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Archive for November, 2010

Sunday Musings 11/28/10

First posted on Crossfit.com.

Sunday musings…

1) Obesity. In an article on a BMW SUV the writer bemoans the increase in size of the vehicle in order to accommodate “calorically enhanced U.S. customers.”

Calorically enhanced…How good is that!?

2) Country ads. In the back of the NYT Sunday magazine, and indeed often found in the body of periodicals like the WSJ, are advertisements for countries. You know, put your business in Singapore, or buy New Zealand. Stuff like that.

Makes you wonder what those ads would be like if there was something like an international FTC riding herd on them, applying “truth in advertising” criteria and all.

Come to think of it, though, “truth in advertising” is probably an oxymoron, even in, say, Sri Lanka…

3) Volume. No, no, no, this isn’t a ‘size matters’ thing. I’m talking about the volume of work you do to increase your fitness. Have you been following the video series from Tahoe? I find it fascinating and very enlightening to be a fly on the wall for those discussions, especially the ones about training volume and strategies for competitive WOD’s.

Used to be, when we had more like 5-700 posts every day here, that we would get an equal number of questions and concerns on both sides of the training volume thing. Is the WOD enough? Should I do more? How much do the Rockstars do (Hi Jackie)? Or things like, what if I can’t do the WOD as Rx’d? I’m kinda tired and strung out after 1 or 2 or 5 months of WOD’s; should I take a break? Pretty much an equal number of questions from folks looking for more and folks overwhelmed by the WOD.

Now? Well, if you only come here you’d think all of the questions have been answered by the sponsored athletes and those of their ilk. Ya gotta do more, More, MORE if you’re gonna get Crossfit fit. Right? I mean, that’s what we all have to want, to do, right?

BZZZZZZT. Wrong. Sorry. Elite fitness is a self-defined term, one that each one of us defines for ourselves. In truth, if we’re doing this Crossfit thing correctly, elite fitness is always just a few more WOD’s away, a few more trips along the neuroendocrine response highway. Face it…for most of us Crossfit is nothing short of the best fitness program (no matter what version of Crossfit we might do) we’ve ever encountered, bringing with it massive fitness returns on our effort invested.

But that’s it. You vs. you. Still.

There’s a quote in today’s paper from a Master’s athlete: if you undertrain, you may not finish; if you overtrain, you may not start. Pretty good, eh? There’s some genius in that little gem. How much is enough? The answer to that lies in an open and honest evaluation of your own personal goals, your own personal needs, your own personal barriers and boundaries. For example, I have 60-75 minutes 5 times each week for my entire fitness experience, and any injuries I suffer will not only affect my ability to “start” in the gym, but also affect my ability to “start” in my day job. You?

The genius of Crossfit–and it IS genius–and the gift given to us by Coach, is not the competition between Crossfitters produced for spectator consumption, but the competition produced in ourselves. By defining fitness, WCABTMD, Coach and Crossfit give us something totally new and vitally important: fitness that is measurable, observable, and repeatable. We then have a goal for each workout, to achieve an increase in intensity, an increase in power, as well as a strategy with which to do so (constantly varied functional exercise…).

I love the videos, I really do. And I love the Crossfit Games, still more fitness festival than commercial convention. But the beauty of Crossfit lives here on Crossfit.com and in the 2500 Affiliate gyms where each one of us willingly put ourselves through the exquisite challenge of a WOD in order to achieve our own individual goal. Our own version of of fitness.Our own version of a better you tomorrow than what you were yesterday, through the efforts you make today.

So…how much Crossfit is enough for YOU?

I’ll see you next week…

Thanksgiving Is My Favorite Holiday…

…because there’s nothing to advertise. There’s nothing to buy. Ever since giving gifts to Indians went out of style Thanksgiving is no longer one of our gift–giving holidays. That’s a good thing!

No, Thanksgiving is the last of the pure holidays. Nothing commercial, nothing to promote, nothing but an opportunity to do just what it sounds like: give thanks. Think about it, there’s exactly one Thanksgiving holiday song. “Over the River and through the Woods” and all that. There’s pretty much only one industry that depends on this day, the turkey industry. Pretty small potatoes, that. Thanksgiving pretty much equals going home.

Think for a moment about your Thanksgiving, this year and in years past. There’s an awful lot of sameness about it, isn’t there? The years of the gatherings all blend together because this is the one holiday where we go out of our way to do those same things year after year. Same meal; same pies; same games; same traditions. For as long as it can be, same people.

