Crossfit and Medicine - Pushing the limits

This is being worked into a more formal, less first-person document. But I wanted to share a story and perspective.

I want to take a moment and talk about the way we work as Crossfit athletes, about our goals, and ask some hard questions about what could be done for these athletes to push even harder, to higher levels. I would also like to discuss, or at least broach the subject of the notion that some of this might constitute “doping.”

It should come as no surprise to people that the Crossfit “Metcon” – metabolic conditioning – is perhaps one of the most demanding activities we ask of athletes in sport today. It is this tough because it is designed to be tough; Greg Glassman talks about the multiple energy pathways available to athletes: the anaerobic phosphagen and glycolytic cycle, and the aerobic oxidative phosphorylation cycle. Glassman says in numerous lectures that the goal of Crossfit is to increase an athlete’s “work capacity across broad time and modal domains.” That is to say, to take an athlete and extend their ability to work – and by work, Glassman uses a very specific definition, a unit of power achieved, whether it’s moving one hundred pounds two feet, or twenty pounds five hundred feet, it’s a measurable, objective, consistent unit of work – across domains that they are inherently not suited to doing.

So yesterday after I came home from my workout, my triceps and my upper pectorals and my deltoids had for all intents and purposes quit working; it was not a function of pain or stiffness, really, they were just numb, and this is something we commonly get from eccentric muscle contractions. The workout in question had been lots of overhead walking lunges with a 45-lb plate and hand-release pushups and I think the count wound up being on the order of 150 of each.

As I came in the door, I grabbed a pint of chocolate milk which is my recovery beverage, and inhaled it as quickly as I could and felt just a little bit better. I then realized quickly that it wasn’t going to be enough and I had a second pint, so that’s about a litre of chocolate milk, and about 800 calories, fifty grams of sugar.

Almost immediately, lay down on the carpet in the entrance to my apartment because my legs were exhausted and my arms couldn’t really hold me up, and I was not strong enough to undress and get in bed or go stand in the shower. And so I sat on my side for a moment on the carpet, and it hurt less to turn over and I fell asleep on my face on the carpet, in the living room.

Apparently I started dozing and my wife noticed and said, go get in bed, and I went, and did that.

Over about an hour or ninety minutes, I stayed in bed and tried to recover a bit but ultimately the numbness – it’s not a numbness, if you’ve ever done this sort of exercise, it’s not a numbness so much as a lack of action in the muscle; you don’t get the feedback that the muscle has been pushed out when you extend it. When you contract the muscle, it feels like the limb moves, but you don’t actually feel like the muscle has done anything. It’s almost as if there’s a neurological disconnect, things still sort of work, and there’s not a lot of pain involved, but things are very weak and there’s very little ability to bear any weight.

Two hours into this, I realized that I needed to be pushing fluids, that I was quite possibly in shock, and that I wasn’t physically capable of putting fluids or calories into my body rapidly enough to compensate for the – I hesitate to use the word damage – but the work that I had accomplished: the calories burned, the muscle tissues torn down, the water lost through sweat and urination, the blood flow change from my extremeties to then digesting this milk ‘meal’, to ostensibly some blood pooling then on my back in bed. I realized I was in a very bad way in terms of being able to recover in that kind of a position, in that kind of condition.

I needed to be upright, walking around, breathing properly, getting circulation, massaging those muscles – we talk about myofascial release and certainly mental stimulus, even if it was something as simple as conversation or reading might have made me more alert. But effectively what happened was the workout was so thoroughly grueling that afterwards I was left physically unable to replenish or nourish, or effectively repair what I had done to myself.

And so the thought occurred to me, why is it that there is a social and indeed a legal stigma to a medical doctor giving someone like me in a condition like that IV fluids? If I had gone to an emergency room in shock and had just run a marathon for the first time, they’d have given me a liter of saline and possibly a liter of dextrose, and sat and watched me. The difference is here, this workout I do sometimes six days a week.

I find myself wondering what it is that’s actually wrong with the notion of using something like IV fluids to recover when you have worked your body beyond the point when you can ingest water through your face to the point you are healthy again. The second thought that occurred was, what specifically is wrong with palliative care, with analgesic care at this point? We know that somebody who has gone and exercised this hard, and gone through this much activity, is in pain, is at least having a little bit of mental difficulty from the event, and is most likely having an amount of shock. And it occurred to me, what would be wrong with, in that condition, giving me, as a patient, a litre of saline, a litre of dextrose, and a grain of Demerol or some small token dosage of dilaudid.

Now the major difference here between me and a trauma patient from a car accident who might indeed have the same exact injuries – torn muscle fibers, dehydrated, in shock, disoriented – the difference is that I did it to myself. And when somebody has it done to them, it’s okay to treat them with full medical rigor. So I find myself wondering, why it is we have this stigma, and I wonder if there’s room in society at some point with the medical profession to offer as part of what we’re starting to see as “concierge medicine” and agreement where the doctor understands an athlete is trying to be the best athlete they can be and push those physical boundaries we’re finding we can now push past – that you are working to be the fittest that you can possibly be – and I know that you are capable of out-working your body’s ability to absorb oxygen or water, so what I want you to do is I am going to let you free-breathe oxygen and I’m going to give you IV fluids and dextrose because your body needs those carbs and if you’re having minor muscle cramps I’m going to give you a little bit of an analgesic and you’re in the same condition as somebody who might have, for example, crush syndrome.

I really wonder, why there would be such a stigma with that. Because it seems to me the two are very similar. I have to wonder. When we look at the reasons, specifically with Crossfit, and I hate to pick on Crossfit as an example of people who are doing things that are “Forging Elite Fitness” and all these sad clichés that we throw around because there are elite athletes in every sport. But in Crossfit in particular, we have athletes who can consistently induce – not that they’ve shoved a finger down their throat – but they can work hard enough that they vomit because they cannot absorb oxygen rapidly enough through their lungs. We have athletes who have learned to work through the mental pain and anguish that says “your muscles are quitting,” and they get rhabdomyalosis. We have athletes who exceed their body’s abilities to replenish water through their mouths, and they pass out from dehydration and wind up in infirmary tents being treated by medical professionals.

So why is it, then, there would be such a stigma with treating athletes who work hard enough to tax all their biological systems, and effectively, augment those systems with technology? When we create a protein supplement and allow an athlete to get 500 grams of whey protein in 250ml of water, that’s not something they’d normally be able to do; we’re able to do all kinds of things technologically for athletes, and yet we draw the line at the needle. And for me, that seems like an arbitrary place to draw a line and I am sure that the vast majority of the community disagrees with me, but I would be interested in hearing cogent disagreement.

Why is it not okay to IV rehydrate an athlete who has exceeded their body’s ability to rehydrate? Why is it not okay to take an athlete and put oxygen on them after an event? Why is it not okay to given an athlete dilaudid who has done enough eccentric muscle contractions that they have burned 25 or 100 grams of muscle fiber and they are in pain, when it is okay for anybody else who has sustained those same injuries involuntarily through trauma?