Foreword:
I initially wrote this back about 20 months ago for CF, but they didn’t want it so it’s been sitting on my hard drive for a while. Hope you guys have a better understanding of what this condition is and what to look for after reading this.
Also, I’m planning to try to get some more things out in the future. I have some topics on diseases of civilization, and I definitely need to get some more injury stuff out such as a more in depth look at the feet. Those two will probably be next along with my supposed rewrite of the tendonitis article.
A closer look at rhabdomyolysis
First off, this article isn’t meant to “diagnose” anything. That should be done by a qualified medical practitioner after running tests. However, awareness and especially identification of symptoms of rhabdomyolysis can not only help ward off any unnecessary deaths but also potential lawsuits (Makimba Mimms case). Additionally, this information is relevant to most people within the CrossFit community because it can most importantly give trainers something to keep an eye out for and avoid potential cases, and also enhance recovery of individuals affected when properly identified.
Physiology of rhabdomyolysis
Okay, so the first thing we need to examine is how rhabdomyolysis occurs. Simply put, rhabdomyolysis is an INJURY to the rod-shaped/striated tissue (“rhabdo”) which is muscle (“myo”) where the muscle itself is broken open (“lysis”) and the cellular contents spill out into the bloodstream. This can occur under various circumstances, but the one we are most concerned with is the exercised induced variety.
Damage can occur during concentric and isometric exercise; however, most of the damage induced to the muscles occurs during eccentric exercise or negatives.(1-2) Eccentric exercise is the strongest form of exercise allowing the muscles to handle upwards of 120-125% of the load that can be lifted concentrically. As the muscle lengthens under eccentric load, the sarcomeres (individual contraction units of the muscle) are unable to support the tension and thus “pop” and distend uncontrollably which is the cause the disruption of the sarcomere plasma membrane.(1) Too much damage results in a loss of structural integrity of the sarcoplasmic reticulum which lets metabolites and intramuscular proteins spill out of the muscle cells.(2)
Delayed onset muscle soreness (DOMS) cause is very similar in nature as it is primarily caused by eccentric damage.(2-3) What happens in DOMS is that as the muscle damage accumulates by destruction of the cell membrane which allows the metabolites leak out into the cell. This causes an immune response via chemical messengers such as prostaglandins. Prostagladins, for example, are part of the fatty acid component of the cellular membrane and released when the membrane is compromised. The immune system responds to this inflammatory call by sending white blood cells as well as release various cytokines. This results in localized inflammation as well as localized edema. Also, the sensitization of local pain receptors when the muscles are contracted are hallmarks of DOMS.(3)
Thus, in a sense, we can think of both rhabdomyolysis and DOMS as close cousins. DOMS is not an either/or effect as there are varying intensities of DOMS. We should think of rhabdomyolysis in the same way as the intensity of rhabdomyolysis can increase depending on how much muscle damage there is. For example, particularly bad cases of rhabdomyolysis occur when the urine turns a darkish-brown color as kidney function is impaired.(4) If this goes on long enough acute renal failure and death may result. In addition, the metabolites from the destroyed muscle tissue pull fluid volume from the blood into the muscle causing swelling.(3-4) On the other hand, non-severe cases of rhabdomyolysis may just result in the form of small decreases in muscle strength and some localized edema.(3-4)
If you are confused about me not explaining rhabdo more in depth, it is basically an extreme case of of what produces DOMS. If you continually exercise the small microtears that allow DOMS to occur will eventually result in macrotears that allow large structures within the muscles to leak out. These include proteins such as myoglobin which is the main cause of rhabdomyolysis. Myoglobin leaking into the bloodstream and thus into the kidney eventually will inhibit function and eventually shut them down leading to renal failure and death.
Assessing rhabdomyolysis risk
From an anecdotal standpoint, rhabdomyolysis often occurs in former athletes or those who have had a previously high fitness or strength level who are detrained. This is because their mind has had the abilities of high performance or strength before, and they are accustomed to pushing themselves. However, this is what you often have to be wary of as they can push themselves far into a state of rhabdomyolysis as they overestimate their own abilities. If a client is a previous athlete and has been out of working out or fitness for years, it is a good idea to let them know that they should start off cautious because their minds can be far ahead of their current physical capabilities. Better to keep them safe than sorry.
