Open letter to John Rusin & T-Nation
Imagine this... You are a typical guy/gal with ambitions to start some sort of fitness program that appeals to your taste buds. After all, it's been a while since you participated in a fitness program. You just started a fresh new job with an unquenchable thirst for success, so you work hard with long hours to demonstrate your awesomeness. Today, 84% of jobs require at least 28-37.5 hours a week sitting down for computers, driving, meetings and, etc. (5). Houston is the place to be with about 1000 newcomers a month (mainly for work), it's the hub of young-health-conscious-uprising-professionals of our nation (4). So, perhaps you're looking into group fitness or intramural activities to get you jump started again, get you socializing, and to get you excited about the guy/gal looking back from the mirror. Hmmm, like Yoga? Pilates, Zumba, Running Club, oooh how about Boot Camp? (lots of them on Groupon). You have always wanted to try racquetball or even tennis." But something with POWER." Your buddy or girlfriend has been telling you about military influenced training for tuff mudder. Above all of the buzzing fitness outlets available on the wall of health and wellness, CrossFit makes the most impression on you. Now, before we press on, I find it extremely important for you to understand the irrelevance of the activity you decide to participate in. The way I see it (you should consider this too) is that the entire purpose of being active is being active. Whether it's badminton, ping-pong, swimming, horse polo, Krav Maga, CrossFit, Powerlifting, BodyBuilding, Running, even rochambeau (http://www.urbandictionary.com/define.php?term=rochambo?). It's not about the sports type or fitness method that can be dangerous. But the lack of understanding of how to participate, your cognitive understating of how you move within that sport, how your body communicates with you, and what to do, to prevent injury. I call it the "why/when/what/how" approach. Recently, I came across this article by John Rusin published by the widely know website - T-Nation (click here to read the article). It was titled "The 4 most damaging types of training" (6). The article provided some shocking statements by a Human Performance Specialty Physical Therapist, and from what I gather a very successful doctor of PT nonetheless. I personally appreciate reading articles that provide evidence-based principles to support or refute their claims, which he did, I'll get back to this shortly. The article made its aggressive demands from its readers to "pledge your allegiance, pick a side, and get ready to wage war." wait what? I thought to myself as a reader, wage war against CrossFit, Powerlifting, BodyBuilding and Running? Now, his reasonings are his reasonings and I respect that. After all, I understand his perspective. I too played a similar role against Yoga, Pilates, and CrossFit too (click here to read the blog about - How Olympic Weightlifting and CrossFit changed my philosophy). Dr. Rusin makes his opening paragraph by stating "here's where I stand on which training methods are helping us achieve a greater overall level of fitness and health, and which methods should be banned in all 50 states" (6). To be honest, there is not a single recreational sport, fitness method, and wellness establishment that doesn't have an injury potential lurking with every move (1) (2) (3). Again, I understand that finding the truth is difficult, especially about CrossFit or similar training models. We advocate performance, injury prevention, and rehabilitation. "We seek truth, you will be wise to withhold judgment and not simply put our trust in the writings of what we find online, narrow minded supremacist discipline. We must question and critically examine those writings from every side. We should submit to argument and experiment, and not to the sayings of any person (and that includes me). Because every human being is vulnerable to all kinds of imperfections. As we search for the truth, we must also suspect and question our own ideas as we perform our investigations, to avoid falling into prejudice or careless thinking." Al-Hazen I am not trying to “wage war” or battle your opinion, rather give you a different perspective. Crossfit, like all of the other genres of athletic training you have mentioned, can be a beautiful thing; If done correctly. With that said, the following quotes are from the research Dr. Rusin uses to justify a portion of his claim. I have broken them down to so readers from either side can better understand the writing. Here we go, but don't hold your breath. ("to date no evidence exists in the literature to the injuries and rates sustained") (3) ("The purpose of this study was to determine the injury rates and profiles of CrossFit athletes sustained during routine CrossFit training") (3). ("injury rates with CrossFit training are similar to that reported in the literature for sports such as Olympic weightlifting, powerlifting and gymnastics and lower than competitive contact sports such as rug!y union and rug!y league") (1)(2). All which should be and can be intramurally incorporated ("Over the past twelve years since its inception it has grown to include almost 3,200 affiliated gyms worldwide and a recent ten year sponsorship with Reebok") (1) Actually it's 10,000 + worldwide. ("described as "constantly varied" criticism has been made with regard the apparently random exercise regimes and lack of individualisation for participants of these programs") (1). I agree with the individualisation factor, as it is widely seen (within the medical world) in other programs such as Yoga, Pilates, kickboxing, and other organized programs. However, the reality is, these fitness activities are not going to stop, and most importantly, CrossFit is not going anywhere! Dr. Rusin, I would encourage you and others to think about my proposal. Instead of bashing and criticizing a particular activity that makes such a difference in the lives of the participants, let's help and shape that community. As a CrossFit participant, I have witnessed the amount knowledge coaches have these days. They read endless articles, attend workshops, and educate themselves to help enhance the quality and experience of