Do I have Rhabdo? How Can I Tell If I have Rhabdomyolysis?

Updated September 22 2024. How can you tell if you have rhabdomyolysis (rhabdo)? I believe you have come to the right place if you're looking for answers. For over a decade, I've been educating people about rhabdomyolysis caused by exercise (exertional causes). I wrote the first book on this serious medical disorder and have counseled more people over the years than I ever thought when I started this journey. If you think you have rhabdo now or are wondering about what your rhabdomyolysis treatment will be, let me try to help by telling you about the symptoms you may or may not be experiencing and what I think is the best course of action.

Check Your Rhabdo Symptoms

Most people begin their search for whether or not they have rhabdomyolysis by looking for symptoms. Let's start by checking if you have the classic symptoms: reddish-brown urine (think tea-colored), really bad muscle pain, and weakness.

While these are often called classic symptoms, you should know not everybody gets experiences them.

You May Not Have The Classic Symptoms

If you are searching for rhabdomyolysis answers, you may have heard about the classic 3 symptoms, sometimes called the “triad:”

1. dark-colored urine
2. muscle weakness
3. intense muscle pain

You may have also heard about kidney failure too. While these are all signs of rhabdomyolysis from too much exercise, you need to know that not everybody experiences these well-known symptoms. Over the years I've heard from many who did have ANY of these problems.  So, you should not base if you have it or not on these symptoms.

One possible way that may help you is to remember that regular muscle soreness doesn't when you are not moving. This is different from rhabdo-related pain which may hurt even when you are at rest.

Rhabdomyolysis Non-Classic Symptoms

Now that we've pointed out that not everyone has the symptoms most have heard about, it's good to remember you may have symptoms most people have not considered. For example, you  may have non-typical symptoms such as:

• muscle bruising
• fever
• feeling tired/muscle weakness
• irregular heartbeats
• vomiting
• muscle stiffness/cant bend or extend limbs
• muscle swelling
• liver problems/liver failure (elevation of liver enzymes)

Do you have any of these problems?

I've seen muscle bruising in the upper arms in people who performed hundreds of biceps curls. The bruising is likely the result of burst blood vessels from the trauma of too much exertion.

Can Rhabdomyolysis Affect Your Heart?

Heartbeat irregularities occur when the heart does not beat normally. You may notice your heart racing or what feels like skipped heartbeats. This is due to imbalances in salts like sodium, potassium, and calcium in the blood.  These salts (also called electrolytes) are minerals and they are also found inside muscles.

Rhabdo causes muscle fiber breakdown. This allows the electrolytes (salts/minerals) in your muscles to enter the blood. When this happens, they can alter the way the heart works. This can be pretty serious in some cases. While rare, rhabdo can cause heart attacks.

Rhabdo and Dark-Colored Urine: Not Always True

This is the most infamous rhabdomyolysis symptom that you may have heard about. Someone with rhabdomyolysis may notice that their urine looks dark brown or reddish-brown. The urine can also look lighter than this. The darkness of the urine is related to how much muscle damage has occurred.

It takes about 3.5 ounces (100 grams) of muscle loss to see a visible change in urine color. The darker the urine, the more muscle damage.

While it's scary to see dark urine in the toilet, it's important to know that you can still have rhabdo even if your urine looks “normal color.” This is why dark urine should not be used as a litmus test for rhabdo. It doesn't always happen.

But if your urine does change color it may mean you have rhabdomyolysis. But, the cure is not to stay home and drink lots of water as some so-called internet “experts” may say. Why is that?

Drinking Water Doesn't Prevent Rhabdomyolysis

Rhabdo can cause kidney failure. Because of this, some mistakingly believe drinking lots of water will prevent rhabdo or help it go away. However, drinking water will not stop muscle fiber destruction. Staying hydrated does not address the other issues that can also occur, like muscle swelling, pain and issues related to your heart.

The public puts too much emphasis on drinking water as protection against getting rhabdo.  The idea that drinking water prevents rhabdo is not only shortsighted, but it can also have a bad side effect.

If your kidneys are damaged, they may not be able to excrete that extra water you are drinking. This can cause fluids to build up in the body, leading to hyponatremia. Hyponatremia, also called water intoxication, happens when electrolytes in the body are diluted too much. Hyponatremia can be just as serious as rhabdomyolysis. Ironically, hyponatremia can also cause rhabdomyolysis.

How To Tell If You Have Rhabdomyolysis

As you can guess by now, determining on your own if you have rhabdo is not always easy.  So, if you don't have the dark urine sign, how do you know?  Generally, if I suspect someone may have rhabdomyolysis, I will ask them these questions:

1. Did you recently -in the last 1-3 days – do an exercise or activity that you had not done before or was more intense than usual? For example, did you take a new exercise class? Or, did you recently get a personal trainer for the first time?
2. Do you feel pain when you are not moving?

If the answer to #1 is yes and you are feeling “not like yourself,” I might start to suspect you may have it. If you also say you are in pain when you are not moving, then this might also be a sign. Regular muscle soreness after exercise does not hurt until you move. When people have rhabdo, they often – but not always – experience pain at rest.

So, Do You Have Rhabdo?

I've studied rhabdomyolysis for over 10 years. The best advice I can give you is to go to the hospital and get checked out by a doctor. That's the only way to know for sure. One test a doctor will do is measure your creatine kinase (CK) levels. Creatine kinase is an enzyme that goes up with muscle damage. Generally, a CK level that's five times higher than normal can indicate rhabdomyolysis.

Doctors will also measure your liver enzymes, such as AST and ALT. Elevated liver enzymes can also be a telltale sign. These “liver enzymes” are also present in your muscles. So, as muscles break down, these enzymes enter the blood. However, rhabdo can cause direct side effects on the liver, too, due to inflammation and free radical damage. Myoglobin may also be toxic to liver cells too.

For more, see episode 34 of my podcast. Tests like these can quickly tell you if you have it or not.

I know this may not be the answer you may be looking for, but I think it the best answer. I think getting checked out by a doctor is better than sitting home alone, suffering, not knowing what's happening, and searching the internet for answers. Rhabdomyolysis is weird because not everyone will have the same signs or symptoms. The only way to know for sure is to get checked out by a doctor.

I hope this helps you.

More Information

• Is it Muscle Soreness or Rhabdo?
• Mild Case of Rhabdo? Fact or Fiction?
• Rhabdomyolysis Myths
• Rhabdo videos

Do You Have Any Questions?