From the CrossFit Journal.
We warned of rhabdomyolysis in a previous issue (CrossFit Journal 33, May 2005) and return to the topic this month not only to repeat our warning but to share the lessons we’ve since learned about “exertional rhabdo.”
Before the first rhabdo case was brought to our attention, we regularly warned of CrossFit’s potency wherever we had the opportunity. In the January 2005 issue of the journal, we offered the following caution for newcomers tackling the WOD (workout of the day):
“Countless bad-asses from sporting and special operations communities, long regarded as bulletproof, have been burned at the stake of ego and intensity.” As it turns out, the burning is rhabdo, and we now find ourselves obligated not just to explain CrossFit’s potency but to warn of its potential lethality.
We can dispense with much medical detail with a quick and easy description of rhabdomyolysis as a potentially lethal systemic meltdown initiated by the kidneys in response to the presence of shed muscle-fiber debris and exhaust in the bloodstream. There are several causes and types of rhabdo, classified by the underlying cause of muscle breakdown. With CrossFit we are dealing with what is known as exertional rhabdomyolysis. It can disable, maim, and even kill.
To date we have seen five cases of exertional rhabdo associated with CrossFit workouts. Each case resulted in the hospitalization of the afflicted. The longest hospital stay was six days, the shortest two days. All have made full recoveries. The hardest hit was extremely sick, the least afflicted had no complaints other than soreness. All were extremely sore. Soreness doesn’t adequately explain the discomfort of rhabdo, however. The worst hit, a SWAT guy, recounts that six days of intravenous morphine drip barely touched the pain.
Victims include:
1) Female college student, surfer, mountain-biker, early twenties. Her second-ever CrossFit class in three days was a fast-moving, hard-hitting group workout that included high-rep assisted team pull-ups. She got sore, then sorer. Went to the E.R. Got admitted. Spent three days in the hospital. Didn’t “feel sick.”
2) Dermatologist in his late forties. Avid tennis player. Recreationally active and competitive. His first CrossFit workout was on Monday, the second on Wednesday. Played several hours of tennis on Friday, Saturday, and Sunday. Hospitalized on Monday. Chief complaint was soreness.
3) Middle-aged fit SWAT guy famous for his exploits in a busy sheriff’s office. A CrossFitting friend took him through a “Helen”-like first exposure. Almost killed him—literally. Our first and worst bout of Rhabdo (and the one described in detail in issue 33 of the journal). Now an avid CrossFitter.
4) Female collegiate softball pitcher. Challenged the manhood of her runningback boyfriend when he complained about CrossFit’s “Tabata This” workout. The running back gave the girlfriend the Pepsi challenge. She didn’t finish the workout and was hospitalized three days later for four days. Very sick girl.
5) Special operations personnel. Ignored warnings to learn something about CrossFit before attending a three-day CF seminar. He put his bodybuilding and running regimen to the CrossFit test and suffered third and fourth quartile outputs on the first two of three days, was reduced to watching on day 3 (this probably saved his life), and in the hospital for days 4 through 8. Way too much CrossFit way too soon.
All five have made complete recoveries. The worst hit, the SWAT guy, is now a committed CrossFitter and can easily blast through workouts that once nearly killed him.
We’ve seen rhabdo in men and women, and in the young and middle-aged. They’ve each been and remain tough competitors and were, by popular and common standards, very fit. All were athletes. We have neither seen nor heard of a case of exertional rhabdo involving previously sedentary or inactive individuals.
The settings, circumstances, age, gender, background, and trainers involved varies widely in our five cases but each victim was brand new to CrossFit. Each was wounded by a first or second workout. The victims of the one-two punch had their second workouts two days after their first.
