Rhabdo: A rare but serious complication of… exercise

It’s a new year, the gyms are unusually busy, and many of us started a new physical activity. Several health clubs are offering fun, interactive, and dynamic exercises such as whole-body workouts, functional training, CrossFit, high-intensity interval training, spinning, etc.

Some of these classes are incorporating intense workouts, which was a hot topic in exercise physiology in 2017. There is significant enthusiasm around these programs among my friends, family, and patients. Some of these classes have loud music, lights, and trainers whose job is to push you to a new level. Increasing the intensity of a workout may bring significant health benefits for some; however, lately we are starting to see cases of a potentially life-threatening disease as a result of these activities. It’s called rhabdo.

The other day I saw someone wearing a shirt that said “Pushing until Rhabdo.” That made me cringe. And I realized that, although rare, some people do not understand how serious rhabdo can be.

What is rhabdo?

Rhabdo is short for rhabdomyolysis. This rare condition occurs when muscle cells burst and leak their contents into the bloodstream. This can cause an array of problems including weakness, muscle soreness, and dark or brown urine. The damage can be so severe that it may lead to kidney injury. Intense physical activity is just one of the causes. Others include medication side effects, alcohol use, drug overdose, infections, and trauma/crush injury. Fortunately, most people who have rhabdo do not get sick enough to require hospitalization. But if you develop any of these symptoms after a hard workout, it’s a good idea to set up an appointment with your doctor. A simple blood and urine test could help establish the diagnosis.

How to avoid rhabdo

I know you are probably excited about your new exercise program, and you want to excel. And that’s great. But take it easy, especially if this is a new exercise routine. You want to challenge your body, but avoid extremes. If you are working with a trainer, make sure you tell him/her where you stand in terms of fitness level and health concerns. In addition:

  • Drink lots of water. That will help prevent problems and help flush your kidneys.
  • Avoid using anti-inflammatory medications such as ibuprofen and naproxen. These drugs may worsen kidney function.
  • Avoid drinking alcohol. Alcohol is a diuretic, which means it will make you more dehydrated. You need more fluids in your system, not the opposite.

If you experience intense pain and fatigue after your workout, you should call your doctor. Most cases of rhabdo are treated at home simply by increasing fluid intake. If muscle enzyme levels are high, or if there are signs of kidney problems, IV fluids may be needed. In some cases, we have to admit patients to the hospital and even to the ICU for close monitoring and further treatment.

Ramping up safely

Be smart and train your muscles to adapt to new activity. Exercise is better if it is enjoyable and entertaining, and I have to say that some of these classes are incredibly fun. But make sure that you listen to your body. Watch out for trainers who may push you too hard to the point of exhaustion. That should not be your goal when you are first starting a brand-new routine, especially if you haven’t been active for a while. A good trainer should get to know you and will tailor the exercise routine to your level of fitness. Adding a new workout to your day is probably one of the healthiest habits you can incorporate in 2018, but don’t “push until rhabdo.” Instead push slowly but consistently, challenging your body toward wellness and better function.

Comments:

  1. Paul Burgess

    This really needs greater awareness – I suffered from this a year or so ago following an intense session with a personal trainer in the UK. My legs were incredibly sore after doing something like 200 plus squats with and without weights. The personal trainer actually told me it was going to hurt afterwards but just to take ibuprofen to make it feel better! After 2 days of pain and one incident of passing very dark urine (cola coloured!) I called the NHS non-emergency line who advised to see a doctor asap.

    The initial diagnosis was possible kidney stones as evidence of blood in urine was found in a sample. After giving a small blood sample I was sent home for a day or so – only to be called by the hospital who admitted me for 4 nights. Thankfully I just need a course of fluids and monitoring but my initial blood test showed very high levels of creatine kinase (CK) – first reading was nearly 9000 u/l!!

    My local GP hadn’t heard of it before and almost none of the people that I knew who were ‘serious’ gym people knew of it. The only person who knew a lot about it was someone who worked with race horses – as its a very common issue.

    Thankfully for me – no permanent issues, but with the potential irrecoverable damage to kidney function, its a good one for people to be aware of.

  2. Ang patty

    Brilliant details just about to signup for some gym sessions this has being of great 👍 help

  3. Tammy Lynn McNabb

    I’m glad you pointed out the importance of drinking plenty of water and not just for obvious reasons. We are really focusing on water intake to our viewers and TV show followers.

    Great article!

    Tammy-Lynn McNabb