April 5, 2014 by Kimberly Beauchamp, ND
…CrossFit, that is.
I’m in reasonably good shape, and I didn’t think that I was really at risk for developing rhabdomyolysis (also called rhabdo), a condition characterized by skeletal muscle damage that can be caused by intense physical exertion and that may lead to kidney failure and other serious complications.
But this past week, I DID get rhabdo after working out. The story doesn’t end there, though. I’ve been treated for the condition, I’m recovering, and I plan on going back to CrossFit when I’m completely better.
Feeding the fear
An article called CrossFit’s Dirty Little Secret recently brought rhabdo into the public consciousness, and concerned friends and family members started asking me if I was worried about getting it. In a nutshell, the article’s author made the claims that doing CrossFit is risky and that CrossFit enthusiasts (including the trainers) make light of rhabdo.
While we may be seeing rhabdo more frequently, the reasons for this have more to do with training intensity than with CrossFit, in particular. Several other inciting causes of exertional rhabo have been identified, including marathon running, spin classes, triathlon training, swimming, football training, and even plain ole push-ups. So let’s not run out and black list CrossFit just yet, unless we’re also willing to do the same for football.
Regarding CrossFit trainers and how seriously they take the condition, let’s just say that in this close-knit community of health and fitness enthusiasts, NO ONE takes rhabdo lightly. If anything, the fact that CrossFit trainers learn about the danger signs of rhabdo and how to prevent it speaks volumes in defense of the sport. I’d much rather my trainer had knowledge on the topic than had never even heard of it. Now that would be irresponsible.
This is your body on rhabdo
As muscle tissue breaks down, it releases myoglobin into the bloodstream and causes a rise in an enzyme called creatine kinase (CK). This flood of myoglobin can overwhelm the kidneys, potentially leading to kidney failure. Higher CK levels are indicative of greater muscle damage and can predict the risk of developing kidney failure.
Muscle pain and swelling, fever, weakness, fatigue, cramps, and changes in urine color are all hallmark signs and symptoms of rhabdo.
The first thing that most people with rhabdo will likely experience is muscle pain and swelling. This swelling is probably unlike anything previously experienced. The affected area may swell significantly, and the tissue under the skin may feel “mushy” to the touch. It kind of looks like you just put on 50 lbs overnight and lost all your muscle tone at once. If it progresses, the skin may become tight and shiny from the increased pressure building beneath it. This may be a sign of something called compartment syndrome, where extreme swelling may lead to loss of circulation and tissue death. This is REALLY serious.
Some, but not all, people with rhabdo will also notice their urine color changing from a normal pale yellow to a dark amber or cola color. This is caused by the presence of myoglobin in the urine.
Besides compartment syndrome and kidney failure, rhabdo may also cause electrolyte imbalances that can lead to abnormal heart rhythms and sometimes even death.
Rhabdo is also seen in association with certain medications (like statin drugs), from traumatic injuries, and in substance abusers. “White collar rhabdo” is the term used for deconditioned people who develop it after suddenly adopting an intense exercise program.
My rhabdo is out of the closet
Last Saturday I went to the box, where some friends and I decided to do this workout during open gym time:
4 rounds of 25 reps of
- Box jumps
- Jump rope
We started with the normal stretching and then a short row to warm up. This workout wasn’t anything out of the ordinary, and I’ve done many similar ones with no problem.
About 2/3 of the way through my push ups (which aren’t beautiful, but I can usually get through with somewhat decent form), my arms started fatiguing and I resorted to doing some on my knees.
The next day, my arms were sore. Not horribly sore, but I had trouble bending them. By the following morning, I felt less sore and headed back to the box and did another workout.
Tuesday morning, the soreness in my triceps had intensified and I couldn’t rest my arms comfortably on any surface. When I went to take a shower, I noticed that my arms (especially the right one) were very swollen. Here’s what it looked like:
I went to my doctor right away, as I was pretty sure what was going on. He didn’t think it was rhabdo, but he ran my CK levels to be sure. When I didn’t hear back from him by that evening, I rang the doctor on call and asked if my levels were in. He called me back and reported that my CK was at 2,330. The normal upper limit is about 200.
Since it was almost midnight, I didn’t want to drive to the ER by myself, and my levels weren’t at a critical level, I decided to hydrate like crazy and go to the doctor the next morning.
But my doctor beat me to the punch. He called first thing in the morning and told me to go the the ER, as my CK was at 11,000. Quite a shocker, given the number I’d heard the night before. I don’t know where the break in communication took place, but clearly I needed to get the hospital for treatment ASAP.
I called my friend Melanie, who drove me to the local hospital an hour later (I couldn’t hold up my arms at this point to drive). When I got there, my levels had gone up to 13,000, but my kidney function was “perfect.” Here’s a pic we took in the ER:
They started me on IV fluids to flush the myoglobin out of my system and gave me something to relieve the pain. Over the next couple of days, I received countless bags of fluids, endured numerous blood draws, and felt a heck of a lot worse before I started feeling better.
On the second day in the hospital, I developed a killer headache and back pain in addition to the pain in my arms. Walking to the bathroom every 1/2 hour was tiring, and I actually accepted the pain reliever whenever it was offered. (I usually like to feel what I’m feeling. This was a notable exception.)
With treatment, my CK levels dropped substantially each day, until they reached 5,400 yesterday. I was discharged with instructions to look for signs of increased swelling, continue to hydrate, take pain reliever as necessary, and be outfitted with an “event” monitor to look for cardiac abnormalities that may have worsened or resulted from the rhabdo. I have to wear that 24 hours per day for 30 days. I’ll also repeat blood work in a couple of days and follow up with my primary care doctor.
I have to put a plug in here for South County Hospital, while I’m at it. I had the most thorough, compassionate, professional care that I could ask for, complete with visits from my friend, interfaith minister, and hospital volunteer, Erin Goodman. Two of my fellow CrossFitters also worked there, adding to the exceptional quality of my care and keeping me VERY well fed with delicious, nutritious meals. (Yes! Delicious hospital food!) The nurse-in-training who was assigned to my room was an angel in human form, comforting me through the pain and tears, and attending to every detail that I couldn’t manage on my own.
Today I’m tired, but content to be home in my own bed with the sounds of my girls playing happily in the background.
I definitely plan to return to CrossFit after I’m fully recovered, hopefully in a couple of weeks. I’ll *very* gradually increase the amount and intensity of my workouts over time.
I’ll write another post about how I plan to decrease my risk of developing rhabdo again. Reflecting on it, I see some things that I could have done differently. I honestly feel that rhabo can be prevented, and it doesn’t have to come at the expense of avoiding the exercise that I love.
The information contained in this blog is for educational and/or informational purposes only, and is not intended to diagnose, treat, or prevent any condition. If you have any concerns about your own health or that of a family member, you should always consult with a healthcare professional.