A Run-in with Rhabdo

Imagine this…..

You are in your early 20’s, haven’t ever really worked out, but your wife’s sister and her godparents do this crazy thing called “Crossfit”  and they have convinced you that yeah…this seems like something you should try.  You schedule an appointment with the owner of the local Crossfit; it’s the same one that your wife’s godparents attend.  They have told you both how great it is and how knowledgeable, passionate and caring the staff are. After the first introduction class with the owner himself you think to yourself, “Heck yeah, I can do this,  actually I need to do this.”

So you and your wife begin your Crossfit Journey.  A lot of the stuff the coach says makes sense and in a way already applies to you.  You already eat fairly clean, you hardly ever drink alcohol, and you have no problem sleeping for (at least) 8 hours a day.  You like that he says it’s not your typical Competitive Crossfit and that he focuses on teaching proper movement patterns.   By your first official “WOD”  you feel ready to go.

After the first day it seems to be a good fit.  The coach was attentive, and he seemed to scale things conservatively so that you and your wife would not go out too hard or too long on your first few visits, though the intensity did begin to ramp up.   Then about 2 weeks in,  somewhere around your 7th or 8th workout possibly, you did something you had never done before.  It was a rough Sunday workout and you perfect full range of motion Knees to Elbows.  Ok maybe “perfected” wasn’t the right word, but you did one hell of a job that day.  It was great.


Monday your abdominal wall was extremely sore and swollen.  You weren’t sure what to do.  Your wife’s sister, a Physical Therapist and avid competitive Crossfitter, advised that you check your urine to make sure you didn’t have “Rhabdo.”    Your urine was fine, but what was this Rhabdo?; you had never heard of it.

You wrote it off, since your urine was fine, and thought that this was just a really bad case of DOMS (delayed onset muscle soreness)  and decided to rest up on Tuesday.

Super sore on Tuesday….you do nothing and feel really weak in those abdominal muscles.

You can’t sleep on Tuesday night, and decide that on Wednesday, feeling incredibly weak and sore, you need to go to the Emergency Room.

Once there you inform them what you think is going on.  They do not seem as concerned as you would like.  After hours of waiting, you get in, they take your blood and urine, which gets left on a shelf next to you in the room (they never check it).  They don’t believe it has anything to do with exercise. They think it is your appendix.  So they give you a contrast solution that will show up on the CT Scan, and then they will be able to tell what’s up.   Only it doesn’t show anything.  (You later find out from a nephrologist, a kidney specialist, that the contrast solution can be toxic to the kidneys and may only have exacerbated your situation.)

They give you muscle relaxers and send you home .

The next day you feel better.

The day after that you workout.

Then you think you are ok.

But the following Monday you are so incredibly sore again, after a workout that was not intense, was not strenuous, and was heavily modified.  You check your urine and it looks more like Coca-Cola than Pee. Shit.

Your Wife’s Sis says get to the emergency room immediately and tell them you have Rhabdo.

You get there.  You tell them.  Finally they believe you.  You were right. You are kept in the hospital for 4 days, and released.  With no kidney damage, thank goodness.  What an experience for your first month at Crossfit.

Imagine that story.  Imagine how you would feel.  Imagine if you were the owner and head coach of that box.  What would you do?  What could you do?  Who’s fault is it?  Was it the programming?  Was it lack of hydration?  Was it pushing too hard? Was it the first visit to the emergency room, giving the contrast solution?  There are so many factors in a situation like this that at times it is hard to put a finger on it.

This is not a fictitious story. It happened to me 3 weeks ago.  I am that coach, and my great member Nico is that young man.


Nico and I  have met several times since then, and talked and tried to look back and think what went wrong; Was he working too hard? Did he do too many reps? Was he dehydrated? Should he have taken more rest time?  Obviously we know the answer to some of those questions straight away.  It’s one thing to know it in hindsight, but how can we recognize those signs better in the future?  He and I decided that a blog post to educate might be the best way.  So what is Rhabdo, or Rhabdomyolysis?

**A small disclaimer, I am not a medical doctor, and the information I gleaned here comes from hours of reading and talking to doctors, physical therapists and trainers.  So here’s what I have learned….

Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.

What Nico had is called specifically “exertional rhabdomyolysis.””Exertional rhabdomyolysis” is a rare, but serious, complication of too much exercise. It can affect people of any race, age, or fitness level.