My earliest Thanksgiving memories actually revolve around football. In New England the Thanksgiving day football game represents the peak of the high school football season. Most high schools played a game against some decades–old rival, some of these rivalries extending back to before World War II. It was always cold. Man, it was always so cold. I had my first cup of coffee at a Southbridge versus Bartlett Thanksgiving Day football game at Bartlett; they ran out of hot chocolate before halftime. The games themselves were huge, played by heroes too large to describe. No dream was bigger for my Pop Warner football teammates than to be a part of the Southbridge–Bartlett Thanksgiving  game someday. I played in one as a freshman before we moved. Three more Thanksgiving Day games in Rhode Island, Lincoln versus Shea, rounded out my playing days, but every other year for two more decades Thanksgiving day started with two hours bundled up in the stands watching the game.

Then we ate! You remember what you had for Thanksgiving at age 10 and 15, 20 and 25 because you had the same thing EVERY YEAR! Each and every family has its traditions. Turkey, of course, but it was really the fixins that set each family apart. Ours was a pretty standard table, much more proletariat then patrician no matter how well-off the family might have been. Mashed potatoes, green bean casserole, creamed onions and corn, with the simplest bread stuffing bursting out of the bird. It’s funny how a Thanksgiving Day tradition can highlight the differences between families, too. My wife Beth’s family got all of their turkey day fixings from the local farms, everything fresh and homemade. Neither way was better or worse, and that’s really part of the point. It’s Thanksgiving, and it’s always enough…always good.

Even the changes that eventually come, the evolution of any particular family’s Thanksgiving day traditions, represent a call to home. When our oldest, Danny, went to college a couple years ago we decided to bring our family Thanksgiving celebration home, to our house. The kids returned to their own home and visits with their childhood friends, just like we had done for so many years in our “ancestral” homes. Thanksgiving is all about the coming together. The gifting is in the giving of your time, your presence to the rest of family gathered. Even stuff that comes in from the outside like the annual Detroit Lions massacre is about the coming together with everyone gathered around the television set in various stages of repose or food coma.

Yup, Thanksgiving is my favorite holiday. Nothing fancy, nothing to buy, as little pressure as there can possibly be on an American holiday. All about home. All about family. All about being thankful for both. As cold as it may be outside it’s always warm in the house. There’s football, some kind of football, even if I don’t get to go to a traditional New England rivalry game. Each year is enough of the same that it, too, will blend in with all that came before.

And did I mention the pies?

Preview Of A New Definition Of Health

What follows is the draft of an article that Kathy Weesner and I submitted to the Crossfit Journal in the Spring of 2010. Consider it a preview, a “sneak peak” of a series of articles that I plan to post on Health.


Two Crossfitting MD’s Look at Health

We figured it out! Coach gave his Crossfit definition of health about a year and a half ago and it’s taken us this long to figure it out. We thought we had it after a dinner at the 2009 Crossfit Games,  but something still didn’t quite fit. There was something about “Fitness Over Time” that seemed incomplete. Health to a couple of doctors seemed as if it had to include something else, something other than just fitness as Crossfit defines it and a calendar.

Crossfit defines fitness as “Work Capacity Across Broad Time and Modal Domains”.  With precision and accuracy we can chart or graph our fitness by looking at our power output in multiple domains against time; we can then compute our work capacity, the area under the curve.

[Insert classic CF Graph work capacity age 20 CF training guide]

Coach has declared that his ultimate mission is nothing less than to revolutionize healthcare, to produce healthier individuals who can lead more productive lives and live longer while doing so. Consistent with that goal, and certainly consistent with his development of Crossfit, Coach first had to come up with a definition of “health’. The Crossfit 3-D definition of health is “fitness over time; fitness over a lifetime”.

A little background is probably in order. We are two practicing doctors who happen to be relatively experienced Crossfitters. Kathy is a pediatric anesthesiologist, so she’s the smart one of this pair! Darrell is an ophthalmologist or eye surgeon. We did a little experiment after Coach started to talk about health. What, exactly, do physicians think is the definition of health? What does it mean to be healthy?

When we started to ask our colleagues this question we were almost universally disappointed in their responses. We surveyed newly minted physicians right out of training as well as those who have been practicing for over thirty years.  Believe it or not, the most frequent answer we received when we asked doctors “what is your definition of health” was: “gee…I dunno…I never really thought about it.” Nuts, huh? Not so surprisingly, especially with an audience of American doctors, was the answer “health is simply the absence of disease.” All Crossfitters have heard Coach talk about the 95 year old man with absolutely no diseases on not one single medicine who can’t lift his ass off the toilet without help.  No disease, but healthy?

The flip side of that is where we as doctors struggle with simply defining health as “fitness over a lifetime.” How about the 36 year old man with a 500 Lb. deadlift, a 5:00 mile, 50 pull-ups and a 2:30 “Fran” who drops dead from pancreatic cancer 3 months after posting all of those numbers? Was he “healthy” then? He surely was fit, at least using our Crossfit definition of fitness, but it’s hard to say that he was “healthy” because the volume under his life curve abruptly stopped increasing.

