How to Prevent Rhabdomyolysis

5

April 10, 2014 by Kimberly Beauchamp, ND

I wish this could be a foolproof plan, but I have no way of knowing that it is. However, I think this is a good place to start.

Remember, this information is for informational purposes only. It is not intended to diagnose, treat, or prevent any condition. Do not use this information as a substitute for professional medical advice. If you have any reason to believe that you may have rhabdomyolysis (or any medical condition, for that matter), consult your doctor.

Also, bear in mind that I am not a professional trainer. The recommendations given here are based on my personal experience and research. Consult a knowledgable trainer for specific recommendations.

As many of you know, I was diagnosed with rhabdomyolysis (a.k.a. rhabdo) last week. My recovery hasn’t gone quite as I’d hoped. After my initial discharge from the hospital, I developed worsening back pain on par with that of childbirth that put me back in the ER earlier this week. All my labs, however, point to improvement, so at this point we’re kind of waiting it out to see how it goes. Long story short, no one should ever have to go through this, so I’ve been actively researching what tends to bring on rhabdo and the best ways to prevent it.

Many different types of medications can predispose a person to developing rhabdo. I’m not going to go into these, as my focus here is solely on exercise-induced, or exertional, rhabdo. That’s not to say that the two can’t go hand-in-hand. Certainly, the risk of rhabdo increases with certain medications, and you are even more likely to develop rhabdo if you add intense physical exercise on top of that. If you’re taking a medication, check the possible side effects. 

These movements are associated with a higher risk of rhabdo

Most cases of rhabdo occur after doing lots of repetitions of exercises that use a large eccentric component. Eccentric movements are those that require the muscle/s to lengthen during the movement.

Here are some examples of exercises with a large eccentric component:

  • GHD sit-ups
  • jumping pull-ups
  • push-ups
  • squats
  • thrusters
  • walking lunges
  • kettlebell swings

These conditions are associated with a higher risk of rhabdo

Dehydration. Dehydration is a major risk factor for developing rhabdo.

High temperatures. Higher ambient temperatures increase fluid and electrolyte loss and contribute to an increased risk of rhabdo.

Being deconditioned. If you aren’t exercising regularly and you jump into an intense exercise program without a proper ramp-up phase, you may be at higher risk for developing rhabdo. “White collar rhabdo” is the term used for deconditioned people who develop rhabdo upon initiating a training program for which they aren’t physically ready or capable of.

Taking a break from your routine and returning at your previous training level. Many individuals who take a number of weeks off of their regular workout regimen will return to their routine where they left off. This is a big mistake. In 2011, thirteen University of Iowa football players were hospitalized with rhabdo after completing an intense workout upon their return to training after winter break.

This is what you can do to lower your risk of rhabdo

Progress gradually. If you’re new to exercise, or returning after a break, take it really slowly. Gradually build up (over a period of several weeks) to higher weights/greater intensity/longer workouts as tolerated.

Hydrate. Make sure you drink before, (preferably) during, and after your workouts. Low potassium levels can increase the risk of rhabdo, so consider using an electrolyte replacement drink.

Ask Doctor Mama

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Coconut Water is a natural alternative to many sports drinks and it’s been shown to replace lost fluids better than water and as well as sports drinks. HOWEVER, if you develop rhabdo, you may also develop electrolyte imbalances. IF YOU SUSPECT RHABDO, CONSULT YOUR DOCTOR IMMEDIATELY AND DO NOT DRINK ANYTHING EXCEPT WATER UNLESS DIRECTED BY A PHYSICIAN. (Take home message: Don’t try to treat rhabdo at home.)

Pay attention to your body’s cues. If a particular movement doesn’t feel right, if you have to break form to complete your workout, or if any other little voice in your head is telling you to stop, LISTEN. Your body is wise.

Stop, instead of breaking form (or doing an “easier” or modified version of the exercise). A continuation of the previous thought, if you have to modify the movement or your form is compromised, these are signals that you should stop.

Limit high repetitions of exercises that use the same muscles. For example, you may want to think twice about doing high rep push-ups and thrusters in the same workout.

Do fewer reps with higher weight (especially when you’re new). Many trainers have found that having a person use a heavier weight (within reason) forces them to slow down, whereas lighter weights allow the person to push themselves beyond what might be reasonable safe. For example, it’s easier to crank out a bunch of air squats very quickly, but doing a high number of clean and jerks in the same amount of time is less likely. And it’s the fast, high-rep squats that are more likely to lead to rhabdo.

Rest. Your muscles need time to rest and repair. If you’re still noticeably sore the day after a workout (or longer), take the time to let your body recuperate before returning to intense exercise.

