Extreme workout conditioning programs are extremely popular in the fitness world right now, but can these workouts cause serious injuries that keep you out of the gym altogether?

I work out in a gym with traditional weights, machines and cardio equipment, like most gyms. About half of the building, though, consists of an area with a large amount of free space, with squat racks and kettlebells lining the walls. Several times a day, 20 to 40 people gather for classes that fit the definition of extreme conditioning programs (ECP).

These programs involve circuit training, with a variety of exercises including resistance training, running intervals, plyometrics and bodyweight exercises. They involve aggressive sets, often pushing the athletes to perform a maximal number of reps in a certain time.


How safe are extreme workout programs? In a new study in the journal Sports Health, Kyle T. Aune, MPH and Joseph M. Powers, MD surveyed members of Iron Tribe Fitness. Below I have listed some of the important findings of this study, as well as my own observations:

1. 85 of the 247 athletes who completed the survey suffered 132 injuries during their training. Therefore, the prevalence of injuries during the ECP training was 34%, with an incidence of injuries of 2.71 injuries per 1000 training hours.
2. This incidence rate is similar to that of lifting weights and playing many sports. It’s also similar to that of CrossFit observed in other studies.
3. Athletes new to extreme conditioning programs, meaning that they had less than six months with that kind of training, were 2.5 times more likely to suffer injuries than more experienced athletes.
4. Exercises that used weights on barbells caused injuries more often than other equipment (kettlebells, medicine balls, pull-up bars, rings or bodyweight). Over half of the injuries resulted from Olympic-style lifts.
5. Squat cleans, ring dips, overhead squats and push presses were the most common exercises to cause injury.
6. Athletes with a history of musculoskeletal injury were 2.6 times more likely to suffer an injury during the ECP. Those participants with a previous head, neck, back or trunk injury were 5.8 times more likely to injure that body part again.
7. An athlete who has had a neck, back or head injury in the past should make sure that area has healed completely prior to starting one of these programs. You should also modify certain exercises in these programs if they cause discomfort.
8. The shoulder can be an especially problematic area for ECP athletes. Athletes with the history of a shoulder or upper arm injury were 8.1 times more likely to reinjure it.
9. Almost half (47%) of the shoulder injury athletes in these programs suffered that needed medical treatment ended up requiring surgery. Shoulder injuries were 15.7 times more likely to need surgery than injuries to other body parts.
10. Athletes with previous shoulder injuries or people new to these programs should learn perfect techniques when performing moves that stress the shoulder. They should modify their workouts if exercises cause shoulder pain or other symptoms.
11. The three factors listed by participants as being responsible for their injuries were overexertion, improper technique and predisposition from a prior injury.
12. Athletes participating in an extreme conditioning program should learn and use perfect technique with each exercise. They should also take enough rest between sets or exercises as needed to recover and prepare for the next move.

Injuries in extreme workout programs

Also read:
Should you worry about CrossFit injuries?
4 tips to prevent workout injuries

Aune KT, Powers JM. Injuries in an Extreme Conditioning Program. Sports Health. Published online ahead of print October 19, 2016.