Rhabdomyolysis – Uncle Rhabdo, Pukie the Clown, and the CrossFit Controversy

Uncle Rhabdo, Pukie the Clown, and the CrossFit Controversy

The last few days has seen a hot topic flying around the blogosphere and message boards: rhabdomyolysis,  rhabdo for short. The firestorm of opinion was sparked by an Australian health article titled “What Crossfit Doesn’t Want You to Know” published mid-September 2013. (When you mention characters like Pukie the Clown you are just asking to go viral.)

Before continuing, let me briefly define rhabdo.  Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes kidney damage.  In layman’s terms, rhabdo is overdoing it to the point of muscles falling apart.  The proteins breaking down move into the bloodstream to the kidneys, which attempt to clean the protein out of the blood.  Kidneys weren’t designed to process this protein, called myoglobin, and can be damaged, sometimes irreversibly.  That rhabdomyolosis is a dangerous condition should not be understated.

Rhabdomyolysis Muscle Breakdown

Rhabdomyolysis Muscle Breakdown

So why the controversy?  Here is where CrossFit enters the picture.  What is Crossfit? CrossFit is a military style fitness program designed for strength, conditioning, and endurance.  Unlike, say, bodybuilding, CrossFit aims to get the participant in a useful sort of shape.  If there is a building on fire, a CrossFitter should be able to help fight it, carry people to safety, or outrun it instead of just one of the three.   CrossFit is TOUGH.  And CrossFit is trendy.  With increasing numbers of people discovering CrossFit, rhabdo has come back on the health and fitness radar.

The controversy, really, stems from this picture:

Rhabdo the Clown Uncle Rhabdo simplyfitandclean

Uncle Rhabdo

Uncle Rhabdo.

The CrossFit Journal introduced this character in a journal article by Dr. Will Wright in 2011, aimed at identifying, preventing, and warning of rhabdomyolysis.  Rhabdo is pictured as a clown, and this imagery concerned people.  Clowns are funny!  Rhabdo isn’t funny!  They have a sick sense of humor!   In fact, Rhabdo was drawn in this way to mirror the controversial “Pukie the Clown,” an unofficial mascot of Crossfit:

Pukie the Clown crossfit simplyfitandclean

Pukie the Clown

Pukie is a lightning rod for CrossFit debate. This  article loves Pukie, and this one hates him. Pukie represents that moment when a CrossFitter pushes so hard in training they vomit or even pee themselves. Uncle Rhabdo represents what happens when CrossFitters embrace Pukie the Clown too eagerly.

While some see Uncle Rhabdo as irresponsible, I have to disagree.  CrossFit has introduced this character as a way to visualize a very real danger that they have always warned about.  Overexertion can be very dangerous, and the creators of CrossFit WANT the public to know this, hence Uncle Rhabdo’s appearance in their own journal with many warnings of the seriousness of rhabdomyolysis.  Dr. Will Wright says in the article linked above, “Coaches and trainers are the ambassadors of our clients’ health and well-being.  Given this unique position, there are predisposing conditions that trainers should be aware of; they include the types of exercises being performed, environmental conditions, and most importantly, the capabilities of the client and his or her known medical conditions need to be considered.”

No shortage of Crossfit gear

I applaud CrossFit for addressing this issue vocally and publicly.  They want you to be happy and healthy, not hospitalized.  Rhabdo is not a “dirty little secret” or a problem CrossFit “doesn’t want you to know.”  It is clear from their official publications that CrossFit is trying to responsibly inform the public of the specific risks associated with their program.

If you suspect you or someone you know might be getting an unwelcome hug from Uncle Rhabdo, the following are symptoms that should not be ignored: 

Muscle pain, stiffness, and extreme weakness

Dark urine, the color of tea or cola 

As the condition progresses, these symptoms are possible and must be treated at a hospital:

Swelling of the hands and feet

Difficulty breathing

Irregular heartbeat

Unexplained bleeding 

More importantly that treatment is the prevention of rhabdo:

Introduce new, intense exercise routines gradually

Drink lots of water following an intense workout

Always alert trainers of pre-existing medical conditions 

Never sacrifice safety 

CrossFit is a great program, but as with all fitness methods, never turn off the brain to turn on the muscles.  Just like a marathoner doesn’t go from sitting on the couch to running 26 miles in a single day without major risk of injury, listen to the warnings and don’t do more than your body can handle.


“Can CrossFit Kill You?” http://nypost.com/2013/09/22/can-crossfit-kill-you/
“What CrossFit Doesn’t Want You to Know” http://www.news.com.au/lifestyle/health/what-crossfit-doesn8217t-want-you-to-know/story-fneuzle5-1226724864790
“Rhabdomyolysis” http://www.uofmchildrenshospital.org/healthlibrary/Article/40544
“CrossFit’s Dirty Little Secret” https://medium.com/p/97bcce70356d
“Hey can you answer the door, I think Uncle Rhabdo is here…” http://www.crossfitreality.com/?p=381
“Rhabdomyolysis Revisited” http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf
“Rhabdomyolysis” http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
“CrossFit Induced Rhabdo” http://library.crossfit.com/free/pdf/38_05_cf_rhabdo.pdf
“In Praise of the Vomiting Clown” http://crossfitlisbeth.com/2013/01/08/in-praise-of-the-vomiting-clown/
“Why Pukie the Clown Isn’t Funny” http://breakingmuscle.com/crossfit/why-pukie-the-clown-isn-t-funny
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