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

[gcclarke]

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

 

[Michael OLeary]

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

 

[gcclarke]

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.

 

[painswessex]

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.

 

[buzgo]

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.

 

[ballz]

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.

 

[Eye In The Sky]

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.

 

[The_Falcon]

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. 

 

[painswessex]

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.

 

[buzgo]

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.

 

[The_Falcon]

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) 

 

[Strike]

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.

 

[The_Falcon]

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.

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). 

 

[DVessey]

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

 

[The_Falcon]

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.

 

[Strike]

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.

 

[buzgo]

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...

 

[aesop081]

RE: The CANFORGEN

"should"

"shall"

There's a difference.

 

[AgentSmith]

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?

 

[aesop081]

and can we still do Crossfit on our own time?

"CF PERSONNEL SHOULD AVOID PARTICIPATING IN ECPS"

RE: The CANFORGEN

"should"

"shall"

There's a difference.