# CANFORGEN on Rhabdomyolysis &  INTENSE PHYSICAL EXERCISE OR EXTREME CONDITIONING PROGRAMS (ECP S)



## gcclarke (31 Aug 2012)

SUBJ: EXERTIONAL RHABDOMYOLYSIS AND INTENSE EXERCISE/CONDITIONING PROGRAMS BILINGUAL MESSAGE/MESSAGE BILINGUE 1. THE PURPOSE OF THIS CANFORGEN IS TO INFORM CF PERSONNEL OF A POTENTIAL HEALTH HAZARD ASSOCIATED WITH INTENSE PHYSICAL EXERCISE OR EXTREME CONDITIONING PROGRAMS (ECP S) 2. ECP S CAN RESULT IN INCREASED INJURY RATES, INCLUDING A POTENTIALLY LIFE THREATENING CONDITION CALLED EXERTIONAL RHABDOMYOLYSIS. WITHIN THE PAST YEAR, CF PERSONNEL FROM SEVERAL BASES HAVE DEVELOPED EXERTIONAL RHABDOMYOLYIS. THOSE MOST AFFECTED REPORTED ENGAGING IN AN INTENSE COMPETITON OR WORKOUT, PARTICULARY CROSSFIT, PRIOR TO THEIR DIAGNOSIS 3. ECP S ARE NOT ENDORSED BY PERSONNEL SUPPORT PROGRAMS (PSP), PAGE 2 RCCLHAV6003 UNCLAS DIRECTORATE OF FITNESS (DFIT) OR DIRECTORATE OF FORCE HEALTH PROTECTION (DFHP). CF PERSONNEL SHOULD AVOID PARTICIPATING IN ECPS:
INSTEAD, THEY SHOULD UNDERTAKE SAFER TRAINING AND CONDITIONING PROGRAMS AS DEVELOPED BY DFIT OR LOCAL PSP FITNESS PERSONNEL.
INFORMATION ON AVAILABLE COURSES CAN BE FOUND AT:
HTTPS://PUBLIC.CFPSA.COM/EN/ABOUTUS/PSP/DFIT/COURSES_CERTIFICATIONS/PAGES/DEFAULT.ASPX
4. ADDITIONAL INFORMATION ON EXERTIONAL RHABDOMYOLYSIS AND ECPS CAN BE FOUND AT:
HTTP://CMP-CPM.FORCES.MIL.CA/HEALTH-SANTE/WN-QN/ADV-AVI/DEFAULT-ENG.
ASP
5. SIGNED BY RADM A. SMITH, CMP


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## Michael OLeary (31 Aug 2012)

http://en.wikipedia.org/wiki/Rhabdomyolysis



> Rhabdomyolysis  is a condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream; some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure. The severity of the symptoms, which may include muscle pains, vomiting and confusion, depends on the extent of muscle damage and whether kidney failure develops. The muscle damage may be caused by physical factors (e.g. crush injury, strenuous exercise), medications, drug abuse, and infections. Some people have a hereditary muscle condition that increases the risk of rhabdomyolysis. The diagnosis is usually made with blood tests and urinalysis. The mainstay of treatment is generous quantities of intravenous fluids, but may include dialysis or hemofiltration in more severe cases


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## gcclarke (31 Aug 2012)

So, this defnintely seems like a fairly significant policy shift, as it certainly had seemed in recent years like the department was leaning more towards / encouraging the Cross-fit style workouts.


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## painswessex (31 Aug 2012)

And to think i was going to do this in preperation to re join the military. I did a BMI thing on the internet and it said i was obese. I knew i had "a few extra pounds" never though obese. 220lbs at 6' i thought was ok.


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## buzgo (31 Aug 2012)

The message is not to stop doing this stuff, its to do it intelligently. The TAIC and AFTA courses both cover Crossfit-style stuff including combat fitness.

The problem is that individuals and units have been pushing ECP or HIT without any trained people monitoring things. A level 1 CrossFit 'certification' doesn't count.


