CrossFit Myths DebunkedBest Practices for Inclusion

& Risk Management

Christina Lafex, CTRS/L

Orlando VA Medical Center

Recreation Therapist

Alec Zirkenbach

CrossFit

Adaptive Training Course Lead

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CrossFit Myths Debunked

• Alec Zirkenbach (CrossFit, Adaptive Training Course Lead SME)Alec is passionate about, and specializes in, adaptive and wounded warrior training. As a disabled veteran, service members’ fitness and long-term health are deep-rooted passions for Alec. After college (Virginia Tech B.S.), Alec was commissioned in the U.S. Navy and was deployed to combat zones multiple times. He suffered a tragic injury that left him hospitalized for months and required 20+ surgeries attempting to save his leg and regain function from paraplegia. Traditional rehab and recovery was a slow and demoralizing process for him…until he rejoined a CrossFit community. Despite losing function and sensation in his right leg and suffering a spinal cord injury, Alec returned to active-duty service for two more years. During his last tour, he co-founded Kuwait Naval Base CrossFit (military affiliate) and being medically retired, he opened Fathom CrossFit and ran that affiliate for five years. He was then hired by CFHQ to create an Adaptive Training Course to teach coaches how to train adaptive and temporarily impaired athletes. He now works full time for CFHQ as the director for Adaptive Training program and lead subject matter expert.

• Christina Lafex, CTRS/L (Orlando VA Medical Center, Recreation Therapist)After receiving her Bachelors in Recreation Therapy in 2005 from Southern Connecticut State University, Christina began her career at Gaylord Specialty Healthcare in Connecticut on the in-patient spinal cord injury unit and worked for the Sports Association where she assisted in running over 15 adaptive sporting events throughout the year. In 2011 Christina took a position at Kessler Institute for Rehabilitation in New Jersey on their spinal cord injury unit where she developed an exercise program with patients at bedside and integrating into the community gym. Additionally, she developed an accessible transportation group allowing patients to trial getting on and off airplanes, trains, wheelchair accessible vans and cars. In 2012 Christina began her career at the Orlando VA as a Recreation Therapist where most recently she created and implements an Adaptive Sports program for outpatients with varying ability levels. Additionally, Christina holds CrossFit certifications Level 2 and Adaptive Training.

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CrossFit Myths Debunked

Purpose Statement: This training will provide Clinicians and other Professionals with an overview of Adaptive CrossFit. Attendees will be able to identify benefits of participation in Adaptive CrossFit and apply what they learn within their own programs.

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Learning Objectives:• Describe what CrossFit is and the benefits

specifically for the disabled population

• Learn the two most effective tracks when starting an Adaptive CrossFit Program

• Promote safety and success for people with disabilities through Adaptive CrossFit

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CrossFit Myths Debunked

What is CrossFit?

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Cross ● Fit noun trademark A high-intensity fitness program incorporating elements from several sports and types of exercise

“…fitness was work capacity measured acrossbroad time and modal domains, and that indeed isfitness and is CrossFit.”

- Greg Glassman

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CrossFit Myths Debunked

What is Adaptive CrossFit?5

• Work Capacity

• General Effect on Work Capacity

• Specific Effect on Work Capacity

“…true fitness is a general physical capacity that would lend itself well to any and all contingencies.”

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CrossFit Myths Debunked

Goals of Adaptive CrossFit 6

• Lifelong Fitness

• Functional Movements

• CrossFit Charter – Effective, efficient & safe training

– Mechanics - Consistency - Intensity

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CrossFit Myths Debunked7

Myths Debunked

• High intensity

• Injuries are common

• Not for beginners

• Competition focused

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CrossFit Myths Debunked

Adaptive CrossFit used to support Whole Health Initiative

“Being physically active is one of the most important actions individuals of all ages can engage in to improve their health”

• According to the American Medical Association Physical Guidelines for American approximately 80% of adults and adolescents are insufficiently active

• Average CrossFit Class is 55 minutes

• Recommended 150 – 300 minutes/week of moderate-intense or 75 – 150 minutes of vigorous-intensity physical activity.

