What do you think is the best topic to freak out about – piss poor movement, obesity, or Rhabdo? Hmm…Rhabdo’s incidence in the U.S. is less than 0.06%, over 30% of Americans are obese, and we’re guessing that most of the population does not even perform a squat properly. Imagine what being overweight with poor movement mechanics will do to your knees over time.
The folks at Dr. Theresa Larson’s Movement-Rx Human Performance group have had a lot of inquiries this past week regarding our thoughts on the article “CrossFit’s Dirty Little Secret,” written by Eric Robertson, an assistant physical therapy professor at Regis University.
Here are our thoughts exactly:
Incidence of Rhabdo versus Obesity & Heart Disease:
Rhabdomyolysis occurs in 0.06% of the population and often occurs with individuals who are taking certain statin drugs to treat high cholesterol. Exertional Rhabdomyolysis can occur with mechanical or excessive strain placed on muscles during athletic activity which can quickly break down muscle tissue. Eccentric contractions or actions that involve lengthening of muscle tissue as it attempts to shorten are the most problematic especially if performed incorrectly (i.e. squatting, jumping). Once muscle membranes get tattered, the inner contents and minerals such as potassium that are supposed to be in the cells are now out in the blood stream and can effect heart function if they accumulate at high levels. This is very rare but can happen in ANY extreme conditioning program such as ultra-marathon racing, snowboarding, football, weight lifting, cycling, etc.. It can also happen in a CrossFit gym and or even in a physical therapy clinic (see below video)
The real problem in our country is living sedentary lives. Our obesity rates are above 30%, and even more frightening is that 49% of American have at least 1 of 3 risk factors for heart disease: Hypertension (or high blood pressure), high cholesterol (Low-density lipoprotein), or a smoking habit. I have not personally tested athletes in a CrossFit gym, but there are very few obese individuals, even less who smoke and it is unlikely many have high cholesterol (and if they do, it is not for long).
For more Peer Reviewed Rhabdomyolysis information please visit: Rhabdo Study
Who actually gets Rhabdo?
In an excellent article by Jim Bledsoe on Sports Injury Bulletin mentioned, “Although rhabdo is usually thought to be a rare condition, the truth is that many athletes suffer from a mild version of it from time to time.” “If you’ve ever had stiff and tender muscles after exercising, you’ve probably had a slight case of rhabdomyolysis,” notes Marc Rogers, Ph. D., an exercise physiologist at the University of Maryland. Novice exercisers can develop the problem, but so can the most highly trained, accomplished athletes (‘Catastrophic Medical Events with Exhaustive Exercise: White Collar Rhabdomyolysis,’ Kidney International, vol. 38, pp. 709-719, 1990). It can also happen with military recruits, drug users, alcoholics, those who are on some forms statin drugs, rowers, CrossFitters, and others.
Jim even went on to say that, “Strangely enough, a small dose of rhabdomyolysis might actually have a positive effect. Various scientists have speculated that the build-up of calcium inside muscle cells during rhabdo can stimulate increased protein synthesis inside the cells, perhaps producing some of the beneficial adaptations we associate with training (more aerobic enzymes, more contractile proteins, more mitochondria). It’s only when too much damage is done and the whole process gets out of control that rhabdo becomes a severe threat to health.”
How to avoid exertional Rhabdo:
My advice is as a new athlete to any sport such as CrossFit, look at your background and understand what energy systems are being used. CrossFit trains all three energy systems your body has- glycolic, phosphor-gylocolytic, and oxidative. If you go from being a long distance runner your whole life and have never touched a weight in your life, or casually workout, then CrossFit will be a significant change for you. Managing your body and knowing your limits is the key. The more you grow accustomed to the workouts that involve weight training, gymnastic movements (pull-ups and pushups), and endurance exercises (rowing and running) the better you will be.
One of our physical therapists was certain they got a minor version of Rhabdo from their 20+ mile hikes while in the Marine Corps after not getting enough rest and not being hydrated; it took them a few days to recover. It happens!
Rhabdo Cartoon and RISKS:
Every sport has risks, and CrossFit has a cartoon that represents the risk! It is not a joke, but rather a warning. There are risks in ANY sport you do and would hope that you were aware of the risks prior to participating. When one of our therapists was training in Muai Thai for a short stint my coach made them well aware of the risk of injury. Ok cool! The therapist was responsible for their body and knowing their limits and the coach was responsible for teaching them the proper technique. They signed the waiver and knew what they were in for.
If you ask us, the real risk is letting your body go, and moving poorly!
To make sure you perform the movements correctly, and keep the athletes safe throughout their entire duration at the gym.
Our advice to health professionals:
Focus on the things you can control: Setting an example and focusing on things you can control and helping the sport, athlete, situation get better!
As a human performance company who employs doctors of physical therapy, mobility and movement is our specialty. A good portion of our practice includes working with high performing athletes and getting them moving efficiently so they can perform at higher and higher peaks. We work with CrossFitters, football players, baseball players, and martial artists. What we would suggest to other health professionals is, use your knowledge of medicine as well as strength and conditioning and to help individuals move more efficiently. Not only help conserve their energy, but improve their work capacity, the importance of hydration, and educate them on timing and rest so they have the ability to finish a workout and not feel smoked. That is our job as physical therapists and human performance coaches.
A good resource for movement and mobility is Dr. Kelly Starrett, who posts very informative techniques that will help you move better whether you CrossFit or not (visit: MWOD).
Community of CrossFit:
If you’ve moved past the fear-mongering of Dr. Robertson’s article and are interested in the positives of CrossFit, do check it out for yourself. Movement Rx focuses on this wonderful community because these athletes and participants live their life out loud. Strong friendships are built, body-mind-spirit changes are made, and humble self-confidence is grown.
I challenge you to find a good CrossFit box in your area, talk to the coaches, take a class and see what you think! What do you have to lose?
Check out this video, and be inspired: