I first heard about rhabdomyolysis, also known as exertional rhabdomyolysis, years ago after a few marathon runners experienced the effects of it following the completion of a marathon. Back then, however, there was minimal research on it and a limited amount of case studies. Fast forward a couple of decades. If you do a Google search for rhabdomyolysis today you come up with more than one million results. You can also find many first person accounts of athletes and non-athletes who have experienced “rhabdo.” There is even a 2011 documented case you may remember involving the University of Iowa football team. In this particular case, ten players had extremely elevated CPK levels after a series of football workouts that “averaged” 188,617 UI/L and one player was even reported to be over 300,000 UI/L. Keep in mind the normal CPK range is 60-400 UI/L. Here are just a few of the documented cases that I found all over the internet: case 2, case 3, case 4 and case 5.
First, what is Rhabdomyolysis?
It is the breakdown of muscle tissue in your body that can occur following extremely intense exercise. When your muscle tissues breakdown they release large amounts of myoglobin into the bloodstream. Myoglobin levels appear to rise within two to three hours of a heart attack or other muscle injury. Myoglobin is a protein, similar to hemoglobin, that binds oxygen in the muscle. Myoglobin is found in the heart and muscles and eventually gets filtered by the kidneys and too much of it can damage the kidneys and lead to renal failure.
What are the Symptoms?
- Elevated CPK (creatine phosphokinase) levels in the blood
- Dark urine color
- Decreased urine production
- General overall weakness
- Muscle stiffness or aching
- Muscle tenderness
- Weakness of the affected muscle
- Joint pain
- Unintentional weight gain
What causes it?
Rhabdomyolysis can occur as a direct result of extremely vigorous exercise, especially unaccustomed exercise. It can occur in anyone, from the elite level athlete to the soccer mom. It occurs when someone is encouraged to exercise beyond their physical limits.
What can you do in terms of Prevention?
Train safely by using a periodized training plan that gradually increases the volume of work (sets x reps x load) over time. Drink plenty of fluids after strenuous exercise in order to dilute your urine and flush any myoglobin that may have been released from your muscles out of your kidneys. Also drink fluids after any condition or event that may have damaged skeletal muscle (especially following heavy eccentric exercise).
The mortality rate for rhabdomyolysis is 5% and this increases to 20% if kidney failure occurs.
Knochel JP (1972). Exertional rhabdomyolysis. N England J Med, 287:927–929.
Sayers, SP and Clarkson, PM. (1999). Etiology of exercise-induced muscle damage. Can J Appl Physiol 24: 234–248.
Springer, BL and Clarkson, PM. (2003). Two cases of exertional rhabdomyolysis precipitated by personal trainers. Med Sci Sports Exerc 35:1499–1502.
Brudvig, T and P Fitzgerald, (2007). Identification of Signs and Symptoms of Acute Exertional Rhabdomyolysis in Athletes: A Guide for the Practitioner. Strength and Conditioning Journal. 29:10-14.
Smoot MK, Amendola A, Cramer E, Doyle C, Kregel KC, Chiang HY, Cavanaugh JE, Herwaldt LA (2013). A Cluster of Exertional Rhabdomyolysis Affecting a Division I Football Team, Clin J Sport Med. 23(5):365-372.