The beginning of the solution to our quandary did come from one of our surveyed doctors.  Darrell was speaking in Florida and, as always, he asked the audience of physicians to define health. One of the docs at that meeting replied “unlimited potential, or life performance without any limits or potential limits.” BINGO! That’s the missing link–PROSPECITVE fitness, the potential to express fitness in the future.

The Crossfit 3-D definition of health is a LOOK-BACK, a retrospective evaluation of how healthy we have been. As such it is missing one of the key aspects of what health is more generally thought to include, the ability to make predictions about future life–in our case as Crossfitters about future levels of fitness. To truly invoke a three dimensional definition we need to include two more dimensions, two additional variables that affect our potential performance.

Interestingly, Crossfit already talks about one of these dimensions when Crossfit instructors discuss “wellness” at Level 1 Certifications. Wellness includes such widely discussed objective, observable, and measurable variables as blood pressure, cholesterol, %body weight fat, waist circumference and chest/weight ratios. Although we can agree that society as a whole is TOO focused on these variables, they do have some value in predicting future levels of fitness.  We are confident that we can identify a validated “wellness scale” that scores this category based on these established markers.

[Insert Illness-Wellness-Fitness Arc pg 16 CF training guide]

The last variable, the third dimension of a comprehensive Crossfit definition of health is “well-being”– emotional and mental health. Although it is virtually impossible to establish a universally agreed upon definition, let’s call this the “happiness” metric. It’s impossible to maximize your fitness if you have some mental or emotional problem that becomes a barrier. We can certainly understand how named problems like depression, bipolar disease or severe pathologic anxiety can affect our fitness. In the same way our ability, or relative inability to handle both the chronic stress of everyday life and the acute episodes of stress we face can affect our fitness.

How do we measure something as amorphous as “well-being” or happiness? We could certainly use something like the inverse of the VAS or Visual Analogue Scale that anesthesiologists use with all of their patients to evaluate pain control in the post-op period. A better option would be something along the lines of the Quality of Life Indicator (http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg511 ). This independently validated proprietary test fulfills our measurable, observable and repeatable Crossfit mandate.

We would like to propose a slight variation on the Crossfit 3-D definition of health by specifically naming two additional dimensions: traditional Wellness, and let’s call it “Well-Being”. We would further like to expand on Coach’s contention that increased fitness will drive all of our wellness measurements in a positive direction by saying that fitness, wellness, and happiness form a bi-directional “virtuous circle” that leads to health; any increase in each of the three elements will drive the others in a positive fashion leading to greater health.

In the end we think Coach has it more right than anyone else when he says that health is work capacity over time. By explicitly adding the pre-existing Crossfit definition and concept of Wellness to this definition, and then by going further and adding the concept of Well-Being we complete the full 3-D Crossfit Definition of Health. Health at any one point can be depicted by a sphere whose volume is determined by the interaction between Fitness, Wellness, and Well-Being.

Our conjecture (hypothesis?) is that the volume of the “Health Sphere”, perhaps combined with the volume trends over time, is a more accurate predictor of prospective fitness or work capacity in the future.

If this is indeed the case we will have further cemented the primacy of Crossfit’s definition of physical fitness. By combining our measurement for fitness with similar metrics for medical wellness and happiness Crossfit will have created the first truly measurable, observable, repeatable, and ACTIONABLE comprehensive definition of health.

So, time to begin our Crossfit conquest of healthcare!

(NB: Graphs and figures to be added)


I will address all three categories and then expand on the unified definition of health in upcoming posts.

The Role Of Adults In Youth Sports I: Safety

Among the many things that I have called over the course of my lifetime, none has been more meaningful than “Coach”. I spent time on the sidelines and on the bench for about 10 years coaching junior high school sports.  When my own children moved on to high school sports I retired to the committee rooms and the grandstands where adults who don’t coach play their role in youth sports.

There are three roles that adults can and should play in youth sports. First and foremost, all adults who are involved in youth sports should have as their primary goal the safety of the children playing the games. Secondly, kids who play sports should be guided by the adults around those games, taught by their elders not only about the games but also taught the life lessons that one can glean from playing sports. Finally, we ARE talking about kids here; the last important role that adults have in youth sports is to make them FUN!

Let’s start by talking about safety.

I suppose we should probably define youth, huh? There’s not much to debate the inclusion of grade school or junior high school kids. Sure, reasonable people can disagree about the importance of playing time and, when to start cutting kids and when to start playing to win, but through eighth grade there is simply no question that these kids would be considered in the “youth” category. In some quarters it might be a little more dicey with high school athletics, but when it comes to safety I don’t see how you can separate high school kids from their younger brothers and sisters. Protecting ALL of these kids is job number one for every adult involved in youth sports.

