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The Truth About Rhabdo by Dr. Michael Ray - CrossFit Journal

The Truth About Rhabdo

By Dr. Michael Ray

In Medical/Injuries, Reference

January 04, 2010

PDF Article

Rhabdomyolysis is only occasionally seen in athletes. Dr. Michael Ray explains why, how the condition is treated and how trainers minimize the risk for their athletes.

Rhabdomyolysis is a medical condition that may arise when muscle tissue breaks down and the contents of muscle cells are released into the bloodstream. One molecule in particular, myoglobin, is toxic to the kidneys and can cause kidney failure and, in the most severe cases, death.

Rhabdo has been seen after high-intensity exercise. It is well known to emergency department physicians who see it in victims of crushing injuries and electrocutions. It can also occur in those with severe bee-sting allergies and massive infections, and occasionally it is seen in athletes, particularly those who have become dehydrated after prolonged exertion in high heat. I work in northern Arizona and see it most commonly in people who have been hiking in the Grand Canyon.

Strategies to reduce the risk of rhabdo include a gradual introduction to intensity. The athletes at highest risk seem to be those with a reasonable baseline level of fitness they have obtained through some non-CrossFit training, or those who are returning to CrossFit after a layoff. These athletes have sufficient muscle mass and conditioning to go hard enough to hurt themselves but do not have the protection that develops with regular exposure to real intensity.

The severely deconditioned don’t seem to have enough muscle mass or the capacity to break down enough muscle to do damage. Established CrossFitters seem to be protected, though the mechanism remains unclear.

There is no way to separate the effectiveness of the training from all risk. A completely safe training program is doomed to produce only couch potatoes. The safety of strength and conditioning programs across the board, including CrossFit, is very good, especially when compared to sports like basketball, football and soccer.

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10 Comments on “The Truth About Rhabdo”


wrote …

The gentleman in the photo bears a striking resemblance to the original CrossFit Ninja (AKA CrossFitEast Beast or the Godfather of Jacksonville).


wrote …

Straight forward reporting and explanation from the ultimate Crossfit straight shooter. Prudent WOD planning by each individual trainer and athlete can dramatically reduce the incidence on Rhabdo, but nothing other than not starting can reduce the incidence to zero. Dr. Ray and Dr. Jones offer us the knowledge and tools to do our part.

Very nice, Mike. Thanks.



wrote …

interesting to have the pic of Jacksonville's CF godfather tied in with this article. great article none of the & knowledge is mute without applying it to our training and life in general.


Frank DiMeo wrote …

It's good to have this covered again, and in such a clear format.


wrote …

Nicely written article, thank you.

Lookin' good, Nigel :) (In reference to photo.) Miss you at CFHEL.


wrote …

I agree with the article except for one do not need muscle mass to get rhabdo. My girlfriend was crossfitting for approximately 2 weeks when she developed it(she did not exercise at all before this, maybe 1 mile run here and there). I keep reading about this as I sat in the hospital with her for 5 days and I believe the exercises you do as well as hydration are the two most important factors. She was doing jumping pullups(one of the top 3 per brand x) when she developed rhabdo. I feel that if she had done another exercise at the same intensity she would not have developed it. Also had she done them correctly and not focusing so much on negatives i do not believe she would have developed these. A word to the trainers out there neagtives are not for beginners!


wrote …

Excellent article. Thanks Mike for making a potentially complex subject much easier for all of us to understand and apply to our training.


wrote …

Awesome 'facts is facts' writing, thank you Mike. Paul


replied to comment from William Lawson

William, I'm pretty sure that Mike addressed exercises with eccentric movements like jumping pull-ups with negatives in the article. Doing JPU w/ negatives in an intense WOD for time is not advised. However, small doses of JPU done with negatives as a way to increase your PU ability, NOT for time, is well-established as a way for beginners to improve. It is the volume and intensity of JPU and negatives in a WOD that is dangerous, as you correctly note.



replied to comment from William Lawson

hey william, sorry for your gfriend getting rhabdo. I too have it now from CF workout. I got it 2 months ago and was wondering if you had insight on how long it took to fully recover?

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