During rhabdomyolysis, the contents of skeletal muscle cells are dumped into the blood stream. The two most important factors are 1) creatine kinase, CK (a muscle enzyme, sometimes abbreviated “CPK”), and 2) myoglobin (a muscle protein). Extremely elevated concentrations of CK in the blood confirms the diagnosis, however, it is the presence of myoglobin in the urine that generally alerts the athlete that something is really wrong, causing them to seek medical attention. When myoglobin appears in the urine, the urine color changes to a dark brown.

So when focusing on how to recognize possible rhabdo you should look to three important markers:

  1. Severe, incapacitating muscle pain (not like, “I’m having trouble walking,” but “I can’t even get up because I’m stuck in bed and cannot move.”)
  2. Elevated levels of creatine kinase (CK) in the blood (only can find this out by doctor)
  3. Myoglobin in the urine (Coca-Cola colored urine)

So, why do most athletes only experience the benign and predictable “DOMS” after strenuous exercise while others develop the very serious condition known as rhabdomyolysis?

-First off, it’s important to understand that it is extremely difficult to give yourself rhabdo.  It is not in any way “easy” to get. It requires complete obliteration of your muscle tissue, and most of us stop before we take things that far.

– However, studies have shown that some people may have a genetic predisposition. People  with “CPT II deficiency,” an inherited trait, have a higher likelihood of developing rhabdomyolysis. This genetic condition is common among Ashkenazi Jews.

– Eccentric exercise: Eccentric exercise means the skeletal muscle fibers are lengthening while exerting force. It is well known that eccentric exercise causes more muscle soreness and muscle trauma than concentric exercise. (Think about doing a high rep- like 40-50 rep- WOD, where you slowly lower yourself from flexed arm hangs, for example.)

– New to exercise : The physical conditioning of the athlete does appear to make a difference.

-Hot weather/heat stroke: Heat stroke is associated with rhabdomyolysis. This may be an aggravating factor in some cases of exercise-induced rhabdomyolysis.

Even though exercise-induced rhabdomyolysis is extremely  rare, it is important to be aware of it and to consider prevention strategies:

Train properly: Research shows that when athletes and unfit subjects participated in the same amount of exercise, CK levels rose only in the unfit subjects (Karamizrak SO, et al. 1994). Thus, the intensity of exercise is not the only variable…an abrupt increase in exercise intensity relative to your current fitness level is an important factor.

Focus on proper hydration before and after workouts, and in fact, every day:  Do your best not to participate in binge drinking after extremely difficult workouts.

Consume a recovery drink immediately after exercise: Several recent studies show that CK levels post-exercise are lower in athletes who consume a sports drink that contains protein (aka: “recovery” drinks).

Cool down and Rest properly.

You may be asking yourself,  “How can I tell if I have simple post-exercise DOMS or if it is the more serious rhabdomyolysis?”  If you are moving and sore, then it is a pretty good chance that it is simply DOMS and not rhabdomyolysis.  In all this talk, and even though it absolutely happened to Nico,  don’t forget that Rhabdo is EXTREMELY rare, and if you have been training for a while, and are continuing to do the things mentioned above, then you will more than likely never get it. 

Remember the diagnosis of rhabdomyolysis is made by measuring CK levels and myoglobin levels in the blood. If your muscle soreness is super severe, and, if your urine turns dark brown (“Coca-Cola urine”), then you should seek medical attention immediately. The release of massive amounts of muscle proteins into the circulation can lead to kidney failure, which can be life-threatening. Fortunately, with early and proper treatment, most athletes who develop rhabdomyolysis will make a complete recovery.

I can not really put into words how this makes you feel as a coach. It makes you question your programming, question your judgment, and question how it can even be possible. I watched how he moved, I scaled his weights, his reps, his intensity. And never did it look for a second like he was working hard enough to do this to himself. It causes you to “what if?” yourself to death.

Since then I have read volumes, more than I knew existed, spoken with doctors, other CF coaches, and read blogs by athletes who have experienced  rhabdo before, and the one thing that all of the instances had in common were, surprisingly enough, nothing. That’s infuriating as a coach. I found it cited that cases of rhabdo were somewhat more prevalent in endurance events, such as marathons and Iron Man training/events.  Some attention has been called to cases at Crossfit Boxes, but there have even been cases resulting from conga drumming, karate kicking, mechanical bull riding, hiking and cheerleading training. I read a blog (which I could not find again to recall the specifics) from one individual who was in training consistently for an event of some sort and had done nothing irregular, monitored everything and after a long run, he got it. His quote (or a close summary of it) went like this,”Sometimes, things happen.”