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## ballz (31 Aug 2012)

It hasn't been a secret for a while that Crossfit athletes/competitors etc are at a higher risk for rhabdo... I am not surprised they are seeing the same trend among CF members with it's growing popularity within the CF.


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## Eye In The Sky (4 Sep 2012)

painswessex said:
			
		

> And to think i was going to do this in preperation to re join the military. I did a BMI thing on the internet and it said i was obese. I knew i had "a few extra pounds" never though obese. 220lbs at 6' i thought was ok.



BMI on its own is a horrible way to measure fitness.  It doesn't take into account bone structure/body type, muscle mass, etc.  You'd be far better off getting a body fat % calc done.


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## The_Falcon (4 Sep 2012)

signalsguy said:
			
		

> The message is not to stop doing this stuff, its to do it intelligently. The TAIC and AFTA courses both cover Crossfit-style stuff including combat fitness.
> 
> The problem is that individuals and units have been pushing ECP or HIT without any trained people monitoring things. A level 1 CrossFit 'certification' doesn't count.



And just curious why doesn't a CF L1 Cert count in your opinion?  You must pass a knowledge test to obtain the cert, and the topic of Rhabdo is discussed on the cert, specifically what not to do, so you don't induce it in yourself/clients.  The level 1 goes into a bit more depth than the fitness mod for PLQ.   There are tons of people out there running PT sessions in their units/sub units etc, who have no clue what they are doing (some of them even have done the PLQ fitness mod and/or the CF L1).  But is it their fault or the CofC for allowing people to run PT who shouldn't (or in some case telling people to run PT, as a form of PD)?  

This (CANFORGEN) to me highlights the organizational ignorance of fitness training inherant through out the CF at many levels, which is ironic in a bad way, since our jobs and overall mission require us to be "fit" in some capacity.


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## painswessex (4 Sep 2012)

Eye In The Sky said:
			
		

> BMI on its own is a horrible way to measure fitness.  It doesn't take into account bone structure/body type, muscle mass, etc.  You'd be far better off getting a body fat % calc done.



That's exactly why i thought it was weird. I am sick of my "gut" so i am going to go to gym. Now just to find the proper motivation. Wait i got it, think positive i do this and the military is defiantly going to call and offer me a job.


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## buzgo (4 Sep 2012)

Hatchet Man said:
			
		

> And just curious why doesn't a CF L1 Cert count in your opinion?  You must pass a knowledge test to obtain the cert, and the topic of Rhabdo is discussed on the cert, specifically what not to do, so you don't induce it in yourself/clients.  The level 1 goes into a bit more depth than the fitness mod for PLQ.   There are tons of people out there running PT sessions in their units/sub units etc, who have no clue what they are doing (some of them even have done the PLQ fitness mod and/or the CF L1).  But is it their fault or the CofC for allowing people to run PT who shouldn't (or in some case telling people to run PT, as a form of PD)?
> 
> This (CANFORGEN) to me highlights the organizational ignorance of fitness training inherant through out the CF at many levels, which is ironic in a bad way, since our jobs and overall mission require us to be "fit" in some capacity.



My personal opinion is that the CrossFit mothership is in it for the cash at this point and while they may be producing a good cert program, what are they doing to monitor and enforce standards? Anyone could go and get a L1 cert and then go out and wreck people who don't know any better. 2 days of training doesn't make a trainer or a coach.

I agree with you about the people running things with no clue - we have not been doing a good job of getting people onto the BFTA and AFTA courses, and PSP doesn't always keep up with the latest and greatest in the training world (but they are also required to do risk analysis and train for minimal standards).

CFPSA and PSP are not ignorant, the health care system is not ignorant. I would argue that our PSP staff are on the cutting edge in some things (BFOR) and of course behind the times in others, but mostly very good. Of course at the local base level your mileage may vary.


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## The_Falcon (4 Sep 2012)

signalsguy said:
			
		

> My personal opinion is that the CrossFit mothership is in it for the cash at this point and while they may be producing a good cert program, what are they doing to monitor and enforce standards? Anyone could go and get a L1 cert and then go out and wreck people who don't know any better. 2 days of training doesn't make a trainer or a coach.



