They talk about that day, throughout your life. Those educators, the ones that keep part of your early morning mind awake, to watch for things out of the ordinary. They all say, one day this training and education will pay off. I’ve been there. Training with the Military for many years, I’d hear every-day with my bottom bed sheet strewn across my right shoulder at 5am ‘now pay attention you misally lot!, one day this information you’re lucky enough to receive will pay off’ A blank stare, trying desperately not to make eye contact showed the realisation that being told this for the 101st time hadn’t improved the sponginess of our early morning minds.
Throughout our Physiotherapy studies the tutor would inform us with a similar technique ‘now listen in to these signs and symptoms. If you get two or more answers in the affirmative, then you must refer directly to the patients General Practitioner as the individual may have spinal cord compression and need a decompression to continue using their legs in the future.’ That was more than enough to get my attention. Why didn’t the Military use this technique? It would have worked first time.
In the CrossFit Level 1 Certification Course held in Melbourne, Australia last year, we were introduced to rhabdomyolysis. This was the first I’d heard about it, the causes, signs and symptoms, and effects were all new to me. Now let’s be clear, the training staff on that specific course were exemplary, they covered rhabdomyolysis in detail and confirmed that it wasn’t indeed a new form of electric therapy that improved your Fran time to under 3 minutes, but was in fact, a lethal killer.
“Exertional rhabdomyolysis (ER) is a condition characterised by muscle pain, swelling, and weakness following exertional stress, with or without concomitant heat stress” (O’Connor et al., 2008). Athletes who experience ER often present to the emergency department, the training room, or the physician’s office (in this case) often feeling as though it is a severe case of delayed onset of muscle soreness (doms). Essentially rhabdomyolysis is a breakdown of the muscle tissue, where the components of the tissue enter the bloodstream.
When the muscle breaks down during rhabdomyolysis, it’s the skeletal muscle that’s affected. The skeletal muscle on break down releases Myoglobin (a protein component) and Creatine Kinase (an enzyme) into the bloodstream (Nabili S.T).
Early complications of rhabdomyolysis may include very high levels of potassium in the blood. This can lead to an irregular heartbeat or cardiac arrest. One in four cases of patients with rhabdomyolysis report with liver problems post diagnosis and 15% of cases lead to kidney failure.
This particular case, starts with a lady, we’ll call her Liz. Liz is 52 years old and commenced CrossFit training in July 2011. A dedicated CrossFitter, Liz consistently trains at upwards of 3-4 sessions a week. On this particular week, Liz completed ‘Angie’ on the Monday (100 pull-ups, 100 push-ups, 100 sit-ups, 100 squats for time) on the following day, Liz did some strength work and box jumps.
Liz recounts her week “I completed the 'Angie' WOD on the Monday, on the Tuesday I just thought I was a bit sore and tired, nothing really unusual at that stage. On the Wednesday, I noticed my muscles were starting to ache. When I think back now to the Wednesday, my arms were really quite sore and I felt quite restricted in what I could do with them. By the Thursday the arms were still sore, and more aches in the body, particularly the left side. I also felt extremely tired, washed out and also nauseous.
I woke with the same symptoms on the Friday and so I booked in to see Alex my Physiotherapist, I was very close to going straight to the doctor, but decided against it, as I thought that it was still a case of doms. Alex listened to my story and recount of the week, coupled with my symptoms and slight feelings of nausea, Alex referred me directly to my general practitioner. My GP did not think I had rhabdomyolysis, as she stated that it was very rare and she had not seen this in 30 years of practice as a doctor. She thought my muscles had just gone into spasm from working out so hard. However, she agreed to get urgent blood tests based on Alex’s referral and concerns.
I went away that weekend to Rutherglen. I received a call from the Doctor on the Friday night advising that Alex’s diagnosis was correct and that I needed to go to hospital immediately. She advised me I had a creatine kinase (CK) reading of 32,000 (normal values are between 90 and 140) and that I needed to get to a hospital so they could get me on a drip to flush out these enzymes. She had been in touch with a Specialist prior to contacting me to confirm diagnosis and treatment. She did not know I was away, however, we worked out the closest regional hospital to be Wangaratta in regional Victoria. She arranged everything so they were expecting me. I was well looked after by staff in emergency and transferred to Wangaratta private hospital the following morning. It took about 10 days to get the CK's back down to a normal level”.
As you can see, Liz’s story is dramatic and real. With early detection and diagnosis, there is a high possibility we prevented liver damage, liver failure or cardiac arrest in Liz. I can safely say that Liz is travelling well at the present period. She has slowly integrated back into CrossFit training, with a schedule to build her training back up to her previous level over a twelve month period. Her story reflects the seriousness of the situation, the truth that with the burst of CrossFit into the world, comes the reality that we as CrossFit Coaches and Health Professionals have a duty of care, a need to be on the ball, highly educated, non-complacent and we need to be one step ahead of our clients.
As Coaches, Affiliate owners, and Health Professionals working with CrossFitters, we need to improve our communication across the board. Health Professionals need to be debriefing affiliate owners on the clients that they treat and affiliate owners need to communicate this to their coaches. We need everyone on the same page. After all CrossFit is about longevity, it’s about the longevity of our work as Health Professionals, longevity as Coaches, longevity in Business but most importantly it’s about longevity of the Health and Fitness of our clients and us as individuals.
By Alex Drew
Alex Drew is a Physiotherapist and Founder of Evolutio which strives to provide 'Innovation in Athlete Treatment and Education'. Evolutio has just opened in Kew and will soon be opening in South Yarra, Melbourne for specialising treatment and advice for sporting athletes, CrossFit athletes, Powerlifters and Olympic Lifters.