As a coach, that’s terribly unhelpful.  As a coach, I need to keep everyone in my box well-trained, taken care of, and above all else, safe. It was difficult for me to write this without having a definite, “here is exactly how you prevent this from happening to you” answer. But I felt the need to put it out there nonetheless. So, in summary, here’s what have I learned:

-Make sure you are doing the preventative things to take care of yourself.

-Find comfort in the fact that in all of the time I have coached and worked in the fitness industry, I have only seen it personally twice and have only heard of one other person getting it.  That’s 3 cases over the last 12 years among all my thousands of friends and online acquaintances, who compete in Crossfit, Iron Man, marathons, martial arts…the list goes on and on.  So the chance of you getting it is very small. For the majority of us, we need not worry about getting rhabdomyolysis, but we should know the warning signs, not only for ourselves but for anyone around us.

I would like to take the time to personally thank Nico and Laura, and say that I know he is looking forward easing back into his workouts in a couple of weeks. I can’t wait to have him back.

In closing, here is a pretty in-depth article on Breaking Muscle.  If you have time and eyes after this, give it a read.



Isn’t it incredible to be alive?

Take a walk.  Unplug.  Breathe in fresh air.  Walk through a creek.  Hug someone you love.  Hug someone you don’t love.  Call someone you have been meaning to for a while.   Show your children you love them.   Be grateful for such things.  Be happy.  Choose to be happy.  It’s more fun than choosing to be frustrated.  You work all the time, you don’t feel good, you hate your job, you fight with your spouse, your kids can’t stand you, you look like shit, you feel like shit, you aren’t good in front of people,  you hate your boss, your boss hates you.  What are these things.  What are these thoughts that you give power to on a daily basis.  Why do you let them control you.  Your mind is a computer and either you, or your environment is the programmer.  Absent of you choosing to your mind will let whatever stimulus it comes up against program it.  How scary is that?   Just watch the news, or listen to your “friends” complain…and bam….down that endless road called negativity.  But should you choose to be brave and become the master of your own destiny.  Well then….the world is at your freaking fingertips.   Believe in you.  It’s hard, it’s uncomfortable, but guess what we weren’t put here to be comfortable.  We were put here to grow, to challenge ourselves, that’s how we are made up.  We are literally movers and shakers, to deny that is to deny the very make up of our body and souls.  Give me the crabbiest nastiest human being in the world,…i put them in my class and take them through a Robstacle course and you will see them smile.  Why is that…because your body and mind crave challenge, and they crave movement….  Isn’t it incredible to be alive and be human.  We are the most complex movers and thinkers on earth  (we think)  Why deny it…you can’t ….just let go and get on with life.  I am so grateful for the position I find myself in everyday.   Is it easy….  Heavens no.  It’s not even close to easy.     “Don’t pray for an easy life, pray for the strength to endure a hard one”

I have the strength, and I have the muster, and I have the ability to think better, be better ,move better, and I practice it every single day.  And I am thankful every single day that I have been blessed with my parents, my wife and children, my mind, my body and my community…..and I will do my best to elevate those around me for the rest of my life…..




Go out and Be Amazing….stop being scared of yourselves…..

3/21/2015 WOD

….she’s a good one



4 x 5min EMOM’s

1. 7 Box Jumps  ( Slow Mountain Climbers)

2. 10 Hand Release Pushups  (Slow Crunches)

3. 10 Thrusters 35/45  (Seal Jacks)

4. 7 Burpees  ( Breathe)


Every minute on the minute perform the exercise and desired number of repetitions.  For the balance of the remaining 60 seconds perform the exercise in the parentheses.


Good Luck….she was a bastard!!!


Thanks to the 9am Class for letting me fight along side them.  It was a pretty epic one this morning!!!



18 min of Movement
32 Feet- Foot hand Crawl on 2×4
16 Feet Farmer’s Carry on 2×4
and 10 Reverses with KB racked on 2×4

(5 reverses per side)

Continue through these three exercises until 18 minutes has passed

you can click the youtube link below to see an example of the movements….have fun if you try this one.  Slow purposeful and as always mind your movements!!!


WOD 3/13/2015… Friday The 13th!!!!



