CrossFit's Dirty Little Secret

CrossFit's Dirty Little Secret | Eric Robertson
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CrossFit's Dirty Little Secret

Posted: 09/24/2013 10:32 am
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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
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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 percent. 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 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 stressinduced 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 jiggly 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
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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.
Eric Robertson is assistant professor of physical therapy at Regis University in Denver, Colorado. He operates and writes for
the website PTThinkTank.com. This piece first appeared on Medium.
Earlier on HuffPost:
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311 people are discussing this article with 598 comments
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Kendall_M
1 Fan
This article is just another over-hyped, anti-crossfit piece. I know people that have been
injured doing all sports of activities. Why don't we write more articles complaining about
the danger of running or skiing? Anything taken to the next level can be dangerous. All
intense sports are high risk/high reward.
What really makes me angry is the comment about women peeing. Yes, it is okay to pee
during double unders. If this MALE author had stopped and taken a moment to think
about what vaginal childbirth does to a women's body, then he might realize that almost
all women have issues with any sort of jumping activity. Some women even pee while
sneezing or laughing. Is that dangerous, too? Am I going to get Rhabdo from a giggle fit?
What that gyno was trying to do was take the shame and embarrassment out of
something that, regardless of training, can't always be controlled.
25 SEP 2013 12:21 AM
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Kristine0011001
0 Fans
AMEN Kendall!! I thought that too when I read about the "peeing"; but then again, it
is written by a man. He does seem to have a personal vendetta against CF,
because this issue he refers to is also caused by a multitude of things (which he
conveniently fails to mention). Maybe he is looking to repurpose this article by
simply replacing the term Crossfit with "NFL", "NBA", "Wrestling", etc., etc.
because all of those sports involve pushing yourself to the limit.
A year and a half ago I dislocated my knee while playing a dance game on Xbox.
Maybe that should be the next "dirty little secret". I can see it now "Xbox's Dirty
Little Secret - the Dangers of Dancing with your Kids".
Give me a break.
25 SEP 2013 1:06 AM
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Johnny V. (Johnny_Vineyard)
SUPER USER 115 Fans
Apply logic to everything.
There are often dangers to different types of workouts. Crossfit enthusiasts have a
"Used Car Salesman" attitude, but the hype and following (some say "cult") have hooked
and helped a lot more of my friends than anything I've ever seen before.
All in all, the number of people who benefit from Crossfit far outweighs the number of
people who are hurt by it. The same cannot be said of obesity.
26 SEP 2013 1:26 PM
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Kevin_C_Moore
11
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Would you care to back up that statement with something more than your personal
hunch?
Crossfit is to fitness culture what fundamentalism is to religion: a small but
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extremely vocal group who's media presence skews the centerline of acceptable
behavior. The problem is not limited to the folks who attend "boxes"; it's also the
broader dissemination of the notion that damaging yourself over vanity is anything
less than neurotic.
Put enough sexy, tribal, in-group spin on even the most insane ideas and they will
sell--a fact Glassman has exploited really well here.
26 SEP 2013 3:00 PM
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Red_of_Tooth_and_Claw
63 Fans
Hey, that workout cult I kept referring to as a dangerous scam turned out to be a
dangerous scam. How about that.
26 SEP 2013 9:49 AM
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2mbd5
32 Fans
Hm Ive been doing crossfit for three months and I have friends that have been
doing it for years and this has never happened to any of us. Why? Because we
are smart and most crossfit people are as well knowing when to stop. This lady
was not smart.
26 SEP 2013 11:42 AM
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nathanm
17
17 Fans
Wow. I'm shocked. The cult that brought us the dangerous idiocy of high rep Olympic lifts
doesn't grasp that over training destroys athletes, not improve them. Shocked, utterly.
Crossfit, the Scientology of exercise. Carry on hardcore elite, but remember you'll never
out work traditional trainees if all your muscles are exploded and your kidneys blow up.
25 SEP 2013 3:24 AM
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londonbarcelona
237 Fans
Eat ORGANIC, or as my grandparents called it, FOOD
Crossfit, the Scientology of exercise. This is spot on. My husband is the CMO of a
company that 'loves' crossfit trainers. Because they are usually too stupid to know
any better. Doesn't surprise me that X military like this 'sport.' I've heard it's big
among PREPPERS and gun toting crazies that think the US is in the end times.
Crossfit, the Scientology of exercise. Well done. Over the last 5 years or so, the
big corporations have laughing at you and taking your money. But don't worry, we'll
still support things like the Crossfit Games that were just in Carson, CA. I never
saw more meaty girls than I ever did there.
I can't wait to see what these chunky women and men look like when they are
older. FAT.
25 SEP 2013 6:59 AM
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Dannnnn
36 Fans
By all means, please continue to sit on the couch and avoid any and all of the many
'dangers' of physical activity. This article was written to sensationalize and inflict fear,
based on exactly one person's negative experience. Rhabdomyolysis is extremely rare.
I am both a physical therapist and personal trainer, and I have seen it once in the past
decade. It is always safer to exercise under the supervision of a trained fitness
professional, rather than on your own. I am sure that there are fewer injuries among
crossfit users than there are among people who exercise alone. Some common sense
regarding listening to your body and not overdoing it will do you more good than the
hysterics in this article. (and no, i do not have any association or profit based on
crossfit, jus an interest in people staying motivated to be healthy).
27 SEP 2013 4:12 AM
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SinisterK9
10
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6 CF cases of Rhabo confirmed within the first year of affiliates. And thats 8 years
ago before the company really blew up. One very famous case of a client
permanently disabled and nearly killed under the care of CF experts. Resulting in a
6 figure payout in court.
An unparalleled 16% injury rate under the supervised instruction of experts.
Warned against by the Air Force, the Navy, the Army, the Naval Commander of
Special Warfare (SEALs, DEVGRU). Turned down by the US Army Rangers. Same
with a Canadian Forces experiment.
Labeled by the ACSM, NCSA and military health and performance consortium as
an extreme program (not a compliment).
There are not only two choices in this world: Crossfit or Couch. Although, judging
by the founder of Cf, you might think so. Seeing as he is obese, and he openly
doesn't subscribe to his own exercise program or diet. No, not every program has
the same inherent risks. When you have an exercise program, that has an
exponentially higher injury rate than a violent contact sport like football, then you
need stop blowing smoke.
27 SEP 2013 5:14 AM
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dhendr3229
12 Fans
This crossfit thing is just the latest brain wash workout fad. You can't lose in 6 weeks
what it took you years to gain. You have to have a 'BALANCED' diet with foods that are
good for you. You have to workout in a way that works your muscles with out taking
them to FAILURE.
26 SEP 2013 2:29 AM
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Kathy S. (roseyaire)
SUPER USER 2,202 Fans
Adopt, don't shop
Preach that common sense, f/f

