Crossfit: milestones, medicine and landing on my feet (heels!)

I must make clear that what I’m sharing is a purely personal experience and all the opinions are my own, formulated over time and through online research. As a surgeon I have medical knowledge, but I’m in no way an expert on sports physiology (how the body works) or sports medicine (injury prevention and treatment/rehabilitation).

When I first started at Crossfit Blackfriars coach Balazs asked me what my goals were. “Everything!” I thought. Skinny arms, weak muscles, belly, bad flexibility- where to start!?

Milestone: ˈmʌɪlstəʊn. “A significant stage or event in the development of something” January 2016 marked some significant milestones for me. It had been a full year for me at Crossfit, I ran my first mile and followed it with a WOD (Workout Of the Day) – without running out of breath! By the beginning of February, I had accomplished my first Rx (prescribed) workout, kicked up into a handstand and crucially, maintained it.

It doesn’t end there. I learnt new skills and entered a fitness competition for the first time in my life. It was all about change. Which brings me to my second point: Change. Crossfit has effected three significant changes in me:

The documented change is strength – power and endurance. I could only squat 50Kg, push-press 25Kg, and deadlift 50Kg. These have moved to 90Kg, 60Kg, and 125Kg respectively, notwithstanding countless other weightlifting moves I learnt. My endurance also went from being out of breath after running 400m and being unable to power through an AMRAP (As Many Reps As Possible) to running over a mile, coupling it with a WOD and actively enjoying endurance classes (previously avoided like the plague). Better still, after a diet change brought on by resident dietician Emma, I saw my energy levels skyrocket as well. A good way to keep track of all aspects of training is to log them in a “Circle of skills”. I’ve looked everywhere online for it in vain. Go ask coach Ben for a copy of his.

The unexpected change is social. When I came across Crossfit, it was from a fitness point of view. I wasn’t aware of the community built around it. As a group activity, Crossfit has been an incredible social leap for me. We are actively encouraged to know all members on a first-name basis. I have never made so many friends in such a short period of time. After maintaining 3 to 4 sessions a week and seeing the same members on almost every session, I realised that I meet them more frequently than my other friends and family!

The most elusive change, I find, is physical. Friends and family keep commenting on how toned and different I look since they last saw me. A change in our physical appearance is least apparent to us. Our brains are programmed to “remember” what we look like, what our limbs extend to and all our bodily dimensions – so much so that people who have lost a limb still experience feelings in it – the “phantom limb” because it is difficult for the brain to un-learn information that has been there for a long time. Be it a friend’s comment, or a t-shirt that suddenly fits better, it is a welcome change that my skinny teenager self would have aspired to.
The appeal of Crossfit does not end with how my t-shirt suddenly fits. My medical career makes it all the more attractive to me. It is scientific. It looks at mobility and form, and puts technique before speed and weight. The coaches, led by Fergus, are very tuned in to this. Famously, he stresses on landing on one’s heels. (Try it. It works! ) Coaches Ben and Matt never tire from reminding everyone to cork-screw one’s legs. Once I got the hang of it, feeling the lock, stability and the pre-load it offers before a move has been a game-changer for me. Likewise, all of the coaches without exception reiterate the importance of squeezing the glutes. One has to try it to appreciate the benefit. In addition, the coaches design workouts with this structure in mind having both short and long-term plans. Very satisfying.

I was told by a friend “you will love Crossfit until your get seriously injured”. This is an important point to consider. A quick search online will yield an abundance of posts on the topic. They range from general ones like joint affection and muscle fatigue, to specific ones like Achillies tendon tears (from box jumps, I couldn’t find any solid evidence for this) and rhabdomyolysis (a condition where excessive muscle breakdown leads to protein leakage into the blood stream which then clogs the kidneys like sand, potentially leading to kidney shutdown – again, no clear link with Crossfit). A recently published study from the UK by Hak et al in the Journal of strength and conditioning suggests that Crossfit injury risk is not more than that of Olympic weight-lifting, power-lifting or gymnastics.

