This is the first time in 4 years I am not competing in the CrossFit Games season. And while it’s a tad depressing, at least I can do my part in helping others do their best! So, I will post my thoughts and tips on how to approach the Open workouts. Here’s the first one!
We have a lot of baseball players that come through both Courage Performance locations. Most of these athletes are in the 13-17 year old range, and we have a good number of college level, and some pro guys who come through as well. One of the first things I try to make clear to these guys is what to expect out of training on our program.
The goal with our program is to get people to move better. We assess movement, correct dysfunction, and build strength and power. We help to make you a batter athlete. But to become a better baseball player (or anything specialized: football, basketball, triathlon, martial arts, CrossFit, walking, etc.) you must work on your specialization with the same intensity, focus, and intelligence you will work on your athleticism in the gym.
We can help build a strong shoulder and arm, hips and legs, core and everything else. We can help keep needed laxity while building incredible amounts of stability and power in the body to produce a more explosive swing, or pitch. But all of this work will not do very much if your swing or throwing mechanics are atrocious. I have seen too many ball players come asking for additional exercises to help build more strength in their arm, yet do not take that time and energy (or find the proper coaching) to perfect their throwing mechanics.
One thing must always be understood: the gym is an accessory to the work you put in on the field. If you want to become a better baseball player, you must play baseball, and always be working on getting better at those skills needed to play. The gym will help build athleticism, and help to balance and correct issues so that you can be stronger. This helps you adapt to mechanical changes on the field. This helps you have a greater chance to prevent injuries. This helps you sustain, and continue to be effective over the course of a season. Basically, the gym helps to give you the tools needed to become a better baseball players/specialist
But if you work you ass off in the gym (and if you are a Courage Performance athlete, you are working your ass off, and you’re doing it right!), but then don’t take that same intensity and focus on correct movements and mechanics on the field; you are doing yourself, and your coaches a massive injustice.
We don’t care if you can squat 350, or clean 225, or deadlift 400. If you don’t know how to throw a baseball properly, that big squat is not going to help you become a better baseball player.
Just like we are constantly evaluating every aspect of how you squat, you must do the exact same thing (if not more) with how you throw, field, and hit. A strong shoulder does not automatically mean a strong thrower.
Take pride in your sport. Work each and every day to perfect the movements needed to be the best you can be. Courage Performance will be here to help you move better, to help you get strong as hell, and explosive as hell. Now it is up to you to take that good movement, that strength, and that explosiveness, and apply it to the sport you want to play.
Never Stop, GET FIT.
As a follow up to my long, detailed information-post on Rhabdomyolysis, I promised I would write about my own personal experience. I'm treating this post as a complete personal experience thing; this means I am just telling my story and my theories as to how everything went down. I have put three weeks of thought and research into this now and have come up with a ton of thoughts and ideas. I will also preemptively write that I may go down some theoretical rambles about how I work that some people won't relate to; just a warning. My intention here is to be forward and honest as I always am with this blog, and hope that it can help some people out there.
First things first. Not surprisingly, I have received a rather large amount of private messages from my first post about athletes who have gotten rhabdo. The main thing that popped out at me very quickly was that a good deal of these were either other coaches, or athletes who train with groups and such who admitted that it wasn't only them who got it, but a collection of people at the same time. This strengthens my theory that way, way more people get Rhabdo than we thought. Perhaps all those "scary posts" that came out a few months back were actually right!
I need to make something clear here: this does not mean you should be scared, blame CrossFit or some other "governing body" of exercise and sport. It simply means that Rhabdo truly is a common condition that a lot of people will deal with at some time or another. It probably won't kill you, hell, it probably won't even bother you all that much. But, it's better to be educated and smart, then brush it off or lie about it like an ignorant or stupid person. Just accept it, take responsibility for it, learn from it, and move on.
One more point to make (and one I will reiterate at the end of this post) is that Rhabdo is not a selective condition. It does not matter if you are male or female, experienced or a newbie, a CrossFitter or a jogger, anyone can get it. Here is how I would discribe who might get it:
If you do more than your body is prepared for, you put yourself at a very high risk of getting Rhabdo in some degree.