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CrossFit Myths Debunked

On-Site Adaptive Training

• Clinician attends Adaptive Training Course and facilitates on-site fitness 1:1 and/or group fitness sessions

• Establish cleaning protocol with infectious disease concurrence

• Equipment maintenance

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Implementing Adaptive CrossFit Programs

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CrossFit Myths Debunked

Implementing Adaptive CrossFit Programs10

Partnering with community CrossFit Affiliate

• Coaches take Adaptive Training Course and teach individuals with a disability Adaptive CrossFit.

• Establish a partnership with CrossFit Affiliate via MOA/contracted agreement

• Provide recommended assessment tool

• Educate coaches about helpful tools, modifications, training aids and equipment

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CrossFit Myths Debunked

• Must be medically cleared for physical and cognitive participation in Adaptive CrossFit

• May need to provide own transportation

• Participants do not need to have an athletic background

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Eligibility Criteria

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Initial Assessment Tool

CrossFit Athlete Initial Assessment

1. Contact Information

Name:_______________________________________

Nickname:_______________________

Current Mailing Address:_________________________________

Phone Number:_____________________

E-mail Address:______________________________

Emergency Contact:__________________________

Phone Number:_____________________

Date of Birth:_________________ Height:_______ Weight:_____

Gender: M F

2. Military Service Information

Military Status: □ Active Duty □Veteran □Reservist

Branch of Service: □USN □USMC □USA

□USAF Rank:______________

Years of Active Duty:______________

Date of Separation from Active Duty:________________

3. Personal Goals

What brought you into the gym

today?_________________________________________

What are your top three goals?

1.______________________________

2.______________________________

3.______________________________

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CrossFit Myths Debunked13

Initial Assessment Tool (continued)

Do you have an athletic background? If so please disclose in detail__________________________________________

Are you currently experiencing pain anywhere on your body? If so can you identify a number on a “pain scale” to establish the severity 1 (watching TV on the couch) – 10 (we need to call 911)___________________________________________

Do you have any diet restrictions and/or allergies? □ Yes □ No Please describe:__________________________________

Do you have any injuries that you impact your ability to perform exercise movements? If so please answer the medical information questions.

4. Medical InformationWhat is the nature of your disability:_____________

Date of Onset:__________________

4a. Combat Stress/PTSD/MST (Military Sexual Trauma)Do you have flashbacks? □ Yes □No

Do you have panic attacks? □ Yes □No

Are you sensitive to loud noises? □ Yes □No Do you isolate yourself? □ Yes □No

Do crowds make you feel anxious? □ Yes □No

Do you get angry easily? □ Yes □No

Do you get anxious easily? □ Yes □No

Are you hyper-vigilant? □ Yes □No

How can we best support you should you become anxious, fearful, angry, etc.?________________________________

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CrossFit Myths Debunked14

Initial Assessment Tool (continued)

4b. Traumatic Brain Injury (TBI)

Have you sustained a TBI? □ Yes □ No

Date of injury:______________________

What is the cause of your TBI? ___________________

Has your TBI affected you in any of the following ways?

Short-term memory impairment □ Yes □ No

Decreased attention span □ Yes □ No

Problem-solving difficulties □ Yes □ No

Inability to concentrate □ Yes □ No

Decreased balance □ Yes □ No

Vestibular impairment □ Yes □ No

Do you have headaches? □ Yes □ No

How often do they occur?___________________

What triggers headaches?____________________

How do you treat your headaches?

