If you stay connected to the Internet and are interested in fitness and exercise, you probably are familiar with an article by Dr. Eric Robertson, which blamed CrossFit® for the development of Rhabdomyolysis – a potentially life-threatening condition. Also, if you kept up with the story, you may have also seen a great piece by Erika Andersen, which promoted personal responsibility for anyone participating in any type of exercise program – especially CrossFit®.
Although I usually try not to engage in this type of controversy, as most pieces are primarily based on personal opinions and everyone is entitled to their own, there are some misconceptions that were alleged on the first article I would like to address. As some of you know, over the last year our laboratory has focused on the study of CrossFit® as a training modality. These studies have provided me the opportunity to read, research, meet and talk to a vast number of individuals, both for and against this training modality.
CrossFit® causes Rhabdomyolysis.
Although it is unfortunate that anyone has to experience this condition, regardless of severity, the premise that CrossFit® causes Rhabdomyolysis suggests a “cause and effect” that is simply not true and is based on the experience of ONE individual, which is far from the number required to make this type of association. Then, “is it possible?” Yes, of course, but so is dying from sudden cardiac death during an athletic event, or during an exercise stress test. These risks are inherent in any type of physical activity, regardless of their intensity. Yet, we continue to promote physical activity and exercise to people around the world because the benefits of such activity outweigh the risks for most individuals. This is so much so that the American College of Sports Medicine (ACSM) recently changed their Guidelines for Exercise Testing and Prescription to encourage all individuals to perform light to moderate activity regardless of their risk classification, suggesting that not being physically active has a greater risk than participating in such activity (read more about that here).
Rhabdomyolysis in the scientific literature
If we look in the scientific literature we find several instances of rhabdomyolysis as a result of some type of physical activity (exertional rhabdomyolysis). Inklebarger and colleagues (4) reported the first case of self-induced rhabdomyolysis in a 63-year-old woman who exercised on a stationary bike a day prior to her emergency room visit. In 2011, Boni and Rabiti (1) reported on the first Italian case of exertional rhabdomyolysis after a session of indoor cycling – Spinning®. Three other cases have been reported specifically related to resistance training, all of which occurred in a national fitness center chain (2,7). However, cases of exertional rhabdomyolysis have also been reported in young adults while preforming less “strenuous” activities. A 25-year-old woman required hemodialysis for six-weeks after hiking for hours in the Grand Canyon (3). A 19-year-old college freshman experience exertional rhabdomyolysis after playing in a ultimate Frisbee tournament (5). Therefore, to say that CrossFit® causes exertional rhabdomyolysis is like blaming your favorite running shoe <<ENTER BRAND NAME HERE>> for your shin splints.
Exertional Rhabdomyolysis is caused by a breakdown of muscle fibers due to unaccustomed exercise and it is a life-threatening condition, characterized by muscular pain, muscle weakness, and dark urine. Seeking early treatment is paramount to minimize damage to the kidneys and preventing kidney failure. Moreover, even though overexertion may be the primary factor leading to this condition, secondary factors such as dehydration, genetic conditions (sickle cell trait), metabolic defects in the muscle, bacterial or viral infections, heat stress, nutritional supplementation and drug use exacerbate muscle damage, regardless of the exercising intensity (7). Thus, individuals – and coaches – should be aware of these factors to minimize the risk of this condition.
A fitness industry problem?
This brings us to the topic of the CrossFit® Level 1 certification – don’t shut me out here; please keep reading. A week before Dr. Robertson’s article, Patrick McCarty, a Master level CrossFit® athlete, wrote a great piece on what it means to be a CrossFit® coach; however, this didn’t get as much hype…
The certification process for CrossFit® coaches is no different than any other “basic” certification in the health and fitness industry. Most personal trainers are certified in the same manner. This might suggest an issue with the entire fitness industry, not just CrossFit®. The “good” coaches seek continuing education opportunities that enhance their understanding of their job, just like any other professional (read Patrick’s post above). CrossFit® coaches are no different. As a matter of fact, some CrossFit® coaches have one of the highest distinctions in the industry – the Certified Strength and Conditioning Coach (CSCS) certification.
The Level 1 certification is just that, a basic introduction to the core and basic concepts by which this training modality was designed. As Erika Andersen eloquently presented in her piece, consumers should be responsible to seek out coaches that are sufficiently qualified to keep them safe throughout any session. Just like in other professions, there are good coaches and not so good ones. When was the last time you went to a dentist you didn’t like?
Obviously, CrossFit® is not for everyone. However, with good instruction everyone can participate in this training modality and gain significant improvements (6). From a health promotion stand point; CrossFit® has revolutionized the fitness industry furnishing the opportunity to all individuals (particularly women) to participate in vigorous resistance type of physical activity programs, which they might have never attempted otherwise.
