Pre-post note: this article is very long. Probably one of the longest I’ve ever written. But the point of this is to supply as much info on rhabdo as I can, not to entertain you all with my thoughts and ideas like my blog is usually about. Also, I have a post following this with my atual experience and ‘my thoughts’ on how I got it. Enjoy!
Rhabdomiolysis (rhabdo) is a surprisingly common issue where an influx of toxins are released into your bloodstream after extreme muscle tissue breakdown. The influx of these toxins (known as CPK, or creatine phosokinase) can lead to increased myogloben levels that could lead to kidney issues and, in extreme cases, death. Let’s go over why the heck I know so much about rahbdo, and exactly what the heck this annoying problem is. And lastly, what are the best ways to take care of yourself if you think you have it, or you know you have it.
First off, who the heck am I to talk about this? Well, I’m not a doctor or scientist or anything, but since I actually was hospitalized for getting rhabdo less than a week ago I have done hours of research on everything possible. I’ve also established that at this point, I know more about rhabdo than 7 nurses and 4 doctors. Anything I write here is purely my opinion from experience and tons of research. My goal is to get some actually scientific studies done, and I personally am in the process of planning one out myself (I will be taking blood work on specific demographics of clients, performing specific styles of workouts, and measuring their before and after CPK levels). So take what you will from all this. This post is meant to be a resource for anyone interested in the topic of rhabdo.
What Is Rhabdomiolysis:
Rhabdomiolysis is muscle-based conditioning where extreme tissue damage causes a release of damaging toxins (CPK being the main one) into your blood stream and can cause anything from kidney failure, to limb damage, to death.
The most common symptoms are extremely sore muscles, swelling of the sore area (edema), and, in more extreme cases, dark (coke colored) urine. It’s tough to diagnose rhabdo right off the bat. So, if these, or some of these continue for more than a couple days, it’s probably a good idea to go get a blood test.
What Is CPK:
CPK is a protein/toxin called Creatine Phosokinase. This protein is released by your muscles whenever you break them down (through exertion, through impact, through drugs, whatever), and at lower levels is pretty easily processed by your kidneys and passed regularly when you piss. When the levels get higher, the toxin can actually overflow your kidneys and cause acute renal (kidney) failure. And this is not good.
While there is not a universally accepted CPK reading that all doctors can read and claim that you have rhabdo, there seems to be a base level of understanding for what constitutes a rhabdo diagnosis. There is also a commonly understood level that would suggest hospital admission. There are generally understood CPK levels that could lead to certain levels of risk. So, here’s the rundown:
It is generally understood to claim a person has rhabdo if their CPK levels test at least 5x greater than their highest normal range. The average normal range is around 100-300 units per liter (U/L), but some people may have normal ranges that are a little higher. But even if you have a level of 1,000 U/L, that would, mean a CPK reading of 5,000 would constitute having rhabdo.
This would not necessarily put you at a risk of any organ damage though. And most people who are in shape enough to workout hard enough to get a CPK reading like that after a workout, are probably hydrated and fit enough to just work through it within a couple days.
So, if your reading is below 10,000, you’ll most likely be totally fine. But, if your reading is up towards 10,000, you should probably consider taking things a bit more seriously. And of your reading is at 20,000 or above, you should get an IV in you and get regular blood tests to make sure your kidneys are safe.
Some extreme cases (like my own) can get a reading well over 100,000. This is risky, and you should really get into the hospital to get proper fluids and keep an eye on your insides.
How Can You Get Rhabdo:
The common extreme cases of rhabdo are seen with high impact patients. So, people who get in pretty nasty care crashes, or have something fall on them, or something like that will tend to have very high CPK readings (like 300,000 or some absolutely insane reading). These people are at risk for the scary rhabdo; the kind that causes kidney failure, permanent limb damage to loss of limbs, and death.
You can also get rhabdo from certain drugs (like statins). Honestly (and I’m sorry to those struggling with this) I don’t actually know very much about this side of it. I tended to graze over all the medical journals and information that talked about rhabdo and drugs.
