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I don't hate CrossFit

As a physiotherapist, in particular in women’s pelvic health, this is not the common view. But let me explain why I feel this way.

Let me just quickly take you a few years back to the unthinkable video … a 5-minute YouTube video showcasing CrossFit (CF) and Stress Urinary Incontinence (or EIUL as they coined the term in the video).

As horrified as I also was with this acceptance of what was considered and congratulated as “normal”, so started the much needed and fun discussions and collaborations with musculoskeletal/sports physios, women’s/pelvic health physios and the CrossFit community around the world.

Now, not long before this video, just as CF was exploding in popularity, I started to see a couple of women in my clinic with pelvic floor dysfunctions - who were doing CF! All I could picture was videos I had seen at CF Games/competitions with women in proud puddles jumping on boxes or holding 150kg over their head while squatting…all the way…to the FLOOR! Ugh. What were these silly women thinking?!

I don’t like the unknown or uncertainty and I wanted to know more of why people were becoming “addicted” to lifting heavy things and sweating so much…so I jumped into the research and put myself into these women’s shoes (more in a figurative sense - I don’t need nor want 150kg above my head, but that is just me). I just wanted to know more so I could educate and treat these women who are involved in this type of sport…and possibly talk them out of it! But what I thought I knew about CrossFit was challenged.

What I have learned is that there is way more to this CrossFit thing than exercise. It is a big positive, supportive, motivational community. It is way more about the relationships and environment than the actual exercise itself. The community is what seems to be the addictive part of CrossFit and why so many people don’t want to give it up. The type of community that many people need to either start a journey towards health and exercise, or maintain one. A place I would hesitate to take a patient out of.

What I also learned is that CrossFit is just a sport, like any other sport. Just like gymnastics, just like powerlifting, just like running, just like trampolining. A sport that som​​e people really like and enjoy, despite whether or not people tell them they shouldn’t do it. A sport that yes, will increase intra-abdominal pressure, like other sports I mentioned above, depending on what exercise you are doing. It isn’t and doesn’t have to be all heavy lifting, jumping and kettlebells. You could just work on mobility if needed. It can be adjusted and scaled right back to what we teach as basic rehab exercises.

And on the topic of intra-abdominal pressure and sport, I reviewed the evidence (or evidence showing a lack of evidence) looking at intra-abdominal pressures (IAP) in sport, as well as looking at elite athletes and pelvic floor dysfunctions. The three conclusions that seem to surface are:

• IAP possibly correlates to intra-pelvic pressure - it’s higher in activities that are higher in intensity (as opposed to breathing at rest) but it’s very individual • sport may cause the pelvic floor to strengthen, possibly above “normal” resting tone and into “overactivity” • sport may cause excessive and repetitive stretch/lengthening damage to the pelvic floor muscles themselves and the connective tissue supporting the pelvic organs and contributing to continence mechanisms

The risk of pelvic floor dysfunction and the path an individual’s body will go is so varied, complicated and INDIVIDUAL. But I have seen quite a few women in CrossFit with impeccable pelvic floor strength, even despite connective tissue and/or muscular deficits. Much like other elite or higher level athletes, their ability of their pelvic floor to compensate for the extra IAP and force, plus or minus the dysfunction, is not what I see in the general population…if only some of my patients had their strength. Yes, some would argue they border on dysfunctional PF hypertonicity (which I have also seen in higher level athletes) but it has been the minority thus far.

I am still not at the stage of recommending CrossFit to people as THE fitness regime to start, much like I will probably not advise my patients to take up aerial skiing. I continue to have some hesitation with aspects of CrossFit - the possible lack of knowledge base of coaches/trainers, in particular musculoskeletal dysfunctions, the group setting and possibility of not catching someone before the point of fatigue and loss of form, especially in the intensity that is desired in training, and the competitive nature on intensity and form - but I am willing to continue to help educate those coaches, trainers and athletes. I am more than willing to encourage individual assessment with a women’s pelvic health physiotherapist and do what I can do help someone continue something they love to do, if at all possible.

#crossfit #pelvicfloor

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