Please read the above sentence a few times so that you can actually understand what I am saying there. That means a person who has never exercised has around the same chance as a very experienced exerciser at getting it. And again, the line of it being very dangerous and not so dangerous is a very fine one. Actually, now that I think about it, an experienced exerciser is going to be more "comfortable" with being really sore and will be more prone to ignoring it, taking a few days off, and just moving on without actually getting that blood work. So I would argue that experienced exercisers actually get Rahbdo more than beginners. Beginners will just tend to get it diagnosed more because of how extreme the soreness feels to them. Make sense? If not, I don't know, just email me or something.
Here's my story.
I am a very experienced exerciser. I played pro baseball, ran 12 marathons, ran a 50-miler, competed in jiu-jitsu, and triathlon, and have placed pretty damn high in a lot of CrossFit events ("competitive fitness events" to use the legally correct term, but I'll use language that the majority actually understands), even getting up to the Regional level three years in a row. So, I am pretty used to pushing my limits on a very regular basis. In fact, My blog started many, many years ago as a sort of journaling of my process to find my own physical limits. It's a major curiosity of mine to see how far I can push myself. I want to challenge myself physically and mentally as much as I can so that I can grow and get better.
So, after missing out on my 4th Regionals appearance last year by 3 spots, I moved to a weightlifting and powerlifting workout program. I didn't stop doing metcon workouts or anything, just toned them back to focus on the barbell. Then about two months ago, the fire was re-lit and I started programming in those crazy CrossFit style workouts to get myself prepared for the Open. I slowly brought in high rep movements, skilled movements that I would only recommend competitive CrossFit athletes do like high rep box jumps, kipping/butterfly pull ups, kipping handstand push ups, and high rep olympic lifts. I wouldn't say I was back to my normal "CrossFit shape" but I was getting there. I was still definitely heavier than I had been while at my higher competitive levels. So I was "in progress" when I programmed a sheer volume workout for myself and my training partner. We were to do 100 each of: wall balls, pull ups, push ups, and dumbbell snatch at 75#.
It was the pull ups that did me in. I could feel my arms tighten up around rep 50. And through the push ups and DB snatch I was having a hard time straightening them out. That night at dinner my training partner and I were joking about how sore we were and how we felt like body builders walking around with our arms bent so much. The next day was much of the same. My arms and lats were swollen, and they were incredibly sore. No discolored urine at any point. I kept drinking a LOT of water, and constantly checked for this symptom. I did a very light KB and TRX mobility focus workout hoping to get the blood flowing and aid recovery, but I actually felt worse after. I then got a massage and things actually felt a little worse after that too. Thursday was the same, and I seriously thought about heading to the hospital. But I talked to a doctor on the phone and chose to hang out another day to see what would happen. Well, Friday actually felt a tad better during the day. But by the late afternoon things just got event worse. My arms were so swollen, incredibly painful, and I really started getting scared. After supporting one of my athletes at a Crossfit event on Saturday, I figured enough is enough, and went to the hospital. Sure enough (and after 6 hours of being in the emergency room dealing with some pretty, um, not smart medical staff) I was admitted with Rhabdo. My tested CPK levels were at 55,000 U/L, and my estimated levels were over 100,000 U/L (they had to dilute it three times after the original "over 25k" reading came out to get that 55k).
So, how did I get this? Well, simply put, I did more than my body could handle at that time. I found a physical limit. I would argue that this was a bit of a "perfect storm" of events that led to this. Looking back, I really don't think I made any form of bad choice in doing the workout. Yes it was a crazy one, but nothing my body wasn't used to, and nothing that actually made me nervous in any possible way. I am confident I was fueled and hydrated sufficiently, and I was more than warmed up seeing as I had just completed my programmed barbell work and was feeling really good physically. So what was wrong?
