Just a strained hamstring.
Kyndall Voskamp, known in the softball community for her place on the pitcher’s mound, was limping around and aching throughout her upper body. But the problem wasn’t her joints, it was the fact that she was overcompensating for her pulled hamstring. At least, that’s what she thought.
It was summer 2008, the summer between her junior and senior years of high school. Junior year had been her best year, yet. The summer before, in club softball, a new coach had retrained her pitching and hitting, giving her the best softball season of her life. That fall, she was the starting pitcher on her high school team—a position she’d held since joining varsity her freshman year—and she batted third. The high from the successful season propelled her to dive back into competitive swimming, which she hadn’t done since elementary school.
Senior year could only be better—especially with college recruiters watching from the stands, holding the keys to athletic scholarships.
That was the plan: Get a full ride for softball, and ride the wave for the next four years.
So what was the deal with this pain?
“I had had soreness from softball before,” Kyndall said. “I threw too many pitches, I wore myself out … But this pain, it was constant … It felt like every time I would bend anything, the joint would lock into place.”
Wrist. Elbow. Shoulder. Even her fingers. She’d bend them—to hold a pen or grip a softball—her joints would lock, and when she tried to release, her joints would grind on themselves to open back up. Like the tin man in dire need of oil.
At first, everyone kept blaming her pain on her hamstring. She thought she’d pulled it one day in practice, but rest wasn’t part of her training vocabulary, so she kept playing and soon the soreness traveled up her torso and down her arms.
Kyndall wasn’t your typical high school athlete. She wasn’t a fan of lifting weights and cross-training, but she loved pitching. At age 10, after several years competing both in the pool and on the diamond, she committed to playing competitive softball and, specifically, pitching. Three, four, five times a week, her parents brought her into Denver from Bailey for games, practice, and batting and pitching lessons. At home in the front yard, she practiced even more.
Her dad, Dave, remembers a day when, outside, it was snowing sideways.
“Kiddo, you really need to pitch,” he told Kyndall. “Go get your cleats and go out there.”
It was a joke, but in moments, she had her cleats and was ready to practice.
At the Colorado Sparkler Tournament toward the end of the summer season before her senior year, Kyndall got up to bat. All game, she’d struggled to grip the softball, but she wasn’t warming the bench. Grinding her hands around the bat, she readied to swing, hit the ball, and then hobbled to first base.
“What’s wrong with her?” she heard someone on the other team ask.
“I think she might be hurt.”
She spent the rest of the game in the dugout.
A month passed between the end of the summer season and school starting back up in August. She took the time to rest, hoping her hamstring and everything else would calm down. But when she returned that fall to the batting cage at her high school coach’s house and picked up the bat to swing, pain shot up from her wrist all the way to her shoulder. It hurt to grip the bat; it hurt to swing. Her elbows and shoulders hurt. She kept batting, but the only thing on her mind was pain.
She spent most of her senior season watching from the dugout. Her coach gave her opportunities to get out and play—put her on third base sometimes, played her on first at her senior game—but for the first time in her life, she spent more time spectating.
When she finally saw a doctor, the doctor sent her to a physical therapist. The physical therapist thought she’d injured her rotator cuff, so they did therapy to treat that—even though it didn’t account for the pain in her wrist and fingers. After several therapy sessions, they visited an orthopedic surgeon. The surgeon looked at their family medical history and saw that Kyndall’s mom, Joyce, had lupus.
“Have you ever seen a rheumatologist?”
A bright red rash flared over 25-year-old Joyce Voskamp’s face and arms. Am I aging prematurely? she wondered. Is this a skin disease?
She went to see a dermatologist, but they didn’t provide any answers other than the comforting: “You don’t have old age.”
The symptoms got worse. Along with the rash, Joyce constantly felt achy and feverish.
“It got to the point where I couldn’t walk anymore, so they took me to the emergency room,” Joyce said.
After a series of tests, someone mentioned lupus. A rheumatologist was brought in. Joyce was diagnosed and put on steroids and cortisol therapy.
