Thursday, September 26, 2013

Rhabdo Is A CrossFit Unsecret

This article ( has all of the limitations associated with one person's limited knowledge of a very large and complex topic, which CrossFit is - at least from my view. The hook of the article, that rhabdo is CrossFit's "dirty little secret", is contradicted in the article's own quotes. There are 7,000 affiliates at this point, as I hear, and each of them has several Level I Trainers, and each of those trainers has been taught about rhabdo, because it is rare but potentially lethal, and CrossFit has been sounding the alarm about rhabdo for years.

From the author's uninformed but proud perspective:
"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?"

I repeat myself, but rhabdo is no secret in CrossFit. CrossFit has been sounding the alarm about rhabdo publically for years, starting in 2005. Here are the articles from from which you can learn about rhabdo:

Back to "CrossFit's Dirty Little Secret" (a secret perhaps only to this author):
"Is this a thing with CrossFit? It turns out it is.
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."

If you read the articles, I think you would agree CrossFit has not been nonchalant about rhabdo.  I had a class mate at US Navy Aviation Officer Candidate School who rhabdo'ed himself in the pool.  We had to swim a mile.  He was a terrible swimmer.  Tony was mortified of failing the mile swim, which we took towards the end of our commissioning program.  He absolutely worked like an animal and passed the swim with little time to spare, but had pushed himself so hard, he wound up in the hospital a day or two later.  I never knew what he had until I found CrossFit and learned about rhabdo.  In one study, about 40% of those who graduate from US military boot camps have rhabdo, but to a degree that does not require hospitalization.  Apparently about 7 folks annually die from running marathons, and some of these are from rhabdo.  So, his stats above are both right and wrong - rhabdo to the degree that it requires hospitalization is as uncommon as he describes, but it is part and parcel of heavy exertion and there are no stats for those who work hard and have "normal" levels of rhabdo.

The author terms CrossFit's recent discussion of female urinary incontinence during workouts "glorification" of urinary incontinence, but I see it as a continuation of what CrossFit has done ever since I have been associated with it - tell the truth about CrossFit, the good and the bad. CrossFit was so devoted to that concept that they had an injuries thread on the message boards so folks could talk about their injuries with each other. CrossFit has been blunt about the fact that when you exercise for performance, you get results and you get injuries. The perspective has been consistent from the beginning - you get to choose the risk/reward relationship you want. Is it safe to drive? No. But you can drive anyway if you choose. Is it safe to work as a police officer? No. But you can choose that. Is it safe to fly military aircraft fast into enemy territory or low through the mountains on a training mission?  No. But we pay you for that. You name something that you really love to do, and I'll bet you there's an associated risk of death or serious injury - you choose to do it anyway, and you should.
The essence of CrossFit is that it has chosen to offer a fitness program with a different reward/risk curve, and people choose to pursue CrossFit for the rewards. This is only wrong if CrossFit were to be deceptive about the risks.  CrossFit has not been deceptive, which is largely proven by the author's limited quotations in this very short, and limited article. CrossFit is more like the "unsecret" of the fitness industry, and rhabdo is the unsecret of CrossFit.

The article has a gem of a quote, from another article, which goes:
"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."

That's because you are the idiot who went too far.

Or does that person think you become a child who gives up responsibility for yourself when you enter a gym? If you abdicate the responsibility for what you choose to do, you are the idiot, plain and simple. But let me correct myself; you are not an idiot when you "go too far". You are choosing to test your limits. What would make you an idiot in my view is if you choose to test your limits, and then decide it was the coach's fault that you chose that.  I was chasing performance and testing my limits in many arenas long before I started CrossFit - injuries and martial arts, for example, go together like a hand and glove. Bench pressing, which I used to do but seldom do now, kills about 12 people annually.  Runners have a reported 75% injury rate (nevermind being hit by a car). Cyclists - how many cars pass you, when out for a ride, at speeds that would be fatal if the driver were to make the slight miscalculation that would result in collision? Football? Soccer? Basketball? These sports have very high rates of injury, some fatal or crippling. Shooting? Hunting from a tree stand? Mountain climbing? Drinking booze in a bar? Mowing the grass?  You folks are adults in and outside of a gym, and get to name your poisons.

And just because it highlights the human capacity to discount the high risks we always endure while accentuating (freaking out over) the low risks that are novel too us, let me remind you that every two years, humans kill themselves/each other in automobiles at a rate that exceeds the total casualties from ten years of war in Viet Nam. The vast majority of the rest of us kill ourselves with sugar (or at least "lifestyle driven disease" even if you would quibble about whether sugar/carbs are the killer).

You cannot live unless you choose the risk/reward curve for life every day. Please do not pretend that self responsibility stops when you walk into a gym. Please do not get high and mighty if you make an observation that is as obvious as "you can seriously hurt yourself doing CrossFit." Dude, get a clue, you are about seven years late to that dance.  I have been choosing CrossFit since 2007, and I have been injured from CrossFit workouts - extreme soreness, probably a case of rhabdo or three, back pain, knee pain, shoulder pain, torn skin on my hands, and shredded shins - which is much like what I experience doing martial arts, football, skiing, and bodybuilding.  The different is, I've also been in the highest peak of performance during these last six years that I have ever experienced.  I can do anything I would dare attempt.  It's worth the risk for me, and each year I learn how to throw myself into CrossFit with less and less injury.  My clients will all benefit from my pain.

The author's conclusion:
"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? "
This person, as ignorant as they are about CrossFit, wrote an entire article only to arrive at this question, which is entirely germane and applies to everything you do in life at least after you reach age 18. But he reaches his climactic point as if he had never considered it before. It invites one to make comments about removing craniums from rectal orifices.

Because it is clear this author isn't the only one ignorant about the dangers of exertional rhabdo, or the risk/reward consideration inherent throughout one's life, I'm glad he wrote this article. I hope it encourages people to learn about the dangers of rhabdo in CrossFit, marathoning, endurance cycling, and the other inherent risks of each life activity (or inactivity).  I hope it helps people to realize that they can do a lot to reduce their rhabdo risk by tending to the basics (like managing hydration).

What I see in CrossFit is the best gyms let people choose their own intensity level, and do not spend any time exhorting people to "push harder", or any of that cheerleader/drill instructor style of "pushing" people. You work as hard as you choose for your own reasons, and frankly that's the way it should be since IT IS YOUR BODY.  CrossFit attracts intense people who want to compete, who want to push, who want to test themselves.  That is all good with me.

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