5 Critical Errors Women Make During CrossFit
CrossFit is a worldwide phenomenon. The CrossFit Games Open had nearly 300,000 entries for the first workout. There are over 11,000 affiliates around the world. CrossFit is here to stay and it is a GOOD thing.
But just like every other exercise program or sport in the world, sometimes CrossFit isn’t suitable for everyone…or is it? Part of the beauty of CrossFit is that it is “infinitely scalable.” That means you can change the exercise or modify it so you are working out at a relatively high intensity – a high intensity for YOU.
But despite the best wishes and efforts of the coaches and athletes, injuries happen. Some are simply unavoidable and unexpected, but others, in my opinion, can have their risk reduced significantly. For this blog post, I want to highlight 5 critical errors I believe women make during CrossFit that significantly increase their risks of injury.
Women are simply different anatomically to men. Because women have a vagina, there is an extra passage from which pressure can “leak” from compared to a man. Not only that, the vagina doesn’t have a “sphincter” like the urethra and the anus does (where you urinate and defacate from). These simple facts put women at higher risk to pelvic structures due to increased pressure without the proper support.
Here are what I consider to be 5 critical errors women make when CrossFitting (or similar kinds of high-load activities):
- Not using training strategies that take female anatomy into consideration
- Not listening to their body’s signals
- Not using the right technique for their body
- Not considering a pessary
- Not getting an internal assessment by a Women’s Health Physical Therapist
1. Not Using Training Strategies That Take Female Anatomy Into Consideration
In a male-dominated world, much of what gets “decided” is basically whatever is good for the guys and the “girls” have to just follow. The same occurs in the fitness world.
However, strategies men use can be sub-optimal for women. In particular, I want to highlight the way men use intraabdominal pressure to support their trunk.
Remember how I highlighted the vagina and that it doesn’t have a sphincter to close the passag and this leaves it vulnerable to pressure? A common technique men use is to take a breath in, lock everything down and hold their breath to stabilize their trunk. This is a well known strategy that is effective typically.
The problem with this strategy is that the pressure will seek the easiest way to leak out if things are not perfectly locked down. Do you get heartburn when you lift heavy? That would be the pressure leaking up through your throat. Does your belly button become a soft bulge or your groin hurt? That could be a hernia. Some people aggravate their back pain – that is the pressure pushing out the back and irritating something that triggers the memory of pain you have had. Or, you might soil your pants or leak some urine. That would be your pelvic floor unable to meet the demands of the task.
But even worse than that is the use of weightlifting belts. Made of leather or synthetic materials, they support your abdomen and back and allow you to generate MORE pressure which will usually let you lift more. Here’s the issue: The belt will decrease your risk of developing a hernia and maybe even make your back feel a bit safer but all that pressure has to go somewhere. You have a sphincter for your oesophagus, one for your urethra, one for your anus and vocal chords for your throat…that means the one passage that can leak pressure is now under MORE pressure!
The result of putting excessive pressure onto your pelvic organs is that you can develop pelvic organ prolapse. This is where your bladder, your uterus or rectum can actually stretch the walls of the vagina and bulge into it. The consequences of developing a pelvic organ prolapse can range from no symptoms or issues (in mild cases) to being quite serious and beyond the scope of this blog post. Check out the International Urogynecological Association’s pamphlet on Pelvic Organ Prolapse for more information.
2. Not Listening To Your Body’s Signals
Controlling pressure is a problem for female athletes who CrossFit. Adding to that problem is the fact that the normal menstrual cycle of women means that the tissues in a woman’s body can undergo changes which make them more flexible at certain times during their menstrual cycle.
This tissue flexibility can seem like weakness – you simply can’t lift the weight you could last week. But it is the fact that the tissue is stretching more. If you put extra pressure onto these tissues, you can “overstretch” them and contribute to problems such as pelvic organ prolapse. Therefore, it is important that every woman who has a menstrual cycle listen to her body’s signals. Pay attention to how you are feeling and how your numbers are going at the different times of your period. Some women will feel a funny stretch or heaviness in the vagina or they feel like they might leak urine when they normally wouldn’t.
3. Not Using The Right Technique For Your Body
Similar to the first point, women often use techniques developed by men for men and then get distressed when they don’t fit a certain pattern. A classic example is the hip in the squat.
The angles that your legs form during a squat depends on many factors. The angle of the acetabulum, the angle of the femoral neck, and the rotation of the femoral head with relation to the femur all play a significant role in how you will squat. Add to that the “Q Angle” (the angle your femur forms with your tibia) and the flexibility (or lack thereof) of the ankle and you suddenly have many variables to consider when choosing how to train someone who is looking for the “right technique”.
Sometimes it isn’t just the anatomical differences that affect the body. The way you hold your breath can cause “bearing down” on the pelvic floor or it can spread the load (#spreadtheload) around the body. Learning the routine I teach on how to #spreadtheload will help get women back to lifting. In theory, it is safer for a woman to lift while still breathing but the reality is that you simply can’t lift as much that way, so learning how to mitigate this risk is important. You need to find good health and fitness professionals to help you.
