Crossfit modifications?

[Statko]

Anyone have any insight as to how / if Crossfit workouts can be modified for those who are employed yet injured?

 

I live in a rural town that has a small but enthusiastic Crossfit community. I have noticed (might be imagining it) an increase in workplace injuries in those who also participate in Crossfit. I'm a weakling and am pretty intimidated by the whole Crossfit concept; I don't really understand how it works. I thought it was a pretty prescribed, full-body regimen that people are expected to power through.

 

I find myself putting people on workplace restrictions and then see their cars in Crossfit parking lots. I'm not experiencing an uptick in people who are trying to avoid going back to work. These are pretty motivated patients and I get the sense that they are going to work and work out no matter what I recommend. It's tricky to assign appropriate lifting / activity restrictions that don't completely leave them out of being able to work, but that don't encourage them to go full-steam at crossfit and experience delays in healing / new injuries.

 

Two issues - which came first - workplace injury or crossfit injury (I'm not even getting involved in that one... in my mind, doesn't really matter now that the injury is there and I've gotta figure out how to deal)

but secondly, I'd like to know more about the crossfit culture and if any PAs have any tips for setting injured crossfitters up for success?

 

[Reality Check 2]

I don't do CrossFit and I have several patients who are addicted to it and obsessed. It is a culture that I see quite a bit.

 

IF a patient has a workers compensation injury and you have written restrictions ---- those restrictions are in effect BOTH AT HOME AND AT WORK.

 

If you work note says no squatting - that means no squatting at home or exercise. If it says no overhead reach - same thing.

 

So, the patients need to be counseled that THEY ARE RESPONSIBLE for following restrictions.

 

Workers Comp boards are not above private investigators with cell phone cameras filming patients doing things that they aren't supposed to and it shuts down their claim, ruins their credibility and often gets them fired from employment.

 

A patient with a work injury should be seeing a licensed physical therapist and doing only prescribed exercises and activities. IF the PT feels they can do certain things in their normal workout routine - such as upper body weights only - no leg lifts - then the PT writes it down in their note and you incorporate it into your work restriction listing. 

 

I have viewed many videos of workers comp patients (worked in Occ Med) doing things not supposed to be doing - driving a car with a concussion or head injury, carrying a cough up stairs while on full leave for back injury, going snow skiing with "bad back" .

 

Put the onus on the patient and remind them you can't go home with them to monitor but a private investigator can...... 

 

People need to not be dumb - tough one to overcome

 

My very old tainted 2 cents..........................

[Statko]

Hey Reality -

Totally on board with your comments, you're spot-on. Especially the can't cure dumb part. :)

 

I am more curious about whether the crossfit culture actually recognizes ("allows"?) modifications. If the workout is prescribed and people are getting a lot of grief or peer pressure when they do less reps, less weight, modify the grip, etc then it's much easier for me to say "No crossfit." or "No crossfit until cleared by PT" (sorry to throw it off on the PT...)

But my patients claim otherwise... and so it makes it harder to say "well, you can't lift 25# at crossfit, but you can at work." And I am sure as heck not going into a crossfit in my soft postpartum state to find out! haha.

[Reality Check 2]

I just had a mental flash of Joe Piscopo in Napolean Dynamite in parachute pants leading the dojo group.....................

 

Have you consulted with a Crossfit leader or their website? Perhaps you can pose an anonymous question to their website about medical restrictions and work injuries and participation in CrossFit.

 

I don't want to go in their gym - no desire whatsoever. Former soccer player here - completely happy to walk for exercise with a knee that needs to be scoped again.................

 

Hopefully someone who does or knows CrossFit will post and give us some insight.

[TheFatMan]

I used to do CrossFit a few years ago, and the only thing I would add is that the crowd typically believes that "the doctor doesn't know what he/she is talking about, what I do is completely safe," when in reality they probably haven't been coached on proper ways to do most exercises and/or are doing them too fast with little to no supervision. Just an FYI. 

[RuralER/Ortho]

...meathead checking in here....