You have to re-cert every 5 years now.  But the arguments about monitoring and enforcing standards, can be equally applied to every kind of fitness certification out there, in that its a buyer beware world.  Unless governments start licencing and monitoring the fitness industry, this will always be the case.  Doesn't matter if its a CF gym or your local globo chain.  



> CFPSA and PSP are not ignorant, the health care system is not ignorant. I would argue that our PSP staff are on the cutting edge in some things (BFOR) and of course behind the times in others, but mostly very good. Of course at the local base level your mileage may vary.



Agree the higher levels of those organizations, are on top of things, since they are the ones doing the research and putting out the various PAMS.  My comment was directed more at well every one else doing their "own thing" (there are exceptions of course, some units/individuals etc. have made the effort to get their personnel more training and experience)


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## Strike (4 Sep 2012)

Hatchet Man said:
			
		

> You have to re-cert every 5 years now.  But the arguments about monitoring and enforcing standards, can be equally applied to every kind of fitness certification out there, in that its a buyer beware world.  Unless governments start licencing and monitoring the fitness industry, this will always be the case.  Doesn't matter if its a CF gym or your local globo chain.



Actually, there is a national coaching certification program available for a whole plethora of different sports.  It's all based on the same program and many sports have individual requirements in addition to its minimum requirements.  It's called NCCP and it is very difficult, of not impossible, for any sport in Canada to get recognition or funding for their program by Sport Canada unless they are recognized or represented within the NCCP program.

This link provides a list of sport specific options.
http://www.coach.ca/sport-partners-s15443

Until such time as Cross-fit sets itself up as a national organization under which all others follow, it will never be part of the NCCP program unfortunately.


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## The_Falcon (5 Sep 2012)

Strike said:
			
		

> Actually, there is a national coaching certification program available for a whole plethora of different sports.  It's all based on the same program and many sports have individual requirements in addition to its minimum requirements.  It's called NCCP and it is very difficult, of not impossible, for any sport in Canada to get recognition or funding for their program by Sport Canada unless they are recognized or represented within the NCCP program.
> 
> This link provides a list of sport specific options.
> http://www.coach.ca/sport-partners-s15443
> ...



I am aware of the NCCP, and as you helpfully pointed out, its a certification for "sports", the NCCP does not deal with world of personal/fitness training  and certification.  Google personal training certification, and you get a whack of certifying organizations and courses out there, NCCP not one of them (of course some trainers get NCCP certified in things like weightlifting and gymnastics to supplement their other certs/training).  Currently the CF level 1 is accredited by ANSI (American National Standards Institute).  And while CF has taken on a "sport" like aspect with the whole CrossFit games, it is still by and large a general physical fitness program and not a sport.  And seeing as how CF is American, I am pretty sure they aren't really interested in Canadian certifying bodies or funding.  

Edited to add this
http://www.ansi.org/news_publications/news_story.aspx?menuid=7&articleid=2759#.UEbAr9ZmSuk

Again not saying a CF cert is the be all and end all, but when compared to other fitness trainer certs, its really no better or worse and in the end it comes down to individual trainer (certified or not) to ensure they know where their knowledge and experience ends and not do stupid stuff because they don't have that experience and knowledge (which someone people in the CF who lead/put people in charge of  PT sessions aren't very good at).


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## DVessey (8 Sep 2012)

This seems a little strange. If you follow the links in the CANFORGEN, there is an advisory from DFHP and it looks like this whole thing started when 3 people presented with ER in sometime in May 2012 from the same base. Only 2 of them said they were doing CrossFit. They also went back and checked levels for some chemical and there might have been 19 (IIRC) other *possible* cases throughout the last year. There's absolutely no numbers about how many CF members who are doing CrossFit and aren't injured.

How many injuries have happened in the last year due to running, soccer, hockey and other sports? My bet is a lot more than 19. Are there advisories out to stop playing those sports or doing those activities?

Please don't get me wrong - I am all for better educated personnel, jumping straight into CrossFit workouts can hurt you in more ways than just rhabdo. But the CANFORGEN just comes out recommends against it.