4. Not Considering Using A Pessary
Basically, if you use techniques that aren’t friendly for vaginas (increased downward pressure without the right intrinsic muscle/fascia/ligament support), you will run the risk of worsening pelvic organ prolapse or developing it. You have to listen to your body to ensure you don’t overload it during heavy lifting and impact exercise as well as find someone to coach the right technique for YOU during the workout.
One way to help a woman with symptoms of pelvic organ prolapse is to offer her a pessary. A pessary is a device that sits inside the vagina and supports the pelvic organs and the walls the vagina. This is a great way to help reduce the risks of injury but it isn’t failproof as accidents still can happen. What are we to do? Live a life of “safety” and not taking any risks at all?
NO! That is not the human way.
I strongly recommend women wear a pessary if they are doing CrossFit (and have risk factors for pelvic organ prolapse), especially after having babies and the tissues are stretched out and the hormones and breastfeeding are keeping you extra-flexible! This is something that can be further discussed with your GYN, Urogynecologist, or Pelvic Physical Therapist (Women’s Physio).
Pessaries are fitted by some OBGYNs, Urogynecologists, or Pelvic Physical Therapists in some countries (Australia is one of them).
5. Not Getting An Internal Assessment By A Women’s Health Physical Therapist (Pelvic PT).
This last point is my most important point.
A good Pelvic Health Physical Therapist (Physiotherapist) / Women’s Health Physical Therapist (WHPT) will be able to advise you about A LOT of things that are going on “down under”. They can see if you have any pelvic organ prolapse, they can see why your bladder doesn’t quite work right. They can help with any pelvic pain you might be experiencing.
In Australia, we have WHPTs that are expert fitters of Pessaries and there are more modern thinking WHPTs who don’t mind CrossFit and how it can be beneficial with the right environment, the right patient and the right coaches.
An internal examination done by a WHPT is DIFFERENT to the one performed by your OBGYN at 6 weeks after your baby was born. The WHPT will look for different things during their examination and hopefully test how your pelvic floor contraction is and how you hold your breath and brace for loading. (Pelvic Guru sidenote – we will share more in the near future about what an evaluation with a pelvic physical therapist entails)
A visit to a good WHPT is worth the money. The very good ones will give me a report about what they have found and I can then help patients with programming and scaling their exercises to suit.
I have listed these 5 critical errors because I believe they put female CrossFit athletes at the greatest risk of injuring themselves.
Try to find a good coach that will take the time to understand how female athletes differ to male athletes.
Please, please, please understand that females have slightly different anatomy that makes them vulnerable to problems like pelvic organ prolapse. You want to sort those problems out ASAP and an ounce of prevention is better than a pound of cure!
The best way to determine your own individual risks are to find a good WHPT who you can work with and have them advise you on the best pessary for you to help protect you during lifting (please note that there are reasons why you may not be able to use a pessary).
If you try to avoid these critical errors, I believe you will significantly increase your longevity in the sport of CrossFit as well in the lifestyle that CrossFit brings.
Pelvic Guru side note – As some of you know, I’ve written about my concerns about the infamous “CrossFit and pee” video before. It’s still one of the top viewed blog posts. My mission was to make sure the correct information made it out to the public vs. condemning CrossFit as a whole. Leaking during high-intensity exercises is actually quite common (particularly after childbirth and years later). Women don’t have to simply accept it – there’s help! You can find pelvic health specialists (including pelvic health physical therapists) with this directory. Instead of suggesting that one is not a “real athlete” unless they leak, we emphatically believe that there are ways women can train to improve these symptoms. Thank you! ~ Tracy
If you want to learn more about how to deal with female athletes in high intensity exercise like CrossFit, we have a live course (for physical therapists, personal trainers, and other health professionals) available in Orlando in July 2016!! The Female Athlete. – A focus on the pelvic floor, core, pregnancy/postpartum and more! * You can use the code pelvicguru until April 15th midnight to receive a 5% discount off of the course.
Antony Lo The Physio Detective Sydney, Australia Australian Physiotherapy Association Titled Musculoskeletal Physiotherapist Master in Manual Therapy (UWA) B.App.Sc.(Physio)(USyd). Antony Lo is a physiotherapist from Australia and runs The Physio Detective service. He earned his degree from the University of Sydney and has been in practice nearly 20 years (old enough to see old things come back as new things!). He completed his post-graduate masters in Manual Therapy (Musculoskeletal Physiotherapy) from the University of Western Australia and has completed his Specialisation training in Musculoskeletal Physiotherapy. He has been involved with treating CrossFit athletes for 5 years and has helped some of the world’s best CrossFitters at the highest levels through to beginners of all ages. He loves and participates in CrossFit and is a strong advocate for the sport. Through participation and through his work as a Physiotherapist at all levels of CrossFit, he has developed a model of treatment that utilises the best from Sports Science, Musculoskeletal/Sports Physiotherapy, Pain Science, and Women’s Health research to provide a realistic holistic model of care balancing the biopsychosocial model of healthcare. He is NOT an employee of CrossFit, he does not represent or work for them in any way and his views and opinions are entirely his own. He holds a CrossFit level 1 – Trainer Certificate and is a CrossFit Football Coach/Consultant. Antony has a wife and 3 beautiful children in the best city in the world – Sydney, Australia!
Edits and Additions by Tracy Sher, MPT, CSCS