Workouts that contain a high volume amount of eccentric movements carry considerable risk for rhabdomyolysis. A couple of the more potent offenders are Michael – 3 rounds for time of run 800 meters, 50 Back Extensions, 50 Sit-ups – anything with copious amounts of negatives such as jumping pullups, or “long” 20 minute efforts such as Cindy especially for newer clients who have not adapted to the considerable intensity AND volume. Similarly, high volume efforts on similar movements may be a poor idea such as a combination of squats, thrusters and wall ball.
The offender in Michael tends to be the GHD situps which have considerably more range of motion than people are used to for abdominal exercises, as well as a long descending eccentric component. Couple this with a high number of total repetitions (150), and it presents a large risk for rhabdomyolysis. In addition, many athletes in particular tend to overestimate their abdominal fitness level and are therefore susceptible to rhabdomyolysis from this workout alone even with a fair amount of CrossFit experience. When in doubt, especially with movements that have a large range of motion, it is better to be conservative and scale the workout.
It is important for any trainer, especially CrossFit trainers, to recognize their client’s ability levels from the start. For safety reasons, it would be a good idea to start clients with short workouts of less than 5-10 minutes (or even less!) on movements that do not have considerable eccentric components. Movements that involve movements that tax cardiovascular capability such as burpees are always preferable to movements that substantially tax the muscles – as long as the client has a heart healthy for physical activity. On that note, always have your clients check with their doctor before rigorous physical activity. Allowing the body to adapt by “ramping into intensity” with shorter efforts is a good idea to help stave off any rhabdomyolysis that may occur. Also, it will help limit the amount of DOMS a client has to allow them progress to higher frequency work much faster.
In my opinion, after an initial workout we can think DOMS as an indicator for rhabdomyolysis. Let me explain. Muscle damage is both related to DOMS and rhabdomyolysis; thus, as the intensity of DOMS increases we will also “tend” to see increases in the seriousness/risk for rhabdomyolysis as well. This is my preference for trying to ascertain if there is any possible rhabdomyolysis. If we gauge it according to this, it is very easy to tell when decreased volume or more rest may be needed to prevent rhabdomyolysis from occurring. Remember, rhabdomyolysis can be caused as an acute event – a single workout – however, it can also be caused from the accumulation of multiple workouts, especially high volume, if the body is not allowed much time to recover.
Reducing Rhabdo Risk
After discussing rhabdo more in this thread, I think proper working programming is the key to reduction in rhabdo for your clients.
Many people use an On Ramp program for new clients where volume and intensity of workouts can be reduced. However, from recent information even 10 minute Cindy or shorter AMRAP workouts can be an issue for clients, especially if they are former athletes who are used to pushing through workouts.
Thus, for the first 2-3 weeks it may be a good idea to only use X rounds of Y,Z movement type workouts.
This cuts down on the amount of “restrictions” you may have to place on athletes such as eliminating the eccentric from pullups or capping the rounds of AMRAP workouts. This should then allow people to focus more on form and improving their workouts.
Properly programmed “X rounds” workouts are a good enough stimulus for new clients, and thus you can more accurately limit the amount of volume and thus the amount of DOMS and other negative factors associated with high intensity workouts. Additionally, since the volume is limited you can include strength work before the workouts which will help improve their abilities much quicker.
So all around this is probably the better option for potential beginner programs.
Soreness as an indicator of potential risk
As I stated in the previous paragraph, after an initial workout I like to tend to use DOMS as an indicator of assessing rhabdomyolysis risk. I follow a specific protocol to assess how many, if any, workouts should be done either consecutively or when the person wants to train again. One exception is that after ~3 or so days the client should be fine regardless of how much DOMS is. This is because DOMS can last up to 7-10 days while the muscles themselves are for the most part healed within 48-72 hours.
1. If the client is too sore to move you should have them at least exercise lightly to get blood flowing to elicit faster healing. Your client should also be hydrating, self massaging, foam rolling, ice baths/contrast showers, or whatever else they can do to alleviate the symptoms and speed up recovery.
2. If the client is not too sore to workout then go for it. But DO NOT overdo it. Depending on how intense the soreness is, it might be a good idea to refer back to #1.
