Coping with Injury: Learning from a couple of CrossFit hipsters.

Guest author: Steph Habif, EdD, MS, CHES

If you do Crossfit, do you know anyone at your gym who has suffered an injury? Have you been injured? It seems the sport is producing more and more injuries – which may be true. Crossfit is rapidly growing in the United States. More participants means more injuries. And while we don’t know how many people do Crossfit, nor how many Crossfit injuries there are, we can accept injury as a normal part of sport.

John has been doing Crossfit for two years. He is 26 years old. Last December, he had a double hip replacement.

Steph is a retired triathlete who did Crossfit in 2010 for 10 months. She is 35 years old, and between 2006 – 2007, she had three hip surgeries.

What, if anything, do these two people have in common besides Crossfit and hip injuries?

John found Crossfit in September 2009 while rehabbing from a shoulder injury. He was active in the weight lifting world, and after reading an article on Crossfit, John reached out to a trainer at a local Crossfit gym. Serendipitously, that trainer had experienced two shoulder injuries himself and had extensive injury knowledge. Together, they pursued a path to ease John in, really focusing on the foundations of Crossfit to ensure his shoulder was safe.

By 2010, John caught the Crossfit bug and was training heavily. He wanted to compete in sectionals. That wasn’t to be, though, because by July 2010, John was dealing with daily hip pain. He did everything to manage that pain – long warm-ups, anti-inflammatories, heat and ice therapy, foam rollers and proper stretching – including taking an entire week off. During that week, John realized the pain was far worse than he thought. He stopped training in August 2010.

By September 2010, John was in the hands of multiple doctors. After extensive exams, he was diagnosed with avascular necrosis. Also called osteonecrosis, avascular necrosis is bone death caused by poor blood supply to the area. It is most common in the hip and shoulder. John and his doctors tried to reintroduce better blood supply to his hips by using crutches (to take stress off the bones) and bone strengthening supplements. That strategy didn’t work. So they scheduled hip replacement surgery for December 1, 2010.

John’s surgeon offered him a progressive technique called SuperPATH which involves replacing both hips on the same day. Because John is young and strong, they collectively decided to do it. John’s surgeons began at 3 PM and finished by 6 PM. His hips now look like this.

“By 8 PM I was in the recovery room, and at 7:30 AM the next day, I went for a walk around the hospital with the physical therapist. I spent two days in the hospital, and since then, the recovery has been really smooth. I did seven weeks of out patient physical therapy, continued to rebuild my strength, and on March 1st, I went back for my first Crossfit workout,” said John.

“The hardest part was coping mentally. I knew I could handle the surgery, but how fast could I get back to my activity? Did Crossfit cause my injury? No, but I think Crossfit and my active lifestyle revealed the problem with my hips – a problem that was already there. I did not spend time focusing on why it happened. Instead, I focused on the solution and recovery. I was very optimistic. I stuck to my paleo diet and fish oil supplements. This is an opportunity to relearn how to do everything again, and get better at it. It has been a humbling experience, but I get to rebuild.” John says he is grateful to be walking around with no pain, and intends to do a Crossfit competition sometime in the future.

Steph had three hip surgeries between the ages of 31 – 33. None were replacement or resurfacing surgeries, which means she is still all-natural. She has played sports her entire life, and just before her 30th birthday, she was diagnosed with advanced osteoarthritis. Meaning, she had no cartilage left in her hip joints.

The surgeons Steph chose reconstructed her hips to stop the degeneration. The first two (bilateral) hip surgeries were performed 14 weeks apart by a surgeon who specializes in bone disease. He did a procedure called osteoplasty, which means they shaved and reshaped Steph’s hip bones to get rid of all arthritic bone, and establish a situation where the joint could function better. The surgeon also fractured the bones in order to generate healing. Steph spent 16 weeks on crutches during her recovery. A few months later when she was able to exercise again - a specific progression prescribed by her doctors she diligently followed - she noticed the right hip not feeling “right.” When she went back to the doctors, they said she needed a replacement. Steph knew there had to be another option, especially since her doctors said her bones looked good.

So Steph found another hip surgeon in Vail, Colorado who was able to do a procedure that nobody else in the world was doing at the time. He cut off the top part of her IT band and grafted the tissue, which he used to reconstruct all of the cartilage in her right hip. Steph once again has hip cartilage, and has modified her lifestyle to better protect her hips. She no longer competes in triathlons, and when she does Crossfit, she modifies to avoid running and other risky hip movements.

Both John and Steph:

• Worked hard to secure an accurate medical diagnosis.
• Exhausted all non-surgical options for healing before choosing surgery.
• Advocated for their health with employers and health insurance companies.
• Found doctors and other healers to match their personal values.
• Tended to their physical and emotional health with psychotherapy, books, friends and family, medication, proper sleep, clean nutrition, and therapeutic exercise.
• Reframed their injury as an opportunity.
• Brought discipline to their rehabilitation.
• Cultivated an attitude of gratitude.

John and Steph say they are much better now at listening to their bodies. Being injured or previously injured does not mean you have to stop exercising. It means you have to listen to your body, communicate with your trainers, and practice healthy habits.

We know that people with high negative life stress, high anxiety levels, poor coping behaviors, and low social support are more likely to get injured. People with a history of injury are also at higher risk of injury. Does that mean that if you are going through a highly stressful life experience, you are more likely to get hurt doing Crossfit? Maybe. Maybe not. Some people are good at channeling their stress into exercise. However, high stress levels make it harder to make good decisions. Should you push through that last set? Even though your back is sore, should you dead lift? When should you skip the WOD?

Jorgen Matsi is a pro fighter and Crossfit athlete in Europe. He is also a sport psychology consultant. “People love the social identity of Crossfit, which adds to their desire to keep going back. And while this is healthy, it can also contribute to injury because sometimes a person cares more about being there and participating competitively than paying attention to form. People will overtrain because they don’t want to miss out.”

If you do suffer an injury, commit to an anti-inflammatory diet. The body’s natural and immediate reaction to injury is inflammation.

Check out these other resources: Kelly Starrett’s Mobility WOD: http://www.mobilitywod.com/

Mark’s Daily Apple: http://www.marksdailyapple.com/bodyweight-exercises-and-injury-prevention/

Association for Applied Sport Psychology: http://www.appliedsportpsych.org/resource-center/injury-and-rehabilitation

Here’s to happy, healthy training!

Dr. Steph Habif lives in San Francisco, CA. She serves as a sport psychology consultant and specializes in behavior design. You can contact her at steph@habifhealth.com Steph hopes to start Crossfit again in June 2011.