It is important to recognise that we are at risk of injury in any activity we undertake, not just sports. Acknowledging the existing risk, one’s own limitations and foreseeing high risk situations all mitigate negative consequences. In my opinion it takes a lot of self-awareness and a lot of situational awareness to foresee/prevent an adverse event. The two times I “slipped” and either hurt or sprained a body part, I realised that I had a lapse of concentration. And it gets worse with fatigue. As fatigue is a hallmark of the progression of a WOD, it’s tremendously important to increase the focus. Much like driving a car, one is encouraged to look at each mirror sequentially to take stock of hand and foot positions, it is just the same in exercise: tempo, tool, posture, starting position, landing position – and repeat.

Thankfully I have not sustained any major injury. When I sprained my left little finger I had allowed my hand to crash in to a wall ball. This caused tears in the ligaments (strong condensed tissue that gives joint stability) near my finger tip. A small plastic cast and some pain killers did the trick. For the 4 weeks it took to heal, I concentrated on lower body exercises.

Don’t get me wrong, Crossfit is not for the faint-hearted. It is heavy-duty, intense and I would recommend a proper medical check-up before starting. Reassuringly, the incidence of sudden cardiac death among adults in the UK is estimated to be 9.1 in 100,000 and mercifully it is only a real risk if there is a family history of sudden cardiac arrest, a previous sudden cardiac arrest episode, or pre-existing heart disease.

While on the topic of health, I have a blood disorder called “factor 5 Leiden mutation” which is a problem with one of the proteins in the blood rendering it more prone to clot in certain conditions (It’s actually a fairly common condition with a prevalence of about 3-8 % in European populations). For a young and healthy male like myself, I was cautioned against immobility during long-haul flights and after orthopaedic surgeries because it’s the biggest risk factor that may give me a clot. Last Christmas I was shocked however to be diagnosed with a small clot in my leg. Out of the blue. I
hadn’t been on any travel, nor was operated upon. I was started on blood thinners and my first anxiety was “How will I continue to exercise while taking these?” It was a scary thought. Scarier still was a suggestion that I may need life-long blood thinning medication. Crossfitters know all too well the dreaded shin bash during a failed box jump.

I took to the scientific literature to find an answer to living with a bleeding disorder while maintaining my Crossfit. There was an abundance of material on athletes with blood clots and how to treat them on the short-term. Frustratingly there was no satisfying answer for long-term treatment or lifestyle advice. Even seasoned coaches couldn’t advise me. I decided to soldier on during the 6 weeks it took to treat my clot, but I scaled the exercises significantly – and it went well. Most of the time I forgot I was even on any medication.

In my opinion, scaling is one of the most important features of Crossfit. It allows the new starter, the recovering and the learning to move from a position of baseline ability to a higher one, all while avoiding injury.

Finally when it was all over my doctor said they would not need to put me on long term blood thinners. She also hypothesised that the clot might have been brought on by dehydration (besides immobility, it is the second leading risk factor for clots) while working out. The answer is of course: hydrate. The adage goes: If you feel thirsty, it’s already too late.

It’s not all blood, sweat and DOMS (Delayed Onset Muscle Soreness). There is immense fun and trivia. One of the days someone asked why joints make a popping sound. The doctors among us rushed to research it and came back with the answer: excess carbon dioxide produced by the body which accumulates and is released with a pop!

To wrap up, I am delighted to see my box grow with new members joining regularly. Unlike other business models where subscriptions are encouraged but attendance not, the onus at Crossfit Blackfriars is on showing up. The coaches’ approach led by Richard promotes this and is evident just by glancing at the scoreboard at the end of the day. Rows upon rows of names.

I joined Crossfit to do something different and change. I have emerged one year later bigger, stronger and grounded. At the end of the day, if you pace yourself, squeeze your butt, cork-screw your legs and land on your heels- you’ll be fine!

Aly Shalaby (MBBCh, MSc, MD, FRCS) is a paediatric surgeon working at Great Ormond Street Hospital for children.

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