It was late (around 8:30, and I had not been pushing myself with longer, high intensity workouts all that late at night recently). I was extremely stressed and in a pretty bad mood (as was my training partner). Now, there is no research out there on cortisol levels and their effect on rate of muscle tissue breakdown, but logic tells me they are very closely related. I really would like to help get some science on this! While I had done a good bit of 15-20 minute time domain workouts, this was the first one that had me pushing at a high level, well into the mid 30 minutes. While I had begun to reintroduce the CrossFit style kipping pull ups back into my training, I had done no more than 5 at a time, and no more than 50 in one session before attempting this 100.
I think I was more tired than I thought, the stress had me moving under more tension and less efficiency than I am normally used to. The added body weight made the stress to my body greater. The rusty kipping technique had me controlling the movement more than I normally would, and the length and intensity of the workout added to the breakdown the pull ups caused.
I think that the overly controlled pull ups were the main culprit for all this. While my normal technique on the butterfly pull up allows for very minimal eccentric loading because of the efficiency of the technique, my being rusty actually increased that eccentric loading much more than normal. I would kip, pull myself over the bar, then, when I would normally let momentum and gravity just guide me through extension and back into the kipping concentric portion, I would actually tense up and control my body through the extension. This is literally the form of contraction that tends to lead to something like Rhabdo: high rep, eccentric muscle contractions. Ugh.
I've been through a good number of ups and downs with all this. I take a lot of pride in knowing my own body, and for a while I was mostly embarrassed that this sort of thing could happen to me. Yeah, I just figured that being in respectable shape, having a pretty high level of general fitness, and being healthy would mean I wouldn't be susceptible to something like Rhabdo. But it's clear to me now that it doesn't matter if you are in great shape. It doesn't matter if you feel you are not pushing yourself. It doesn't matter who you are, you are NOT immune to getting hurt or messed up. The fact of the matter is, I am lucky that I know myself well enough to have made the smart choice and went for a blood test. And that is the message I hoped to get across in the last post: if you think you might be in trouble at all, even if it's just a fleeting thought, go get a blood test.
After this will I ever do high intensity work again? Of course! I will spend the rest of my life challenging myself and pushing myself to new limits. And I'll will probably get some bumps and bruises along the way. But this is the way that I choose to live my life because hiding in my room, avoiding risk out of fear of hurting myself is in no way at all the way I want to live. And please, for the love of all that is holy, do not interpret this post or my last post as me trying to tell everyone to be scared of Rhabdo! In fact, it's the other way around! Most of you have probably already had it at one point or another and I'm sure you are mostly fine. I am simply talking about being smart. Know the risks you are getting yourself into. And if you can accept those risks, have fun! Seriously.
I recently asked the question in my gym about what is worse: avoiding things that have potential risk altogether, or, blindly doing anything with no regard for the risk?
I honestly think they are equally bad/stupid/ignorant. Don't live your life avoiding things because you might get hurt. You can literally get hurt doing ANYTHING! And don't be a jackass and just do things without having a clue as to what you are doing. Be smart, know your risks, understand what you are doing, then dive into that challenge with an open mind and open heart. You will learn so much. You will grow so much. I am not upset I got some mild case of Rhabdo, not in the least. It took me out of serious working out for two weeks. Big whoop! I learned SO much about my body, about health and fitness, about hospitals and doctors, and it all helped me grow into a better person than I was a few weeks back. And this happened because I embraced it all.
I hope this posts helps!
Never Stop, GET FIT.
Pre-post note: this article is very long. Probably one of the longest I’ve ever written. But the point of this is to supply as much info on rhabdo as I can, not to entertain you all with my thoughts and ideas like my blog is usually about. Also, I have a post following this with my atual experience and ‘my thoughts’ on how I got it. Enjoy!
Rhabdomiolysis (rhabdo) is a surprisingly common issue where an influx of toxins are released into your bloodstream after extreme muscle tissue breakdown. The influx of these toxins (known as CPK, or creatine phosokinase) can lead to increased myogloben levels that could lead to kidney issues and, in extreme cases, death. Let’s go over why the heck I know so much about rahbdo, and exactly what the heck this annoying problem is. And lastly, what are the best ways to take care of yourself if you think you have it, or you know you have it.