3. Otherwise, if the soreness level is manageable don’t worry about it too much.
If client is training ENOUGH (at least 3x a week), DOMS should start to go away as they become more conditioned. If it doesn’t this indicates a problem in the client or individual’s recovery. Too little sleep, poor and/or hypocaloric diet, or too many daily stressors may be factors. It is also possible that the volume is too much and needs to be ramped back into instead.
Remember, while soreness can be a badge of honor, it does not indicate whether someone has had a good workout that would increase their performance (or muscle gain or fitness for that matter). It only tends to indicate that the body is not used to a certain load or volume. Significant gains in performance can be made while an athlete is not sore hence why I personally tend to think of it as a hindrance only when coming back from a break or recovery period where deconditioning occurs.
Signs of rhabdomyolysis
It is imperative that if you see signs or symptoms of rhabdomyolysis in your client (or yourself for that matter) that you get the client checked out at a hospital because of the potential pitfalls of acute renal failure in particular. If you suspect rhabdomyolysis, you should hydrate a lot to help flush the kidneys of myoglobin.
Hydration is extremely important because it helps preserve kidney function and is also a potential risk factor for rhabdomyolysis in the first place. If you’re trying to be hard on your clients to get the most out of them that is good, but if they want a drink of water ALWAYS allow them to do so.
1. Dark-brownish colored urine (does not always occur as it is a continuum of damage.. however, if you get this symptom drink lots of water with eletrolytes and GO TO A HOSPITAL!).
2. Localized edema (swelling/puffy looking areas). Watch out for compartment syndrome which is so much swelling/edema that it impedes drainage of the veins and lymphatic system thus increasing pressure leading to ischemia (lack of oxygen) to the limb. You can possibly lose a limb or die.
3. Constant muscular and joint soreness (regular scheduled workouts -> soreness doesn’t go away). Chronic DOMS indicates insufficient recovery of the muscles and gives the client a higher susceptibility to get an acute case of rhabdomyolysis.
4. Muscle weakness. Now, DOMS is associated with decreased muscle strength; however, if a client has significantly decreased muscle strength after recovery with no soreness there is a strong chance they had at least a mild form of rhabdomyolysis.
Even if you’re a very good trainer, be aware of the indicators of rhabdomyolysis in clients and even in other people who do intense physical activity. It could potentially save lives!
References and links
1. Morgan DL, Proske U. Popping sarcomere hypothesis explains stretch induced muscle damage. Proceedings of the Australian Physiological and Pharmacological Society (2004) 34: 19-23. Accessible at www.apps.org.au/Proceedings/34/19-23/19-23.pdf
2. Koh, Timothy J. “Physiology and Mechanisms of Skeletal Muscle Damage.” Skeletal Muscle Damage and Repair: Mechanisms & Interventions. Ed. Peter M Tiidus. New York: Human Kinetics, 2008. Pages 5-12.
3. Cleary MA, Sitler MR, Kendrick ZV. Dehydration and Symptoms of Delayed-Onset Muscle Soreness in Normothermic Men. Journal of Athletic Training 2006;41(1):36–45. Accessible at http://www.nata.org/jat/readers/archives/41.1/i1062-6050-41-1-36.pdf
(discussion about DOMS causes is in discussion – one of the more complete summaries I’ve seen among journal articles which is why I chose this one).
4. Muscal, Eyal and contributors. “Rhabdomyolysis.” Medscape. 2009. E-medicine from WebMD. 28 Jan 2008. Acessible at http://emedicine.medscape.com/article/1007814-overview.
Previous CF journal:
http://www.crossfit.com/journal/library/33_05_killer_workouts.pdf
Wikipedia information (generally most science on Wiki is accurate because of citing):
http://en.wikipedia.org/wiki/Rhabdomyolysis
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“I initially wrote this back about 20 months ago for CF, but they didn’t want it so it’s been sitting on my hard drive for a while.”
…makes one wonder how much solid material is out there, not exposed to those who, perhaps, need it most?
Excellent work, Steven, thank you for sharing.
Well, they told me that they were setting up some sort of committee to release something that was up to lawsuit. I guess they never did end up doing that… and the stuff out there on rhabdo is pretty piss poor still unless you want to do your own research.
Hopefully it helps you guys.
Funny, they’re working on releasing something? I just took the cert class this year and they say little more than nothing about it. Interestingly enough, I just got rhabdo, spent a week in hospital.