Want to read more? Here are some of the references I used:
- Boni R, Rabitti PG. [Spinning-induced rhabdomyolysis: importance of MRI for patient’s outcome. A case report]. Reumatismo. 2011; 63 (1): 44-8.
- Casares P, Marull J. Over a millon Creatine Kinase due to a heavy work-out: A case report. Cases J. 2008; 1 (1): 173.
- Clarkson PM. Worst Case Scenarios: Exertional Rhabdomyolysis and Acute Renal Failure. Sports Science Exchange. 1993; 4.
- Inklebarger J, Galanis N, Kirkos J, Kapetanos G. Exercise-induced rhabdomyolysis from stationary biking: a case report. Hippokratia. 2010; 14 (4): 279-80.
- Krivickas LS. Recurrent rhabdomyolysis in a collegiate athlete: a case report. Medicine and science in sports and exercise. 2006; 38 (3): 407-10.
- Smith MM, Sommer AJ, Starkoff BE, Devor ST. Crossfit-based high intensity power training improves maximal aerobic fitness and body composition. J Strength Cond Res. 2013.
- Springer BL, Clarkson PM. Two cases of exertional rhabdomyolysis precipitated by personal trainers. Medicine and science in sports and exercise. 2003; 35 (9): 1499-502.
Great article! I use CrossFit myself for cross training. It’s important to find a great coach and use some common sense.
Thank you! I couldn’t agree more.
I was reading here and realized I was reading an article from Dr. Yuri Dr. Feito. Great article- Jenn Gregurich
I’ve had to defend CrossFit to a few people since that article came out! I had never heard of rhabdo until one of my CF trainers told me about it (soon after I started). He was probably a wee bit too cautious, if anything! CrossFit isn’t for everyone, but it’s taught me olympic and power lifts that I would never have learned on my own, and given me a joy of lifting a barbell rather than using machines in the gym (which I probably never would have done if it wasn’t for CF).
Fiona, good for you! Certainly one of the points I wanted to come across. Thank you for reading!
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Great article! Very happy to see an educated explanation on the causes of Rhabdo.
Thanks
Tony
Thanks for reading Tony! Glad you liked it. Please share as you see fit.
Reblogged this on The Road to Physical Fitness and commented:
You know, I have literally got into heated debates regarding this in some odd places… such as on the trail during a half-marathon or while pulling First Responder coverage at an Auburn football game… I mean, a lot of people are REALLY good at being narrow minded regarding CrossFit for some reason. :(
Because crossfit coaches suck! I am a REAL weightlifting coach that competed nationally and I can’t count how many times a so called crossfit coach has come to my gym to learn how to lift. Pathetic. The problem is the certification process and the thought that this type of training leads to any tangible gains for anything other than crossfit. A total scam. The author needs to get off crossfit’s balls. Try some real powerlifting and weightlifting,not for a couple of months, but for 10 years then go back to this type of kindergarten crap and tell me how much easier it is. I have nothing but hate for this stupid system.
Joel, thank you for reading my blog and leaving a comment. I guess, you never read the part where I talked about the certification process. Like you, I have also been in the industry for over 10 years – not doing CrossFit, by the way. Your suggestion that I have some type of connection to CrossFit is erroneous. I am a scientist; I do physical activity research. Perhaps you should do some too, considering your statement that “this type of training doesn’t lead to any tangible gains for anything other than CrossFit” is also incorrect. Again, thank you for stopping by! Best, Dr. Feito
Joel,
The fact that CrossFit coaches seek you out to learn more about your specialty is a testament to a good coach wanting to learn. We also seek out top Powerlifters, Gymnasts, Runners and other CrossFit coaches from whom we can learn. I just sent me and all of my coaches to a seminar with Kendrick Farriss and Cara Heads, both US Olympians. How is it pathetic that a coach would seek out someone better to learn from? A terrible Coach is the one who thinks they know it all already. You have it backwards, that is not a pathetic coach that is a good one.
Your blind hate is rather odd to me, why do you care? If you don’t do CrossFit why do you give it one once of thought. If I were you I would embrace it and make money coaching and helping CrossFit coaches and athletes improve their Weightlifting technique.
On your last point of no tangible gains from CrossFit, that is stupid. In my gym we measure strength first and we consistently hit PRs throughout the gym in all of our lifts. Also many new weightlifters are coming from CrossFit and qualifying for National events. Your hate is a little misguided, I would focus my energy on more important things…
Good luck!
PS- Where are you located? Could always work with a good lifter. ..
Joel,
My comment below is for you. Here is an interesting perspective from a REAL Weighlifting Coach:
http://coachdanbell.wordpress.com/2013/10/28/thank-you-crossfit/
Read your article, and couldn’t agree more. It is probably easy for many to blame CrossFit since this training form has really spread out and a lot of beginners are probably overrating their abilities and have not received too much info on the safety risks of over training. I don’t know how it is in USA, but in Norway (where I’m from) it is not yet standar for personal trainers to inform about risks with exercise and for those with limited knowledge, like beginners etc, how can they learn about this?