First off, who the heck am I to talk about this? Well, I’m not a doctor or scientist or anything, but since I actually was hospitalized for getting rhabdo less than a week ago I have done hours of research on everything possible. I’ve also established that at this point, I know more about rhabdo than 7 nurses and 4 doctors. Anything I write here is purely my opinion from experience and tons of research. My goal is to get some actually scientific studies done, and I personally am in the process of planning one out myself (I will be taking blood work on specific demographics of clients, performing specific styles of workouts, and measuring their before and after CPK levels). So take what you will from all this. This post is meant to be a resource for anyone interested in the topic of rhabdo.
What Is Rhabdomiolysis:
Rhabdomiolysis is muscle-based conditioning where extreme tissue damage causes a release of damaging toxins (CPK being the main one) into your blood stream and can cause anything from kidney failure, to limb damage, to death.
The most common symptoms are extremely sore muscles, swelling of the sore area (edema), and, in more extreme cases, dark (coke colored) urine. It’s tough to diagnose rhabdo right off the bat. So, if these, or some of these continue for more than a couple days, it’s probably a good idea to go get a blood test.
What Is CPK:
CPK is a protein/toxin called Creatine Phosokinase. This protein is released by your muscles whenever you break them down (through exertion, through impact, through drugs, whatever), and at lower levels is pretty easily processed by your kidneys and passed regularly when you piss. When the levels get higher, the toxin can actually overflow your kidneys and cause acute renal (kidney) failure. And this is not good.
While there is not a universally accepted CPK reading that all doctors can read and claim that you have rhabdo, there seems to be a base level of understanding for what constitutes a rhabdo diagnosis. There is also a commonly understood level that would suggest hospital admission. There are generally understood CPK levels that could lead to certain levels of risk. So, here’s the rundown:
It is generally understood to claim a person has rhabdo if their CPK levels test at least 5x greater than their highest normal range. The average normal range is around 100-300 units per liter (U/L), but some people may have normal ranges that are a little higher. But even if you have a level of 1,000 U/L, that would, mean a CPK reading of 5,000 would constitute having rhabdo.
This would not necessarily put you at a risk of any organ damage though. And most people who are in shape enough to workout hard enough to get a CPK reading like that after a workout, are probably hydrated and fit enough to just work through it within a couple days.
So, if your reading is below 10,000, you’ll most likely be totally fine. But, if your reading is up towards 10,000, you should probably consider taking things a bit more seriously. And of your reading is at 20,000 or above, you should get an IV in you and get regular blood tests to make sure your kidneys are safe.
Some extreme cases (like my own) can get a reading well over 100,000. This is risky, and you should really get into the hospital to get proper fluids and keep an eye on your insides.
How Can You Get Rhabdo:
The common extreme cases of rhabdo are seen with high impact patients. So, people who get in pretty nasty care crashes, or have something fall on them, or something like that will tend to have very high CPK readings (like 300,000 or some absolutely insane reading). These people are at risk for the scary rhabdo; the kind that causes kidney failure, permanent limb damage to loss of limbs, and death.
You can also get rhabdo from certain drugs (like statins). Honestly (and I’m sorry to those struggling with this) I don’t actually know very much about this side of it. I tended to graze over all the medical journals and information that talked about rhabdo and drugs.
Exertion-based rhabdo (what I got, and clearly the focus of this article and my future studies) is pretty interesting. It is commonly understood that you run the risk of getting rhabdo though high rep eccentric contraction. This means that when you contract your muscle by extending the joint (the “down” portion of a pull up would be the most common one here) for many, many reps, you will be at a higher risk. But, this is not the only way. Any form of extreme muscle tissue breakdown, eccentric, concentric, isometric, whatever-tric, as long as it’s extreme breakdown, can cause rhabdo. Eccentric is just the quickest way for it to happen. And again, commonly, beginners are at a higher risk. Under-fueled/dehydrated people are at a higher risk; but then again, anyone who works out really hard is at a pretty damn high risk of getting rhabdo at some level. In fact, I would argue that pretty much every single person who has experienced extreme soreness has technically had rhabdo.