Exertion-based rhabdo (what I got, and clearly the focus of this article and my future studies) is pretty interesting. It is commonly understood that you run the risk of getting rhabdo though high rep eccentric contraction. This means that when you contract your muscle by extending the joint (the “down” portion of a pull up would be the most common one here) for many, many reps, you will be at a higher risk. But, this is not the only way. Any form of extreme muscle tissue breakdown, eccentric, concentric, isometric, whatever-tric, as long as it’s extreme breakdown, can cause rhabdo. Eccentric is just the quickest way for it to happen. And again, commonly, beginners are at a higher risk. Under-fueled/dehydrated people are at a higher risk; but then again, anyone who works out really hard is at a pretty damn high risk of getting rhabdo at some level. In fact, I would argue that pretty much every single person who has experienced extreme soreness has technically had rhabdo.
Say what?!?! Yep, as you read above in the CPK explanation, just having a 5x increase of your normal CPK levels would technically mean you have rhabdo.
So, be aware of what you are doing. Keep workout and food journals so you know how you’ve been progressing. As a strength coach, it would seem like a pretty high risk to put a group of beginner clients who can’t do a pull up through a 100 pull up workout. I would almost guarantee that most of that group would get rhabdo in some degree. My point is, make the effort to know your body, and even then, be safe. I know my body incredibly well, and have spent literally 20+ years challenging myself, learning about myself, and building myself, and I still got rhabdo. To be honest, if I didn’t know my body the way I do, I’m sure I would have gotten some pretty serious, and probably permanent damage to my arms had I not decided to go to the hospital.
My goal isn’t to scare everyone by saying you’ve all had rhabdo at some point. The point is to make sure as much info is out there for all you to understand this a bit more. I spent hours researching and there was so, so little info out there as to what this is.
The reason rhabdo is a scary condition is that there’s such a fine line between it not being a serious issue, to it being a very, very dangerous condition. This is why playing it safe is always the smart thing to do (you’ll find the process I suggest a little further in this post). This isn’t all that rare, think of water. Water is one of the best things you can possibly put in your body. But, if you drink too much of it, you can seriously damage your body. More similarly analogous would be cortisol.: cortisol is a stress hormone that is extremely good to have as it helps you react to extreme situations. But, if your cortisol levels get too high, it causes an overwhelming amount of problems.
So how do you assess this risk? First off, if you are more sore than you’ve ever been before (unintentional rhyming there…), go get a blood test. If you’re like most people who workout and get sore, but feel abnormally sore, look for dark urine, look for swelling and lack of mobility in that area, and if you have any of those, go get a blood test. If you choose not to get a blood test and your conditions last up to three days, go get a god damn blood test!!
It’s not that complex. If you are worried about how you are feeling, and your soreness is so bad that it deters you from normal workouts, just go get your CPK levels tested. It’s better to figure out earlier that they are elevated so that you can assess the potential risk you are in and act accordingly.
It is no joke that there is a fine line between taking some time off and drinking water, getting admitted to the hospital for a couple days, and possibly losing limbs or life. While that latter issue is an extreme case, it is possible. And the greater risk, getting kidney failure, is not a good thing at all.
Edema And Compartment Syndrome:
The issue that was actually a concern for me while at the hospital was the swelling (edema) in my arms. The swelling had been pretty sever for 4 days before I checked in to the hospital, and finally began to go down on the second day of being there. The concern here is that the swelling causes compression and restricts the blood flow to different compartments the effected area. This can lead to permanent damage to limbs, and could even lead to loss of limb.
It’s a scary issue, and one that one should really be concerned about if severe swelling continues for more than a few days.
A small hiccup in the whole situation is that a lot of people react to swelling and pain by taking ibuprofen. But ibuprofen is notoriously tough on the kidneys. If you are possibly or definitely dealing with rahbdo, you probably don’t want to add any additional threat to your kidneys. So, get to the doctor!
Let’s recap: if you are pissing brown, go to the doctors. If you are feeling really, really sore, go to the doctor. If you have severe swelling and it lasts, go see a doctor. If you feel like seeing a doctor is stupid, stop being stupid and go see a doctor!
