The Show Up Fitness Podcast
Join Chris Hitchko, author of 'How to Become A Successful Personal Trainer' VOL 2 and CEO of Show Up Fitness as he guides personal trainers towards success.
90% of personal trainers quit within 12-months in the USA, 18-months in the UK, Show Up Fitness is helping change those statistics. The Show Up Fitness CPT is one of the fastest growing PT certifications in the world with partnerships with over 500-gyms including Life Time Fitness, Equinox, Genesis, EoS, and numerous other elite partnerships.
This podcast focuses on refining trade, business, and people skills to help trainers excel in the fitness industry. Discover effective client programming, revenue generation, medical professional networking, and elite assessment strategies.
Learn how to become a successful Show Up Fitness CPT at www.showupfitness.com. Send your questions to Chris on Instagram @showupfitness or via email at info@showupfitness.com."
The Show Up Fitness Podcast
How to train a client who had Rhabdomyolysis
Send us a text if you want to be on the Podcast & explain why!
The fitness industry has a dark secret that qualified trainers need to address head-on: exercise-induced rhabdomyolysis. This potentially life-threatening condition, once primarily associated with catastrophic events or extreme military training, has become disturbingly common in regular gym settings due to unqualified trainers pushing clients too hard, too fast.
This eye-opening episode tackles a real case study of a 38-year-old client who developed rhabdomyolysis after just her second session with a previous trainer. What should have been a routine workout turned into a five-day hospital stay with dangerously elevated creatine kinase levels of 10,000 (normal post-exercise levels might reach 600-700). The culprit? A punishing 90-minute session filled with high-repetition exercises, minimal rest, and culminating in exhaustive rowing - a perfect recipe for disaster.
We break down exactly how qualified trainers should approach clients with fitness trauma, beginning with the crucial first workout. You'll discover the specific exercise selection, rep schemes, and rest periods that rebuild trust while still creating an effective session. The detailed programming walkthrough demonstrates how to gradually increase intensity over subsequent sessions while ensuring the client feels safe and successful.
What makes this case particularly powerful is the outcome: through proper progression and client-centered training, this traumatized client stayed with the qualified trainer for over three years. The key wasn't just physical programming but psychological understanding - acknowledging fears, educating about exercise physiology, and prioritizing the client relationship over ego-driven "tough" workouts.
Whether you're a personal trainer looking to level up your skills or a fitness enthusiast wanting to understand what separates qualified professionals from dangerous ones, this episode delivers actionable insights that could prevent injury and pot
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Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time, with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitnesscom. Also, make sure to check out my book how to Become a Successful Personal Trainer. Don't forget to subscribe, rate and review. Have a great day and keep showing up. Howdy y'all. Welcome back to the Show of Fitness podcast.
Speaker 1:Today we're going to help you design a workout for a new client who had a past experience with rhabdomyolysis. If you're not familiar with rhabdo, this is a terrible condition that we typically tend to see in terrible, tragic events like 9-11, where you have concrete slabs crushing you and you destroy the muscle in the body so much that you get an accumulation of your muscle in the bloodstream and the kidneys are unable to filtrate out. The byproduct Nasty, nasty condition, and you can die from this. Thanks to CrossFit, this is now a term that is popular within fitness. I'm going to review a situation where a client submitted a form. We're going to read it to you right now and then take you through what our first workout looked like. So rhabdomyolysis the prefix rhabdo is Latin for rod-like shape and that's referencing the breakdown of muscle fibers, where myeliasis is the breakdown of muscle. And think of a shower and if you put a little bit of hair in the drain, it's just going to filtrate it out. It's going to be fine, but if there's a lot of accumulation it's not going to get clogged and essentially that's what happens in the bloodstream we're unable to get out this byproduct and then your kidneys begin to excrete the muscle fibers via your urine and that's why you will experience a very, very dark hue.
Speaker 1:Urine output Almost looks like Coca-Cola. You could type in rhabdo urine and look at the images that you see on Google Literally disgusting. Our pee should be the color of lemonade If we're really dehydrated. Maybe it's apple juice color, maybe we've had a bunch of B vitamins or energy drinks and it's more neon yellow, not optimal, but that's the color you may experience. If you have a bloody color, that's also very bad because you are peeing out blood. Don't even get into what happens if it's green or some type of STD, bs and the shenanigans you young kids are getting into today. It should not be that color. So we got an inquiry.
Speaker 1:Show up in this a 38 year young individual and the inquiry was in late December. She said in September, during her second session with a new trainer, she developed rhabdo. She couldn't work out for six weeks. She started a cardio again, but very cautious about getting back into weights and working out with a trainer. However, my main goal is to get tone, lose some weight and feel better overall.