Say what?!?! Yep, as you read above in the CPK explanation, just having a 5x increase of your normal CPK levels would technically mean you have rhabdo.
So, be aware of what you are doing. Keep workout and food journals so you know how you’ve been progressing. As a strength coach, it would seem like a pretty high risk to put a group of beginner clients who can’t do a pull up through a 100 pull up workout. I would almost guarantee that most of that group would get rhabdo in some degree. My point is, make the effort to know your body, and even then, be safe. I know my body incredibly well, and have spent literally 20+ years challenging myself, learning about myself, and building myself, and I still got rhabdo. To be honest, if I didn’t know my body the way I do, I’m sure I would have gotten some pretty serious, and probably permanent damage to my arms had I not decided to go to the hospital.
My goal isn’t to scare everyone by saying you’ve all had rhabdo at some point. The point is to make sure as much info is out there for all you to understand this a bit more. I spent hours researching and there was so, so little info out there as to what this is.
The reason rhabdo is a scary condition is that there’s such a fine line between it not being a serious issue, to it being a very, very dangerous condition. This is why playing it safe is always the smart thing to do (you’ll find the process I suggest a little further in this post). This isn’t all that rare, think of water. Water is one of the best things you can possibly put in your body. But, if you drink too much of it, you can seriously damage your body. More similarly analogous would be cortisol.: cortisol is a stress hormone that is extremely good to have as it helps you react to extreme situations. But, if your cortisol levels get too high, it causes an overwhelming amount of problems.
So how do you assess this risk? First off, if you are more sore than you’ve ever been before (unintentional rhyming there…), go get a blood test. If you’re like most people who workout and get sore, but feel abnormally sore, look for dark urine, look for swelling and lack of mobility in that area, and if you have any of those, go get a blood test. If you choose not to get a blood test and your conditions last up to three days, go get a god damn blood test!!
It’s not that complex. If you are worried about how you are feeling, and your soreness is so bad that it deters you from normal workouts, just go get your CPK levels tested. It’s better to figure out earlier that they are elevated so that you can assess the potential risk you are in and act accordingly.
It is no joke that there is a fine line between taking some time off and drinking water, getting admitted to the hospital for a couple days, and possibly losing limbs or life. While that latter issue is an extreme case, it is possible. And the greater risk, getting kidney failure, is not a good thing at all.
Edema And Compartment Syndrome:
The issue that was actually a concern for me while at the hospital was the swelling (edema) in my arms. The swelling had been pretty sever for 4 days before I checked in to the hospital, and finally began to go down on the second day of being there. The concern here is that the swelling causes compression and restricts the blood flow to different compartments the effected area. This can lead to permanent damage to limbs, and could even lead to loss of limb.
It’s a scary issue, and one that one should really be concerned about if severe swelling continues for more than a few days.
A small hiccup in the whole situation is that a lot of people react to swelling and pain by taking ibuprofen. But ibuprofen is notoriously tough on the kidneys. If you are possibly or definitely dealing with rahbdo, you probably don’t want to add any additional threat to your kidneys. So, get to the doctor!
Let’s recap: if you are pissing brown, go to the doctors. If you are feeling really, really sore, go to the doctor. If you have severe swelling and it lasts, go see a doctor. If you feel like seeing a doctor is stupid, stop being stupid and go see a doctor!
Now, after yelling at you all to go to the doctor, I’ll proceed to rip on doctors!
How To Deal With The Hospital/Doctor:
It seems that from not only my experience, but from a good bit that I found in my research, if you walk into the hospital with sore muscles and no discolored urine, the people there probably won’t take you all that seriously. But if you are smart, and care enough about your health and well-being to actually go to the doctor or hospital, you should insist on getting blood work done. Even if you get a doctor like mine who thinks you and your training partner pulled both your biceps at the same time, insist on getting a blood test (yes, my training partner got rhabdo at the same time as me... it is very strange).