I was in the hospital for 5 days with intravenous fluids. My CK levels were 77 000 the first day (3 days after my work out), and they had decreased to just below 8 000 when they released me.
What frustrates me the most is how difficult it is for me to find any info on what to do next….how soon can I start my work-out, what should I be aware of, should I follow up with my local doctor? If so, for how long? Doctors here are not very familiar with Rhabdo, and the only info I got from the doctor in the hospital is that I should avoid such training in the future. But I will not give up CrossFit, as this is something I really love doing! And I do not blame CrossFit either, it is only my own fault (and probably the lack of info from our trainers, on which I have advised they must improve by talking openly about this)
It is now 1 month since I was hospitalized, I started out very carefully with easy jogging, and only a very few repetitions of push-ups, ring-rows, sit-ups…only the more easier things. No lifting yet, and no pull-ups… After my 1 work-out session last week I was sore for 6 days, so I guess that is telling me something….however not sure exactly what…hehe.
Bottom line….we are responsible for finding info on any kind of activity we want to attend, if we do not know too much from before. It’s easy to have something else to blame, but does it really help at all? Be smart, use your brain, and stop using unnecessary time trying to find something to blame for your own faults.
At least now my training community has a better understanding of rhabdo, after I have been there telling my story.
Lisa, 10/31/13, 5:09 am,
You appear to suffered from rhabdo, and as CrossFit Chief Scientist, CrossFit would like to understand better what happened to you.
You wrote,
I don’t know how it is in USA, but in Norway (where I’m from) it is not yet standard for personal trainers to inform about risks with exercise and for those with limited knowledge, like beginners etc, how can they learn about this?
Are you writing about personal trainers in general, or about CrossFit trainers? CrossFit certifies Level 1 and 2 trainers worldwide to identical standards. Their primary duties are to safety, and include scaling workouts to their clients’ capabilities and condition, to teach the correct form for the basic movements, and to watch clients’ workouts to prevent injury and overwork. However, while CrossFit highly recommends one of its trainers, it still offers its conditioning as a do-it-yourself program, especially for those beyond the range of trainers or an affiliate who want the benefits of better health and fitness.
Rhabdo has hundreds of causes and co-factors. Even within the narrow range of Exertional Rhabdomyolysis, there are still several co-factors to which you might be susceptible. I would like to know as much as you could share about your background and history of exercise, and exactly what WODs you were following and with what supervision when you became ill. I would also be interested in the clinical information from your hospitalization, especially CK history, which I believe can help diagnose the causes.
If Dr. Feito would let us share that information on his blog, I’d be happy to do so. Everyone, including CrossFit, could gain by your experience, and your willingness to write frankly about your illness is indeed a rare opportunity. If he wouldn’t agree, or for privacy, please contact me at drrocket@crossfit.com.
I extend this invitation to anyone who has experienced rhabdo with CrossFit, and I guarantee both civility and privacy.
Jeff, I apologize for the delayed “approval” of this comment. For some reason the approval never came through before. I would certainly be interested in this discussion and topic from a writing stand point. I’m in the process of writing a piece regarding Rhabdo and this could be a great case study.
If Lisa gets an alert to my invitation of November 8 now that it is approved, or to your notice of approval of March 25, perhaps she’ll get in touch with me, either by posting a comment here or by private communication via email. I’ll be in touch as she allows.
Re CrossFit® does not cause Rhabdomyolysis… Unaccustomed exercise does.
Dr. Feito,
Thanks from CrossFit for your on-going contribution to debunking the mindless CrossFit bashing.
I would like to change one word. Delete the “not” where you say,
Obviously, CrossFit® is not for everyone.
This concept is fundamental to understanding CrossFit. For evidence, see
http://www.crossfitkids.com/
http://www.crossfitwalterreed.com/Reed
http://crossfitsilver.blogspot.com/
http://www.noexcusescrossfit.com/about/kyle-maynard/
Dr. Glassman, thank you for reading! I appreciate your feedback. Although I agree that everyone ‘can’ participate in CrossFit, my statement was more geared towards the individuals who do not enjoy group exercise, or working with a coach, or with others around them; hence the “not for everyone“. As you pointed out, I too believe that everyone ‘can’ do it regardless of fitness levels as long as they have proper coaching and some type of progression, which is paramount for safety and enjoyment.
thank you very much for this, my mom is freaked out about this cuz she doesn’t want me getting it from crossfit at only 16 years old. and it helped me with research a lot
Austin, your welcome! Keep your own abilities in mind when performing any exercise program, including CrossFit, and you will be safe. It is important to also consider where you are being coached and by whom. Although CFHQ does a good job and training their coaches, some times the coaches, once certified, may “deviate” from CF’s basic principles to make it “more exciting” and/or “appealing”, when it reality it doesn’t have to be… Be smart, be safe, and have fun. Good luck!