How to Increase Performance and Decrease Injury Risk in CrossFit – Part 1
As a Certified CrossFit Level 3 Trainer, competitor, and Doctor of Physical Therapy, I’ve seen the advantages of this unique sport from just about every angle. From cultivating community to increasing strength to improving fitness and vitality, there’s so much that CrossFit has to offer. Over a decade of training, teaching, and treating has allowed me to spot some patterns, notice common challenges, and identify areas where many CrossFitters can improve.
This first installment of a two-part series will discuss how to:
Make time for multi-planar exercises
Embrace unilateral accessory work
Work on structural balance
Slow it down with tempo work
I hope this gives you some ideas that boost your WODs, reduce your chances of getting hurt, and enable you to train sustainably for years to come!
Combining CrossFit and Physical Therapy
First, I’d like to share a little about my journey to finding CrossFit. In high school, I played tennis, basketball, and volleyball, but rarely did any weight training. Even in college, I was a runner and practiced Pilates spending little time lifting weights. For the first couple of years after finishing school, I was a traveling physical therapist. This meant moving clinics and locations every three months. By the time I ended up in the Northwest, I’d still not discovered strength training. In PT school, we didn’t dive into strength and conditioning principles as much as I would have liked, leaving me still intimidated about how to start weightlifting or high-intensity training.
I moved to a new place again and my clinic was right across the street from a CrossFit gym. I was still nervous about this kind of workout and didn’t think I’d be strong enough to do it, but I decided to just give it a try and see what happened. It didn’t take long to start seeing the benefits of getting stronger, fitter, and stabilizing my hypermobile joints. It was also a great way to meet new people when I was moving so often.
Soon enough I was enthusiastically drinking the CrossFit Kool-Aid and immediately seeking out a new “box” to train at in every new place I went. At the time, a lot of my PT colleagues were down on CrossFit because they claimed it caused a lot of injuries.
My first Olympic weightlifting meet at Kitsap CrossFit
I wasn’t seeing or experiencing that and since then, a review by Spanish researchers and another by a German team concluded that the injury rate in CrossFit is comparable to powerlifting and weightlifting, while another study found it’s lower than sports like hockey, soccer, and American football.
There was still a lot of skepticism back then and still today. Which is why I was so encouraged to meet the owner of one of the gyms I trained at. Like me, he was a PT and was further along in his career. He showed me how I could combine CrossFit with physical therapy to not only improve pain and injury, but also people’s fitness, health, and vitality.
That changed my career path.
I took the CrossFit Level 1 certification and started coaching, and more of my PT clients started coming from the gyms I was coaching at.
Now that I’ve been working with this population for a decade, I’ve started to see some patterns in how to effectively prepare for CrossFit, perform well, and recover adequately. A trial-and-error process in my own training, programming for athletes, and treating them has also revealed common mistakes people make and gaps in their approach. These can lead to:
nagging overuse injuries
load management issues
inability to bounce back between workouts AKA poor recovery
Fortunately, all these problems are fixable, so let’s look at a few simple solutions.
Make Time for Multi-Planar Exercises
While programming has improved significantly in the 10 years since I first discovered CrossFit and coaching has become more nuanced, the main gaps I see are still the same: a lack of multi-planar and unilateral movements that can result in asymmetries and imbalances.
Most core CrossFit movements – including deadlifts, squats, push presses, and cleans – are flexion/extension exercises performed in the sagittal plane. As people accumulate so many reps in such exercises, they’re almost always going front to back and up and down. On the flip side, there are few lateral (frontal plane) or rotational (transverse plane) movements in a typical week of CrossFit programming, that these patterns are often underutilized.
If you're mainly working in a single plane of motion, you're going to work one group of muscles more than others. As a result, athletes can start to develop imbalances. For example, you may have anterior shoulder pain, and your biceps tendon (and often the rotator cuff) may be getting irritated from a high volume of extension during push-ups, muscle-ups, and dips in CrossFit. There is a lot stress on the front side of the shoulder, but you may not have the strength or stability around your joint to balance that out. This could lead to tendinopathy or other overuse injuries because one side is always working harder than the other.
Doing multi-planar movements will work different muscle groups so that over time they're all steadily getting stronger and evening out the forces around the joint to increase stability. This keeps the joint balanced, ensures there isn’t excessive stress being placed on one muscle group and certain connective tissues, and reduces injury risk. Multi-planar movement provides a 360-degree approach versus only looking at and developing one side.
Examples of lateral and rotational exercises:
lateral step-ups
Cossack squats
curtsy lunges
lateral raises
Cuban press
CrossFitters get used to doing toes to bar, L-sits, and sit-ups, but they rarely work their core rotationally or with resisted rotation.