The goal of this post is to supply enough info to people who think they might get rhabdo that you might be able to talk to your doctor with a little more education. Medical facilities and professionals can be a little intimidating. Doctors are experts that we put very high up on pedestals in terms of entrusting our health and our bodies to them. But the fact of the matter is, and in my case (and I know many, many other cases) my expert doctor was very willing to send me home, completely ignoring my knowing there was a problem. He was willing to tell a guy who was sitting in front of him asking for a blood test to just go home and take a couple more days off. Well, it’s a damn good thing I insisted on getting that test, because I definitely had serious rhabdo.
So, again, if you are good enough to yourself to get to the hospital, insist on getting that blood test no matter what. And know that if your blood work comes back with CPK levels that are a concern, you should probably get admitted and get an IV in you stat so that you can flush things out of your body as quickly as possible.
So stand up for yourself if you need to. Insist on the blood test, Know what serious levels are, and insist to get the treatment you need if those levels are high. Remember, it is your body, and you should take care if it as best you can at all times.
What To Expect At hospital:
If you are in some form of critical conditioning with your rhabdo, I honestly have no idea what you should expect. But if you have what the vast majority of rhabdo patients have, you can expect your stay there to be between 2 and 5 days, and you can expect to have an IV in you the entire time, and to be really bored. The fact is, you are there for the IV, and to just keep an eye on your organs and/or limbs because you really don’t want to run the risk of messing those up at all.
They’ll hook you to a normal saline solution, and most likely to a sodium bicarbonate (basically baking soda) to really help with the flushing out of toxins. You’ll get daily blood tests to make sure risky toxins are in fact decreasing, and that’s about it.
Be patient, read, watch movies, write, do work, whatever you need to do. Just try to relax and let your body recover. Remember, you got yourself into this mess, so allow yourself the time to get out of it.
How To Recover:
Take your time!
For people who have control over their training and program, this should be easy enough. It will be challenging and probably depressing that’s for sure, but easy enough. And if you are like most people who push themselves hard enough to actually get rhabdo, you really need to dial in your recovery process as to not put yourself at an even greater risk.
Remember, just because you feel better does not mean you are better. And when you are back from the hospital and feeling recovered you most likely have some pretty elevated CPK levels. Along with having had severely broken down muscle tissue, your body will be at a pretty fragile state for a t least three weeks. For some, this might mean take 2-3 weeks completely off. For others (and the way I approached my recovery) I took 1 week completely off and then very slowly got back into training. In the big picture, what is the point of rushing back into things and possibly destroying my arms for the rest of my life when I could take just one more week off my training and fully recover?
If you really want to play things safe, make a point of getting at least one more blood test about a week after you leave the hospital. Then, when you feel like you are ready to get back into training, start deliberately slow. I think the worst part of this process is the anxiety. After having such a scary thing happen from simply working out, every time you start to do something you become hyper aware of every single bit of tension and twinge that happens. Again, just take your time and stay smart. If you have a coach you really trust, talk to him/her and get some really focused help.
In the end, the experience of getting rhabdo should just be a great learning experience for you if you are actually interested in your own personal health. Learn from it, help others, and share your story.
I hope that this long post supplies some assistance to anyone who might have had rhabdo, or think they might have it. Know that this condition is so extremely under-diagnosed, and most people have actually had it at some level. Know that if you are smart about things, you will most likely be fine. Be safe, get a blood test, and reach out to people you trust and can help.
Never Stop, GET FIT.
Yep. So is walking down the street if you think about it in a certain way, and sitting at your kitchen table for that matter. There has been a lot of talk on my social media feeds (thanks to me being “internet friends” with a lot of fitness people) about the potential health risks of high intensity exercise, or what we know as CrossFit. So, I thought I’d offer my take on all this jabber.
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