CrossFit. Granted, the conscious and collective experience is still not where it should be. We can start by explaining educational material to not just coaches, but the participating individuals as well. As a highly educated and disciplined performance specialty Physical Therapist, you should have the skills to break down complex movements to basic elementary format. To be honest, as a specialty practitioner I am a bit disappointed in your lack of understanding of how things work. Putting a band-aid on the injury is not the solution, and unfortunately your practice hinders and promotes tunnel vision. I am not judging you tho, I too played a similar role not too long ago. I get it; it's much easier to explain to your recent CrossFit injured patient "just don't go back" "Crossfit is dangerous and has no real evidence-based principles to support its benefits." Medicare and privet insurance just won't give you the amount of time to dedicate to the patient-education aspect of physical therapy. Nevertheless, with the staggering patients waiting outside your doors, how can you have the time to correctly guide your patients and help them understand the "why/when/what/how" to participate in the fitness affiliation of their choice. Forgive me if I assume, but if I were to assume, I would say you probably and successfully treat 3-4 patients at time. I don't blame you, today's PT practice is just that. Before you roll your eyes and say something nasty at your computer screen you should know that some of my mentors, educators, and influential role models are Physical Therapist. So I mean no disrespect towards the profession; it is just the nature of the beast itself. ("with regard the loss of good and proper form during timed workouts which may predispose to injury.") (3) Would you agree that this notion can also be applied to everyday movements,such as repetitive picking objects off the ground, or sit to stand movements? This is true as well, however, how would you expect otherwise? This takes me back to my original statement. It should not be "stop doing something that has the potential of damaging or causing injury". But let's explain the movements in CrossFit, Powerlifting, BodyBuilding, and Running. Let's simplify the pros and cons, what to worry about, what to feel and look for in your body or muscles. Let's work on technique and posture, and if you are starting out, don't worry about the time or PR. It is also about connecting the patient to their body and waking their innate understanding of one's habitual movement pattern. It is that simple. The CrossFit community is one of the most dedicated and supportive communities I have even analyzed. Ask them, and they shall come forward. A recent study by Hack end colleagues in 2014 (the only real study quantifying CrossFit, this is the first paper in the literature detailing the injury rates and profiles with CrossFit participation). They aimed to define the risk of injury during CrossFit workout participation and also define the pattern of sustained injuries by using a cross-sectional observational, experimental design. This will enable an evidence-based approach to the understanding of the risk of injury during CrossFit participation (7). Things to take away from the research: ("Injury rates with CrossFit training are similar to that reported in the literature for sports such as Olympic weight-lifting, power-lifting and gymnastics and lower than competitive contact sports such as rugby union and rugby league.") (7) Contact sports also mean football and lacrosse. ("Shoulder and spine injuries predominate with no incidences of rhabdomyolysis obtained.") (7) ("The high prevalence of shoulder injuries is higher than those previously reported for elite and competitive Olympic weightlifters.")(7) This is what we should be focusing on, "why/when/what/how" to work the shoulder to reduce the injury rate. Not completely stop it. It can be done...it must be done. A final note to my patients and friends: I say this, do your research and question everything. Participate in the game of life and be active in any sport, whether recreationally or professional. Run, Powerlift, Build your body, and CrossFit. Just make sure you prepare before and after. Do not be stupid, understand your weaknesses and strengths. Do not give a shit what people say about you or how much your deadlifting. Take your time and learn the sport. Form and technique should be your building block, your main focus at first, and foundation. Except the fact, that some movements are just not ok for you and are deemed damaging, so replace it with something that works. It is a matter of problem-solving, work on the movement that activates the same muscle group without the negative impact... THINK AND MOVE DIFFERENTLY Reference: 1) Paul Taro, Emil Hodzovic, Ben Hickey. (2014) The nature and prevalence of injury during CrossFit training. Published by Shannon Rodrigez. Lippincott Williams & Wilkins. Journal of Strength and Conditioning Research Publish Ahead of PrintDOI: 10.1519/JSC.0000000000000318. Source found on https://www.scribd.com/doc/208739450/CF-injury 2) Raske, A. and R. Norlin. Injury incidence and prevalence among elite weight and powerlifters. American Journal of Sports Medicine, 2002;30(2):248-256 3) Requa RK, DeAvilla DN, Garrick GJ. Injuries in recreational adult fitness activities. The American journal of Sports Medicine, 1993;21(3):461-467 4) Houston is the place to be with about 1000 newcomers a month (mainly for work), it's the hub of young-health-conscious-uprising-professionals of our nation 5) Today, 84% of jobs require at least 28-37.5 hours a week sitting down for computers, driving, meetings and, etc. 6) John Rusin. The 4 most damaging types of training. Published by T-nation.com on September 23, 2014. Source was found at http://www.t-nation.com/training/4-most-damaging-types-of-training 7) Hak, Paul Taro MBChB, MRCS; Mr; Hodzovic, Emil MBChB; Dr; Hickey, Ben MBChB, MRCS. (2014). The nature and prevalence of injury during CrossFit training. Journal of Strength & Conditioning Research: Post Acceptance: November 22, 2013doi:10.1519/JSC.0000000000000318 Original Investigation: http://journals.lww.com/nsca-jscr/Abstrac/publishahea/The_nature_and_prevalence_of_injury_during.97557.aspx
