How to Protect Yourself From Rhabdomyolysis

Rhabdomyolysis is a painful and potentially dangerous muscle condition, with rapid breakdown of the muscles. It can strike athletes and exercisers during or after extreme exertion, especially when exercising in high temperatures. It can make headlines when it strikes student athletes, but you should be aware of it for your workouts as well.

What Are the Symptoms of Rhabdomyolysis?

Symptoms of rhabdomyolysis include tea-colored urine, muscle weakness, 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, thirteen Iowa football players were hospitalized and diagnosed with rhabdomyolysis after a tough pre-season workout of 100 back squats. All recovered and were discharged, but an inquiry is underway to identify the practices that lead to such a mass effect. Usually, rhabdomyolysis is rare and occurs in isolation in athletes, although other reports of teams being affected do exist.

Who Is 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 recent 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 paper published about the Iowa cluster, they found increased likelihood of rhabdomyolysis with percent bodyweight lifted, number of sets and time needed to complete 100 back squats. They were more at risk if they forced themselves to go to muscle failure. It was noted that the positions the students played factored into it, and it was likely that they were not yet fully trained at the time of the incident. Interestingly, those who had more protein shakes before the extreme workout had a decreased risk in this incident.

How to Prevent Exertional Rhabdomyolysis

Short of knowing that you have a genetic condition that may increase your risk, here are several training tips that should substantially reduce the risk of rhabdomyolysis.

1. Progress gradually in your workout program according to your existing fitness, whether it's cardio, circuit or weights.
2. Monitor your fluid intake, particularly when your workout is long, intense or hot, especially all three together. But don't go overboard; more fluid is not necessarily better.
3. Don't exercise hard on low-calorie diets or after long fasting periods. Ensure you have sufficient fuel on board to allow your muscles to work efficiently. Be careful of low-carb diets mixed with hard and long exercise.

1. 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. Most will probably be okay.

_Source:

_{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. doi: 10.1097/JSM.0b013e3182914fe2.}