Speaker 1:I'm looking for an experienced trainer for one-on-one sessions. As we review her medical history, she said she's worked with trainers for 10 plus years, some great, some okay. Most recently in September she had a young trainer that had her work out for 90 minutes straight. They did nothing over 10 pounds in weight. However, many of the reps were at a fast paced, mostly working arms included the abs, legs and cardio. They ended the session with a 10 minute erg row machine to exhaustion. She woke up the next morning with severely swollen arms. Could not extend fully. Ultimately she went to the ER that day, admitted to the hospital with rhabdo. She stayed in for five days with CK levels of 10,000. I'll reference what CK stands for in a second.
Speaker 1:Obviously now very concerned and cautious about doing weights. I've only done cardio since the incident. However, I've been doing free weights and machines for over 10 years and never experienced rhabdo. I think it was a lack of rest in between sets and also low hydration, as well as too many reps without much ramp up period Too much, too soon. I do want a very experienced trainer, someone who's at least heard about rhabdo and knows the signs and how not to let it happen again. This is crazy. We are experiencing this in the fitness realm.
Speaker 1:I did a post on Instagram the other day. There was someone a PE teacher who exposed a bunch of kids to rhabdo by doing so many burpees. That was inappropriate. Burpees aren't bad. Squats aren't bad. There was a PE teacher in the Midwest 30 students got rhabdo because they did 400 bodyweight squats. There was a PE coach in Texas who had their football players experience rhabdo by doing way too many sprints without hydration in the humid heat.
Speaker 1:It's crazy that we think of it as like Rabdo's a badge of honor. Crossfit even has Rabdo the clown Search that. It's disgusting that we put this out there as a joke Like, oh, you got Rabdo, you're weak. You will see people comment kids today are snowflakes not working hard enough. I used to do that for a warmup.
Speaker 1:Rabdo isn't like COVID, you don't catch it. It's from doing something too hard, too intense and the organism isn't ready for it Very common in the military. You'll experience it If you listen or read David Goggin's book. He was doing a pull-up contest. I think he did like 2000 plus pull-ups in 24 hours. I think he did like 2000 plus pull-ups in 24 hours. He talks about how the discharge of his urine was very dark. He had rhabdo. That's an extreme situation that should not be happening with clients. This is why trainers have a bad rep. If you are a qualified trainer, you will never experience this with your clients, even working with advanced athletes or competitors high rocks, crossfit, whatever. If you are in charge of that group, you understand the human body and I can do a quick screen and I can have five people over here. Do a modification of a workout where I have 10 people on the other side, do something that's more progressed and appropriate for them and no one would get rhabdo.
Speaker 1:The thing that really disturbed me the most about this message was how she kind of swept it under the table and almost put blame on herself, the trainer. First thing I asked her when she came in is what happened to the trainer? Where was the accountability Were they fired and she didn't even bring it up to the manager because she felt guilty. How terrible is that? That a human being experiences it because the trainer was a fucking idiot. Annihilate the clients, no pain, no gain. That's what we need to do. It's unfortunate that she experienced this, and so the first thing that you need to do it's unfortunate that she experiences, and so the first thing that you need to do as we did during this assessment is let her know that this, absolutely 100%, will never happen again, because you're working with qualified trainers.
Speaker 1:All of our trainers have gone through the best internship in the world and they understand the human body. Unfortunately, the average trainer reads a textbook. I'm sure the trainer that you worked with had their NASM, ace or ISSA Is that correct? She showed me the bio and what do you know they did? They don't understand the human body like we do. I apologize for what happened with him, but you're never going to experience that with us.
Speaker 1:Think of rhabdos like a bee sting. If you go smack a bee's nest, there's a greater likelihood that you're going to get stung, but if you see a bee and you keep your distance and you're not a lunatic, you're not going to get stung. It's not likely to happen again. That's not how it works. This is a condition because the intensity was too high, too many repetitions. So this trainer is thinking oh, it's a girl, can't lift heavy, don't want to get big and bulky, let's just do a ton of repetitions. Can't lift heavy, you don't want to get big and bulky, let's just do a ton of repetitions. I guarantee you you were doing lunges and pushups and half modified reps and they were just pushing you, pushing you, pushing you without much rest.
Speaker 1:Why did you go for 90 minutes? That's crazy. I'm not saying this to her, I'm thinking this hypothetically. I've never trained a client for 90 minutes. Sure you would if you're a coach and you're working with a football team or something along those lines, but a 90-minute personal training session is asinine. Why would you do that? So I was fumed. I said this trainer you should actually reach out to and you should get them fired. That trainer should be on a blacklist. If you work with me, I want you to know that I had a client get rhabdo in the past. That is absolutely bullshit and for some reason we allow for it to happen. That's why the interest standards are so low. That's why 90% of trainers quit within the first year. We get scared and we just annihilate and hurt people. But as a qualified coach, which you are, you don't want to hurt people. So, as she said, someone should be at least aware of what it is.
