An earlier verson of this story incorrectly identified CrosSFit of San Francisco in a number of instances when it should have named CrossFit, Inc. Also, the story implied that CrosSFit changed a workout plan due to a lawsuit in Virginia that targeted CrossFit workouts, which was not the case.SF Weekly regrets the errors.

Julie Kahn signed the waiver. It might have said something about not suing, but she wasn't sure, because it was 6 a.m. on her first day of fitness bootcamp at Crissy Field and the morning sun had barely made a dent in the fog. She was cold, wet, and tired. Nonetheless, she dropped to all fours for the first round of push-ups. The normal cattle call at the gym had gotten old, and Kahn was eager for a new, more extreme way to exercise.

But as the morning progressed and the workout intensified, something didn't feel right. It hurt too much. Maybe it was the repeated strain on her wrist, which had seven pins in it from a previous injury, or maybe it was jumping from high platforms into squats, but Kahn soon began to wonder whether fitness bootcamp could land her in the hospital. Even though she was new, instructors had hardly asked about prior injuries and offered no novice modifications for the exercises.

The next morning, she decided the risk wasn't worth it and slept in.

Fitness bootcamps, which feature high-intensity workouts originally designed for young soldiers-in-training, are becoming ubiquitous in San Francisco. Elliptical machines are out; "suicide" sprints are in. Some of these bootcamps separate their trainees by fitness level, but many combine the fit with the flabby, expecting that people know their limits.

Kahn managed to avoid reinjuring herself — but others aren't so lucky. San Francisco resident Ilene Duncan attended just one of the high-intensity classes and couldn't tie her shoes or fit clothes over her swollen arms for two weeks because of muscle damage. Duncan's friend, Jane (not her real name), attended a class at the same outfit a month ago and woke up two days later with swelling and intense pain — she ended up in urgent care. As bootcamps go mainstream, some new recruits are dropping like dumbbells, and some are even winding up in the hospital.

Many bootcampers know exactly what they're in for when they sign on — as did Duncan, who knew that the class she attended would be vomit-inducing. That's why she signed up.

CrosSFit is one of three San Francisco "affiliates" of the company CrossFit, Inc. Affiliates pay a fee in exchange for use of the name and for certifications to coach CrossFit workouts. The company Web site notes that there are 1,000 affiliates worldwide. The site also notes CrossFit has a "get what you give" (or, as one Yelp poster put it — referring to the LaLanne Fitness CrossFit affiliate in San Francisco — "Show up and throw up") philosophy, and followers have been known to border on the cultish. The growth of the CrossFit subculture is partly due to its open-source, online daily regimen of exercises followers can do at home.

Crossfit advertisements indicate that the company revels in its no-guts, no-glory reputation, featuring mascots like Pukie the vomiting clown and Uncle Rhabdo, another clown with festering wounds standing in a pool of blood, with a kidney that appears to have fallen out of his own body floating on top. Rhabdo is short for rhabdomyolysis, a syndrome resulting from serious muscle damage that can lead to kidney failure, permanent tissue damage, and even death. Crossfit's Web site warns of the potential dangers involved in its workouts, which have received a lot of flak from the national media because their particularly high-intensity strength-training workouts turn out to be a recipe for rhabdo and other potentially serious injuries. A 2008 lawsuit brought by a former Navy sailor in Virginia claims CrossFit workouts left him permanently injured.

In May, Duncan was training for a marathon when she developed tendonitis in her foot and decided that a CrosSFit class would be an equally ass-kicking alternative to running. She signed a waiver, paid her fee, and stepped into her first "all-levels" class. An exercise called "Mary" involved a set of squats, pull-ups, and handstand pushups attendees were to repeat for 20 minutes with a partner. By the end of her first round, Duncan thought her muscles were done for. But the speed of others in the class, the presence of the instructor, and the pressure from her partner all helped push her beyond her limits.

The next day, Duncan couldn't reach for things. She couldn't scratch her back. Two days later, she e-mailed the San Francisco CrosSFit gym's owner, Kelly Starrett: "My body was so fatigued (almost immediately) there were moments when I felt concerned I might injure myself," she wrote. Still, she ended the e-mail on a positive note: "I will return to CrosSFit. I like a challenge." Starrett wrote back, suggesting she call him. Duncan did. Duncan says he never replied.

Five days after Duncan took the class, her arms had swollen to twice their normal size. She tried contacting Starrett again with no luck, and e-mailed a close friend about her concerns: "I still can't extend my arms ... beyond about 125 degrees. My lats and pecs are now also sore to the touch. I can't sleep on my side. Putting on socks is painful." She described her upper arms as "totally swollen, fat, and hard."

Duncan didn't go to the hospital. But according to Dr. Anthony Luke, a sports medicine specialist at UCSF, it's likely she was suffering from "compartment syndrome," an extreme muscle strain that can arise from overexertion; she may also have had a mild case of rhabdo.

Jane, meanwhile, attended a CrosSFit class just last month with similar results: agonizing pain, swollen arms. When she went to urgent care, she was told she had rhabdo.

Both women say their instructors should have been paying closer attention. But Starrett, who is a licensed physical therapist, said in a recent interview that "the responsibility lies absolutely with the athletes." Starrett's gym is now in its fourth year of operation. He says he's seen four cases of rhabdo during that time, but, he added, "I guarantee that we will have more cases of rhabdo in the future." That's why he says he gives clients a lengthy warning before their workouts. Neither Jane nor Duncan recall hearing such a warning.

Starrett said that in January he added a two-week "intro series" class before clients are thrown into "all levels."

Luke says that in the last three or four years he has seen a lot more patients with injuries from bootcamp fitness classes. The ones who get injured, he said, either started at a high level and weren't ready for the kind of workout they got, or were veterans who should have known their limits. He suggests that preventing injury is ultimately up to the individual, but that good trainers should ease their clients into the workout program for at least a couple of weeks.

Despite their horror stories, both women say they would take more bootcamp classes, proving that it may take more than one trip to the hospital to deter fitness devotees from the lure of getting ripped.

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