As the guy whose been almost single-handedly educating the American public about rhabdomyolysis (rhabdo) for over a decade – AND the author of the first book ever written on rhabdo and exercise – it's safe to say, I get a lot of questions about this medical condition. But no question is more common than “Do I have rhabdo or is it muscle soreness?” This makes sense because both rhabdo and Delayed Muscle Soreness (DOMS) have some things in common. If you've been searching for whether you have DOMS or rhabdo, you have come to the right place. I'm going to answer that question now.
Other Rhabdo Posts
- Can you have a mild case of rhabdo
- Can spinning cause rhabdo
- Interview: This woman got rhabdo from spinning class
- Can you die from rhabdo
- Rhabdo and personal trainers
- 5 reasons rhabdo happens in the gym
- Podcast: Rhabdo Genetics
- Podcast: Rhabdo Myths Exposed
What Is DOMS?
Delayed Onset Muscle Soreness (DOMS) is the feeling of pain and discomfort we've all felt at one time or another. Delayed muscle soreness usually shows up a day or two after exercise or other physical activity and it's especially common with activities that are harder /more intense than usual or activities we have not done before or not done in a long time.
While the exact cause of DOMS is a mystery, much of the pain is the result of eccentric muscle actions (“negatives“) which occur as the muscle is lengthened. An example, of this, is lowering a dumbbell during a biceps curl.
While DOMS may hurt – and hurt a lot – it is not serious and should start to feel better after 3-4 days. Muscle soreness should be mostly better after about 5 days.
What Is Rhabdo?
Rhabdomyolysis -like regular muscle soreness (DOMS)- also occurs after performing lots of unfamiliar activities. This can be workout-related or non-workout related activities such as household chores or gardening. Activities which cause rhabdo are also rhythmic in nature. In other words, activities where the same movement pattern occurs over and over again. For example, doing 10 sets of biceps curls or taking an indoor cycling class or painting a room.
Also like DOMS, rhabdo has a connection to eccentric muscle actions too (negatives). All that said, there are some differences between rhabdo and muscle soreness and these differences can help you tell them apart.
Rhabdo vs. DOMS: The Differences
While both rhabdomyolysis and DOMS share things in common, there are some key differences that most overlook. They are:
- The pain starts to hurt quicker than DOMS
- Rhabdo pain hurts when you are not moving
Let's address each of these in more detail next.
Video: The Difference Between Rhabdo And DOMS
Here's a quick video I created to help you tell the difference between rhabdo and muscle soreness
Rhabdo Pain Occurs Quicker
While delayed muscle soreness (DOMS) usually occurs 24-48 hours after exercise, rhabdomyolysis pain can begin almost immediately after someone ceases the activity. Sometimes however the pain can take up to 24 hours before it kicks in.
The pain progressively gets worse as the hours' tick by. So, the pain may be much worse 8 hours later. This is why it's important to not wait before going to the hospital if you think you have rhabdomyolysis.
Over the years, I've received emails from people who waited until after 1 am before they decided to start researching what was causing their pain on the web. By that time, everyone else was asleep and they were embarrassed to call for help.
Please don't be that person.
Rhabdo Pain Hurts When You're Not Moving
My Rhabdo Book
For me, this is the key difference between rhabdo and DOMS. Regular, delayed muscle soreness, does not hurt when you remain stationary. You only feel pain when you move or press on the area. The muscle pain from rhabdomyolysis hurts even when you are not moving.
So if you're reading these words and think you have rhabdo, sit where you are and don’t move. Do you feel pain now? If no, it's probably DOMS. If you do feel pain, it may be something else.
Obviously, this simple test does not tell us if something else is going on like a strain or sprain. But, if you remember, that pain and discomfort felt when you are not moving is a sign of something other than DOMS, this arms you with more information that can help you make a choice whether or not it's muscle soreness or not.
What About Dark Urine Color?
Many people these days discuss how rhabdomyolysis is accompanied by a change in the color of the urine. The urine is darker than normal and described as looking like ice tea or cola-colored (think Pepsi or Doctor Pepper or Coke-a-Cola). While this is often true, do not use urine color change as a visual sign of rhabdo. This is because many people with the disorder have normal-looking urine.
The pee test doesn't always work. So, you can still have rhabdomyolysis even if your urine appears normal-looking.
Do I have Rhabdo?
OK, let's sum this up. If I were with you right now and you told me you thought you had rhabdomyolysis, these would be the questions I'd ask you:
1 Did you recently do an exercise or activity (workout, gardening, painting the house, etc.) you had not done before or done in a long time?
2 Do your muscles hurt when you are NOT moving?
If the answer is yes to those 2 questions, I'd suspect you might have rhabdo. At that point, I might also ask you how your pee looked but even if you told me your urine looked yellow or looked normal, I might still suspect it from too much exercise/ activity.
The fact you are having muscle pain when not moving isn't normal. I'd recommend someone take you to the ER and if nobody was available, call 911.
Why Do I Suggest Calling 911?
There are two reasons I suggest calling 911 if you think you have rhabdomyolysis:
1. Because by now you are probably freaking out over everything you've read on the internet about how bad this can be. Because you are not thinking normally, it's possible you might have a car accident as you raced to the hospital.
2. Rhabdomyolysis can be serious in some cases. Sometimes it can even impact how your heart works. I would not want you passing out while driving.
I'm admittedly a worst-case scenario kind-of-guy when it comes to stuff like this. I like to try to look down the road and try to minimize bad things happening before they occur. This is why I'm suggesting having someone drive you to the hospital or call 911.
Will I Be Ok After Rhabdo?
