I saw someone post a paper published in the British Journal of Sports Medicine the other day, which discusses injury prevalence in Functional Fitness. The paper defines functional fitness as practice that includes varied functional movements performed at high intensity, including Olympic lifting, calisthenics, strength/power, gymnastic movements, plyometric exercises, running, and rowing.
As part of the paper, they also produced a nice glossy infographic with some interesting ‘statistics’ on there, relating to injuries in functional fitness. So, I thought it would make for an interesting discussion.
As a Physio and who coaches Crossfit classes, who occasionally participates in functional fitness, whilst managing my lower back pain – I felt I would be fairly well positioned to offer a bit of perspective on this topic. Especially given that I’m sure this paper will start doing the rounds, and could very easily be misinterpreted and even misused.
What did the study find?
First of all, lets look at some to the key points that came from the systematic review, which reviewed 26 papers (which you can find here) –
- The average prevalence of musculoskeletal injuries was 32.8%, ranging from 2.4 to 60.6%.
- Most studies reported the incidence of injuries per 1000 hours of functional fitness training, ranging from 0.21 to 36 injuries
- Experience with functional fitness has been included in a large number of studies, most of which have shown that more experienced individuals reported more injuries
- The prevalence of injuries that needed to be treated varied between 9.2% and 71.8% in the studies. Physiotherapy, injections, medications and surgical interventions were the types of treatment most used.
On the face of it, these statistics don’t really look very favourable for the ‘Trend” of functional fitness, as the paper describes it. But lets break these findings down a little bit, and add some context.
The average prevalence of musculoskeletal injuries was 32.8%, ranging from 2.4 to 60.6%.
Essentially, for every 100 people that participate in functional fitness, on average 33% will get an ‘injury’. In all, the review looked at 26 papers. Most were of ‘Moderate quality’, and pretty much all were at a high risk of bias, which somewhat muddies the water.
So we can see that there is quite a broad ranger with regards to the prevalence. There is also no comparisons made between the prevalence, the quality of the paper, and more importantly, the severity of these injuries. So we have no context to understand what proportion of these injuries were significant (or insignificant for that matter).
Incidence of injuries per 1000 hours of functional fitness training, ranged from 0.21 to 36 injuries
This basically means that for every 1000 hours of functional fitness that are completed cumulatively as a population within the study, between 0.21 injuries (So one every 5000 hours), and 36 injuries were sustained…
That is a huge range. Again there is no comparisons drawn to the severity of injury, or the quality of the papers at either ends of that spectrum.
So, essentially, this tells us … well… absolutely nothing to be honest. Great content so far…
Most studies have shown that more experienced individuals reported more injuries
It’s easy to jump to conclusions with this, with more experienced Functional Fitters… (That’s a term now) more likely to increase their load, train more frequently, with higher intensity, more likely to compete, and spike their load over a weekend… which is initially where my mind went.
But again, without any real scientific or robust content behind this statement, it doesn’t really offer us any more insight. ‘More experienced’ functional fitters could also mean they are… well, just older? Have evolving life circumstances such as increased demands at work… children… reduced sleep?
The prevalence of injuries that needed to be treated varied between 9.2% and 71.8% in the studies. Physiotherapy, injections, medications and surgical interventions were the types of treatment most used.
Physiotherapy, injections, medications and surgical intervention were the types of treatment most used. Again, that’s quite a broad spectrum, and I actually feel like the term ‘intervention’ would have been a better fit here. The term Physiotherapy doesn’t always have to mean that there was a hands on treatment process to ‘Right a wrong’ so to speak. My gut tells me that the intervention was far more likely to be some reassurance, guidance on appropriately rebuilding load, and generally just allowing an injury to settle.
Also, there is nothing in this paper that gives any context to those figures in relation to how many needed physiotherapy vs injection vs surgical intervention….
Did 71.8% need surgery in that paper? and 9.2% need a few days of paracetamol in then other paper?? This is where statistics like these need to be treated with a healthy dose of scepticism, caution and context.
My thoughts…
Anecdotally, I can tell you that within the functional fitness community, functional fitters… get injuries. Shock horror.
But guess what, so do
- Rugby players (46.8 per 1000h**).
- Netballers (11.3-14 per 1000h**)
- Runners (7.1-17.8 per 1000h**)
** Based on a quick google scholar search of some similar papers. The same limitations I have outlined I am sure will apply to these papers, so believe me that isn’t lost on me.
So essentially, within every athletic population, physical activity at times, can cause injury. But, guess what other population are are equally, if not more at risk of debilitating aches, pains and chronic health conditions? The inactive population….
Why does it matter?
My experience with data presented on visually appealing infographics like this is that it can occasionally be misused by people who have a bit of a bee under their bonnet about the function fitness trends, to try and dissuade people from participating.
“They’re all injured”
“If you carry on you’ll get injured”
“Don’t lift like that you’ll damage your spine
Source – ‘They’
I’ve heard these all before, and now I just shrug them off. Injury incidence in rugby is through the roof, and don’t even get me started on the incidence of concussions. But do we dissuade people from playing rugby? No, of course not. We understand the value that rugby brings to peoples lives, physically, mentally and socially. So we do what we can to educate and coach, and to mitigate the risk of injury as best we can.
And similarly for me, the benefits of functional-fitness…ing(?) far FAR outweigh the negatives. Reduced risk of heart disease, cancers, diabetes and other lifestyle related diseases is just the icing on the cake…. (perhaps not the best metaphor…)
All these are before we have even got on to the benefits on mental and social wellbeing! These gyms, studios, boxes, fitness spaces – in my experience, more often than not are hugely supportive communities. People of ALL abilities are welcomed, and supported to achieve their goals, and made to feel socially integrated.
So if you do come across this study, or any other study for that matter, be sure to interpret statistics like these with a healthy dose of context. Let us not use these studies to dissuade people from engaging with activities that can have such a drastically positive impact on Physical, mental and social wellbeing .
If you are interested in giving functional fitnessing a go, we have a huge variety of services on the platform, so go and check them out!
Thanks for having a read.
Mike Whichello – Founder One Stop Wellbeing
Thank you to HBA Photography for the use of the Photos! This man is an incredible talent!
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