If you think you may have rhabdo, get to a doctor RIGHT AWAY. Tell him or her that you suspect rhabdo and that you want to be tested (if the doctor isn’t already leaning that way). Many doctors haven’t seen a lot of rhabdo, and they may think it’s something else. Time is of the essence in getting treated in order to avoid kidney failure and other serious complications, so don’t wait. Better safe than sorry. My CK numbers went up by 2,000 in one day. If I’d waited longer to get help, I may be in a worse position now.

Hot baths can exacerbate rhabdo. Again, if you suspect that you might have rhabdo, consult your doctor immediately and stay out of the hot tub.

I can’t tell you how many people asked me why I even suspected that I had rhabdo. In my case, the crazy swollen arms were the dead give away, but other people may only notice darkened urine or pain out of proportion to the workout.

As I discussed in my first article, there was nothing in particular about that workout that was novel (I’ve done dozens like it before), and I can’t say for sure why I got rhabdo that time. This isn’t really usual, as it turns out. In CrossFit competitions, some individuals end up hospitalized with rhabdo after doing a “routine” workout, whereas others have no problem. Researchers are hunting for answers to these perplexing cases. Perhaps as we see more rhabdo in the intermediate athlete (like me—I’m neither deconditioned nor an elite athlete), some answers will come to light.

In my case, these are the factors that I believe led up to the “perfect storm” that culminated in rhabdo:

  • Dehydration. I don’t pay attention to how much I’m drinking in the cooler months. I didn’t drink before that workout.
  • Not giving myself enough recovery time. I was still sore 2 days later, but I went back and worked those same muscles again.
  • Not paying attention to my body. I can usually do regular push-ups (they’re not perfect, but I don’t do them on my knees). For some reason, my arms fatigued during that workout, and I threw in some knee push-ups to be able to finish. I should have stopped when I failed the regular push-ups.

I’m not trying to scare anyone with this information, and I certainly don’t want to discourage anyone from exercising (especially from doing CrossFit!). My intention is to inform and help people prevent this condition. I believe that knowledge is power. Let’s use it to keep us exercising safely, not as an excuse to avoid exercise. There’s far more danger in being sedentary!

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5 thoughts on “How to Prevent Rhabdomyolysis

  1. Jen says:

    I was just curious how your recovery process has been? I got Rhabdo back in August with a CK level of 66,000. I was released after four days in the hospital. I resumed Cross Fit after two months. I was very cautious resuming my training but had a bout with Rhabdo again a few weeks ago with a level of 4,000. I have decreased energy levels and general achiness much more than before. I was curious if you have any long term side effects? I am seeing a neurologist in a few weeks, but I am frustrated at the lack of information available.

    • Hi Jen,
      I’m sorry to hear about your bout of rhabdo.
      My progress has been mixed. It took a while before I could exercise again without feeling a lot of pain afterwards. I ended up being retested 2 more times for rhabdo, and both times it was negative. My doctor feels that having it may have shifted something in my body and/or changed my pain threshold. There’s been some talk of seeing a specialist, but I haven’t followed up on that.
      The fear that comes with those times of extreme post-exercise pain is VERY real. I also injured my shoulder during an obstacle course race in September, which prevented me from working out as usual. The longer I go between workouts, the more pain I feel after them. But the more I do CrossFit, the more likely I feel that I am to experience rhabdo again.
      In order to try to get back some of my upper body strength and decrease my risk of re-injury, I’ve started doing a lot of power yoga (hot vinyasa). I don’t typically get that same post CrossFit high, and I’ve lost some of the muscle mass that came from lifting, but I DO feel great. I don’t worry about rhabdo any more, I’m still pretty fit, and I like to think it’s making me calmer 😉
      I hope that doesn’t discourage you. It’s just where I am now. I love CrossFit. I love the friends I’ve made there, I love the results that I get to wear around on my body. My hope is to be able to reintegrate CrossFit into my fitness plan, with the goal of going no more than 2x/week, and continuing with power yoga.
      Good luck with your journey! I’d love to hear how you do.
      Warmly,
      Kim

  2. […] let go of certain expectations that I once had of my body. For example, after a couple of years of frequent injuries, I no longer fear that backing off of one type of exercise will prevent me from ever enjoying it […]

  3. Karla says:

    I’ve gotten Rhabdo twice…this January and last January. Coincidence I’m sure. I’ve gone to a specialist that tested for all sorts of myopathies and autoimmune stuff but only found the autoimmune thyroid disorder, no myopathies. My thyroid was functioning normally at the time I got Rhabdo this year. I have been referred to do an EMG (Electromyography). But I’m wondering if you/anyone that has gotten Rhabdo has had this test and if it is really necessary?
    Thanks, K

    • Hi Karla,
      I didn’t have an EMG, but I’d be interested in hearing the results of yours. I believe that even if your thyroid is functioning normally, you might be at increased risk of rhabdo. That could explain the recurrence.
      Hope you’re doing well and are rhabdo-free!
      Kim

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