How to Protect Yourself From Rhabdomyolysis

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.

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 experience profound dehydration, which can quickly lead to full-blown rhabdomyolysis.

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.

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.

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.

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.

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.

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.

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.

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, and especially all three together. The risk of rhabdomyolysis increases with dehydration. That said, 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.
4. 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.