 years in a previous study.[11] In the present study, 60.55% of injuries were acute and 49.54% required medical attention. This is similar to the result reported by Montalvo et al. which found that to be 54.8% and 40%, respectively.[11]

Injury rates reported for other high intensity intermittent exercise programs were close to that of CrossFit. Previous studies have reported injury rates for powerlifters ranging from 1.0 to 5.8 injuries/1000 h.[12],[13],[14],[15],[16] Injury rates among Olympic weightlifters ranged between 2.4 and 3.3 injuries/1000 h. 15,[17] Moreover, Kolt and Kirkby[18] reported an injury rate of 2.63 injuries/1000 h in professional gymnasts and 4.63 injuries/1000 h in nonprofessional gymnasts. This is supported by Montalvo et al., who found a similar difference between skilled CrossFit athletes and less skilled athletes in preforming gymnastic exercises.[11] Fifty percent of the participants of the current study reported having average fitness levels and the fitness level was not an indicator for the reported injuries. Although the difference was not statistically significant, this study supported that injuries are more likely to occur among those who described themselves as extremely fit as compared to those who described themselves as very fit or of average fitness, respectively.

In terms of injury risk factors in CrossFit performers, the number of training hours, which was significantly higher among injured athletes, was related to higher exposure to CrossFit (P = 0.008). In addition, the relationship between height and weight and risk of injury was not significant, which is contrary to the findings of Montalvo et al. and Winwood et al., who reported a significant relationship between these two factors and the risk of injury.[11],[19] They attributed the increased risk to the type and nature of exercises rather than body characteristics. Greater biomechanical load and the tendency to train with heavier weights among larger athletes were proposed as reasons by previous studies. Further, the relationship between the length of CrossFit participation and injury rate was almost significant (P = 0.051); this might be due to the shorter duration of participation (10 months) among the participants of the present study compared to 2.04 years in a previous study.[11] Among athletes who included a cool-down period in their workouts, only 25% sustained an injury, indicating a significantly lower risk (P = 0.004) compared to those who did not include it. As reported by Olsen et al., cooling down can significantly reduce the onset of muscle soreness.[20]

In addition, there was no significant association between injuries and participation in CrossFit competitions, which is similar to the results of Montalvo et al. who found a slight increase in injury risk in the competitors' group.[11] For the current study, it has been hypothesized that many athletes in the study population do not participate in competitions, but spend more time in training, so the risk can be attributed to exposure rather than competitions. Furthermore, CrossFit is considered a new sport in Saudi Arabia and the Gulf Cooperation Countries where it started only in 2014, which means that the number of athletes willing to compete and with access to competitions is less expected than that in other countries.

To the best of our knowledge, this is the first study to examine CrossFit-related injury rate and risk factors in Saudi Arabia. However, the study is not without limitations. As this was a retrospective study, recall bias may be a major limitation. Further, the questionnaires were distributed before the training sessions, which may have resulted in excluding injured athletes not attending the workout session. Future research should examine the relationship between injury location and training techniques.

CrossFit centers and coaches can play an important role by implementing an injury registry to help obtain more precise estimations of injuries. Moreover, it is essential to find a formula for proper scaling that can help athletes achieve their goals without experiencing muscle fatigue and injuries.

 Conclusion



Injury rates among CrossFit athletes and acute injuries that require medical attention are relatively high, especially among athletes with more training hours per week and those who do not incorporate cool-down in their CrossFit regimen. Cooling-down after CrossFit activities might help in reducing the rate of injury. Findings of this study offer useful data that could be adopted for future injury prevention research among CrossFit performers.

Acknowledgment

The authors are grateful to the Deanship of Scientific Research, King Saud University, for funding through the Vice Deanship of Scientific Research Chairs at the King Saud University Medical City.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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