Photo Courtesy Greg Westfall
Everyone has an uncle they’d rather you not meet.
Please
allow me to introduce you to Uncle Rhabdo, CrossFit’s unofficial and
disturbing mascot. Uncle Rhabdo is a cartoon commonly referenced in
CrossFit literature and representative of a troubling trend among
CrossFitters.
He’s a clown. Literally.
The
“Uncle Rhabdo” cartoon depicts an exhausted, yet well-muscled clown,
connected to a dialysis machine standing next to some workout equipment.
Concernedly, his kidney has fallen out and lies on the floor underneath
him, along with some portion of his bowel. He’s left a pool of blood on
the floor below him, but it’s not clear if this is from the
disembowelment, the kidney’s arterial supply, or the collection of
fasciotomies he appears to have endured. Uncle Rhabdo, of course, has
Rhabdomyolysis.
Rhabdomyolysis, apart from
being a subtly pleasant and melodic sounding word, is an uncool, serious
and potentially fatal condition resulting from the catastrophic
breakdown of muscle cells. We’ll get more into the specifics in just a
bit, but first let’s begin with a story.
A Tale of Rhabdomyolysis
One
day, a very fit, young, physical therapist colleague of mine went to
CrossFit. She had been many times before. On this warm Texas evening,
she performed a partner workout, where each would trade off performing
sets of 10 for each exercise. The workout consisted of pushups. Lots of
them. Copious amounts of overhead press were also included.
She performed hundreds of repetitions of each. She was a champ!
“I didn’t want to not match my partner. Normally I may have rested a little, but the partner workout kept me going.”
Both
of these activities heavily involve the triceps muscles and so she
wasn’t surprised to have her beautiful, sculpted arms feel like poorly
set bowls of JELL-O® on the way home from CrossFit. Perhaps it was the
heat. Maybe it was the sheer number of exercises she did. Her muscles
were in crisis. She iced and hydrated when she got home, like a good
little exerciser, but the damage was already done.
As
physical therapists, we’re finely tuned detection machines looking for
normal versus abnormal response to exercise and activity. “Is this
supposed to hurt?” is a question we respond to hundreds of times in a
week. Sometimes the answer to this question is yes and we encourage the
individual to press on, and other times it’s a signal to initiate some
rest and recovery. This signal detection is one of the things that’s
deeply embedded into physical therapists. We can’t help it. And so when
my friend awoke the next morning, her abnormal response alarms were
blaring. She couldn’t bend her elbows! She couldn’t even reach her mouth
to brush her teeth.
Still
entrenched in the CrossFit culture of deplete, endure, repeat, she
quieted the alarms and stoically pressed on to go to work. It didn’t
take long to realize she not only couldn’t bend her arms, they also had
no strength. She wasn’t able to treat her patients. By that evening, her
slender arms had continued to swell into plump hotdogs of ache and
regret, and she was starting to come to the realization that the
morning’s danger alarms were legitimate.
Unbelievably,
it took another 24 hours for her professional sense to break through
the grip of the CrossFit culture, and seek medical attention. She was
diagnosed with acute rhabdomyolysis, and ended up in the hospital for
over a week. While in the emergency department they tested her
creatinine kinase (CPK) levels. Normal is about 100. Her CPK levels were
more than 45,000, a number that indicated damage to the kidneys.
While
in the hospital, she called to cancel her CrossFit membership. As is
standard when something is cancelled, the CrossFit coach asked the
reason for her decision. She replied, “I’m in the hospital.” The
instructor quickly asked, “Is it rhabdo?”
And
here we have arrived at CrossFit’s dirty little secret. The coach was
unusually familiar with what is normally a very rarely seen disorder.
It’s so rare that one study reported the overall annual incidence of
rhabdomyolysis to be 0.06%. That represents single digits of cases out
of hundreds of thousands of patients. How, I wondered, is it possible
that the layperson exercise instructor is on a first-name basis with a
serious, yet rare medical condition? Is this a thing with CrossFit? It
turns out it is.
Rhabdomyolysis: As Told By CrossFit?
A quick search of the Interwebs reveals copious amounts of information about rhabdo purveyed by none other than CrossFit trainers.
Scouring the scientific literature in mainstream medical journals,
however, reveals a only a few peer-reviewed papers. The science confirms
that exertional rhabdomyolysis, as this form is sometimes referred to,
is uncommon and normally reserved for the elite military trainee,
ultra-endurance monsters, and for victims of the occasional psychotic
football coach. Rhabdomyolysis isn’t a common condition, yet it’s so
commonly encountered in CrossFit that they have a cartoon about it,nonchalantly casting humor on something that should never happen.
