Strength Injury Prevention How to Protect Yourself From Rhabdomyolysis Prevent the Dangerous Muscle Condition Seen in Extreme Workouts By Paul Rogers Paul Rogers is a personal trainer with experience in a wide range of sports, including track, triathlon, marathon, hockey, tennis, and baseball. Learn about our editorial process Paul Rogers Medically reviewed by Medically reviewed by Michael Menna, DO on November 08, 2019 Michael Menna, DO is a board-certified, active attending emergency medicine physician at White Plains Hospital in White Plains, New York. Learn about our Review Board Michael Menna, DO Updated on January 09, 2020 Print Ryan Pierse/Getty Images Rhabdomyolysis is a painful and potentially dangerous condition in which muscle cells break down and release a substance into the blood that can lead to kidney failure. It can strike athletes and exercisers during or after extreme exertion, especially when exercising in high temperatures. Rhabdomyolysis—"rhabdo" for short—makes headlines when it strikes student athletes, but you should be aware of it for your workouts as well, as it's also known to happen to everyday gym-goers and exercise newbies as well. Indeed, two cases of rhabdomyolysis were reported in 2014 after people took their first Spinning class. Six other cases involved people who did CrossFit—three who'd participated in it for months to years and three who were less fit and sustained rhabdomyolysis after their first encounter with CrossFit, a high-intensity fitness program. Marathon runners may be at particular risk, as some studies have shown that at the end of a marathon, runners' kidney function can drop steeply and many experiences profound dehydration, which can quickly lead to full-blown rhabdomyolysis. Symptoms Symptoms include tea-colored urine, muscle weakness, and extreme and persistent pain, although a more accurate diagnosis is available with blood tests. The dark-colored urine results from the breakdown of muscle, which deposits a protein called myoglobin in the blood and urine. If these levels are too high, serious kidney damage can result. To distinguish exercise-induced rhabdomyolysis from other forms, the term "exertional rhabdomyolysis" is often used. Rhabdomyolysis Strikes Student Athletes In January 2011, 13 University of Iowa football players were hospitalized and diagnosed with rhabdomyolysis after a tough pre-season workout of 100 back squats, which involve holding a weighted barbell across your upper back. All the players recovered. Rhabdomyolysis made headlines again in 2017 when three University of Oregon football players were hospitalized—one with rhabdomyolysis—after intense workouts. Usually, rhabdomyolysis is rare and occurs in isolation in athletes, although other reports of teams being affected do exist. Rhabdo on the Rise The reason exercise-induced cases of rhabdomyolysis seem to be popping up more is likely because of the popularity of super-intense, leave-everything-on-the-gym-floor workouts. Unlike the small amount of muscle damage that occurs when you exercise within your physical limits—the repair is what makes you stronger—exerting yourself too much really breaks down the muscle and allows the myoglobin to get into your system. Who's at Risk for Rhabdomyolysis Uncommon genetic conditions may cause some people to be more susceptible to the affliction. Two such conditions are sickle cell trait (a blood disorder), and glycogen storage disease, in which a missing enzyme renders your body unable to efficiently store and release glucose for energy. Even so, a team cluster would suggest some common "environmental" co-factor with exercise. A medical review of the condition suggests a range of prescription, over-the-counter, and illicit drugs are associated with rhabdomyolysis, including alcohol, cocaine, caffeine, amphetamines, MDMA, and medications such as salicylates, neuroleptics, quinine, corticosteroids, statins, theophylline, cyclic antidepressants, SSRIs, and others. In a report published about the Iowa cluster, researchers found the likelihood of rhabdomyolysis increased with the speed and intensity of the workout. Players were more at risk if they forced themselves to go to muscle failure, which refers to exercising to the point where a muscle is unable to perform another repetition. It was noted that the positions the students played factored into it, and it was likely they were not yet fully trained at the time of the incident. Nutrition also seems to play a role since players who'd had more protein shakes before the extreme workout had a decreased risk in this incident. Treatment Rhabdomyolysis requires immediate medical attention, and people who have the condition are usually hospitalized. Treatment involves giving intravenous fluids to flush the myoglobin through the system, rehydrate the body, and prevent kidney failure. Rapid response is critical: If treatment isn't started quickly, injury to the kidneys can be permanent. How to Prevent Exertional Rhabdomyolysis Short of knowing that you have a genetic condition that may make you more susceptible to the condition, employing these training tips should substantially reduce the risk of rhabdomyolysis. Progress gradually in your workout program according to your existing fitness, whether it's cardio, circuit, or weights. Monitor your fluid intake, particularly when your workout is long, intense, or hot, and especially all three together. The risk of rhabdomyolysis increases with dehydration. That said, don't go overboard; more fluid is not necessarily better. Don't exercise hard on low-calorie diets or after long fasting periods. Ensure you have sufficient fuel onboard to allow your muscles to work efficiently. Be careful of low-carb diets mixed with hard and long exercise. Limit recreational drugs like alcohol before exercise, and don't take illicit recreational or performance-enhancing drugs. Be cautious of genuine over-the-counter needs like anti-inflammatory drugs and check with your doctor about prescription drugs. Rhabdomyolysis may develop in response to certain medications, but that's uncommon. Was this page helpful? Thanks for your feedback! Get exercise tips to make your workouts less work and more fun. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. DeFilippis, BA, et al. Spinning-induced Rhabdomyolysis and the Risk of Compartment Syndrome and Acute Kidney Injury: Two Cases and a Review of the Literature. Sports Health. 2014 Jul; 6(4): 333–335. Hohenegger, Martin. Drug-induced rhabdomyolysis. Curr Opin Pharmacol. 2012 Jun; 12(3): 335–339. Lozowska D., Liewluck T., Quan D., Ringel S.P. Exertional rhabdomyolysis associated with high-intensity exercise. Muscle Nerve. 2015;52:1134–1135. Mayo Clinic News Network. Variety of Causes Can Be at Root of Rhabdomyolysis. Smoot MK, Amendola A, Cramer E, Doyle C, Kregel KC, Chiang HY, Cavanaugh JE, Herwaldt LA. A Cluster of Exertional Rhabdomyolysis Affecting a Division I Football Team. Clin J Sport Med. 2013 Sep;23(5):365-72.