Sorry you had to go through that experience man.
Spread the word to your friends about this article and related material so that others don’t have to go through it.
I just got released from the hospital this morning after a 5 day stint on IV fluids. I had rhabdo with CK levels 100 points shy of 80,000! The doc I had never saw such a high reading. Interestingly I did not have significantly darker urine and only got myself to the hospital because as a crossfiter I educated myself on how to recognize the symptoms. The thing that tipped me off was the soreness and the swelling.
Matthew,
Hope you recovery well and feel better. Be safe and definitely talk to your coach and/or fellow CFers about the experience so it won’t happen to others.
Nice article.
I’m sure this would be interesting for other readers as you would need to explain the physiology about rhabdomyolysis a bit more.
Just two things:
- Please superscript your footnotes. First had to guess what you meant.
- You are explaining “myo” and “lysis”, but not rhabdo
I don’t know how to superscript with HTML, so I went with the parentheses.
Also, explained rhabdo. Rhabdo function is the same as DOMS except taken to a greater extreme.
Great article, thanks Steven.
Here is a description of and html tags. would be used for superscript. http://www.w3schools.com/TAGS/tag_sup.asp
I can relate to your experience with rhabdo I just went through my first case of it as well. I went and worked out for the first time in a long while but didnt feel like I worked out very hard 3 chest workouts and 3 tricep workouts with only 10 reps each. However upon going home I went to the bathroom and it looked like I was peeing coca cola it was almost black. I called the dr. and went and got soem blood tests done, the next day he called me and said to get to the ER right now for more tests. he told me that normal levels for CK were 5-200 and mine was 312,500, I spent 3 days in the hospital and the levels dropped to 114,000 and they said to follow up with my dr at the beginning of the week. However I have noticed an extreme weakness associated with severe fatigue. I have no energy whatsoever and my lower back is so sore. After hearing how dangerous rhabdo potentially is, I am scared to death of permanent muscle weakness and having repeat cases of rhabdo, anyone with any advice or personal expirience pls let me know.
3 chest workouts and 3 triceps workout in a day? Or 3 exercise for each?
Are you on any medications?
Solid article Steven. Thank you. I have a question. I’ve been cycling 531 for most of this year. In programming assistance work for back squats, I’ve tried 5×10 at about 50% to 60% 1rm, I’ve tried 3×10 wtd bulgarian split squats per leg, I’ve tried 3×10 good mornings. All leave me with fairly severe DOMS that usually lasts 3 days. In your opinion, would it be better to skip the assistance work altogether? Or should I squat more, or less often than once a week? My BS has not really progressed significantly since starting 531. I’m relatively old (51) and have been back squatting for 4-5 years.
Well, if you’re not progressing then there’s no reason why you should be beating your head against the wall doing the same thing to try to get it progress.
Squats are one of those things where it helps if you do them more often though so likely more than once a week is better. Plus, it should help get rid of the DOMS.
Steven, thank you for publishing this information. Rhabdo information is spotty at best, and folks underestimate how dangerous DOMS can be. I didn’t make the connection between the two before.
Most people don’t. But if you think about it the body always operates on continuums in function or dysfunction so it’s always a matter of scale for most things.
Glad that it helped you learn something new.
I tried Crossfit for the first time the other day as one of my friends was doing it and liked it. I went to a different one to hers, where they never scaled my fitness I just joined in. I have been at a gym for 2 years and normally do 3 x 12 sit ups and stop due to lower back pain. With the lumbar support they provided, I found doing these sit ups never hurt till just nearing the end. I was crippled over with abdominal pain for approx 4 days, then noticed swelling in my abdominal and pelvis area. This then dropped all to my pelvis area. Funny enough after reading your article I now realise that the class I did was called “Micheal”.
Sorry that you had to go through that experience.
Take it easy and drink lots of fluids. Light exercise if you can do it without signifincant pain would be good to get the blood flowing as well as mobility work as well.
I think this good. Have you had rhabdo?
Safe training always,
Missy
Thankfully no. Have seen enough of it in CF for one lifetime though.
