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CrossFit and Rhabdo

Originally published at Us.News Eat+Run

By now, you may have heard about "CrossFit’s Dirty Little Secret," an article by Eric Robertson that claims CrossFit is trying to shove rhabdo under the couch cushions like a discarded potato chip. Robertson, an assistant professor of physical therapy at Regis University in Denver, claims that CrossFitters are "largely unaware" of the risk of rhabdomyolysis – a condition where muscle cells explode after very strenuous activity, releasing toxic myoglobin into the bloodstream. Rhabdo can lead to permanent muscle damage, strength loss, kidney failure and death. But these claims about CrossFitters’ lack of awareness are a far stretch from the truth.

Actually, rhabdo affected long-distance runners, endurance hikers and other endurance athletes before it was associated with CrossFit. However, CrossFit has taken huge measures to make sure trainers and participants are educated about the condition’s risk factors, symptoms and treatment. Robertson claims CrossFit is hiding rhabdo. I claim CrossFit is doing everything the company reasonably can to educate people about it, stopping short of parading dancing cows wearing "RHABDO KILLS!!!!" or "Just sit on the couch!!" shirts during award shows.

A couple years ago, I was training for my first marathon and had been participating in CrossFit for about a year and a half. I was not new, nor was I inexperienced in sports or weight training. I had a long run of 13 miles on Sunday. I rested the next day. I did the Fran workout on Tuesday morning. "Fran" is a  21-15-9 rep scheme of thrusters and pull-ups. I was scaling this workout to a lower weight and using an assisted band. I chose to use a less supportive band since I was gaining more strength in my back, shoulders and core. I had done Fran a few times before, so it wasn’t new to me. So, let’s review: longest run in several months on Sunday and a new strength goal on Tuesday. Do you see where this is going? I rested Wednesday. Thursday morning, I was tired and one arm was sore, but it felt no different than DOMS (delayed onset muscle soreness).

CrossFit Rhabdo Rule No. 1: Check your trainer.

On Thursday morning, my trainer asked me how I was feeling. He does that. He checks in with all of us. I told him one arm was sore but that I was feeling fine, just tired. But my trainer looked at it and said he was concerned about rhabdo. He would not let me perform any movement that included my arms, though I could still do the leg movements. I complained and basically pitched a big redheaded fit, but he refused. He told me to stay well hydrated and said that if I noticed any swelling or tightness, I needed to see my doctor immediately. I did the leg workout, kept drinking and honestly didn’t think any more about it.

CrossFit Rhabdo Rule No. 2 Know the symptoms and be proactive.

That afternoon, I noticed my arm swelling. I left immediately to see my doctor. Soon, I was in a room and my doctor came in, looked at my arms and told his intern to start drips in both of them, while also drawing blood. When I left that night, my creatine phosphokinase level – the measure of an enzyme in the blood – was 22,000 and rising. A normal, "safe" CPK level for athletes is less than 1,000. However, my kidney function test was not nearly as bad as expected. I had orders to return the next morning. When I did that, the doctor wanted to admit me to the hospital because my CPK had reached 47,000. I was still not having any symptoms other than the swelling, which was isolated to my arms. He agreed to do another kidney test and continue in-house IV fluids because it was not spreading to my lower body and I still didn’t have other symptoms like nausea, vomiting or brown urine. For five days, I went into the hospital for bags of fluids and tests. One week later, my CPK was down to 2,000.

CrossFit Rhabdo Rule No. 3 Be realistic about goals and limits.

My doctor was very clear in his directions. I developed rhabdo from combining marathon training with increasing fitness goals in CrossFit. I could do both, but I had to find a balance between them. Ten weeks later, I crossed a marathon finish line. Three years later, I’m still running and still going to CrossFit. I know my limits. I know it could happen again. But I know the symptoms and I trust my trainer.

The point I really want to make is this: Rhabdo can be dangerous. Running with diabetes can be dangerous. Playing football can be dangerous. Endurance hiking can be dangerous. It is up to each individual to determine if the risk outweighs the rewards. Also, CrossFit is not trying to hide rhabdo out in the guest house. The company parades it out on the front porch wearing a feather boa, singing show tunes and drinking a mojito.

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