Looks like there's a discussion about this topic going on over here as well: http://www.forums.psppetawawa.com/showthread.php?s=3ef87eb4700892c802a5eb154a2f6900&t=53642


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## The_Falcon (8 Sep 2012)

Its not strange, its an over-reaction and leadership inability take responsibility and control for their own actions/inactions for the lack of planning/co-ordination/training required to effectively lead group PT sessions. A poster on page 2 of that link you provided explained similarly to what I posted.  The problem isn't the program (or any program).  The problem in alot of cases it is people don't know what the hell they are doing, regardless if they are using CF, AFM, CFP etc.  

Perfect example is the co-owner of my gym, she works class b, never had any issues/injuries from Crossfit, was playing basketball for group PT almost a year ago now, tore her ACL.  It still hasn't healed right.  If we are going to start banning or recommending against stuff that seriously hurts people, then all those pick up games of floor hockey, basketball, soccer etc, should rightfully be included.


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## Strike (8 Sep 2012)

But you can't really compare the injuries of other sports with this case because this case focuses on ONE TYPE of injury that seems to affect those doing Crossfit (improperly).  All the sports you mentioned have athletes that present with various different injuries.  Now, if you were to talk about a whole wack of people showing up at the MIR with shin splints or compartmental syndrome because of forefoot running using minimalist shoes then I could see the CF putting out a CANFORGEN on the issue.  But your argument of more people getting injured playing soccer, volleyball, etc, does not hold water.

Note - I am not saying there is anything wrong with forefoot or minimalist running.  I'm just using it as an example.


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## buzgo (8 Sep 2012)

I am not a fan of sports for PT, mainly because of injuries  but at least the injuries aren't causing kidney failure...

I don't think its an over reaction, I think people are overreacting to the CANFORGEN though. It says that HIT is still okay provided its properly led. Jeez, the Combat Fitness program is based on CrossFit and its not being banned...


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## aesop081 (8 Sep 2012)

RE: The CANFORGEN

"should"

"shall"

There's a difference.


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## AgentSmith (9 Sep 2012)

I'm kind of confused. Does this just mean Crossfit won't be a part of unit PT (since it's not endorsed by PSP) and can we still do Crossfit on our own time?


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## aesop081 (9 Sep 2012)

AgentSmith said:
			
		

> and can we still do Crossfit on our own time?



"CF PERSONNEL *SHOULD* AVOID PARTICIPATING IN ECPS"



			
				CDN Aviator said:
			
		

> RE: The CANFORGEN
> 
> "should"
> 
> ...


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## OldSolduer (9 Sep 2012)

AgentSmith said:
			
		

> I'm kind of confused. Does this just mean Crossfit won't be a part of unit PT (since it's not endorsed by PSP) and can we still do Crossfit on our own time?



My advice to my unit when I read this to them was to seek professional advice and work into it slowly. We have a certified cross fit instructor in our unit.


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## MeatheadMick (10 Sep 2012)

Jim Seggie said:
			
		

> My advice to my unit when I read this to them was to seek professional advice and work into it slowly. We have a certified cross fit instructor in our unit.



Not saying this is your scenario Jim, but I know at least one 'certified' CrossFit instructor who isn't worth the ink on her cert. Any goomba can be a 'certified' instructor, it's just a matter of finding a good one.

I strongly support CrossFit. I think it's a great way to stay in shape or get in shape, and personal adjustments can be made when dealing with injury or if one just does not feel like going 'hard' on a given day.


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## medicineman (10 Sep 2012)

I've been trying to stay out of this but can't anymore...there have been some serious cases of rhabdomyolysis I've seen over the years and well before the advent of CrossFit - they were simply as a result of poor supervision +/- lack of maturity on part of supervisors and sometimes lack of fitness on part of victims during all sorts of fitness events...BFT's, runs in high heat and humidity without proper hydration, silly people starting back into weight training at the levels they were doing it previously after a long hiatus, etc, ad nauseum.  Any kind of high intensity exercise, and by that, I mean for the person actually doing it, can cause sufficient muscle breakdown to clog up your kidneys, especially if they're not hydrating properly...I can think of one in recent memory from a BFT who was ill enough to miss some work after spending a day in the ER hooked up to an IV and another from a run that resulted in them being in ICU for a month due to renal failure.  

