Landstuhl CrossFit

I want to get your attention because although it occurs extremely infrequently as a result of exertional or extreme exercise, rhabdomyolysis can kill you, and today’s WOD shares some characteristics with workouts which have led athletes (both novice and seasoned) to rhabdomyolysis in the past.
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From Priscilla M. Clarkson, Ph.D. Worst Case Scenarios: Exertional Rhabdomyolysis and Acute Renal Failure Report, Sports Science Exchange (SSE)#42, Volume 4 (1993), Number 42:

Exertional rhabdomyolysis is characterized by a syndrome of conditions including muscle pain, weakness, and swelling; myoglobinuria; and increased levels of sacroplasmic proteins and other muscle cellular constituents in the blood. Generally, this syndrome is brought on by the performance of unaccustomed, excessive, repetitive exercises such as push-ups and squat-jumps. Rhabdomyolysis can also occur after strenuous recreational activities such as marathon running, hiking, or performance of excessive strenuous exercise during the first days of a new training program. Mild cases of rhabdomyolysis do not require hospitalization, and individuals recover within one week. However, in certain individuals, rhabdomyolysis can be severe. The combination of heat stress (hyperthenaia) and rhabdomyolysis can produce acute renal failure, which, in rare instances, can result in death. The few individuals who have developed severe rhabdomyolysis generally have never shown any prior symptoms. These individuals may have a latent, sub-clinical muscle disorder that predisposes them to the most negative consequences of rhabdomyolysis. For strenuous exercise in the heat, precautions such as adequate fluid intake and acclimatization are critical.

Thrusters like those in our WOD today have a pronounced eccentric component just like other CrossFit-friendly exercises like jumping pull-ups, box jumps/burpees (squat jumps), pushups, pullups, GHD situps, and kettlebell swings, and when performed at high-reps/high-intensity have disproportionate representation in documented rhabdomyolysis cases. If you are working out during our afternoon session, the weather will be hot. A common feature in prior cases of renal failure accompanying rhabdomyolysis which Dr. Priscilla M. Clarkson examined, was that ambient temperatures were generally high – many of the victims were profusely sweating or showed signs of heat stroke. Don’t be lured by the fast times some athletes are able to complete Fran! You can be a seasoned athlete, but especially if you are new to CrossFit, you may need to insert a couple more breaks into the workout above – and there is no shame in this! Breaks allow your muscles oxygen and can help them avoid damage. If you are new to CrossFit, once you reach muscle failure it is not the time to drive on with band- or buddy-assistance, it’s time to stop, and you’ll also need to allow your muscles adequate time to recover in between WODs. Seasoned CrossFitters can push their muscles continuously without risk on a daily basis, but when you are new to CrossFit, resist the military mindset to push the limits of hardcore. Keep in mind that it’s not just heavy weights which present a danger – note Dr. Ahmik Jones’ advice on the CrossFit Message Board to personal trainers:

Avoid giving new people a weight that is too light. Sometimes weight is protective. It makes people slow down due to muscle failure. We had a group of people do Fight Gone Bad with PVC and a 4 lb Dynamax ball and people were throwing-up because there was no need to stop. Give people something that is heavy enough to make the workout legitimate as long as they can lift it with proper form and they will rest enough to keep themselves safe. Once people have been doing this for a while they can do things like light Fran to work on speed without worrying, but it can be dangerous at first.

ER Doctor Mike Ray assures us that exercise induced Rhabdomyolysis is only occasionally seen in athletes – and that in fact the most common scenario he sees by far is from people hiking for extended periods in high heat and becoming dehydrated. Jim Bledsoe at Sports Injury Bulletin credits Marc Rogers, Ph. D., an exercise physiologist at the University of Maryland, with noting that many athletes suffer from a mild version of rhabdomyolysis from time to time.

If you’ve ever had stiff and tender muscles after exercising, you’ve probably had a slight case of rhabdomyolysis… some reports have indicated that acute rhabdomyolysis can strike about one out of every 300 military recruits during their first week of training (‘Rhabdomyolysis, Myoglobinuria, and Exercise,’ Sports Medicine, vol. 6, pp. 93-106, 1988)

And that also, mild cases of rhabdomyolysis actually have a net positive effect on your body:

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.

Here is documentation of such a case. Eugene R. Allen is CrossFit affiliate owner of CrossFit Pierce County. Following is his personal account of what happened to his friend Brian “Black Knight” Anderson after his very first CrossFit workout:

Nothing remarkable along the way save for the second set of 50 KB swings that must have been a little over the top for him. He was using up pretty much all of the air in the room (the “What do you do for cardio” question had not come up) and it was clear he was pretty much done. He told me later he was having a heck of a time getting his pants and boots on (he had to lay down on my driveway to gear up for his Harley ride home) and he called me later to tell me he was feeling OK but that his kidney’s were going to sue me.
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At 0300 the next morning he was in an ambulance enroute to the ER because he was 10/10 for pain and could do little but curl up in a ball on the floor. Agony.
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Rhabdomyolysis…you do not want to get this…He almost died. Literally. He spent 6 days in the hospital on a morphine drip that barely touched the pain. His kidneys were over loaded, he had to get pumped full of fluids to flush out the waste products, pneumonia was a constant threat and the excess fluids created mineral imbalances that threatened his heart. The muscles of his lower back were destroyed and there was the constant threat of kidney failure…
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Black Knight is on our department’s SWAT Team with me and we have been through some really close calls together over the years…We are very close friends and to work him out to the point of near death (a department memo was put out by the administration explaining to all department personnel that he was very seriously ill and under treatment for a frequently lethal ailment) was truly terrifying…
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He didn’t die. He had to stay home from work for a bit (he was too weak to sit upright in a chair) but after a couple months he slowly got back into the swing of things (no pun intended) by starting swimming with me. That got all his muscles working again and strengthened his back. He got better.
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He has been doing CrossFit again since January and he has lost about 15 pounds and 2 1/2 inches from around his waist. He hammers and is back to his hard core self.
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Pukie’s big brother Rhabdo is a mean mo fo. Be happy if all you do [with Rhabdo] is puke a couple times and feel a bit weak in the morning…One of my training goals now is to avoid killing my friends and clients

Most of you are honestly prone to be overcautious on workouts, which is quite a 180-degree turn around from Drake’s work providing CrossFit training to soldiers in the 173d Airborne Brigade, but most likely directly resultant of your professional medical background and all-too-keen understanding of everything exactly that can go wrong. Just keep in mind the incredible adaptability of the human body – as your physiology begins to make changes to take on new and loftier CrossFit challenges, you do have to keep pushing your personal bar higher. Gradual increases in intensity are the key – and stay attuned to perceived intensity – ramping your cortisol levels up won’t do you or your fitness goals any favors.