Examples of core exercises that test other planes of motion:
pallof presses
suitcase carries
rotational med ball throws
side plank variations
It can be difficult to include these exercise examples in a WOD, so try adding them during your warmup or as accessory exercises after your workout.
Multi-planar movement is closely related to another type of training that CrossFit athletes are often underexposed to - unilateral exercises.
EmbracE Unilateral Accessory Work
Most movements in a typical WOD involve using both arms or legs simultaneously and there’s a lot of barbell work (hell yeah!). This is great for training maximum strength and power and can be particularly beneficial to newbies who lack the movement competence for single-sided variations.
However, when you use a barbell, your dominant side is always going to take over and do more of the work. Whereas if you’re doing single-limb variations with a dumbbell or kettlebell (and sometimes even just body weight to begin with), you have to control each side of your body independently through different planes of motion. For example, a dumbbell push press will have a much greater stability component than a barbell variation.
I had ACL surgery on my right knee in high school and – ironically for someone who became a PT – didn’t do my rehab work well. When I started doing CrossFit, my lower body got much stronger overall, but I realized that my left leg was doing a lot more of the work in bilateral exercises. I had to deliberately add in single-limb accessory work to correct this imbalance and increase strength in my right leg. Anyone who’s had surgery on one side or starts CrossFit with an asymmetry could have a similar experience.
It's easier to program single-limb variations into WODs than multi-planar movements. Try switching out bilateral exercises for unilateral versions like a weighted step up instead of a squat or use dumbbells instead of a barbell for bench press. It’s also helpful to include more of the single-sided exercises that already pop up in CrossFit, such as dumbbell snatches, weighted lunges, and dumbbell push press. These create equally balanced strength on both sides and improve balance and neuromuscular control.
It’s amazing to see how someone who’s capable of a big deadlift can struggle with a single-leg version at first but then progress quickly. If you are worried unilateral work will ruin your gains, it won’t - and in fact, you could become even stronger. Check out this article about how unilateral training can improve your bilateral strength.
work on Structural Balance
Unilateral exercises and multi-planar movements both fit into a concept legendary coach Charles Poliquin popularized in the 1980s. According to a post on his website, “The structural balance theory states that you will make faster progress when all the different muscles of your body are in balance with each other.” He also found that achieving this would reduce pain, injury, and a lack of capacity on one side of the body.
Poliquin developed the Poliquin International Certification Program (PICP) upper and lower body assessments to find weaknesses and imbalances in the kinetic chain using certain ratios for different exercises (more details from coach Peter Roberts here), and then offered correctives to address strength deficits. He also suggested improving structural balance by developing stabilizing muscles through isolation work that complements big compound lifts.
Some of my favorites for the shoulder are elbow-on-knee external rotation and Powell raises, which isolate the supporting structures around the scapula. These examples elevate “typical” PT rehab exercises by adding load, not just a light resistance band.
Slow it Down with Tempo Work
Another typical gap in CrossFit is a lack of pacing variations. In a WOD, the emphasis is usually on going hard and fast and often involves accumulating maximum reps or finishing as fast as possible. This tends to lead to more bouncing out of the bottom of the squat or using momentum for movements like kipping pull-ups, thrusters, and push presses to cycle reps faster. Doing so can be considered its own skill that allows you to use heavier weights, complete more reps, and move quicker, which can be advantageous to the competitive CrossFit athlete and improve the overall work completed.
That being said, you can miss out on the control and stability that’s gained from true strength training.
Adding in tempo training will keep your tendons and joints healthy because you’re slowing the movement down and using your muscles and tendons. This requires controlling each stage of the exercise through the full range of motion versus relying on momentum or the stretch-shortening cycle. As a result, you’ll develop mastery, strength, and stability at every point of the movement pattern.
A lot of the clients I see have a weakness toward or at their end range of motion. For example, I can easily get to the bottom position in a squat clean but have more difficulty coming back up. For a long time, I relied on bouncing but began to have hip impingement and pain. I decided I needed to address this weak point in my squat because I was putting more stress on my hip joints and ligaments using momentum versus using my muscles to get out of the bottom of my squat.
Anyone who’s done tempo work can tell you, it’s HARD! But that’s where the magic is. Try adding in tempo front squats with a pause at the bottom as you are working on your squat strength. Over time, you will develop strength in those particular positions and improve your ability to get of those sticky spots.
As a bonus, tempo and pause work reduces the pounding on your knees and hips because it reduces stress on your joints, ligaments, and tendons. In addition, a longer tempo increases the eccentric load, which can lead to greater hypertrophy (muscle growth) over time.
So you are saying I can get gains and healthier tissues?
YES! Give these a try and find out.
Next on your reading list: How to Increase Performance and Decrease Injury Risk in CrossFit - Part 2, in which we will explore focused mobility work, developing strict strength, the importance of technique, and the two biggest recovery pillars.