A quick word about college sports: the brightest, clearest dividing line between youth sports and sports as commerce, or job, is clearly the line that separates college and other athletic programs aimed at very young adults, and professional sports. But even here that line might be a little fuzzy. There are reasonable people who would say that Division I athletes on scholarship are de facto professional athletes. I suppose I’d feel a little more comfortable with this if a larger percentage of these young men and women went on to earn a living from their sport after college. Certainly we can agree that divisions II and III in the NCAA would still constitute youth sports, don’t you think? For my mind only the most cynical among us would draw a line between divisions I and II when thinking about the safety of the athletes.

So, how do we ensure the safety of our children when they are playing sports? It starts at the very top with league commissioners and athletic directors. Every organization that sponsors athletic competition with youth participants, be it a league or a school or some other organization needs to be clear from the outset that job number one is keeping children safe. Commissioners need to set clear guidelines, rules that will be enforced that put safety first. No spearing in football. Elbows in on the basketball court. No head shots–not a SINGLE headshot–in hockey or lacrosse.

Each one of these directives needs to be clearly communicated to the athletic directors or program directors responsible for individual schools or teams. These men and women in turn need to hire or appoint coaches who will make it their primary mission to teach the children in their charge how to play the game safely. Not only must the coaches do this on the practice field, but as they roam the sidelines and pace in front of the bench they must bring this to the games as well. How many times have you been in the stands and cringed when a defensive coordinator screamed at his players, exhorting them to “take someone’s head off?” I can’t count the number of times I’ve been sick to my stomach watching a coach dance with glee as a long pole defenseman stands over the attackman he cross-checked in the back of the head. No amount of teaching in practice can withstand this type of “coaching”.

During games coaches need to look first to the well-being of their players; only after assuring that they are okay can winning and losing enter the equation. I’m certainly not proud to admit this, but I remember one clear instance where I probably should have kept a star athlete on the sidelines during a football game. I actually had my very favorite coaching job–I was the assistant to the assistant to the assistant backfield coach, responsible only for catching the kids doing something right and praising them for when they did. But I was the quasi-team doctor as well, and when our star halfback limped off the field with a sprained ankle, I really probably should have overruled the head coach, the offense coordinator, and the young man’s father and kept him on the sidelines, at least a little bit longer. Coaches need to allow themselves to be trumped by trainers and doctors.

The ultimate arbiters of safety, however, are the officials on the field. Whether it’s grade school, junior high school, high school, or even college sports, the officials who enforce the rules must make the safety of the participants their primary concern. Oh, I know, I know, the officials are supposed to be invisible, doing everything they can possibly do not to impose themselves on the game, not to affect the outcome of the game. The players should win or lose; the officials should not take a role. Blah, blah, balh. All well and good, until the retaliation for the retaliation for the initial hard tackle from behind results in a three ligament knee tear for that girl who was just about to get that shot off in soccer. All well and good, until they’re wheeling the center off on a stretcher, unconscious from the elbow he took to the jaw as he skated through mid-ice. All well and good, because the officials lost control of the game, allowing dangerous plays earlier for fear that they might “affect the outcome.”


As far as I’m concerned the greatest responsibility for protecting our children on the various courts and fields of play lies with the officials. The referees and umpires who are right there in the middle of the game MUST protect the children playing the games. Dangerous play just cannot be allowed. Officials have lots of latitude, and every sport has rules, penalties for dangerous behavior. Blow the whistle! Throw the flag! Pull out that red card! Set the tone early and let it be known that dangerous play will not be tolerated.

My youngest child, in ways too many to count an athletic clone of his father, finished his high school lacrosse career sitting on a bucket on the sidelines, sobbing as he vomited. He was vomiting because he had just suffered a concussion, his third, this one the result of a vicious crosscheck to the back of his head. The play occurred just feet from the sidelines, yards from the referee looking directly at the play. Unbelievably, he hesitated. He HESITATED! He actually gave thought to not even pulling his flag. Eventually, out came the flag and the verdict was rendered: one minute for unnecessary roughness. Almost the smallest infraction in the game of lacrosse. One minute for a blatant headshot, right in front of the referee, right in front of Randy’s coach.

The trainer on duty, a lovely young woman, very empathetic… very concerned, hovered over him. Was he crying because his head hurt so much, she asked? No, he sobbed, he was crying because he knew he had a concussion, and he knew that that his playing role in youth sports was now over, his days as a lacrosse player now officially done because it was no longer safe for him to play. How many more, I asked.  How many more children would be hurt before that referee said enough? How many more, I asked him out loud in a silent stadium, my voice the only sound, clearly heard by every ear in the stadium. Everyone turned to look at the father escorting his injured child off the field. Everyone, that is, save one, the coward who couldn’t look at the child he had just failed to protect.

Officials, indeed any adult, who will not protect the children who are playing have NO role in youth sports.

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