So what is rhabdomyolysis
exactly? Under extreme conditions your muscles cells explode. They die.
They leach protein out into the blood stream, including one form called
myoglobin. Ever stalwart, your kidneys take up the job of clearing
these dangerous proteins from the blood. Why? It’s just what they do.
Unfortunately, myoglobin proteins aren’t designed to be in the blood in
the first place and they can easily overload the kidney. This can
produce injury or death to all or part of the kidney in a short amount
of time, and is potentially lethal. Locally, the muscles are left
damaged and dying. Swelling ensues and weakness occurs as pressure
builds around the remaining muscle cells. Your body’s systems that
normally can assist with this local muscle damage are now offline trying
to help you not die. If you get to this stage, you’re in serious
trouble.
In some cases, acute compartment syndrome ensues, which is an emergency condition that can result in loss of a limb unless your connective tissue is slashed open
to release the swelling , a procedure called a fasciotomy. None of this
is something that people should be handling in such a cavalier manner.
So
what gives? As early as 2005, the New York Times documented
rhabdomyolysis associated with the culture of CrossFit in a piece
entitled, “Getting Fit, Even If It Kills You.” The article included this gem of a quote:
“Yet six months later Mr. Anderson, a former Army Ranger, was back in the gym, performing the very exercises that nearly killed him. “I see pushing my body to the point where the muscles destroy themselves as a huge benefit of CrossFit,” he said.”
What does CrossFit’s founder, Greg Glassman think of this?
“It can kill you,” he said. “I’ve always been completely honest about that.”
Fast
forward to 2013 and this culture has changed little, perhaps even
accelerated. As fellow Medium writer, Jason Kessler pointed out in “Why I Quit CrossFit,”
the elitist, push yourself to the limit culture of the discipline has
increased in light of commercial interests taking hold. Regarding
culture, Jason points out,
“If you ask a CrossFit coach, the injuries were all my fault. In a culture that drives you to go as hard and fast as possible, it’s difficult not to get caught up in the hype. You’re supposed to push yourself to the limit, but when you hit the limit and pay the price, you’re the idiot who went too far.”
In another psychotic example of how the overwhelming culture of CrossFit can diminish professional common sense, one gynecologist was quoted dishing this nonsense:
“Ladies, in my professional opinion, it is okay to pee during double unders.”
No, peeing during a workout is not alright. Ever.
To underline the point, MoveForwardPT.com,
the official consumer information website of the American Physical
Therapy Association (APTA), hosted an online radio show specifically responding to CrossFit’s irresponsible glorification of stress induced urinary incontinence.
The Impact of Rhabdomyolysis
Sometimes
rhabdomyolysis gets better with treatment. Sometimes it lingers.
Sometimes your kidneys are never the same again. One message board
commenter remarked,
“ I seem to “flare” after any resistance training. I came into this by over training- I was in phenomenal shape. I have gained weight. I get swollen and puffy. I feel as though the quality of my muscle tissue decreases on a daily basis- more so than the lack of weight training- seems to be disintegration.”
My
friend experienced a similar, though thankfully less severe long term
effect. It’s been several months and her triceps strength is not back to
normal. Her sculpted arms are gone, replaced by semi-swollen giggly
tissue. Once a muscle tears, damaged, fatty scar tissue replaces the
injured muscle tissue. The result is a permanently damaged muscle, and a
decreased ability to strength train. The irony of pushups causing
flabby arms underscores the age-old mantra: There really is too much of a
good thing.
Crossfitters, largely unaware of
the rhabdo risk, will continue to charge ahead, pressured and happily
coerced into exercising to depletion and exhaustion. My prediction: in a
few years, the peer-reviewed scientific literature will be ripe with
articles about CrossFit and Rhabdomyolysis. Health providers will be
there to scoop up the pieces, but who is there to protect those people
unknowingly at risk?
Exercise
is just about the best thing you can do for your body, but in the case
of Crossfit, we’re left to ponder the question, is this workout worth
the risk? Can the culture adapt to one that embraces safe training
principles? Do coaches truly have the ability to detect what a proper
training load is for their athletes? Only time will tell, but the future
of CrossFit may depend on it.
No comments:
Post a Comment