When it comes to physical therapy and CrossFit, I can say without a doubt that this is one relationship that needs some immediate attention.
The physical therapist is one of the most underutilized avenues of rehab among conventional fitness athletes and CrossFitters. Physical therapists are movement specialists with a deep understanding of human anatomy. PTs are also the main point of contact for physical medicine and unlike many primary care physicians, PTs usually won't tell athletes to give up the sports they love. Instead, PTs will provide athletes with the tools they need to understand how their bodies can perform better in those conditions.
Where do all of the CrossFit injuries come from?
CrossFit isn't the problem. The problem is that we don't fully understand the stress we are imposing on our bodies when we perform movements incorrectly. Oftentimes we are performing complicated movements under the stress of a heavy barbell, or we are racing the clock to squeeze a workout in.
Our bodies go into default in these situations because they are compliant vessels for whatever we demand of them. #ourbodiesareamazing. They will adjust for performance. This embodies survival. However, it can also result in injury. It's not so much the movements that are to blame as it is the physical asymmetries and underlying weaknesses that are uniquely inherent to each of us.
It's not the sport. The sport is just the medium. It's the poor body mechanics and faulty movement patterns that stop us all from performing at our best levels and ultimately what leads to injury.
Communication between physical therapy and CrossFit
How can the physical therapist and the CrossFitter co-exist? First, we have to talk to each other. There is little to no dialogue between these two bodies of knowledge at many of the gyms I have been to. The fitness athlete often comes to the table with some body of knowledge about fitness, movement, nutrition, sleep, stress, and how all of these things interact. Sadly though, many PTs cringe when the see a CrossFitter coming. Which in my opinion, is...well we know my opinion.
These athletes want to be educated on how to manage their impairments in order to be able to do what they love. They have been on google, they have utilized IG, asked their coach, and consulted their doctor. They need physical medicine. When physical therapy and CrossFit come together, amazing things can happen.
Not all, but many CrossFit coaches underutilize the physical therapist in their community. The physical therapist can counteract injury before it occurs, or at the very least manage someone's symptoms before that gym loses a member or needs to put an athlete on hold.
Identify pain
Physical therapists possess the innate ability (taking many patients on the journey through the injury continuum on a daily basis) to be able to identify and replicate a patient's pain in order to treat it. Your hip hurts? Ok, let's make sure that it's not coming from your back. Your shoulder hurts? Let's make sure that's not coming from your neck. The physical therapist is the one that can rule diagnoses in and out in order to help athletes safely achieve their fitness goals.
Pain is a powerful instrument. It can tell us when something is wrong. It is the body's way of checking back in to let us know something we did is "not cool". If pain comes on fast or out of nowhere, that is all powerful information your therapist can use to arrive at a diagnosis. The PT can then make a game plan with the athlete for workouts and injury management.
Assess biomechanics
Where I treat right now, I often use muscle energy techniques (MET) in my treatment programs. I believe more is less and that therapy does not need to be painful to be effective. The body likes to fall into a position of comfort. It compensates for weakness, tightness, and poor joint play in a variety of ways. Muscle energy techniques allow the body to move into more symmetrical movement patterns.
Neuromuscular re-education
You can squat. You can burpee. Sometimes with pain and sometimes without. So you don't exactly know what is wrong. Usually, pain comes from muscles that are tight, muscles that are weak, faulty joint mechanics, or a combination of all three of these things.
Underlying weakness can be difficult to identify without specific testing. We can still perform functional movements because of compensation. Our bodies are the masters of compensation, but after enough time they will start to break down. Muscles need to be re-educated at the core of their neural connections in order to work properly in conjunction with other muscles.
Strengthening
This is simple. Find the underlying weakness and treat it. Isolate the muscle and strengthen it. Many people do not know how to isolate muscles or identify which muscles are truly weak. A physical therapist can help with that!
Stretching
I have so many patients who believe that stretching is the solution to all of their problems and that limited flexibility is the root cause of their pain. However, it's usually a combination of weakness and tightness that is causing their issues.
Stability and mobility
Stability precedes mobility, always. Work with a physical therapist to achieve a stable core before addressing your range of motion (ROM) impairments. There are SO many movements in CrossFit that require an insane amount of core stability. A physical therapist has the tools to assess what level of lumbar stabilization is appropriate for you and will progress you in a safe way.
CrossFit needs physical therapy
These points just skim the surface of the mechanical issues that can creep up among CrossFit athletes. Many individuals fail to realize how important the relationship is between physical therapy and CrossFit. Under the careful watch of a physical therapist, athletes can better understand their movement patterns and subsequently avoid injury or safely return to sport.