 

 

Not a crossfitter whatsoever, but I am familiar with their system and gyms in a general sense. CrossFit is basically a franchise with a loose standardization policy. There really are gyms that run the gamut - from gyms that are owned/coached by a PT or have an in house PT clinic to the opposite end of the spectrum where some knucklehead has a weekend certification and thinks he's an expert.

 

As far as changing the training... I'm sure this varies gym to gym and based on the culture present. Reducing the workload is referred to as 'scaling the workout' in crossfit terminology. Also some offer open gym type times where equipment can be utilized in a typical commercial gym fashion. This may allow patients to easily work around injuries.

 

The quality of the gym is independent of the brand on many levels. If that high of a percentage of your patients really go to this gym it is probably wise to develop a relationship with them.

 

The chronic injuries due to crossfit is a big deal in my opinion. The typical cross fitter who receives the standard coaching will keep shoulder and back surgeons plenty busy in the future....

[sk732]

Smart patients work out around their injuries - of course there are fucktarded coaches (and patients) that don't get it, just as much as there were fucktarded bosses I dealt/deal with in the military when it comes to injuries getting worsened by under/unqualified people running physical training.  Just make sure, like RC2 noted, that if a person is on WCB compensation for a workplace injury OR on restricted duty due to an off time injury, that they're not doing what you've sick noted them to avoid.  I usually let people know that and document it if I'm the least bit concerned about their attitude towards getting better.

 

SK

[Reality Check 2]

As long as PX90 exists - shoulder surgeons will be employed.

 

Cannot count the number of injuries I have seen from this one.

[sk732]

We actually had a general order put out in the Canadian Forces a few years back regarding Crossfit, since we were getting a number cases of rhabdomyolysis...amazing how many trainers tell people to take NSAID's when they don't even know word one about the problems they cause to normal people, forget dumb and dehydrated ones.

 

SK

[Febrifuge]

I just had a mental flash of Joe Piscopo in Napolean Dynamite in parachute pants leading the dojo group................ .

Point of order: Rex (inventor of Rex Kwon Do) is played by Diedrich Bader, not Joe Piscopo. Showing your age there, RC. ; )

 

http://www.imdb.com/name/nm0046033/

[medic25]

Point of order: Rex (inventor of Rex Kwon Do) is played by Diedrich Bader, not Joe Piscopo. Showing your age there, RC. ; )

 

http://www.imdb.com/name/nm0046033/

 

You beat me to the punch; knew I could count on you!

 

"Bow to your sensei!"

 

Ever seen the medical parody of Napoleon Dynamite?  Classic...   

[cbrsmurf]

Crossfit is not a good idea for anyone with any type of injury.  The typical CF gym teaches poor form on their weight/strength exercises and can potentially cause or worsen injuries.  

 

Here is a good representation of crossfit

[Reality Check 2]

Point of order: Rex (inventor of Rex Kwon Do) is played by Diedrich Bader, not Joe Piscopo. Showing your age there, RC. ; ) http://www.imdb.com/name/nm0046033/

Yep - old AND forgetful. Dammit

[Sapper-PA]

All workouts in Crossfit can be scaled or modified to fit your abilities.  That being said, many of the ''boxes'' or gyms have poorly trained coaches that don't know how or won't modify the workouts.  Someone going in for the first time may be encouraged by the coach to continue without proper form.  On the other hand I've heard of boxes that have great coaches that won't allow it's participants to increase weight or reps until they can perform the exercise properly, so it's entirely dependent on the individual gym and coaches.  The other issue that I've seen, and I've got a lot of first hand experience with the military, is that many of the injuries come from peer pressure to do more, faster, which causes the participant to sacrifice good form or not listening to their individual abilities and that leads to injuries. 

 

The overall responsibility should be on the individual to protect themselves but if they ignorant to proper techniques and just plain don't know any better they can be lead astray. 

[Guest ERCat]

Don't even get me started on CrossFit. It is horrifyingly hard on the body. I did it a few times and was shocked to see how risky some of the moves are. They encourage lifting the heaviest weight possible at the expense of safety, as they often do it with poor form. See the video of the pill up guy above. CrossFit is a perfect way to herniated a disc or tear a rotator cuff. No thanks.

[Guest ERCat]