Now, after yelling at you all to go to the doctor, I’ll proceed to rip on doctors!
How To Deal With The Hospital/Doctor:
It seems that from not only my experience, but from a good bit that I found in my research, if you walk into the hospital with sore muscles and no discolored urine, the people there probably won’t take you all that seriously. But if you are smart, and care enough about your health and well-being to actually go to the doctor or hospital, you should insist on getting blood work done. Even if you get a doctor like mine who thinks you and your training partner pulled both your biceps at the same time, insist on getting a blood test (yes, my training partner got rhabdo at the same time as me... it is very strange).
The goal of this post is to supply enough info to people who think they might get rhabdo that you might be able to talk to your doctor with a little more education. Medical facilities and professionals can be a little intimidating. Doctors are experts that we put very high up on pedestals in terms of entrusting our health and our bodies to them. But the fact of the matter is, and in my case (and I know many, many other cases) my expert doctor was very willing to send me home, completely ignoring my knowing there was a problem. He was willing to tell a guy who was sitting in front of him asking for a blood test to just go home and take a couple more days off. Well, it’s a damn good thing I insisted on getting that test, because I definitely had serious rhabdo.
So, again, if you are good enough to yourself to get to the hospital, insist on getting that blood test no matter what. And know that if your blood work comes back with CPK levels that are a concern, you should probably get admitted and get an IV in you stat so that you can flush things out of your body as quickly as possible.
So stand up for yourself if you need to. Insist on the blood test, Know what serious levels are, and insist to get the treatment you need if those levels are high. Remember, it is your body, and you should take care if it as best you can at all times.
What To Expect At hospital:
If you are in some form of critical conditioning with your rhabdo, I honestly have no idea what you should expect. But if you have what the vast majority of rhabdo patients have, you can expect your stay there to be between 2 and 5 days, and you can expect to have an IV in you the entire time, and to be really bored. The fact is, you are there for the IV, and to just keep an eye on your organs and/or limbs because you really don’t want to run the risk of messing those up at all.
They’ll hook you to a normal saline solution, and most likely to a sodium bicarbonate (basically baking soda) to really help with the flushing out of toxins. You’ll get daily blood tests to make sure risky toxins are in fact decreasing, and that’s about it.
Be patient, read, watch movies, write, do work, whatever you need to do. Just try to relax and let your body recover. Remember, you got yourself into this mess, so allow yourself the time to get out of it.
How To Recover:
Take your time!
For people who have control over their training and program, this should be easy enough. It will be challenging and probably depressing that’s for sure, but easy enough. And if you are like most people who push themselves hard enough to actually get rhabdo, you really need to dial in your recovery process as to not put yourself at an even greater risk.
Remember, just because you feel better does not mean you are better. And when you are back from the hospital and feeling recovered you most likely have some pretty elevated CPK levels. Along with having had severely broken down muscle tissue, your body will be at a pretty fragile state for a t least three weeks. For some, this might mean take 2-3 weeks completely off. For others (and the way I approached my recovery) I took 1 week completely off and then very slowly got back into training. In the big picture, what is the point of rushing back into things and possibly destroying my arms for the rest of my life when I could take just one more week off my training and fully recover?
If you really want to play things safe, make a point of getting at least one more blood test about a week after you leave the hospital. Then, when you feel like you are ready to get back into training, start deliberately slow. I think the worst part of this process is the anxiety. After having such a scary thing happen from simply working out, every time you start to do something you become hyper aware of every single bit of tension and twinge that happens. Again, just take your time and stay smart. If you have a coach you really trust, talk to him/her and get some really focused help.
In the end, the experience of getting rhabdo should just be a great learning experience for you if you are actually interested in your own personal health. Learn from it, help others, and share your story.
I hope that this long post supplies some assistance to anyone who might have had rhabdo, or think they might have it. Know that this condition is so extremely under-diagnosed, and most people have actually had it at some level. Know that if you are smart about things, you will most likely be fine. Be safe, get a blood test, and reach out to people you trust and can help.
Never Stop, GET FIT.
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