Look at my website have a great article up there on how to return to physical activity with rhabdo. Also have a great link on guidelines on rhabdo. Could find it helpful.
what is that website I just had my first case of rhabdo and would love more info about it. my ck levels were 312,500 the first day when I noticed the coca cola urine, then dropped to 114k after 3 days in the hospital they released me and told me to follow up with my primary care dr. at the first of the week. I have felt so weak and fatigued though its like I have no energy whatsoever, and the lower back and quad pain and weakness are nothing less of debilitating. Any sugg4estions or tips would be much appreciated thanks.
Hi there , I am a 43 year old female and have recently joines a trx class which after 6 weeks has progressed to trx , kettlebell and pliometrics after my workout on friday which was very intense I was fine but 2 days later my arms are really sore and I am finding it hard to straighten them , I contacted my trainer and he advised epsom salt baths and stretching but on reading about rhabdo I am worried , urine is not dark and output seems normal ,your thoughts please .
regards
fiona
If you are worried you can always go to the ER.
Make sure you drink lots of water.
Difficulty straightening your arms is definitely indicative of severe DOMS, but in the absence of serious swelling or other indicators I’m not sure if that would qualify as rhabdo or not.
Thank you, Steven, for all of this awesome information! I conducted a google search and found a thread that you had posted on a CF message board about Deep Tissue massage producing flu-like symptoms. I am a massage therapist (and licensed Athletic Trainer), specializing in deep tissue work. I was looking for a better understanding and explaination for my patients of why some might experience those symptoms and hate the general “toxins are released in the blood stream” line. We are told in MT school that lactic acid and pyruvate are the toxins. I wasn’t sold on that. You explained it perfectly! Also, as an Athletic Trainer, we think of Rhabdomyolysis in terms of only severe cases. Thank you for pointing out the relationship of DOMS and Rhabdo.
Shannon,
You’re welcome!
It’s actually a fairly complicated process, but yes, deep tissue work can do damage to the muscles which incites a interleukin/cytokine response via inflammation to help start healing the affected areas. This can obviously also cause some systemic flu-like symptoms.
It’s all a continuum though. Typically, this only happens to those who are not used to working out as athletes muscles tend to have some resistance to trauma from weight lifting and other varieties of stress. Most sedentary people can get enough mechanical trauma from massage for this to occur which is why the first couple sessions should always be fairly “light”.
Thank you for the great article. I just went through a case of rhabdo. I dont do Crossfit but I train in a similar style. I didn’t start to experience pain for at least 24 hours, but once it started I was close to tears for the next two days and in the hospital for 5. I have a high pain threshold, but I have never experienced anything that compares. That includes many, many, sports injuries, broken bones, long falls, etc. What I want to ask you about is recovery. It has been more than 3 weeks and I am still experiencing pain/numbness/tingling in the area where it happened. I am noticeably weaker. I am worried because I am scheduled to go on a long ski trip very soon. I am an aggressive backcountry skier with 20+ years experience. I want to go and push myself with my friends who live in the mountains full time. However, I am most certainly not trying to exacerbate my injury. What is the typical recovery period? What are some red flags I should be watching for? My doctors all seemed very confused about my injury and had practically no advice for me. Any insight you have would be appreciated very much!
Additionally, I had some questions about the onset of the rhabdo. In most of the cases I have read, the people affecter were either new to high intensity workouts or were out of their prime without being reconditioned. Neither of these scenarios were true for me. The workout that I did before it came on, I had done many, many times. I was deadlifting and doing inverted pushups for the meat of the workout. The highest weight I did was 225. I have repped 400+ on deadlifts, though I have been staying away from heavy powerlifting. I do a lot of olympic and overhead lifts combined with sprinting, jumping, pullup variations, and lots of explosive, dynamic plyometrics. I was doing high reps, but this I have also done quite a bit.
The only thing I can think of is this: Due to 70+ hour weeks, I had to scale back form gym 5x a week to 1-3x. I did not like this, but so it goes in life… Anyways, the week of the injury I had been able to get three workouts in a row in. Yes the intensity was hight, but this is how I always work out. The other contributing factor could be that all of the workouts that week really hammered my back, though different areas: clean and military press; crosscore pushups, overhead squats, and pullups; then deadlifts and inverted pushups. I did other stuff, but that was the focus of the three workouts. Could I just have overloaded my back? If this is the case, I have no idea why I wouldn’t have had this happen before, considering some of the other strings of workouts I have done in the past.
