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Old 01-06-2011, 09:54 AM   #120
Steven Low
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Re: Rhabdo... 4 days after Rhabdo. URGENT

Quote:
Originally Posted by Katherine Derbyshire View Post
Has CFHQ shown any interest whatsoever in developing that kind of information? I certainly agree that it would be helpful, but it's not going to happen without CFHQ's involvement.

As for hypotheticals, the OP seems to be about someone in exactly the situation I described: new Crossfitter victimized by poor programming.

Katherine
Here's what I know.

As you know one of the articles posting in this thread is this one that I wrote in Feb '09 for CF journal to use

wfs
http://www.eatmoveimprove.com/2010/0...habdomyolysis/

After it being thrown around by the journal people for a while they sent me this reply by one of the people who was on the "Rhabdo Team" who were planning to release something in regards to rhabdo.

Quote:
We should NOT post Low's paper, in spite of its high stylistic quality.

Greg has commissioned the Rhabdo Team to come to grips with the CrossFit position on Rhabdo and other diseases linked to exercise. He has given us a year, and we're actually a month or two into the task. We certainly don't have a consensus, but based on my recommendations to be forthcoming, here are my reasons for not publishing this paper.

1. Rhabdo is not well-defined. Regardless CrossFit has a duty to its clients and to itself to protect against exercise-induced disease, to insure that any such disease is properly treated, to settle meritorious lawsuits, and to protect itself against unmeritorious suits.

2. I am recommending to the Rhabdo Team that CrossFit follow the military textbooks on Rhabdo and compartment syndrome diagnoses and treatment. These are available online at the Borden Institute web site. http://www.bordeninstitute.army.mil/

In this set, Management and Treatment of Training-Related Injuries in Initial Entry Training, Chapter 9 by Hauret, et al., has a summary table of 12 "common training-related overuse injuries". Ten of these do not require physician intervention, but are treated by Rest, Ice, Compression, Elevation (RICE), plus NSAIDS. The two that do require intervention are Rhabdo and compartment syndrome. They are defined in the table as follows:

Type Anatomical Location Signs/Symptoms Immediate Treatment
Compartment syndrome (fn: can require immediate surgery) Enclosed fascial compartment, especially lower leg Swelling, pain, throbbing, tightness, tightness that increases with stretching Immediate evaluation by an orthopedic or general surgeon
Rhabdomyolysis (fn: can be life-threatening) Muscle and other organ systems Generalized myalgia, red-to-brown urine, high creatine kinase Immediate evaluation by a physician

I recommend taking the signs and symptoms as firm criteria for differentiating between the urgent and the routine as far as they can be recognized in the gym. I recommend in particular that Rhabdo must be accompanied by darkened urine to be Rhabdo, and that the myalgia must be generalized. This rules out such notions as "upper body Rhabdo" or, of course, Rhabdo without darkened urine. Low's paper is not consistent with these recommendations.

2. Rhabdo has dozens of causes, some likely more common than exercise. Examples of causes or predispositions are cocaine, alcohol, bee stings and snake bites, crush injuries, genetic mutations, sickle cell. Low's paper is about what is called exertional Rhabdo. It should make that distinction, but even that wouldn't be adequate to publish it.

3. Exercise can cause non-exertional Rhabdo to manifest itself. So someone who is using cocaine but asymptomatic for Rhabdo can become symptomatic upon mild exercise. CrossFit should do everything it can to assure that a proper differential diagnosis is made to determine the etiology of the symptoms for the protection of all parties (including medical malpractice). The ordinary medical practice characterized by "think of horses, not zebras" is unacceptable, both legally and for proper care of the patient. Ordinary medical practice is practicable but with a tendency to maximize costs. Every case discovered in the gym is not exertional Rhabdo despite the correlation. And CrossFit doesn't want to see emergency rooms flooded due to nothing but myalgia.

4. The incidence one of the known genetic mutations, CPT II and MADD, is quite small in the general populace. However, having presented with Rhabdo symptoms, the odds shoot way up, and each Rhabdo-like case should be tested for those defects.

5. Physical training arguably is intended to cause muscle damage, which results in natural adaptation through natural repair. Myaligia and high creatine kinease in the urine are not just normal results from CrossFit, but indeed desired.

6. The Rhabdo Team has expressed two schools of thought relative to informing the client and the trainer, a minimalist approach vs. full disclosure. Both have merit. The minimalist approach is legally advantageous. My recommendation is full disclosure, in part because my non-legal opinion is that anything omitted could be a legal vulnerability.

7. CrossFit needs to be as defensive as possible under the scenario Rhabdo first, then CrossFit, then lawsuit.

Low addresses the problem of the out-of-shape formerly fit individual. That has to be one of the CrossFit warnings. He also addresses Delayed Onset Muscle Soreness (DOMS), which I need to investigate.

Regardless, Low's paper needs to be written either to reflect all aspects of the problem, or that it somehow address a clearly delineated subset of the problem that doesn't contradict the other parts. The best answer is to wait until the Rhabdo Team can reach a full decision.
Since then the only thing posted in CF journal has been this article which was published in Jan '10

wfs
http://library.crossfit.com/free/pdf...ay_rhabdo1.pdf

So that's really all I know in regards to CFHQ and it's stance on rhabdo.


Summary:

~Feb '09 -- I send the article posted above to CF Journal. They say they have something in the works, and that mine is too stylistic and not comprehensive enough (which I do agree with to some extent)

~Jan '10 -- CFJ comes out with the article above. It's not as comprehensive as I would've thought from a specific rhabdo team, and it wasn't as publicized as I would've though from that e-mail I got (but maybe that's my bias from the e-mail I received)

~ Nothing else to my knowledge has been posted or publicized in regards to rhabdo besides the random threads you see on this board including this one.

Today is Jan '11.

You can make your own decisions based on that if CFHQ is doing enough or not.

I don't really know... but I just thought it would be nice if you guys had more facts.
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