Prevention and Wellness

Rhabdomyolysis

Lucas Polley, MSAT, AT, athletic trainer, Premier Health Sports Medicine, answers Frequently Asked Questions about rhabdomyolysis.

What is rhabdomyolysis?

Rhabdomyolysis – called rhabdo for short – is a rapid breakdown of muscle tissue that causes the release of myoglobin into the blood stream. Myoglobin is a protein that stores oxygen in your muscles. Too much myoglobin in the blood can cause kidney damage.

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What causes rhabdomyolysis?

Rhabdo is always associated with some sort of muscle injury. The origin of the injury can be many different things, such as a crush injury, heat stroke, inadequate blood supply, car accidents and intense exercise. I have seen rhabdo in cases of extreme lifting, such as Crossfit routines. Crossfit’s philosophy of “see how many repetitions you can get in this amount of time” increases the probability that rhabdomyolysis will occur.

    What are the signs and symptoms of rhabdomyolysis?

    The scariest thing about rhabdo is that the signs and symptoms are hard to notice. They include muscle weakness, soreness and fatigue, which all are effects of working out in general. How can you tell if you are just experiencing normal workout fatigue and soreness or if those symptoms are something worse? You must try to be aware of some additional symptoms that may occur, including random bruising, swelling in the extremities, fever, nausea and dark colored urine. If you experience any of these symptoms, you should go right to the emergency room just to be safe.

    Are there risk factors for rhabdomyolysis?

    Genetic and metabolic disorders can predispose you to rhabdo. Disorders such as muscular dystrophy, conditions that cause poor metabolism of lipids, proteins or carbohydrates, and hypothyroidism can all increase the likelihood of developing rhabdomyolysis. There have even been cases where viral and bacterial infections were linked to causing rhabdo.

    Is there any specific population that is more likely to experience rhabdomyolysis?

    High endurance athletes (marathon runners, Crossfit athletes, triathletes) are the main population at risk for exertional rhabdo. 

      Can rhabdomyolysis be mistaken for something else?

      Yes. A lot of people believe rhabdo is just general muscle fatigue and tightness after a hard workout. But if you have swelling and your urine is dark (this looks like dark tea or Coca-Cola) go to the doctor. This can be fatal.

      How is rhabdomyolysis diagnosed?

      The gold standard for diagnosing rhabomyolysis is through a blood and urine test. If high levels of myoglobin are found in the blood and urine, muscle damage has occurred.

      What are the treatment options for rhabdomyolysis?

      If you think you or someone else has rhabdo, get to the ER right away. Doctors will treat you with an IV of intravenous fluids for rehydration. This should prevent kidney failure. Your hemoglobin and electrolyte levels will be closely monitored. There have been cases where dialysis was needed, but these are only in severe situations.

      Are there any long-term problems as a result of rhabdomyolysis?

      If the condition is caught early enough, rhabdo should cause no lingering problems. Some people get back to normal health within a few weeks. Some pain and weakness may occur for awhile as the body slowly recovers. If rhabdo is not caught in the early stages, permanent kidney damage can occur. As long as the cause of rhabdo is dealt with (muscle injury, metabolic disorder, etc.) there should not be any other issues.

      Is there an increase in reported cases of rhabdomyolysis?

      I personally have not seen an increase in rhabdo in my profession. However, I can see how marathon runners and individuals who participate in Crossfit make themselves susceptible to it.

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      Is rhabdomyolysis preventable?

      Unless an underlying condition exists, rhabdo caused by exercise is preventable by staying well hydrated before and after strenuous workouts. This helps your kidney eliminate myoglobin as it is released during exercise.

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      What is the return-to-play protocol for an athlete diagnosed with rhabdomyolysis?

      The key to returning to play is to gradually get the athlete or patient back into activity. Trouble can occur if you try to do too much too quickly. Typically, you would start with two to four weeks of rest after leaving the hospital, to make sure your body can sustain activities of daily living. 

      The next step is two to three weeks of low impact activity and low level stretching, static stretching, waist-level pool workouts and slow and short stationary bike work. 

      This is followed by two to three weeks of body weight exercises, band exercises, low-intensity core training and slightly higher intensity stationary bike work. 

      The final recovery phase is to introduce weight lifting at an extremely low intensity, such as 20 to 25 percent intensity with a maximum of just one repetition. Light jogging or running is also added. You must monitor your condition as you move up in weight and keep a continuous chart of your hydration status, muscle soreness and swelling. Work with your athletic trainer to adjust the workouts accordingly. 

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      Source: Lucas Polley, MSAT, AT, athletic trainer, Premier Health Sports Medicine; U.S. National Library of Medicine, UptoDate.com

      Content Updated: December 19, 2017

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