Rhabdomyolysis and Exercise
Rhabdomyolysis and Personal Training Facts You Need To Know
Rhabdomyolysis is a condition that results in the death of your muscle cells from a stress (like exercise) that overwhelms the body's ability to adapt. The muscle cells rupture and release their cellular contents into the blood. This not only can be dangerous, it can be deadly.
Rhabdomyolysis means “skeletal muscle fiber death” and can occur following a variety of scenarios ranging from car crashes, snake bites, anexorea nervosa, and weight loss supplements. Too much exercise is also known to induce rhabdomyolysis. When exercise causes the disorder, it's called exertional rhabdomyolysis.
Rhabdomyolysis was relegated to extreme physical exertions like military training, police academy and firefighter training, or other very demanding situations. In recent years however rhabdo has – unfortunately – also been documented in those who exercise in the gym.
Exertional (exercise induced) rhabdomyolysis, this form of the disorder occurs when people increase the intensity of exercise too quickly. This overwhelms the body's ability to adapt and can happen after only 1 workout. Anyone can get rhabdomyolysis, but some people might be more susceptible to rhabdo from exercise than others. Rhabdo can happen after just 1 workout. This is not something that takes days or weeks to show up. Case reports do exist of it occurring after too many intense workouts too close together, without adequate rest. That said, I believe most cases show up after 1 intense workout that overwhelms the body.
Rhabdomyolysis Signs And Symptoms
While doctors can easily diagnose rhabdomyolysis with a blood test, some of the physical signs and symptoms of rhabdo include:
Heart attack
kidney failure
severe muscle pain / swelling/ weakness/fatigue
dark color urine – think dark brown “coke” color
These symptoms highlight the seriousness of rhabdomyolysis. As the kidneys stop working, there are alterations in electrolytes which can cause heart rhythm abnormalities and heart attacks. The dark color urine is caused by myoglobin in the urine. Myoglobin helps transport oxygen in the muscle cell. This is good however too much can damage the kidneys. This can cause the person to need dialysis in an attempt to help the kidneys recover.
The pain of rhabdomyolysis happens fast – immediately after exercise, up to 24 hours later. This pain happens more rapidly than delayed muscle soreness (DOMS) which typically happens 24-72 hours after exercise. Also, the muscle pain hurts when people are not moving. Remembering this sign – as well as dark urine color – can sometimes help you identify rhabdo.
Ibuprofen
Some people take pain killers – like aspirin or Advil (Ibuprofen) to alleviate muscle soreness but people need to understand that because these pain killers can affect how the kidneys work, using pain killers may increase the chances of rhabdomyolysis occurring. If you think you have rhabdo it's safest to get to the ER rather than take over-the-counter pain killer medications.
Swelling
After exercise, you should never see swelling in your arms or legs as this can also be a sign of rhabdomyolysis. With tissue injury, fluid flows into the damaged limbs. This increases the pressure in the limbs which can cut off the circulation, resulting in further tissue death, then releasing even more kidney-damaging cellular contents into the blood stream. This is sometimes called compartment syndrome.
Water Intake
Drinking water helps reduce the chances of the kidneys from shutting down. Being dehydrated can make rhabdo worse or increase the chances of it happening. Drinking water will not stop muscle fiber death from too much exercise. While the water may reduce the severity of rhabdo, it won't stop rhabdo-induced muscle fiber death. Exercising is healthy but if you are working out so hard that your muscle fibers are dying, are you not being healthy.
Eccentric work (Negatives)
One aspect of rhabdomyolysis and exercise is its relationship to eccentric muscle actions (“negatives“). Negatives put more stress on the muscle and cause more muscle damage, hence their connection to rhabdo. Exercises that involve lots of negatives (like plyometrics) have a greater chance of causing rhabdomyolysis.
Eccentric muscle actions (negatives) do result in greater strength and elevations of resting metabolic rate. But, performing intense exercises that involve a lot of negatives in someone who is not used to – or increasing the intensity of the workout too fast can be a recipe for disaster. Focus on the volume of exercise you are doing, rather than how many negatives you are doing.
How To Reduce The Risk?
The easiest way to reduce the risk of exercise-induced rhabdomyolysis is to introduce exercise slowly and give the body time to adapt between workout sessions. Having a beginner in an advanced boot camp class and on the first day, doing 250 lunges, crunches and squats is a recipe for rhabdomyolysis.
The easiest way to reduce the risk of rhabdo is to not overload the person with too much exercise. When exercising, one way to achieve this is to follow this rule:
First increase the reps you can do
Then increase the sets you can do
Then increase the weight you can lift
For example, when you can do 1 set of 15 reps, then do 2 sets of 15 reps. Then do 3 sets of 15 reps. After that, then try increasing the weight you can lift by a little bit (5-10 pounds for example). By increasing the weight, this should decrease the reps you can do. So again, start at one set and progress to 3 sets, before increasing the weight again.
In this progression, you are giving the body the time it needs to adapt to the exercise. The fact is that any extreme workout or other intense exercise routines can cause rhabdomyolysis. If you are going to take part in any boot camp-type fitness program, start with only 1 session per week. Start with 1 session per week for the first week or two. Then 2x per week in the second or 3rd week and so on.
Remember, the body needs time to adapt to intense exercise.
When we remember what rhabdo is – muscle fiber death – I don't think there is such a thing as a “mild case.” Once those muscle fibers die, they dont grow back.
All personal trainers and group fitness instructors need to be aware of rhabdomyolysis and work to reduce its risk. ANY personal trainer or other individual who doesn't know what he / she is doing can accidentally cause this disorder. Reducing exercise-induced rhabdomyolysis is best done by considering the health of the person and by slowly increasing exercise intensity and frequency where appropriate, and knowing that no single exercise routine or program is best for everybody.