Joyce remembers asking a doctor before having any kids: Will I pass lupus down? The doctor had said, no, he’d never heard of it being hereditary.
When Joyce became pregnant with Kyndall, her lupus went into remission. Over time, other than a few flair-ups here and there, it impacted her life less and less.
But now, her first daughter was in constant pain, and once again, a rheumatologist was being brought in.
The rheumatologist drew Kyndall’s blood and sent it to the lab. Within a couple days, the diagnosis came back:
Kyndall Voskamp, just a couple weeks away from her eighteenth birthday, had rheumatoid arthritis.
“When the doctor came and told us … I just did that to her,” Joyce said, voice trembling.
Here was a lifelong diagnosis for her little girl, and it was tied to her own disease.
Lupus and rheumatoid arthritis are close cousins in the family of autoimmune diseases, in which the body’s immune system turns against healthy tissue. Lupus often surfaces in the form of a butterfly-shaped rash on the face, overwhelming fatigue, and damage to the kidneys and other organs.
Rheumatoid arthritis primarily attacks the joints, causing damage by inflaming the membranes that line the joints of the knees, ankles, wrists, elbows, hands, feet, and shoulders. This inflammation causes swelling and a warm feeling in the joints. Thanks to an enzyme released by the inflamed cells, untreated rheumatoid arthritis leads to bone erosion and joint deformity.
When Kyndall’s diagnosis was finalized and her bloodwork came back, her inflammation levels were off the charts. At first, the rheumatologist put her on a combination of prescription-strength ibuprofen and prednisone, a steroid that suppresses the immune system. About six months later, another round of bloodwork came back so inflamed that her doctor put her on weekly injections of Enbrel, a drug that blocks TNF, a protein produced by the immune system that triggers inflammation.
All of this—the diagnosis, the medications, the fact that she couldn’t walk without pain—embarrassed Kyndall. She was a senior in high school. She was on the cusp of what was supposed to be the best time of her life. Rheumatoid arthritis? That was for old people, not for her.
The rest of her senior year passed in something of a fog. Her friends were out pulling senior pranks, while she was missing school because she hurt so badly.
The principal pulled her aside: What’s going on?
She told him.
“This is not the end of your life,” she remembers him saying, and though she shrugged him off then, she now takes his words to heart.
Spring rolled around; college was on the horizon. Maybe things were looking up?
Then, ten days before high school graduation, Kyndall’s best friend—the one she’d planned on attending Colorado State University (CSU) with—was killed in a car accident.
Grief. Pain. Despondency. At this point, Kyndall’s life became what was best described as an existence.
She went to college that fall, got a special doctor-ordered parking pass because walking from class to class was not a physical possibility. She kept her weekly injections of Enbrel in a mini-fridge in her dorm room, private and separate from her roommate. Almost every weekend, she went home.
“I hated college my first year, actually my first two years,” she said. “I really hated Fort Collins—really hated kind of everything.”
She hardly ate anything, lost a lot of weight. She barely recognizes herself in photos from that time.
In 2013, Kyndall graduated from CSU with a degree in social work. She still lacked excitement for life, but she knew she wanted more. Several months after graduating, she moved to Boston, where she was surrounded by people she describes as very successful. Four months later, she returned to Fort Collins with a desire to stay and build a life there. Over the next year and a half, she switched jobs a couple times and started dating her now fiancé.
Then, early 2016, scrolling through Facebook, she saw an ad for a New You Challenge at CrossFit Alluvium. She signed up.
In 2013, after running his own manual therapy clinic for more than 15 years, Josh Crill opened CrossFit Alluvium for the purpose of getting his patients moving better.
“My whole goal was to take them from the treatment room to the gym,” he said, “and to decrease the amount of times that they would need to see me.”
His plan worked. As his patients improved their fitness and movement patterns, his therapy practice went from treating 50 people a week to between 20 and 25 people a week.
