CrossFit Discussion Board  

Go Back   CrossFit Discussion Board > Community > Running a CrossFit Facility
CrossFit Home Forum Site Rules CrossFit FAQ Search Today's Posts Mark Forums Read

Running a CrossFit Facility Tips and guidance on how to open and operate a CrossFit gym.

Reply
 
Thread Tools
Old 10-15-2008, 08:57 PM   #1
Ahmik Jones
Affiliate Ahmik Jones is offline
 
Ahmik Jones's Avatar
 
Profile:
Join Date: Sep 2005
Location: San Diego  CA
Posts: 506
Top 10 Ways to Avoid Giving a Client Rhabdo

We have all heard about the recent law suit.

In this case it looks like the client was given an appropriate beginner workout and it was a fluke that he got rhabdomyolysis. However, there are several things that have led to rhabdo. Here are some ways to avoid it in your clients.

10. Avoid giving new or prospective clients tough workouts to impress them into joining your gym. This is one of the toughest things to do especially when you are starting out. You have to be confident in your program and yourself. Not only will you avoid hurting people, in the long run you will get more clients this way.

9. Be very judicious when lowering weight or increasing assistance to help someone get through a workout. While this practice is used extensively with more established clients, it can be dangerous with new people. For example, I made the mistake a couple of years ago when training a large group of people at work, of having letting people help their partners through a workout after they failed. The workout was 1 pull-up the first minute, 2 the second, 3 the third... I thought the workout would be too easy, because most of the people could not do very many pull-ups. So when they failed I had them keep going with assistance. Of the 50 people, 49 were fine, but one got rhabdo.
Lowering weight or adding assistance is fine when done in a slow workout to let people finish, but if it is done when someone reaches muscle failure and continues to push hard it can be dangerous.

8. Avoid giving new people a weight that is too light. Sometimes weight is protective. It makes people slow down due to muscle failure. We had a group of people do Fight Gone Bad with PVC and a 4 lb Dynamax ball and people were throwing, up because there was no need to stop. Give people something that is heavy enough to make the workout legitimate as long as they can lift it with proper form and they will rest enough to keep themselves safe. Once people have been doing this for a while they can do things like light Fran to work on speed without worrying, but it can be dangerous at first.

7. Be careful when doing exercises with a pronounced eccentric component. Jumping pull-ups, kettlebell swings and thrusters are disproportionately represented in the rhabdo cases. These are excellent exercises, but when people are new they can be devastating. A study of prison inmates, found 36 cases of rhabdo in inmates that had done high rep low weight thrusters.

6. Have a slow ramp up period when starting new clients. Many affiliates have 3 session introductory courses. While this is more cost effective in the short term it is not long enough to allow people to adapt to the workouts. It is my opinion that an 8 session course taking at least 2 weeks is more appropriate, both for learning the movements and avoiding rhabdo. 4 weeks is even better. A course like this should focus on proper form with little to no emphasis on time or competition. There is plenty of time for competition after your introductory course, and of course the workouts get harder later in the course.

5. Encourage clients to take breaks at first. This allows muscles to get oxygen and can help them avoid damage. Once they have been doing CrossFit for a while they will be able to push their muscles continuously without risk, but not at first.

4. Learn to pick out people likely to get rhabdo. It has been documented that for the most part the people who are most likely to get rhabdo are either in good shape by everyone but CrossFit's standards, or who were once in good shape. People like prior athletes, prior military or law enforcement are very common. Generally, the more mentally tough the client and the more athletic the are or once were, the bigger the risk and the more you have to hold them back.

3. Encourage clients to drink water. This is always a good idea. This doesn’t mean force them to drink during a workout, but it does help to keep thems hydrated in general.

2. Tell clients about rhabdo so they will be aware. With every new client we give them a long talk about what CrossFit is and why we take 8 sessions to get them into our group classes. At the end of this discussion is a description of rhabdo and how to avoid it. It has been very effective.

1. The final thing to watch for is people who have done CrossFit for a while, took a break and want to start up again. This is almost a sure recipe for rhabdo. I can think of 5 cases off the top of my head involving our gym and other local affiliates of people returning after a break with the mental ability to push themselves much harder than there body is able to safely accomplish. The classic story involves a woman who gave birth and came back to CrossFit, but it can happen with anyone who takes a break. The better the CrossFitter the more likely it is that they will give themselves rhabdo.



If one of your clients does get rhabdo, these are some of the signs: Not everyone gets all of these symptoms, some people don’t even have much pain.

1. Pain out of proportion to the amount of soreness you would expect, often coming on much faster than you would expect after a workout, and often accompanied with weakness.

2. Swelling of the body part involved, either with or without pain.

3. Decreased urine output or dark urine. This is the scary one and the one that gets you admitted to the hospital.

If you think someone has rhabdo:

1. Get them to a doctor. You can't be sure how bad it is going to get. It may progressively get worse for days before it gets better.

2. Have them drink water. The only way to protect the kidneys is to ensure they have enough fluid to handle the toxins. If it is bad enough they will be put in the hospital with a catheter in one end and an IV in the other until they recover.

3. Avoid heat. Hot tubs can greatly exacerbate the release of muscle contents and can make a case of rhabdo much worse.

Although the practices above will help you avoid rhabdo in your clients, most people won't get rhabdo even if you do everything wrong. However, it is worth being cautious. One bad case of rhabdo can ruin all the good you have done for your other clients.

