rhabdomyolysis
CrossFit’s “Makimba” Workout
The workout Makimba Mimms alleges caused the injuries he sued a CrossFit instructor over has been named after him and re-categorized it as a kid’s workout by the CrossFit community to mock him. While this might be going a bit far, I am still highly skeptical of Mimms claims and believe the case should be appealed because there is no way the workout could have caused the injuries claimed if performed as prescribed.
According to the Navy Times article,
“The injuries included rhabdomyolysis, lumbosacral spine strain and strain of the bilateral quadriceps, according to court documents. As a result of these injuries, Mimms was incapacitated, lost time from work and required surgery, court records show.”
Frankly, I think this is bullshit.
According to a discussion in one of the CrossFit forums, as mentioned in a previous post on the CrossFit Lawsuit here, the workout Mimms alleges caused the injuries was prescribed as follows:
Three rounds of each of the following, performed for 15, then 10, then 5 reps:
- 10 pound dumbbell thrusters (a thruster is a combined squatting and pressing movement)
- Burpees
- Bodyweight Squats
The exercises are performed one after the other, non-stop. There is no rest between exercises or rounds.
None of these exercises carry a high risk of injury if performed with strict form in a smooth, controlled manner. The sequence as prescribed is not excessive for someone in moderately good condition, even when performed non-stop. If an injury were to occur performing the above routine, it would most likely be due to improper technique, fast or sloppy performance, inappropriate training environment (way too hot, improper training surface, etc.) or possibly just extreme wimpiness.
Over the past couple of weeks, I have had several clients perform this workout, ranging from a very strong 200 pound 35 year old male to a very small-framed, 90 pound 58 year old woman. Two of the men who have done the workout used 20 pound dumbbells instead of 10, and I performed the workout last Friday using 40.
A few people have reported a slightly higher degree of delayed-onset muscular soreness in the thighs, and mine were a bit more sore than usual for a few days, but nothing else. One woman in her 20’s who performed the workout with 15 pound dumbbells and probably could have easily handled 20s experienced no soreness as a result. There wasn’t a single case of exertional rhabdomyolysis, spine or quadriceps strain, incapacitation, or the need for surgery.
The fact that a small, 58 year old woman was capable of duplicating the routine with no problems whatsoever leads me to believe Mimms is full of shit. Either he’s faking or sustained the injuries doing something else and is looking to make an easy buck, or he was using unbelievably bad form. However, I have a hard time thinking his instructor would have allowed that, even considering how bad some of the form is on many CrossFit videos I’ve seen. Without being there or knowing the details of the lawsuit I still can’t be absolutely certain, but the whole thing certainly smells of bullshit to me.
What concerns me about this is a comment another personal trainer made in a previous post on this about potential clients telling him his waiver was beatable in court. He refused to train them, which I believe was a smart move on his part, since they sound like a lawsuit waiting to happen.
On one hand, I believe if someone is seriously injured by a trainer due to negligence or outright stupidity, there should be some recourse. On the other hand, the world is full of litigious bastards looking for an undeserved pay day who may go after a personal trainer or gym if they think they’ve got deep pockets, so trainers, training studios and gyms have to protect themselves.
I’d love to hear opinions on this from trial lawyers who prosecute or defend personal injury cases. How do you ensure that clients or gym members who have been injured due to negligence, incompetence or stupidity (which are all too common in this industry) are fairly compensated, while making sure that good trainers are not wrongly sued by someone just out to make a buck?
Crossfit Lawsuit Update 2
I was recently notified the defendent in the lawsuit against a CrossFit instructor over a workout he claims caused injuries and rhabdomyolysis was awarded $300,000.
The following is from the Washington Post web site:
A Prince William County jury awarded $300,000 yesterday to a Bristow man who sued a gym, a training company and one of its employees for administering an intense strength workout to him that he claimed left him disabled.
Makimba Mimms, 29, of Bristow sued Manassas World Gym, Ruthless Training Concepts and its former employee, Javier Lopez. Mimms, a former Navy information systems technician first class, said Lopez oversaw a CrossFit workout at the gym in 2005 that caused his leg muscles to break down. The jury found all three defendants liable.
CrossFit, which was not named as a defendant in the suit, is a fitness program popular in law enforcement and military circles and has been criticized as being dangerously intense.
