So I'm warming up at CrossFit New England and one of my fellow members comes up to me and says, "My doctor told me to stop CrossFit training. What do you think?"
The question caught me off guard and caused me to reflect about my opinions on CrossFit and what I have heard from other doctors over the past 20 years of my practice.
I am an orthopedic surgeon, and on days when I am seeing patients in my office, I get to hear why people made appointments to see me. They will relate the history of the pain in body parts—a shoulder for example. They will tell me how it started, how bad it is and what they have already done to treat it. Many will have seen other doctors already, and they’ll tell me about their visits and the advice that was given to them. I am writing this essay based on patients' stories and what they have told me. Its purpose is to help CrossFit athletes sort through some of the advice they might have been given.
These are my opinions and should not be construed as medical advice.
Here are some of the quotes that I have heard:
“Never lift any weights over your head.”
You’ve probably never heard your doctor say this: “Don't put luggage in your overhead bin. Don't hold your child above your head. Don't paint your ceiling.” So why do some say you should never lift weights over your head?
The issue arose because some studies on shoulder anatomy showed people with a certain curve to the acromion bone have a higher incidence of rotator-cuff tears. When someone has that shape and the arm is lifted overhead, in theory the bone can dig into the rotator cuff—but some recent studies have questioned this theory. (Read “Shoulder Bursitis and Impingement” for more details.)
First, a lot of people don't have that bone shape and certainly can lift things overhead. Second, having your arm over your head for eight hours is different than having your arm over your head for a few seconds at a time. As with any weightlifting maneuver, weights should be easily controlled and form should be perfect. To suggest you shouldn't lift any weight over your head is wrong in my opinion.
“You shouldn't lift anything greater than 25 pounds.”
“Don't lift your child, your infirm mother or father, the groceries, or your school bag.” Again, your doctor never says any of that, so why do things change when kettlebells, dumbbells or bumper plates are involved?
I think some doctors extrapolate and are biased against weightlifters due to the stereotypical weightlifting mentality they see or hear about. Weight-bearing activity is the most important treatment for osteoporosis and has no medication side effects. No one can argue against this point or ignore the necessity of preventing osteoporosis in our elderly population.
Some doctors might say you will gain weight and raise your body mass index (BMI), a number that is calculated by height and weight measurements. Someone can be obese and have a high BMI. However, an extremely fit person—as defined by CrossFit—can also have a high BMI due to a large amount of muscle mass. I don't subscribe to the BMI-related no-lifting or no-heavy-lifting recommendations.
Individuals have different capacities when it comes to lifting. A novice should certainly not start heavy but can absolutely work toward heavier numbers with practice and proper coaching.
“Don't do CrossFit.”
I give injury-prevention lectures at CrossFit boxes, and at most of the lectures the coaches will turn to their members and say, "Now do you believe me that a doctor is telling you it is OK to CrossFit?"
These coaches tell me they actually have to stop their members from putting excessive weight on the barbell, performing maneuvers beyond their current fitness level and so on. It is the coaches who are more cautious than their members, and a cautious coach is the best kind to have, in my opinion. By telling someone not to do CrossFit, doctors are preventing patients from learning how to move properly under the supervision of a well-trained coach.
You might need surgery.”
As orthopedists we see many conditions that will improve on their own with activity modification, which is a funny way of saying, “Stop stressing the things that are hurting.” Tendinopathy, or the old name “tendinitis,” refers to microscopic tears in a tendon that will heal given the chance.
One has to recognize when things are not normal and adjust accordingly if soreness or pain develops. Sometimes surgery can be avoided with a few weeks of conservative management or rest, which is very reassuring to a patient who thinks something needs to be surgically repaired.
“You need a cortisone shot.”
Cortisone should be reserved for special situations that have not improved with physical therapy or rest. At times it is indicated and helps tremendously. However, cortisone has side effects that can weaken tendons or increase the risk of arthritis when injected in certain areas. It can be a very effective drug when it improves pain by decreasing the chemicals that cause inflammation, but it does not help things heal faster, which is why it should be used judiciously.
“You need to have this bone removed.”
At times surgery has great results when performed to remove a bone spur in the shoulder. But I have seen that surgery is sometimes recommended too often when the anatomy is not correlating with the diagnosis of impingement. The arch of the shoulder is important, and the bone should not be removed if it is not causing pathology.
In some cases, loads can be reduced to rehabilitate injuries and improve long-term health and function. (Dave Re/CrossFit Journal)
“You should never lift weights after surgery again.”
I think it’s unreasonable to make a blanket statement telling someone he or she cannot lift again after surgery. Life continues, and lifting objects is part of living. Just because lifting is done in the gym with weights does not mean you cannot modify your weightlifting. If someone is hurt at work and needs surgery, the goal of that surgeon should be getting the laborer back to work. This might include lifting objects that are heavy.
The goal of any sports-medicine physician is returning the athlete to the sport he or she loves. Every shoulder is different, every knee is different, and every surgery is different. Sometimes a surgeon will give someone the green light with no restrictions whatsoever after surgery.
However, given someone's anatomy, the severity of the injury or the specific surgery, a surgeon might suggest looking to the future and selecting lower weights. Life is not a sprint but a marathon of fitness that should keep you healthy after your 40s, after retirement and into the distant future.
About the Author: Dr. Sean Rockett is a board-certified orthopedic surgeon specializing in sports medicine. Dr. Rockett is a CrossFit Level 1 trainer and has been training at CrossFit New England since 2008. Dr. Rockett serves as assistant clinical professor at Tufts University School of Medicine, and he also enjoys being on the CrossFit Games Medical Team.