*CLARIFICATION: This article has been slightly revised to add attribution and modify the description of CrossFit's workouts. The exact address of CrossFit Fringe has also been added.
COLUMBIA — Michael Wuest has a bloody clown hanging over his head, figuratively speaking.
Personal trainers and gym owners such as Wuest who offer the CrossFit program have found themselves dealing with "Uncle Rhabdo." The cartoon clown has been widely circulated on the Internet and has become the unofficial and gruesome mascot for rhabdomyolysis, a muscular disease that causes kidney failure in extreme cases and can be brought on by strenuous exercise.
"How long has rhabdomyolysis been around? Forever," said Wuest with a hint of frustration in his voice. He owns and operates CrossFit CoMo gym at 3605 S. Providence Road. "But when you hear rhabdomyolysis, what do people think of? CrossFit."
CrossFit's unique brand of intense, often* timed workouts have long been linked with rhabdomyolysis. In 2008, a Virginia gym was sued by a former Navy sailor after a workout left him with rhabdomyolysis. More recently, an article on the Huffington Post about the apparent link between CrossFit and "rhabdo," titled "CrossFit's Dirty Little Secret," has brought negative attention to the popular program. The story focused on one woman's experience of doing CrossFit and developing rhabdomyolysis. The story was shared almost 20,000 times via the Huffington Post and drew more than 600 comments on the site.
While Wuest and Nate Bacott, co-owner of CrossFit Fringe at *4250 E. Broadway, maintain they don't push their clients past their limits, but any exercise regimen poses a danger to the athlete who pushes too hard. Why people strain their bodies beyond their limits is a complex problem that reaches into psychology and requires good trainers to be on the look-out for signs of trouble.
Rhabdomyolysis, or rhabdo, is more monster than clown. The muscle cells in an affected area break down, flooding the body with myoglobin, the protein that makes up muscle fiber. The kidneys are not capable of dealing with myoglobin, let alone in such quantities, which can ultimately cause kidney failure. In serious cases, rhabdo can be fatal.
The disease, which affects 26,000 people a year in the U.S., has a number of causes, including severe injury, genetics, drug addiction — and overexercise. Marathon runners, military personnel and even physical therapy patients can all develop rhabdo.
So what is the CrossFit link? The program uses daily workouts, published on the main company's website, to train athletes. These workouts are "designed to exceed the limits of the world's fittest people, but can be scaled to meet anyone's current fitness," according to the CrossFit website.
In order to become affiliated with the program, gyms pay $3,000 annually to the company. Classes work through the daily regimens together. The workouts are timed, adding to the sessions a sense of competition for both the individual and the group.
In order to become a Level 1 Trainer, Wuest and Bacott say, trainers spend a weekend learning the movements and exercises of the program, including an entire class about rhabdomyolysis, before they take a 50-question multiple choice test. New gym members are often required to attend basic classes — Bacott calls them "on-ramps" — before they can begin full training under a certified trainer and before they can join the culture of CrossFit.
The question isn't so much whether CrossFit somehow causes rhabdo in people who do it. The question is whether it creates an environment in which it's more likely to occur.
Bacott said some trainers contribute to creating such an environment by not getting enough experience before opening gyms and being too eager to buy into the CrossFit stereotype.
"That's why cases like (the one described in) the Huffington Post article happen," Bacott said.
He described two "schools of thought" within CrossFit, one more positive than the other. Some trainers see themselves as professional coaches and use CrossFit within a varied exercise regimen. Then there are the people who buy so heavily into the CrossFit lifestyle and methodology "that they shut themselves off to anything else. ... That leaves a lot of error room."
In that space are the trainers who push athletes in the wrong directions. Jessica Kohler, a Level 1-certified trainer at Bacott's gym on East Broadway, agreed that the trainer issue in CrossFit is important.
"It's a huge problem," she said of such trainers.
CrossFit requires only a Level 1 Trainer certificate and the yearly payment to become an affiliate, according to the company's website. The gyms are not franchises; they're independently owned and operated, which can allow bad coaches to open gyms, Wuest said.
"I'm sure there are CrossFit gyms with bad coaches out there," Wuest said. "Whoever owns the gym, it's up to them to decide on how to treat their clients."
The certificate training course itself may be too easy, further compounding the problem. Bacott doesn't see the test as the flaw, however.
"The reason CrossFit gets a lot of criticism is that the Level 1 test is seen as too easy," Bacott said. But CrossFit is explicit about telling new trainers to get more experience and education before opening their own gym. "Yes, you can call yourself a CrossFit Level 1 trainer after that certification, but they make sure you know that this is, by no means, the end all, be all."