I am eager to hear other people's thoughts on the subject.

Ahmik Jones, M.D.

Last edited by Ahmik Jones : 10-15-2008 at 09:05 PM.
  Reply With Quote
Old 10-15-2008, 09:29 PM   #2
Zach Forrest
Affiliate Zach Forrest is offline
 
Profile:
Join Date: Jul 2007
Location: Las Vegas  NV
Posts: 160
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Great post, Ahmik. I would actually vote to get this one "stickied" at the top of the forum. Thanks for the information.
__________________
--*Insert motivational quote here*--
www.crossfitlasvegas.com
  Reply With Quote
Old 10-15-2008, 11:25 PM   #3
Dan Donche
Affiliate Dan Donche is offline
 
Dan Donche's Avatar
 
Profile:
Join Date: Oct 2007
Location: Seattle  WA
Posts: 86
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Yeah, excellent post. I agree that education is another key element in preventing it in new people, but we forget a lot about experienced people who may have taken a break.

Only thing I can think of that wasn't mentioned is hot temperature outside (you mentioned heat, but not this kind). Most military people who get rhabdo are in basic training settings or outside in hot environments (usually also dehydration is a contributor). Here's a good article about it in the military though: http://afhsc.army.mil/msmr_pdfs/2008/v15_n02.pdf (WFS)
__________________
Be Legendary.
www.crossfitadvantage.com
  Reply With Quote
Old 10-16-2008, 12:36 AM   #4
Samuel Friedman
Member Samuel Friedman is offline
 
Profile:
Join Date: May 2008
Location: Waco  TX
Posts: 63
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

I second the motion to sticky this post...good stuff
  Reply With Quote
Old 10-16-2008, 01:02 AM   #5
Daniel Mick
Member Daniel Mick is offline
 
Daniel Mick's Avatar
 
Profile:
Join Date: Apr 2008
Location: Portland  OR
Posts: 278
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Third for the sticky.
  Reply With Quote
Old 10-16-2008, 03:20 AM   #6
Sean Manseau
Affiliate Sean Manseau is offline
 
Profile:
Join Date: Jan 2006
Location: Amherst  MA
Posts: 209
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Thanks, Dr. Jones!
__________________
Sean Manseau
http://www.pioneervalleycrossfit.com
  Reply With Quote
Old 10-16-2008, 04:31 AM   #7
Ahmik Jones
Affiliate Ahmik Jones is offline
 
Ahmik Jones's Avatar
 
Profile:
Join Date: Sep 2005
Location: San Diego  CA
Posts: 506
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Quote:
Originally Posted by Dan Donche View Post
Yeah, excellent post. I agree that education is another key element in preventing it in new people, but we forget a lot about experienced people who may have taken a break.

Only thing I can think of that wasn't mentioned is hot temperature outside (you mentioned heat, but not this kind). Most military people who get rhabdo are in basic training settings or outside in hot environments (usually also dehydration is a contributor). Here's a good article about it in the military though: http://afhsc.army.mil/msmr_pdfs/2008/v15_n02.pdf (WFS)
You are right. The worst case of rhabdo I have ever seen was in a guy with heat stroke, and the classic case of exertional rhabdo happens on a hot day in someone who is dehydrated.

Heat makes everything worse.
  Reply With Quote
Old 10-16-2008, 06:03 AM   #8
Randy Tarasevich
Affiliate Randy Tarasevich is offline
 
Randy Tarasevich's Avatar
 
Profile:
Join Date: Sep 2007
Location: Norwich  CT
Posts: 1,631
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Great post Doc! Thank you very much.

Sticky it.
__________________
www.sectcrossfit.com
  Reply With Quote
Old 10-16-2008, 09:04 AM   #9
Neil Khant
Affiliate Neil Khant is offline
 
Neil Khant's Avatar
 
Profile:
Join Date: Jan 2006
Location: Naperville  IL
Posts: 487
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Thank you Dr.

For the health of all Crossfitters.
  Reply With Quote
Old 10-20-2008, 09:52 PM   #10
Ryan Wooley
Member Ryan Wooley is offline
 
Profile:
Join Date: Aug 2007
Location: Belmont  CA
Posts: 23
Re: Top 10 Ways to Avoid Giving a Client Rhabdo

Thanks Ahmik,
This is an excellent post and a subject that I have been thinking about a bit lately as I take on new clients. The concept of keeping the loads from being to light had not occurred to me. I have always tended to err on the side of scale weights down for newbies. Do you know the source on the prisoner study? I would like to look at that.
  Reply With Quote
Reply


Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

vB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
Converse All Star Shoes-Should I get High-Top or Low-Top? Lisa Walker Equipment 8 08-21-2008 11:38 AM
Giving Blood need help??? Jason Tanner Nutrition 3 11-05-2007 09:01 PM
Giving up on Crossfit Jason Simpkins Equipment 8 07-07-2005 04:13 AM
On not giving up... Jonathan Kessler Community 4 06-26-2005 07:10 AM


All times are GMT -7. The time now is 10:06 PM.


Powered by vBulletin® Version 3.6.8
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
CrossFit is a registered trademark of CrossFit Inc.