When Kyndall showed up to CrossFit Alluvium for the first time to meet with Crill before embarking on the New You Challenge, Crill was immediately assessing how she moved. When she told him about her rheumatoid arthritis, he barely blinked. The disease runs in Crill’s family: His grandfather died at age 52 from complications of rheumatoid arthritis. His dad has both rheumatoid arthritis and lupus. Crill knows he’s at risk, so he stays ahead by working out and eating well.
“In my mind, [rheumatoid arthritis] is all about inflammation,” he said, “so we immediately changed her nutrition up as an anti-inflammatory diet plan.”
They cut down on dairy, grains, legumes, and most significantly, sugar. And for six straight weeks, they hit the gym.
Her first day, she was so sore she could barely move. Three weeks in, she noticed that she wasn’t sore at all. Morning stiffness and chronic fatigue are typical with rheumatoid arthritis, but she was practically jumping out of bed in the morning and her energy lasted most of the day.
Normally, depending on how she felt, she took a shot of Enbrel every week. During the challenge, she took it only once.
Before the challenge, her bloodwork had come back with relatively high inflammation levels (though, thanks to her medications, nowhere near the height at her diagnosis). Out of curiosity, she had her blood drawn again at the end of the challenge.
“My inflammation levels weren’t even registering on the charts,” she said.
When told this story, Dr. Elena Schiopu, a rheumatologist and associate professor of medicine at the University of Michigan School of Medicine, expressed doubt that the immune system, once stirred up against healthy tissue, could be brought back into line. She raised questions about Kyndall’s original diagnosis: Did she actually have rheumatoid arthritis or was something else going on?
“I don’t think there’s a good explanation why her case got so dramatically better,” she said.
That’s what’s tough with Kyndall’s story: It goes against existing medical knowledge and practice. Exercise is encouraged for patients with rheumatoid arthritis, but it’s usually low-intensity exercise, not the stuff of CrossFit.
“The positive part is, pay attention: diet and exercise,” Schiopu said. “The slightly worrisome part would be, would everyone just completely come off their drugs and see how they do without them?”
Kyndall’s drugs were the first line of defense against the inflammation caused by her disease. Without her weekly doses of Enbrel in the years following her diagnosis, her condition would have worsened. It had already reached the point, when she was diagnosed, that she needed help coming down the stairs and getting dressed in the morning.
But now, following the radical change in her diet and the implementation of regular exercise, Kyndall hardly ever takes her Enbrel. Last year, her doctor officially declared her rheumatoid arthritis as being in remission.
“Whatever you’re doing is working,” he tells Kyndall, “so don’t stop.”
Is it the diet? Is it the exercise?
“There is no diet-plus-exercise formula,” Schiopu said, “in which your rheumatoid arthritis will go away.”
At least, not with the current science. There’s a lack of studies looking into whether inflammation is connected to certain foods. Crill spoke about an anti-inflammation diet, but Schiopu, who dug into the topic for a talk with the Michigan State Medicine Society, found little data to back up the theory.
“Nobody has done the inflammatory—to my knowledge—in a controlled fashion,” she said. “We need those studies. We need to prove it.”
For Kyndall, the change she has experienced is enough proof to keep doing what she’s doing. Last year, she took CrossFit a step further, competing in Girls Gone Rx at Elitch Gardens in September and Battle of the Badges in December.
Her team came nowhere near winning Girls Gone Rx, but the event—with its opening workout of partner deadlifts (265 pounds), sandbag ground-to-overheads (50 pounds), and single-unders with a four-pound rope—lit a fire in Kyndall to get better at CrossFit and be able to compete well.
Before the competition started, Kyndall took a moment to reflect. To remember how far she’d come: from barely being able to move in the morning to now being able to run and jump and lift weights that before her diagnosis she had no desire to touch.
She remembered her best friend, who’d died when Kyndall was still figuring out what it meant to live with rheumatoid arthritis. She pictured her standing and cheering from the other side of the gate.
With her teammates, she braced herself for the 265-pound partner deadlifts. She waited for the timer. This wasn’t going to be pretty.
But pretty wasn’t the point. The point: Kyndall was able to move.