Speaker 1:Ck levels of 10,000. You can Google normal CK levels creatine kinase. It's the byproduct of exercise metabolism. If you just did a pretty good workout and I'm talking full body you got after it in your condition, your levels might be up at 600 or 700. That's after an intense workout. Normal resting levels are less than 200. And she experienced 10,000. I worked with someone in Houston who had a trainer, pushed them through a workout and did a crazy cycle AMRAP thing, emom, all these crazy terms. Their levels got to 100,000, almost died. And it's just so crazy that we're experiencing this today, because it absolutely should not be the case. So the first thing I did is I apologized and I took responsibility for our field. I let her know that that was not going to happen again. I explained to her what rhabdo was, what those levels meant. I gave that analogy of the drain. You're not going to experience this again and I understand through the psyche of the individual that she associated weights with getting rhabdo.
Speaker 1:The soreness that she experienced the next day, she said it was like she got stung by a hundred bees and she couldn't even move her arms. I'm sure we've done a crazy workout sometime. Maybe you've done some German volume training at 10 by 10 and you wake up the next day and your arms are crushed and you kind of chuckle about it. Or maybe you and a buddy did a leg workout or a chest workout and it's sore and it's fun the next day to kind of poke their chest and make fun of how sore it is. That delayed onset muscle soreness can be a result from getting after it something that's new but not to the extent where you can't even move your limb. That's crazy.
Speaker 1:So I listened to her. I empathized. In my mind I'm thinking we're not going to do a CCA. That's not going to be appropriate for her in this moment. We will work up to it. She said her goals are to lose weight and get tone. That's what I told her was going to happen Working with a qualified trainer. Six months from now you're going to be a completely different person. You're not going to recognize the person in the mirror. You're going to walk by and go holy moly. Where did that bookshelf come from? I didn't have that before and I use that humor part of the assessment. I tried to make it as enjoyable as possible.
Speaker 1:I addressed her main concern with rhabdo, but then I got into what her goals were. We did blood pressure, we did a grip strength, but when I implemented the program, from what I learned, I took out certain exercises that would cause soreness. I didn't want to do any lunges or eccentrics. They're going to accentuate soreness and we don't want that. I want her experience to be the best ever and my competition is pretty low because what happened last. So I let her know that we're gonna do a main exercise and then we're gonna rest. I don't want you to think I'm babying you, but I want you to feel comfortable, knowing tomorrow you're gonna wake up and you're not gonna be sore. And if you are a little bit sore, it's not even close to what you experienced, where you couldn't move the next day. So we did a body weight squat. We did a body weight squat. We did a set of eight. We didn't do 15 with a 4-2-1-1 tempo, didn't even come close to exhaustion.
Speaker 1:Talked with her what are your goals. What's your job? What are you doing? How's life? I got to know her as a human. I know that her last trainer didn't do that. He was too busy crushing her in 90 minutes, didn't probably even ask her what her profession was. How the hell do you have a client that you don't know what they do? That's why you have the assessment. You learn about them. So when you sit them down at the end you are giving them a value proposition on why they should work with you and there's no stress or fear over the quote-unquote sales proposition. You are giving them the key to success. You learn about their profession, their stressors, how their sleep is, if they're married, if they have kids, what's going on in life. How far did it take for you to come here? At the time this was in Dublin, california. She worked in San Ramon, which is up the street, so we had a conversation about traffic and life. She had two kids. I got to know her as a human. When she felt good, I said I want to work until you need a little bit of rest. We want to rest and so you can do work.
Speaker 1:And then we did a set number two, two rounds for the first circuit. It's not even a circuit, that's a straight set. And then we went into an upper body pull. We did some cable rows, again low reps, to limit the soreness that could happen the next day. And now because the comfort level was increasing and she felt good working with me, we did an accessory with that and we did some planks no concentric, no eccentric, so we're going to limit the exposure to any type of soreness.
Speaker 1:I challenged her with some trainer engagement. I helped her off the ground, I offered to get her a towel, I got her some water, I got her bottle from the corner and brought it to her. I showed the professionalism that I know the last trainers did not do. We did two rounds of that. We did a squat, we did a pull. What do you think I'm going to do next? We did a unilateral. So we did some step-ups. I got her heart rate up there because she's been doing some cardio. We did eight per side, 16 total. And then we did another accessory. We did a side plank and I did some perturbations on her arm that was floating. I challenged her, I got her to smile, but at the same time I was pushing her within reason because I didn't want the session to be so easy. She's thinking well, that was just a complete waste.
Speaker 1:I set the clear expectations in the beginning. I know she's not going to get rhabdo again, so I need to play the game and get her to feel some exertion. That's appropriate. We did that for two rounds. So what do you think I did last? We did a pull. We did two leg variations, a squat and a unilateral.