If you could offer any insight as to what may have caused my case of rhabdo, I would really appreciate it.
Thanks again for all of the great info, most of the medical community seems to be out of the loop…
Like I think I stated in the article, there are other factors that can affect muscle recovery and ability to tear including dehydration, medications, poor recovery (sleep, nutrition, stress), etc. So it can be any combination of those factors, plus high reps with a bunch of eccentric motions, and then a bit of the deconditioning and subsequent 3 workouts in a row.
As far as coming back though it depends on the extent of the damage and how much general fatigue you have with workouts now. I can’t really estimate that, especially since I don’t know the amount of damage and fatigue you have now. Could be anywhere from a couple weeks to a couple months.
I have been doing CF for over 2 years now and for the past 10 months I have been bloated (abdominal swelling). I’m not pregnant, had an ultrasound and a scope. I kept thinking it’s food allergies. Could I be dealing w/ rhabdo or an exercise induced injury?
Hi Leah,
I would say it’s unlikely unless you’re doing a lot of eccentric work with your abs such as GHD situps. What type of diet and training have you been doing?
I went to a Crossfit class on a Sunday and did the GHD situp for the first time ever. We did 6 sets of 15, with a different workout in between each set. I did them without any problem and even finished before everyone else. Went home feeling great. Monday I felt a little sore and then that night I was feeling quite a bit more so. Tuesday it hurt to laugh, sneeze, cough, and even fully stand up right. I figured it was just a really intense workout, until I noticed swelling around my abdomen on Wednesday.
I remembered the waiver I signed for the class, which had a paragraph talking about rhabdomyolysis. So, I went to an after hours clinic Wednesday evening and the doctor didn’t believe I had rhabdo because my urine looked normal and the pain was localized, not systemic. He felt that blood work was unnecessary. I asked him to do blood work anyway. Thursday morning I got a call from my PCP who had received my blood work saying my creatine kinase levels were at 63,0000 IU/L. I went straight to the hospital to receive saline intravenously to treat rhabdo. I was there for almost 48 hours. Luckily my kidney and liver values all looked pretty good.
I think the scariest thing about all of this was that I felt perfectly fine during the workout. No pain whatsoever. I have come across many forums and blogs about people from all sorts of levels of experience and fitness having problems with the GHD situp.
Yeah, definitely be very careful with movements you have not done before, especially if they have a large eccentric component. Even just 15 reps is a lot when you do 6 sets = 90 reps.
Glad to hear you’re fine.
I had done an xfit workout on Friday, and felt fine. The workout consisted of Turkish getups (I used a 53 lb KB) and I did 12 of these total but felt them in my abdominal region the most. I then did 20 GHD situps. Saturday my midsection was bloated and I had major IBS – major cramping that has me doubled over and a fever of almost 102. Drank plenty of fluids and could not eat on Saturday. I think its just a stomach bug, but abdomen is swollen to a point I dont like it.
STill like this on Sunday except fever broke. I am not sure if its a coincidence. Its a new gym, and I havent done a TGU or GHD situp in months. Thoughts?
Well, I don’t know about rhabdo, but it’s possible that all of your symptoms were from the exercises you did.
Lots of damage to the muscles diverts the immune system to clean that up rather than fight infections, which means it’s easier to get sick if there is a lot of the aforementioned damage.
Likewise, bloating may occur — although I’m not sure about IBS — from the same thing. Leakage of the intracellular metabolites into the intercellular space which draws water to the area.
The volume you did was pretty low, but it’s if you were feeling your abs working really hard then I suppose it is possible on a relatively lower amount of repetitions.
My case of Rhado occurred about a year ago after completing a set of negative pulls up with my personal trainer. After three sets of ten, I ended up in the hospital for 7 days with a ck level of 116K. Thankfully nothing happened to my kidneys nor my liver. Within 2 months, all my lab work (AST ALT, CPK returned to normal within a week or two) returned to normal. My question; however, is what are the long term effects of rhabdo? After one year, my biceps and shoulders are still sensitive to strength building, i.e. yoga for me. I experience mild soreness (which i feel is normal) but I experience a considerable amount of twitching after a yoga session. Is there anything I can do to ensure a full recovery (i.e. diet, certain exercise, etc) and prevent any long term complications? Doctors are still trying to figure out the root cause and checking for any underlying causes. Any experience or feedback would be greatly appreciated. Thank you,
3 sets of 10 should definitely not cause rhabdo.