_________________________________________

Do you have seizures? □ Yes □ No

If yes, date of last seizure:__________________

Frequency of seizures:___________________

Type of seizure:___________________________

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CrossFit Myths Debunked15

Initial Assessment Tool (continued)

4c. Amputation

Date of Amputation:___________________

Level of Amputation: ________________________

Describe the nature of your mobility (i.e. prosthetics, wheelchair,

none, etc.)_________________________

Will you be working out with a prosthetic? □ Yes □ No

Do you have multiple prosthetics? □ Yes □ No

If yes, please describe:___________________

Do you have any skin issues? □ Yes □ No

If yes, please describe:________________________

Do you have pain in your residual limb? □ Yes □ No If yes, please

describe:________________

4d. Spinal Cord Injury (SCI)

□ Paraplegic □ Quadriplegic □ Tetraplegic□ Complete □ Incomplete

Are you able to transfer out of your wheelchair? □ Yes □ No

Are you able to do an independent floor transfer? □ Yes □ No

Is this the wheelchair you will be working out in? □ Yes □ No

Do you have any skin issues? □ Yes □ No

Are you diligent about pressure relief? □ Yes □ No

Do you have a leg bag or any external catheters? □ Yes □ No

Do you practice good shoulder mobility and health? □ Yes □ No

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CrossFit Myths Debunked16

4e. Visual Impairment (VI)

Describe the level of vision you have (completely blind, peripheral,

black spots, blurred, etc.)

______________________________________

Does your vision worsen with bending, lifting, straining, or rapid

movement? □ Yes □ No

Do you experience vertigo? □ Yes □ No

Do you learn better through □ verbal □ tactile techniques?

How much time do you typically need for exploration of a new area

before you are comfortable? ___________________________

Is it ok if the coach provides tactile cues? □ Yes □ No

Are you comfortable using tactile techniques on the coach to learn

proper body mechanics? □ Yes □ No

Initial Assessment Tool (continued)

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CrossFit Myths Debunked17

Coaches Disability Reference sheet Spinal Cord Injury Skin integrity • Pressure- external pressure exceeds capillary blood pressure, the blood supply from the blood vessels to the muscle and skin tissue is impeded, resulting in tissue breakdown.• Moisture- lowers its resistance to mechanical stresses such as pressure or friction• Shear- This causes capillaries to stretch and tear, resulting in reduced blood flow.• Friction- The soft moist layers of skin are exposed which allow bacteria to enter

Do Not:• Massage the area of the ulcer because massage can cause tissue damage under the skin. • Donut-shaped or ring-shaped cushions are NOT recommended because they can interfere with the blood flow to that area and cause complications. • Sit on a hard surface without a pad, mat or cushion

Do:• Encourage pressure relief throughout the workout and schedule

it in every 15 – 30 minutes for at least 30 – 90 seconds

Shoulder Preservation • Decrease the number of nonlevel transfers per day• Weigh of the individual • Number of overhead activities in a day • Be aware of upper limb pain• Energy conservation• Proper positioning in wheelchair• Exercise and Stretching• Stretching exercises of the neck • Particular attention to stretching front deltoids & pectorals and

strengthening scapular stabilizers• All training programs should be individual and progressive• Avoid strengthening exercises if they are painful or if range of

motion is significantly restricted

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CrossFit Myths Debunked

Visual Impairment

• Must be medically cleared for physical and cognitive participation in Adaptive CrossFit

• May need to provide own transportation

• Participants do not need to have an athletic background

• Always allow time for exploration. When introducing individuals to equipment and new movements allow

them time for tactile or visual exploration

• Demonstrate the movement and identify the exercise

and the muscle involved. Ask participants to repeat

some of the skills to ensure understanding and safe performance

• Creating a visual and a tactual perimeter. For safety, mark the perimeter of their working space with rope covered with tape or with contrasting colored tape. The tape helps the participant with low vision to locate the perimeter of their working space

Combat Stress/PTSD/MST

• Do not touch athletes in anyway unless athlete agrees to be touched

• Do not come up from behind participant

• Do not deliberately startle participant

• Do not ask about their combat experience unless veteran/service member engages on this topic