Warm Up- 10 min Roll/ 2 min neck rotation, 2 min shoulder rotations/ Bird dogs- 2 min/ up dog down dog-3 min

Shoulder Prep- 2×8 Wall SLiders/ 2×8 Bi lateral External Rotations/

Skinny PVC- Pressing Prep -3 min

KB Swing Prep- 3 min

-hip extensions/ hip flexors/ hip hinges




12 Min

20 Kettlebell Swings (Russian)

5 Shoulder to overhead


Score is total number of weight moved over head in the some of all Rounds with your 5 Presses/ Push Presses/ or Push Jerks

-you can add or take away weight as needed


Best of Luck

WOD/ 3/9 and 3/10/2015






Warm up

Roll-10min/ Neck Rotations 2 min/ shoulder rotations- 2 min/ Lumbar Looseners- 2 min/  Walking Samson Stretches-2min/ Skinny PVC-3 min

Deadlift Movement Prep-  8-10 min

-PVC Deads

-Kettlebell Deads

-Hip Mobility




Well done on Monday.



“When Chuck Norris Swings a Sword the Air Bleeds”


Warm UP-

Roll-10min/ PVC-3min/ UP dog, down dog, child’s pose (lat Stretch) 6-8min

2×4 Movement-  Reverses, Tripod Extensions



5 Rounds For Time

24ft- Foot Hand Crawls on 2×4

72ft- Farmer’s Carry

:45 seconds Lalanne Plank

50- Mountain Climbers



Fun Last Two Days.

Keep in Mind   This weekend!!!!! look to the calendar….for the events!!!!   Saturday Bring  Friend Day, and on Sunday Recovery Seminar with Chris Nentarz!!!!



WOD 3/8/2015


“Chuck Norris and Superman once had an arm wrestling match, the loser had to wear his underwear on the outside”


Warm up

10 Min Roll/ Child’s Pose, updog, down dog- 3 min

Walking Samson-2min/ Skinny PVC-3min/ neck Rotations and Shoulder Rotations- 3 min

Wrist Prep-2min


30 Jacks/ 10 Toe touches- 4x

Skill Work-  Full Squat Clean, PVC Pipe then SUper light Weight-  Just technique WOrk- 6-9min



6 Rounds   (will be timed, but the goal isn’t to go as fast as possible,   quality movement over time)

36ft- Inverted Crawl

45sec- Plank, alternating slow leg lifts

36 ft- inverted Crawl

10- Single leg Deadlift Toe Touches (5 per side, hinge and balance)

3o sec- Lalanne Planks  ( hold the plank, with arms as far in front of your head as possible,  Zero Extension..)


Good Luck and Happy SUnday!!!


This is it.  Right here.  The life you have…the one you have currently been living….it is here….and believe it or not it is right now.  There are things we have done, and there are things we will do….but in truth all you have that is promised to you is right now.  Don’t you owe it to yourself? Don’t you owe it to your family?  Don’t you want to finish this life off and be able to say ” Yes… I did my best”  “I gave all I could give”  I know I want that.  I want to look myself in the mirror at the end of every day and know that I lived it to the fullest.  I want to know that on that day I stepped up,  I came, I saw, and by god I conquered.   I didn’t ask for permission.  I took and did what I wanted and asked for forgiveness later.  That’s how I want to feel at the end of everyday.  I think as powerful and graceful human beings that is how we are meant to feel at the end of everyday.  I have to be honest with you.  I’m sure that a lot of us out there do not feel that.

So if you don’t feel that way, and you want to what do you do?

You workout.  You train smart, you learn from the best you can find, and by god…once you have the mechanics down you train HARD.

If you have never had the pleasure of feeling what it is like to leave your sweat, heart, and at times even your blood on the mat after a grueling, heart pumping, mind electrifying WOD….then no wonder you don’t want to work out.  If I had to go to a 30000 square foot facility where no one knew who I was, and sit down to do resistance training, or do some sort of bastardized cross country skiing that ultimately gets me nowhere (elliptical)  if I had to suffer through 40 minutes on that thing, and then 40 more minutes traipsing around the gym looking for the right machine…I too would be numb to the idea……  I too would rather stay at home that suffer through that mind numbing monotony. ……