26 SEP 2013 3:35 AM
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Life_Performance_Systems
0 Fans
I must say I am in no way shape or form a fan of Crossfit but this article is rediculous.
Outside of its rediculousness it does provides a good insight into the mentality of
trainers and crossfitters...careless. First off it is incredibly hard to develop rhabdo in a
already trained person. This tells us one thing, this person was highly untrained. And if
this is the common theme they embrace it tells us there are many idiot trainers and
inactive customers involved. Since its explosion to the mainstream...it has opened the
doors to more unqualified trainers and desk jockey customers. The problem lies here,
when you have unqualified trainers supervising unexperience clients without proper
individualized programs this type of senseless stuff happens. Cross-fit should be
reserved for high performing athletes and not the inactive population. All in all, cross-fit
wont kill you, but your highly unqualified trainer with poor judgment might. Cross-fitters
need to use their heads as well and If not, its malpractice on both ends.
26 SEP 2013 2:41 AM
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Mr_Happy_is_here
47 Fans
What does CrossFit's founder, Greg Glassman think of this?

"It can kill you," he said. "I've always been completely honest about that."
Enough said!
26 SEP 2013 3:38 AM
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MuckyPup
102 Fans
15
Think, Thank, Thunk
I think this is a reflection of American culture in general. There is no middle ground here,
you're either obese or anorexic, a genius or a dunce, a winner or a loser. You either sit
on your rear end all day or push yourself to physical extremes. Where's the middle
ground here?
26 SEP 2013 10:46 PM
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DaMostSmartestManAlive
89 Fans
I'm am a GENUIS
I AM A GENUIS
27 SEP 2013 1:15 AM
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hartkid
64 Fans
and guess what, Obamacare won't cover it. Under Obamacare, you have to pay more if
you are healthy and work out and if you get sick from working out, you have to have
your limbs cut off.
5/18/2014 1:17 PM
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Just kidding. This article has no Obamacare angle that I can think of, but if it did, by gum!
It'd be something bad about Obamacare. What do you expect from a socialite from
Kentucky with no social security number or whatever. I heard he was a Mosque! Not
even a Christion!
27 SEP 2013 4:43 AM
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James R. (TXZen)
110 Fans
Nice :) if you only could have included mention of death panels, or cross fit
workout death panels, that require cross fit training or no health care.
27 SEP 2013 5:49 AM
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eliz30
5 Fans
Disclaimer: I am completely aware that I am about to sound like a know-it-all.

I have been a female athlete since the age of 7. In high school we had an amazing
Weight Training coach who took the time to properly teach us how to do dead lifts, the
clean and the jerk. I was proud to be a female athlete who was able to do these kind of
exercises and I was in amazing shape. I remember him saying over and over again, "It's
not about how much weight is on there, you have to have the correct form." I played
lacrosse in college and we had a Strength and Conditioning coach who also taught my
team the kind of exercises that you see in CrossFit and who also made sure we were
doing them correctly.
When I first started seeing people post about Crossfit about a year ago, I distincly
remember thinking to myself "Oh boy, a bunch of people who have never lifted weights
are going to do Cleans?!?" People-exercising should NOT be about the latest trend! Yes
lifting weights is important for building muscle and it's really good for you, but it is not a
competition.
25 SEP 2013 2:05 AM
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msliz11
28 Fans
Yes, but isn't it the coaches responsibility to help their people pace themselves
and not push them to extremes? From what I have heard and read, the whole
Cross Fit culture is about extremes and a mind set that sees it as weakness if you
don't push yourself to the edge.
25 SEP 2013 4:20 AM
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