Traumatic Brain Injury (TBI)

• Short term memory may be impacted

• Visual Aids

• May have limited fine motor and/or gross motor skills

• May have impaired balance and/or gate

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Coaches Disability Reference sheet (continued)

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CrossFit Myths Debunked

CrossFit Specialty Course: Adaptive Training https://training.crossfit.com/adaptive-training

• The CrossFit Specialty Course: Adaptive Training is an interactive single-day course designed to teach trainers and athletes how to make CrossFit accessible to impaired athletes. Participants will learn how to train athletes with a wide range of impairments, from non-permanent (trauma, injury or illness) to permanent (congenital disorders, combat trauma, automobile accidents, etc.).

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Training

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CrossFit Myths Debunked

• Multiple bands – pushups, pullups, overhead press, mobility

• Harness system – barbell movements

• Grip assist

• Monorope – jump rope

• Floor mats – various thicknesses

• Small padded boxes

• Walking leg – everyday leg

• Running blade

• Sport-Specific – lifting, biking, swimming, etc.

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Adaptive Equipment for Athletes with Extremity loss

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CrossFit Myths Debunked

Equipment for Adaptive Athletes Seated Group

• All-Sport wheelchair

• LapMap

• Grip assist – braces, lifting straps

• Extenders on Ski Erg

• Floor mats – various thicknesses

• Padded boxes

• Multiple bands

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CrossFit Myths Debunked

Equipment for Adaptive Athletes with Visual Impairment

• Floor mats – various thicknesses

• Padded boxes

• Goalball – wallballs

• Brightly colored tape

• Velcro

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CrossFit Myths Debunked

Equipment for Standing Adaptive Athletes with Invisible Injuries

• Orthopedic supports – knee and elbow compression sleeve, wrist wrap

• Padded boxes

• Multiple bands

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CrossFit Myths Debunked

Acquiring Adaptive Sports Equipment

VA Requests:

Veteran must have a qualifying diagnosis

• Loss of extremity or loss of use of extremity

• Impaired balance and/or coordination usually associated with significant strength, ROM and/or sensory limitations per Physician documentation

• VA adaptive sports equipment requests:

https://vaww.infoshare.va.gov/sites/prosthetics/2641%20Information/Forms/AllItems.aspx

Private Sector Grants:

• Challenged Athletes Foundation

• Sports Abilities

• High Five Foundation

• SCI specific – Kelly Brush, Triumph

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CrossFit Myths Debunked

Adaptive CrossFit Programming Example:

• VI – 5 ring rows, 10 pushups, 15 air squats, • Standing – 5 ring rows, pullups or Chest to bar pullups, 10 pushups, ring pushups, incline

pushups, 15 box squats, air squats, squats holding a plate• Seated – 5 DB rows, ring rows, pullups, 10 triceps pushups between boxes, 15 slam balls to

box, slam balls to floor

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Cindy

20 minute AMRAP*5 pullups10 push-ups15 air squats

*AMRAP = as many rounds as possible

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CrossFit Myths Debunked

Disability Awareness Day Welcome able-bodied members from CrossFit gym to test their fitness at a modified ability level

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CrossFit Myths Debunked

Questions?

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Christina Lafex, CTRSChristina.Lafex@va.govRecreation Therapist

Alec ZirkenbachAlec.Zirkenbach@crossfit.comAdaptive Training Course Lead

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CrossFit Myths Debunked

References and Cited Sources

1. American Medical Association, JAMA I Special Communication November 20, 2018 Volume 320, Number 19. page 2020 – 2028 “The Physical Activity Guidelines for Americans”

2. CrossFit Specialty Course: Adaptive Training Guide 2018

3. CrossFit.com - The Journal, December 27, 2010

“Defining CrossFit” by Greg Glassman

4. CrossFit.com - The Journal, April 1, 2002

“Foundations” by Greg Glassman

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