Bacott said he firmly believes that if an athlete becomes injured, or harmed in any way, a huge responsibility for that is on the coach. "(A coach's) responsibility is to get (the client) to be an athlete, push them, but safely," he said.
Bacott and Wuest said they feel well-equipped to take care of their athletes. They say the level of technical understanding necessary in the certification training allows trainers to spot people who are at risk of overtraining.
Those whose technique is falling short or who seem to be needing extra breaks stand out to Wuest because those can be signals that the athlete should quit. He said he has sent people home on occasion.
Melissa Carter, a personal trainer with five years' experience, said she uses a similar approach to spotting problems before they can happen with her clients, whether they're using CrossFit, a personal trainer or just working out on their own in the gym.
But she's willing to take it a step further. Before graduating from MU, she worked as a personal trainer at the MU Student Recreation Complex, where she saw students she believed were pushing beyond their limits.
Although she never personally worked with anyone who required help, she was prepared for the eventuality. This is what she decided she would do: "Take them aside, have a light conversation with them," she said. "Put it in their head, 'Maybe I'm exercising too much, maybe I need to see a doctor.'"
Rhabdomyolysis is far from the only problem facing athletes who overtrain. Carter said people who overexercise may not even be aware of the damage their workout is doing.
Once the body burns through glycogen for its energy, it will turn to fat for fuel. After further exercise, the body will begin breaking down muscle to keep itself running, a cruel irony of overexercise, Carter said..
The damage doesn't stop when the gym door swings closed.
"Pro athletes, they can work out for hours a day, but they're eating 6,000 calories and getting 10 hours of sleep," Carter said. "But the average student or average person (who works out that much) isn't getting enough nutrition to help their body repair."
Bacott sees that as one of the central problems. Athletes who suffer the effects of overtraining often aren't getting enough rest or nutrition. In that respect, people must take responsibility for themselves, he said, and part of that responsibility is finding a gym with good coaches who care about more than racking up paying clients.
Why someone would push themselves to the point of harm is complicated. Brian Bowles, a counselor who works with people on various addictions, said there are some signs that might point to those who could be addicted to exercise.
"People may experience withdrawal, where if somebody doesn't exercise, they may feel depressed," he said. "There's some research that the endorphins that are released when you exercise, they play on the same pleasure centers of the brain that using cocaine plays on."
There are other signs. For example, exercise addicts' lives will revolve around the activity. Being unable to exercise causes stress, and the athlete only feels "normal" when he or she is working out, Bowles said.
Several factors may cause people to exercise to excess, including body image, relationship problems or simply having an addictive personality. Of those, body image stands out.
"Something like 30 percent of people with eating disorders also exercise to excess," Bowles said.
Indeed, one of the check marks for diagnosing an eating disorder is excessive exercise. In the experience of personal trainer Carter, the pressure to look a certain way trumps the long-term implications, which include early-onset osteoporosis and fertility issues in women.
Even if people were more aware of the lasting effects of exercise addiction, Carter isn't sure it would cause people to ease off their regimen.
"We're just such an instant gratification culture," Carter said. "Osteoporosis and fertility for a lot of teenage girls is way in the future, and they're not thinking about that."
Meanwhile, the stereotype of CrossFit is stronger than ever: Freak athletes throwing truck tires across a parking lot under the screaming motivation of drill sergeant-like trainers. Bodies pushed to the breaking point. Athletes dropping like flies from pull-up bars.
But Bacott has seen people from all walks of life move through the front door of his gym. Inside, combat veterans with injured or missing limbs, overweight people, middle-aged moms and world-class athletes with bulging arms all lift, pull, run and stretch.
Bacott and Wuest are thinking about the future with the specter of Uncle Rhabdo leering over them.
Wuest sent the Huffington Post article to his gym members, along with response articles. Bacott said his older members knew enough about the program to know rhabdo, and his newer members were the only ones affected by the recent publicity.
"There was fear there," Bacott said of some members who joined since the article's publication. "They came in afraid of it."
CrossFit may be in the spotlight, but risks exist in other exercise. As a blogger who suffered from rhabdomyolysis after a CrossFit workout wrote for U.S. News and World Report, "Rhabdo can be dangerous. Running with diabetes can be dangerous. ... It is up to the individual to determine if the risk outweighs the rewards."
Supervising editor is Katherine Reed.