Preventing Rhabdo

It was everywhere. If you waded through social media’s megalomania, cries for attention, and narcissism, you may have seen the shouts and whispers about…the terror of CrossFit.

A little article, CrossFit’s Dirty Little Secret (it came out in late September), struck fear in everyone’s heart, whether they religiously hit the WOD (workout of the day) or merely blow their wad watching the CrossFit games on ESPN2. The article, written by a physical therapist who unfortunately doesn’t lift, discusses the danger of Rhabdomyolysis or “rhabdo” for short. In his words from the article:

“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.”

Yikes. And the thing is, rhabdo cases are all too common in CrossFit. In fact, back in the early days of CrossFit, it was “cool” to puke when you pushed your body too hard. Getting “rhabdo” was a badge of honor to some, and CF surely didn’t help by putting out the stupid-ass cartoon to the left.

Are physical therapists right to lambaste CrossFit? Is it dangerous, a crazy exercise fad that only hurts people?

I don’t care. Search “CrossFit” on this site and you’ll pull up a number of articles regarding my opinion on CrossFit. Whether HQ is shaking in their boots or greedily rubbing their hands together because of the free press is beyond my fucks to give. What I can tell you is that rhabdo is extremely easy to prevent.

It’s called programming, and it’s not that hard.

Doing even a half-assed job at programming will net you almost zero injuries and progress if you adhere to two main ideas: 1) don’t do anything stupid and 2) condition the bodies of trainees and clients to their workouts via some sort of progression.

I realize the irony in number 1; if you’re stupid, how would you know that you’re doing something stupid? Well, in the case of high intensity conditioning, “stupid” means telling your trainees to do a bunch of shit they aren’t prepared for. That translates to high levels of volume or intensity beyond what they are currently adapted to. Don’t ask for 100 reps of a given exercise if they haven’t done more than 50 in a workout — or if they just showed up at your gym. Don’t ask them to do several hundred reps of anything ever.

Care should taken when programming new movements or exercises that the trainee is unadapted to. In FIT — a general fitness and strength and conditioning book I helped write — I actually provide a repetition cap for new exercises.

“Generally speaking, when introducing a new weighted or ballistic exercise into the program, a strong trainee should not do more than 30 repetitions in any given high intensity workout. Thrusters, Kettlebell Swings, and Box Jumps can cause exceptional soreness if carelessly performed for high repetitions. Calisthenics that haven’t been normally performed as part of a trainee’s previous strength program shouldn’t be done for more than the maximal amount of repetitions the strong trainee could do for one set. This cap will help prevent debilitating soreness by dividing the work into several sub-maximal sets. For example, do three sets of eight repetitions of Dips instead of doing one set of 25 repetitions (pg 168).”

30 reps may seem low, but I’m concerned with inducing an adaptation of improved performance, not excessive soreness or difficulty. Besides, making clients excessively sore will either deter them from coming to the gym or, more importantly, be debilitating for future strength training sessions. And the strength training is what actually matters anyway since it’s the fundamental capacity for conditioning, but I digress.

30 reps is an arbitrary number; it was chosen to give readers a quantifiable marker to prevent them from doing something stupid. And that’s much more than what CrossFit has done for their coaches or trainees. I remember a year or so ago when the CF Open WODs (competitive workouts that select competitors for regional competition — it’s the gateway to the CrossFit Games) had a lot of jumping movements and achilles ruptures were unfortunately common. While CrossFit explains how to scale their workouts on their website, they also foster a “tough guy” mentality and many trainees don’t know when to quit.

But this shouldn’t be about CrossFit, this should be about the coaches. It’s up to individual coaches or trainers to be able to determine the current adaptive state of their clients and structure their exercise regime in a way that isn’t injurious. It’s really not that hard as one of the oldest affiliates can attest.

Preventing rhabdomyolysis isn’t hard, but it requires actually programming training instead of randomly choosing exercises and workouts. If you or a coach you know are completely in the dark on this, then start consuming strength and conditioning literature. FIT is a great resource — especially for programming high intensity conditioning with strength training (and not just because my name is on the cover) — but there are plenty of decent resources available for free.

Hopefully the news about rhabdo will push many coaches to educate themselves on effective programming. There’s no excuse for sending trainees to the hospital.

7 thoughts on “Preventing Rhabdo

  1. The first time I ever heard about this condition was when Albert Haynesworth got it after showing up to Redskins training camp a few years ago out of shape. I must admit I engaged in my fair share of schadenfreude after learning that the team’s 100 million dollar man wasn’t even in football shape. Anyone else remember that? I think because if this I always have associated getting rhabdo with being a useless person.

    Also, looks like Tosh.0–against all evidence–secretly supports the 70sBig movement.

  2. I had never heard of rhabdo before being introduced to cf. Then it seemed like everyone who got sore self diagnosed themselves with it. The interwebs seems to channel peoples inner hypocondriac. In my line of work we hate web-md because it turns a bit of anxiety into a heart attack in a few paragraphs.

  3. I had rhabdo a few years ago…I had been doing crossfit for a couple years and had gone to the certification…I was following an olympic lifting program and also trying to add in my own conditioning on top of it. It was stupid, but I did learn a valuable lesson and luckily nothing serious happened because of it. The ER doctor asked me no less than 10 times if I had been on any kind of drugs, and even though I couldn’t straighten my arms, I was ready to choke the skinny little f*ck out.

    Long story short, I spent a week in bed getting 2 IV’s a day…make sure you take your rest days.

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  5. I’ve been doing CF for about 4 years now and it’s always annoying hearing somebody say puking or getting Rhabdo is cool in the CF community… this cannot be further from the truth.

    From what I’ve learned back when starting CF is that Uncle Rhabdo (the clown) was created to promote the awareness and dangers of Rhabdo. It was never a “cool” thing.

    So why do some people give/get a t-shirt or badge when puking? Because it’s humiliating, and to reduce the person from losing self esteem they got a t-shirt with Uncle Rhabdo. It was a reminder of the negatives associated with pushing yourself too hard.

    It was never created as pat on the back, or a badge.

    With that said, some people have misinterpreted this, especially so called “coaches” and started using this as something cool. If your box considers it as cool, you are probably training at an inferior box.

  6. Pingback: Rhabdomyolysis Is Systemic | 70's Big

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