In the end, it comes down to the Command Teams being attuned to who is properly trained to lead a PT session and ensuring that, especially if they're new to it, are themselves supervised.  There are courses out there to properly prepare PTI's for units...people have got to start using those assets more.

 :2c:

MM


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## Chernoble (12 Sep 2012)

One of the larger arguements when in discussion with people about this issue seems to be that CrossFit as a company, only cares about profit.  I think CrossFit is being confused with Insanity and P90X.  CrossFit is not trying to sell you workout DVDs or the workout itself.  All of CrossFit's information on how to start up, how important it is to scale your workouts as you get used to the training programs and all of their workout information is free at the CrossFit Journal and crossfit.com .  

Once again we are seeing the results from the actions of the few affecting the many.  This is the same way IR and posting benefits get changed, because people don't take the time to educate themselves on how things are supposed to be properly done, abuse themselves or the system and we all suffer for it in the long run.

I can proudly say I am more fit than 95% of the force because of CrossFit and if they want to charge me for it, they will have to catch me first, if they can


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## OldSolduer (12 Sep 2012)

Chernoble said:
			
		

> I can proudly say I am more fit than 95% of the force because of CrossFit and if they want to charge me for it, they will have to catch me first, if they can



Good for you . Has anyone told you that you would be charged? 

I dn't believe I have seen a ban on Cross Fit.


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## aesop081 (12 Sep 2012)

Jim Seggie said:
			
		

> I dn't believe I have seen a ban on Cross Fit.



There isn't one. Some people just have not developed the ability to read that's all.


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## chris06 (12 Sep 2012)

I think any discussion on letting people know about potential injuries in anything they do is important.  However, I think that a CANFORGEN might not be the best way to inform the entire CF.  Sometimes this info doesn’t get down to the lowest levels.  The US has done some great research on ECP’s and Crossfit had rebutted with some strong arguments.  (See link below)

Is Crossfit safe?  Sure.  Can you get injured doing all sorts of PT?  Sure.  I’ve been doing Crossfit since ’07 and did my cert in San Diego in ’08.  The supporting documents in the CANFORGEN reference three cases beginning in March ’12.  I can tell you that the base was CFB Borden.  I know this because I was the first case.  Given my particular situation at that time, and looking back, I pushed myself too hard. (It happened at a local affiliate and on my own time)  What saved me from dialysis was the fact that I recognized the symptoms and went to the MIR and asked for a CK test.       

Here are some information both for and against Crossfit as Military PT:

http://library.crossfit.com/free/pdf/CFJ_Champ_ALL_007.pdf

http://library.crossfit.com/free/pdf/CFJ_111200_Bergeron_Champ.pdf


PM if you want more details.


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## buzgo (12 Sep 2012)

Feel free to correct me if I'm wrong, but by stating that ECPs are not endorsed by PSP, the CANFORGEN is basically saying that if you are hurt doing this stuff you will not be covered. Right?

Just like extreme obstacle races, MMA and some other things that a lot of the troops are into now - without permission from the CoC you are not protected if injured.


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## MJP (12 Sep 2012)

signalsguy said:
			
		

> Feel free to correct me if I'm wrong, but by stating that ECPs are not endorsed by PSP, the CANFORGEN is basically saying that if you are hurt doing this stuff you will not be covered. Right?
> 
> Just like extreme obstacle races, MMA and some other things that a lot of the troops are into now - without permission from the CoC you are not protected if injured.



I think you are reading into it wayyyyy to much.  CA has already pointed out the use of the words "Should" & "Shall".


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## The_Falcon (12 Sep 2012)

He has pointed that out, but it is already becoming apparent is that this CANFORGEN will be misconstrued by others, either accidentally or deliberately, that ECP's including CrossFit are bad and need to be avoided.  I think that the wording and language of this CANFORGEN was poorly chosen, in addition to what has already been stated by myself and a few others, that it does not hold leadership and CofC culpable for their actions and or inactions.  The problem isn't the program itself, its people.


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