Without knowing more details it is hard to comment on the case itself, but this does bring up some important points. If you’re training people it is essential to know their medical history, physical capabilities and limitations and design their workouts accordingly. People need to be motivated to train at a high level of intensity, which often requires pushing them beyond their perceived limitations. However, it is important to be aware and considerate of their actual physical limitations and avoid pushing or in some cases avoid allowing them to attempt to exceed those. › Continue reading
CrossFit Lawsuit Update
I was recently notified the workout which allegedly caused the injuries and rhabdomyolysis resulting in Makimbo Mimms’ lawsuit against a CrossFit instructor consisted of the following:
Three rounds of each of the following, performed for 15, then 10, then 5 reps:
- 10 pound dumbbell thrusters (a thruster is a combined squatting and pressing movement)
- Burpees
- Bodyweight Squats
Although injury to the spine and quadriceps is possible if the movements are performed very explosively, I find it unlikely in an otherwise healthy individual with such light weight and body weight exercises. I also have a very hard time believing a healthy, even only moderately fit person would suffer rhabdomyolysis from such an easy workout.
Either Mimms actually did a far more challenging workout than the one listed above, is terribly weak and deconditioned, or was injured doing something else and is trying to make the CrossFit instructor a scapegoat.
I have a woman in her mid 20’s that does thrusters with 15 lbs dumbbells using a strict, controlled speed of movement for higher reps than that, who has never been injured or developed rhabdomyolysis in the process. You’d think an all-Navy wrestler could handle it.
Lawsuit Alleges CrossFit Workout Damaging
There is an article in the Navy Times on a former sailor suing for permanent injury resulting in disability he claims resulted from a CrossFit workout. The article states:
“Several [experts] in the sports medicine field (military and civilian) have addressed a concern that the program has the potential for causing an increased incidence of musculoskeletal injuries and even muscle breakdown (rhabdomyoloysis) and therefore is not supported by [Navy Center for Personal and Professional Development],” the story states. “Granted, anyone can develop a program that’s very intense, but there’s a safer way of doing this for our sailors.” Picker could not be reached for comment.”
Later in the article,
“Several physicians, including Walter Reed Army Medical Center neurophysiologist Lt. Col. Mark Landau, concluded that Mimms suffered severe injuries following his intense CrossFit workout, according to court records.
The injuries included rhabdomyolysis, lumbosacral spine strain and strain of the bilateral quadriceps, according to court documents. As a result of these injuries, Mimms was incapacitated, lost time from work and required surgery, court records show.”
Without knowing the specific workout performed I can’t be certain, but I think it’s a safe bet the spine and quadriceps injuries resulted from performing one or more Olympic lifts or other exercises in an explosive manner.
This was the point of the CrossFit post I wrote a few weeks back. Many of the exercises recommended and the sloppy form resulting from attempting to move too quickly carry an unnecessarily high risk of injury. The same or better benefits could be had from replacing the Olympic lifts and other explosive movements with exercises that can be performed without reliance on momentum and using stricter form. I have some clients who regularly perform modified versions of the CrossFit routines Fran, Diane and Cindy (many of the CrossFit routines have women’s names) to focus on metabolic and cardiovascular conditioning, and none have have been injured in the process. By replacing the explosive movements with exercises performed in a controlled fashion the routines can be performed with a much lower risk of injury while maintaining the high level of metabolic and cardiovascular demand.
The thrusters in Fran (combined squat and press) can be performed in a controlled fashion, and the kipping pull-ups in both Fran and Cindy and can be replaced with strict pull-ups or chin-ups. I have one client with a grade 3 spondylolisthesis at L5-S1 and others with various knee and back problems who have been able to perform these routines with no problems. If these people can do them safely, they certainly shouldn’t cause spine and quadriceps injuries in a healthy person.
“The suit claims Mimms suffered from rhabdomyolysis — which occurs when tiny shreds of muscle fiber are absorbed by the bloodstream and ultimately poison the kidneys — as a result of performing a CrossFit workout under the direction of Lopez, who worked as Ruthless Training Concepts trainer at the now-defunct Manassas World Gym.”
I do not believe rhabdomyolysis is a problem with CrossFit training any more than it is a problem with high intensity training or any other exercise method, but rather a failure of the trainee or instructor to properly scale the routine to their current level of conditioning. Any workout can cause this if the intensity and volume exceed what is appropriate for the trainee. In addition to prescribing workouts of appropriate intensity and volume, the chances of developing rhabdomyolysis can be reduced by staying adequately hydrated and keeping the training environment as cool as possible. Extra care should be taken with trainees with kidney problems or other conditions such as sickle-cell trait which predispose them to a greater risk of developing rhabdomyolysis.
Trainees should be motivated to perform to the best of their abilities, and to train at a high level of intensity, but not encouraged to push harder or do more than they can handle.
References:
Kark JA, Ward FT. Exercise and hemoglobin S. Semin in Hematol. 1994;31:181-225.