Physical Therapy’s Dirty Little Secret

I have had enough of you guys ask me about Rhabdo that i figured it was worth giving you my opinion on it. I’m guessing it is because of this article that has been shared recently on facebook: CrossFit’s Dirty Little Secret

In simple terms, Rhabdomyolysis (Rhabdo) is rare condition where muscle fiber is damaged and released into the bloodstream and can cause potential kidney failure.

This news story has also gotten some attention and offers a fairly balanced view on the subject: CrossFit Linked to Potentially Fatal Condition Rhabdomyolysis

My response:

That being said, sometimes it is out of your control. Regardless of it’s extreme rarity, any type of physical activity has the potential to cause it. There are confirmed cases of people getting it from chopping wood and digging ditches!

This video makes it clear that Rhabdo isn’t “a CrossFit thing”: CrossFit – “Rhabdo Ben”

YOU CAN EVEN GET IT FROM EATING FLAX SEEDS FOR GOODNESS SAKE: A case of flax seed induced rhabdomyolysis. 

Based on the fact that it has happened before and it was caused by physical therapy, how ridiculous would it be for me to make an article titled “Physical Therapy’s Dirty Little Secret.” with the purpose of convincing people that physical therapy is too dangerous and should be avoided like the plague!?

Everything has a risk/reward ratio. The risk is always minimized by responsible behavior.

  • Annual estimated deaths caused by obesity related diseases in the US: 200,000
  • Annual estimated deaths caused by Rhabdo: WAY FREKIN’ LESS THAN THAT ^

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According to WebMD, rhabdo can even be caused by things that have very little or nothing to do with overexertion:

  • The use of alcohol or illegal drugs such as cocaine or amphetamines
  • A crush injury such as from an auto accident, fall, or building collapse
  • Long-lasting muscle compression such as that caused by lying unconscious on a hard surface during illness or while under the influence of alcohol or medication
  • The use of drugs such as corticosteroids or statins, especially when given in high doses
  • Electrical shock injury, lightning strike, or third-degree burn
  • A very high body temperature (hyperthermia) or heat stroke
  • Seizures
  • A Metabolic disorder such as ketoacidosis
  • Diseases of the muscles (myopathy) such as congenital muscle enzyme deficiency or Duchenne’s muscular dystrophy
  • Viral infections such as the flu, HIV, or herpes simplex virus
  • Bacterial infections leading to toxins in tissues or the bloodstream (sepsis)

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Remember the video i linked earlier with Ben?

My favorite quote from that video is, “It was a pretty well respected physical therapy clinic in Utah… Luckily, being involved with CrossFit was the only reason that I knew what rhabdo was.” 

By no stretch of the imagination did CrossFit invent or cause rhabdo. It is extremely rare NOW as it ALWAYS has been.

So why is CrossFit under attack on this issue!?

  • Simple, CrossFit is the ONLY community educating its coaches on prevention and identification of this rare but dangerous condition. SHAME ON US! (sarcasm)

CrossFit brought the condition into the limelight by creating uncle Rhabdo:

Some people find it offensive and think we are “making light” of a serious condition. Think what you want but i had never heard of it and because of CrossFit i am more educated on the issue. That was the entire purpose of creating Uncle Rhabdo. To get our attention and help us protect our clients from any potential risk. Unlike other communities, we understand that the condition exists and are aware of it’s warning signs like painful, swollen, bruised, or tender areas of the body and dark-colored urine.

A container half-full with brown-stained urine, characteristic for rhabdomyolysis

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We are the only fitness community that ISN’T keeping Rhabdo a secret.

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I think it is safe to say that rhabdo happens and goes undiagnosed in many sports on a daily basis. Marathon runners, triathletes, football players, bodybuilders, etc. have seen it on rare occasions in their communities for decades.

I like what Josh Everett had to say about the issue:

“I played football for 10yrs… During this time I had 3 surgeries, sprained knees, ankles, and shoulders, uncountable bumps bruises, scrapes, and multiple undiagnosed concussions. I’ve done CrossFit for 10 years with no major injuries… The only time I’ve seen a doctor he told me I have the best blood work he has ever seen in an adult male. My football days occurred mostly in my teens, my crossfit days mostly in my 30’s… Can someone please explain to me again how CrossFit is dangerous.” -Josh Everett 

For most of us, CrossFit isn’t a sport. It’s exercise. Minimizing your chance of any and all injuries is simple. Stay hydrated. If you can do it with excellent form, through a full range of motion then you’re good to go. If you can’t, you have options:

  • Scale the workout
  • Stop
  • Rest

It makes me want to punch myself in the face about fifty times every time i hear some genius essentially try to argue that, “Exercising too hard is what’s wrong with this country.” 

genius

Just be responsible and listen to my coaching cues and you will be fine. But you already knew that didn’t you? Because i tell you how to do things safely and effectively every single day you walk through my doors. Derp.

Keep calm, WOD on, and God bless.

-Coach Barnett

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One Response to Physical Therapy’s Dirty Little Secret

  1. You might want to read the follow up article by the Doctor, clarifying his position. He isn’t exactly attacking or assassinating CF. He specifically says so. https://medium.com/health-fitness-1/7c154157c96a

    I don’t think any rational person believes that Rhabdo is occurring by the thousand in CF.. But, yes CF has had it happen way more than they would like. Within only 1 year of affiliation, and only a handful of boxes (at the time), Glassman admits to knowing of 5-6 cases verified, prompting the now standard training in the two day seminar. This was discussed in the 2103 interview he did with Inc.
    And a rash of Several incidents in only a couple of months prompted revisiting of the subject on the CF Journal in 2011. And the discussion clearly stated (From HQ)that it could have been prevented, had the CF community shown more care for new members and affiliates.

    There is fair reason for CF to pursue adopting quality control, quality assurance, and promoting a best practices program. These are staples of successful business models the world over. I also believes what drives a lot of distrust outside the community, is the rabid and sometimes blind defense of CF in the face of medical or other related experts simply, asking questions or offering opinions. If you want to tout open source, and welcome discussion, then welcome it. Especially when it’s coming from undisputed experts. We aren’t talking about a witch doctor. We are talking about a Doctor, a Professor, a Physical Therapist, and instructor of other advances courses in pharmacology, musculoskeletal, and radiology. Not exactly Forrest Gump.

    Yes, you can get injured doing anything, but some things are more likely to hurt you than others. It’s not always some 50/50 coin toss. Also, in the real world where most people live, there are more than two choices; CF or Couch. Do what works for you, your body, and your lifestyle. If that’s CF, then carry on, and achieve great things. If its another program, rock on with that too. The CEO himself doesn’t even do CF. instead, he sometimes uses an exercise that many in the community mock, cycling.

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