IMO, I would be thinking it may be related to some potential medications you are taking (statins can do this for example) and/or dehydration or certain genotypes of the body predisposing muscle damage.
As far as twitching and muscle cramping go, I would start to take up some more aerobic activity to allow the area(s) to heal better, and potentially do some soft tissue work to work out any potential fibrotic scar tissue in the muscles.
Strength training post rhabdo shouldn’t take that long to get back into… if it does there are underlying issues that need to be solved first.
Excellent info in this article…Steve, my name is Steve and I was just released from the hospital 5 days ago, after a 3 day stay for iv treatment. My ck levels were at about 12k and I was released when they got to about 3k. I got the rhabdo doing phys training as a recruit at the fire academy. We were doing 30 sec interval training (mntn climbers, squats, deadbugs, xcountry ski thingys, pushups, situps) with jogging prior, and in the middle and also stairs. Then a second round of the intervals with ~35 secs of each. I assume all the damage I did was to my legs and lower body, as thats where I was in all the pain. I am an athlete, though not nearly as polished as I once was. I have played hockey and baseball me entire life. Though not competitively any more as I am 26. I sod out regularly, cardio running and stairs and lifting. I realize I probably should have done some more different excercises for my legs in heinsight, however this definitely came as a surprise to myself and people that know me and my physicality level. My question is is how much lifeless do you think I lost in my legs/lower, body, and how long will it take for a full recovery. I also want to know just how hard to start back off working out, as I plan to do so, starting in 2 days which is when I was medically cleared to get back to physical training. And how to avoid this happening again. As I will be back at that same academy in 3 months in the midst of a Massachusetts July/august heat with likely the same menu of training on tap. Thanks for any and all info. Your article was very helpful.
*Sod was supposed to say work and lifeless was supposed to be muscle*… stupid autocorrect
Really too hard to tell without knowing how much damage you did (which is really hard to quantify as well).
I would generally take the next month or so to ramp back up to full training, but listen to your body as well. It may take the full 2-3 months to get back up to speed or less potentially.
Thanks for this article! It’s the best one I found while sitting here in the emergency room getting aggressive IV fluids for rhabdo after two tough CF workouts two days apart (I KNEW I should have taken the second one easy but I did extra warmup & it was a partner WOD!). I’m going to send the link for this article to my CF box owners and suggest that trainers always know which clients are new to CF, new to CF-like exercise, or returning from a break and deconditioned (my case).
BTW, thought you might like to know that your entire article can be found on againstthegrainfitness.wordpress.com and it does say at the bottom “originally posted on Eat Move Improve” but it REALLY looks like the author wrote the article himself….. I am pretty confident you’re the original author and not him…
Just for awareness for readers, it was amount of muscle swelling that tipped me off to get CK checked, and even without tea-colored urine my CK was over 27,000. Rhabdo = 5 times normal, which is less than 140IU/L for most people, so if CK of 750 = mild rhabdo… I suspect a lot of CF-ers could be in mild rhabdo and not know it, making aggressive oral hydration always a necessity. It’s not degree of soreness (bc who isn’t sore after a challenging CF workout?) or tea-colored urine that should prompt a lab check. You cannot orally hydrate fast enough for safety when your CK is this high!
@ MSL
Thanks for the update on that site.
And yep, the tea colored urine is the really bad sign and should be the cue to get to the ER ASAP.
Hi, This information has been really helpful. I am a cyclist racing and training at a high level and it has only just occurred to me that what I most likely have been experiencing over the last 8 months is Rhabdo. This is the 2nd attack I have had, all happening after intensive phases of training and the pain weirdly starting after about 3 days of rest of the bike. The pain is so intense in my quads that I am unable to walk, let alone get on a bike. My muscles also slightly swell I have recently noticed. Its a relief to know that this is the probable cause as no physio or OT could work out what was wrong. Has anyone else experience this delayed onset of symptoms?? The GP just told me to drink more water…..
@ Alexis
If what you are experiencing is some sort of prolonged muscle breakdown I would definitely cut back on the physical activity and allow yourself to heal.