….what you need is something that lights a fire under your @$$.   You need to be worried about what is about to happen when you step through the doors.  It needs to cause you anxiety if you think about it.  You have to wake up in the morning and be ready to face it like a dragon that is trying to steal your Princess from you  (or prince).   You need to walk into your Box as if you are going to be forced to eliminate the head of the taliban, save Christmas, punch the devil in the face and run for the President of the United States all at once….and that’s just the Warm Up.   In truth……all Joking aside.   When you walk into your Box, or even your “gym”.   It should matter.  Damnit all. It should be a Big deal….scratch that it should be a HUGE DEAL.   Every WOD, every REP, every rest….is earned…and it is an investment.   It is an investment in you…..  You.     Every time you pick that bar up you are making sure that you are better.  Every time you pull your chin above that bar you are showing the WORLD what you are worth, and you are proving it to yourself.  Each rep builds confidence, each Meter rowed builds ammo for you.  The more you come the more you love it….the more you love it the more you start to live it…..  People notice….People comment…..people see the difference……people FEEL the difference….. YOU FEEL THE DIFFERENCE.   It’s not about the Scale…..   It’s not about the  Time……   It’s not even about the Weight…..and it certainly isn’t about What Place you finish……    What it’s about is YOU!!!  It’s about committing to make YOU  better than the you from yesterday.  It’s about chasing perfection and finding that excellence is a pretty damn sweet place to be.     Sleep well tonight everyone….get up tomorrow morning and crush it!!!!

Why I work out…..and why you should….sobering words.

I want to feel better, I want to look better, I enjoy training hard, I like competing with friends, I enjoy testing my physical limits, I like getting better at a movement skill that I am not good at, I need to set the example for my box that I am striving to be the best I can be on a physical and mental level…. all very valid reasons for me to train and exercise…but not 1/10th as compelling of reason as my “why”

To Keep the Body in good health is a duty…otherwise we shall not be able to keep our mind strong and clear.

In our country a shameful thing has happened. We have, through our mostly sedentary lifestyles, invented a system for the elderly that clearly states; When you get on in years you should have to be taken care of by the younger/ healthier members of your family or put in a home/ facility that will see this happen. We have, through lifestyle choices made in some of the most “active” and important times of our lives seen to it that when we are older we will become a burden to our loved ones. It is looked at as a normal thing for “grandma” to get old, get fragile, and end up being taken care of by her family. That is incredibly sad. We are the only animals in the world that work this way. If a squirrel dies in its sleep tonight of old age that same squirrel was jumping from tree to tree this morning chasing nuts, like it has done its whole life.

My recent moment of clarity smacked me in the face over the holidays. My grandfather, “Pap” to me, is 76 years old and is unfortunately very close to the end. We have thought this for the last 5 years. He has smoked since he was 13 and as a result, has had numerous complications and lifestyle restrictions, and over the course of that recent time Pap has been in and out of the hospital countless times. He is coherent some of the time, but cannot even make it up a flight of stairs without needing oxygen, and he is, without a shadow of a doubt became a stress on his wife, my grandma, his children and even his grandchildren. I have had to watch the man who was, in my memory, strong, confident, witty, and caring, become someone who fuddles over his words, can barely move, and seems as if he is just waiting to die. It is incredibly painful for me to put this down on paper. But it was after watching this first hand this holiday. After witnessing the toll, both physically and emotionally, it has taken on Nan, my grandmother. I came to a realization. The condition he is in is not an accident, and it was not caused by old age. It was caused, very deliberately, though obviously not on purpose, by the lifestyle choices he made. It is 100% Pap’s fault that he is in the condition that he is in. This moment caused me to completely rethink my reasons for exercising and wanting to be healthy.
I have always professed in my Box that my goal for myself and my members was to be able to make it to 75 years old and have the ability to move and play with my great grandchildren. I must admit, until this holiday, those reasons were very selfish in nature. I wanted to be able to see my grandkids, and play with my grandkids. The big change for me now, is…..as I stare in the face of my children, or think about my wife…I know in my heart…it is not their responsibility to take care of me when I am older….it is my fucking responsibility to take care of myself now…to the best of my ability…so they don’t have to take care of me later. I will not have my children, push me around in a wheel chair, and cart me between doctor’s appointments when I am 80 years old, all because I wouldn’t give up shit food, alcohol and sitting on my ass from age 30 to 60…….I will not let that happen!!!

I encourage you to join in with me, and take responsibility for the body you have been given, so that your spouse, or children don’t have to….