Speaker 1:So the last thing that we did was a push and we modified the pushups. She couldn't do them. So I went to the bench press on a bar and we did sets of six. She could easily do 10 plus no eccentrics. And then I complimented that with my famous question If a genie were to pop out of a bottle, keep it, pc. What area of your body would you like to perfect? And she said her glutes. So we did a floor bridge with a band on her knees not going to cause much soreness. We did a set of 10, we did the pushes and then we walked at the end and I educated her and I let her know that in the future we're going to be doing what's called a CCA, a lower body pattern into an upper body pattern and then an accessory and we're going to get after it.
Speaker 1:We're going to be setting PRs. Can you do a pull-up? Well, you can't. We're going to be doing pull-ups. We're going to be cranking out sets of push-ups. We will be doing lunges, reverse lunges, bulgarians all the stuff that you've seen online. But I wanted today to be the best experience that you've ever had and at the end I apologized again and she's like this was exactly what I needed. I said let's talk about training the next time. We're not going to go over sales today and how much I cost, because I want this to be the best experience you ever had and I'm looking out for your best interest.
Speaker 1:I'm sure that last trainer was kind of pushy with their sales. Is that what happened? Yeah, he really tried to make me get this specific package. Is that what happened? Yeah, he really tried to make me get this specific package. I know the industry. I know how trainers work. They're transactional. So in that specific case, I didn't present a package because I knew that she was going to sign up with me, the respect for what she experienced God forbid. It happened and it's never going to happen again working with me.
Speaker 1:So she texted the next day. I feel great. When can we go again? Scheduled her in, took her through a workout, now CA through the whole entire thing, gave her a little more exertion. We used some weights, this time for overhead pressing. Notice, for that first workout we didn't do anything overhead, this time we did. I added weights on the step up, we did more reps with higher intense load for the rows. We pretty much did the same thing, but I just added in an accessory and a little more volume. I'm not just going from A to Z. The next workout we're going CCA, doing EMOM at the end on the skier.
Speaker 1:It's slow progressions and if you have people who are overweight to obese and they haven't worked out in years, you have to be mindful that sets of 15 or 20 at a high intensity, meaning low rest, is not optimal. They can't stomach it. Their cardio sucks, their conditioning is terrible. So be respectful of the person in front of you, but you have to know the game. We are led astray from all the bullshit on social media. You need to sweat, you need to do X amount of sets. No, we need to do what's appropriate for you. If I was a cook, I'm not assuming every person in front of me is going to eat cheese pizza. You ask them what they want Are there any restrictions? And then you give them what they want. That's what you do during the assessment process.
Speaker 1:How I assessed her is completely different than how I assess a client that wants to get better at pickleball. And they're in great shape. You make it tailored for the individual and then we did our first package and I said I'm going to suggest that we do 12 sessions Because of the bad experience you had in the past. I want it to be nice and slowly progressing and then, after that first set of 12, we can reconsider long-term. I'm being respectful for the individual because I'm confident in my competence, knowing that they're going to work with me for an extremely long time.
Speaker 1:She worked with us for over three years. We built the relationship. She actually helped us a lot with our website. She was great with SEO At the time. She helped do some stuff on the back end which would have cost thousands of dollars. But because during our conversations, as I built the trust, I talk about my ambitions.
Speaker 1:Trainers don't do that. We take it. You have to talk about training all day long. We're just going to count these reps out and we're going to be all about business, nothing else. You got to know your client. She was very loquacious as Megan and I were talking before class. She wants to improve her vernacular. She enjoyed talking, but I knew just the amount to push her when she was talking too much to get back into a set but to rest long enough so she could get the work done. To optimize tension, which is the number one driver for her goals. And getting toned yeah, tone is bullshit, whatever. I didn't tell her that we just need to build muscle, lose some fat, get stronger, be consistent. Most importantly, keep showing up.
Speaker 1:I will continue to go through these programs.
Speaker 1:We literally have thousands of these in our database and I feel it's going to be a great experience for you, the listener, to get some reps in special populations. If you have a case example now that we'd like some help on, go to the Facebook group Qualified Personal Trainers Community. Introduce yourself. We just have someone joined from Ohio, working at Anytime Fitness Hello, proud to have you part of the best community in the world where we're helping trainers level up their career. If you want to get certified for life, we have that certification. You never have to go and pay another 200 bucks, like all these other marketing companies make you do. We have our soft tissue cert, which is the best out there, where you're going to learn how to assess clients in pain and implement soft tissue mobilizations. And then we have our nutrition cert, where we're going to help you network with medical professionals so you can level up your career, your streams of revenue and be a competent, qualified personal trainer. Have a great day and remember big biceps are better than rhabdo and keep showing up.