What to Know About Rhabdomyolysis, the Potentially Fatal Condition Caused by Extreme Exercise
Last week, after a series of extreme workouts, three University of Oregon football players were hospitalized, one of them with rhabdomyolysis—or rhabdo for short—a condition in which muscle tissue breaks down so severely that the contents of the muscle fibers leak into the bloodstream and literally clog up your kidneys. It’s as awful as it sounds. Unchecked, it can lead to kidney damage, and in the worst case scenario, death.
The Oregonian reported that the players had endured grueling, "military" style workouts, including a session that involved up to an hour of continuous push-ups and up-downs (which are kind of like Burpees on steroids). But you don’t have to be an elite athlete to succumb to this condition. Anyone who regularly engages in super intense training sessions can get it.
“It’s a product of pushing well past your limits,” says Vijay Jotwani, MD, a primary care sports medicine physician at Houston Methodist who serves as a team consultant for the Houston Astros. “You’re working hard, feeling the burn and go that next step—and another step, pushing far past the point of pain. Later, you have extreme muscle pain and swelling—much worse than delayed muscle soreness. You may also have dark colored urine. That’s because the [protein] myoglobin from your muscles has flooded into your bloodstream and your kidneys are overwhelmed.”
Though rhabdo is rare, some studies have found increasing incidents among the US Armed Forces. And with the rise in popularity of high-intensity, military-style workouts like those performed by extreme CrossFit enthusiasts, rhabdo has earned the nickname “Uncle Rhabdo” in certain CrossFit circles.
“It’s one of those situations that you don’t expect to ever happen, but it can happen, and you need to be aware of it because it can be life threatening if it does,” says Dr. Jotwani. We spoke with him about rhabdomyolsis factors that may increase your rhabdo risk. Below are a few steps you can take to stay safe.
The easiest way to avoid rhabdo is by listening to your body, building up intensity gradually, and giving yourself recovery time after hard workouts, says Dr. Jotwani. “This is especially important when you’re just starting out or coming back from a layoff or injury when it’s easier to overdo it,” he says.
“Rhabdo-related kidney damage comes from muscle protein and dehydration,” Dr. Jotwani explains. So make sure you go into workouts properly hydrated; and if you’ve had a very heavy workout, drink up afterwards. Also take care when you’re exercising in the heat, if you’re sick, or coming back from an illness—all scenarios in which you're more likely to be dehydrated.
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Be careful about competing
It’s extremely unlikely that anyone would give themselves rhabdo working out solo. But in a competitive environment? You may be more likely to push past searing pain to keep up, or impress. When your body says "stop," stop.
Go easier the morning after a night out
It might feel good to “work off” a hangover, but the morning after drinking is not the time to push for a PR. “Alcohol is a muscle irritant. Add in excessive exercise and you have a higher risk,” says Dr. Jotwani. Better to dial it down a notch rather than amp it up past max.
Consider your meds
Certain cholesterol-lowering medications like statins can increase your risk for rhabdo, with higher doses posing higher risks. The relative risk, however, is very low: One case for every 100,000 people taking the drugs for an extended period of time.
Seek medical attention ASAP for symptoms
If you have any signs or symptoms, including severe muscle pain, swelling, stiffness, and/or dark colored urine, head to the hospital. The doctors there can screen your blood for markers of the condition such as high levels of the enzyme creatine kinase and if needed, start treatment immediately to minimize the risk of lasting damage.