Rhabdomyolysis is a serious condition and yes, some have died from its complications – but most don't, so that's good. While many people may recover from rhabdo on their own, you can't know how bad you have it until you get medical attention. While the odds are good you will recover, remember this is your body – the only body you will have. You exercise to keep it healthy. In cases of over-exertion, think of getting medical attention as another way you are keeping your body in tip-top working condition.
I really hope this helps.
Thank you for having these resources (articles and videos) available. I have read and listened to them over and over again over the course of the last few days.
While I stuck with intense hydration for the first two days and urine remained normal – your info on pain without movement prompted me to get labs.
With a CPK of 38,000 and elevated liver enzymes I am glad I went to get treatment.
Now I am here to follow the info on returning to work outs – because you are right – it feels pretty scary.
Thanks for having this info out there!
Thanks so much for sharing, Colleen. I’m so glad I was able to help. I hope you have a speedy recovery and that rhabdo soon becomes a distant memory.
How common is Rhabdo after deep massage? I got one yesterday for some tightness in my neck and shoulders. It was 30 min long, and the masseuses really leaned into some knots. This was my first massage of this type. Today I feel pretty sore in some spots, but only when I move or rub the area. Urine seems to be normal so far.
Hi Scott, while there are some reports of massage causing rhabdo, those reports also make it difficult to know for sure if it was indeed the massage that caused it. If I remember (Id have to look back into my rhabdo book), in one report, a man got a 2 hr massage from a therapiest he had not used previously. I believe he also fell before the massage.
Its normal to feel sore after a deep massage. The fact that you say you only feel sore when you press or move the area makes me think it may be normal muscle sorness. Obviously if your symptoms get worse see your doctor.
Thanks so much for this very helpful article. I spent an hour and a half squatting and crouching around in the shallow end of the pool with my toddler grandson. Who would have thought I’d get so sore afterwards???
So now i know: yes, that’s exercise! And it doesn’t bother my hip or my shoulder! I’m going to take up water walking and toddler play–in smaller doses. (Age 76)
Rae, Im glad this helped you and while Im sure you are sore now, it was worth it to play with your grandson 🙂
Hello! I would like to know your opinion whether or not I have rhabdo. So I exercised my arms after 2 months break. the next day I got pain in both my arms. The second day after exercise however, my left arm recovered completely and my right arm hurts when I move it to its extremities. Applying heat reduces the pain for me and I don’t have a constant pain. Moreover, moving my arm eases the pain. Regarding urine color, I have transparent urine but, In morning, just after waking up, I get dark yellow urine.
Hi Jonathan, I always think it’s best to get checked out by a doctor who can perform a blood test. Based on what you said it doesn’t sound like you have rhabdo but I cannot say that with certainty since I’m not a doctor and cant perform medical tests on you. Not everyone with rhabdo has dark-colored urine so its not always the best indicator. Do you see any swelling in your arms?
How many sets and exercises of arm exercises did you do?
Hi, I just got back at the gym last 2 days and I had a leg workout, I was off for a year and a half. I felt pain in my thighs at rest and it was cramps, the next day I feel a little better but I still can’t walk properly. Should I go see a doctor?
That’s what I’d suggest. At least it will give you peace of mind. After a year of not working out, remember you are a novice. Your muscles have atrophied. As such, I would not focus on working just one body part like legs, arms, chest etc. At the least all that emphasis on one area of the body will cause a lot of muscle soreness. I hope you are feeling better today. keep me posted on how things go.
I had rhabdo back in January of 2019. Happened after an extreme leg day workout with a buddy who is much more fit and stronger than I am. I tried to keep up with him despite feeling progressive pain throughout the workout. By the end, I could barely walk out to my truck.
The next day, I felt severe pain in my thighs no matter how I tried to position my legs. By the second evening (~48 hours after the workout), I had the most excruciating pain I have ever felt in my thighs, I could barely even bend my knees, and my urine looked like a cup of tea. Went to the ER, my CK levels were so high the labs could not even read it. Their test maxed out at 40,000 units, mine was over that amount.
I was admitted to the hospital and immediately put on IV fluids along with orders to push water and electrolyte drinks constantly. It took 5 days in the hospital for my CK level to drop to 20,000 and they finally let me leave when it got below 5,000.
They were worried about the increased fluids causing other problems, and were even considering dialysis at one point. Luckily I did not have difficulty urinating, so I was able to continually flush the liquids out.
All in all, it was the worst pain and experience of my life, even worse than a TIA (mini-stroke) I experienced at 20 years old. Now I suffer from exercise anxiety because every time I feel any soreness I immediately begin worrying that it might be rhabdo.
David, I think its common to feel anxious about exercise after going through rhabdo. Ive heard others say the same thing. The pain has also been described as intense. One women I know described rhabdo pain as feeling like her muscles were being put through a meat grinder. Here is my podcast interview with her
One of my rules is pain felt when you are not moving is not normal. Its not normal to be in pain. So any out of the blue pain you feel when your not moving – esp intense pain -should be checked out by a doctor. Hopefully you are fully recovered from rhabdo and that you never experience it again.
Hi Joe. Firstly just want to say I’ve found your website very helpful and informative.
I had rhabdo 6 months ago after a particularly gruelling workout. Do you know much about people getting rhabdo a second time? Are people more prone to it after having it once?
I haven’t trained properly since my rhabdo and cancelled my gym membership after I left the hospital, and am now terrified I might get it again! Do you have any other tips? I know I should stop exercising immediately if I get pain but how do I balance a tough training session with maintaining optimum health (i.e. not getting rhabdo again!)?
Hi Jess, sorry to hear you canceled your gym membership. One thing Id say is to progress slowly. Dont start by doing 3 sets of an exercise. start with 1 set. Also, you dont need to go heavy either. increase the reps you can do before you increase the weight. Also, remember rhabdo often hurts when you are not moving. this is different than regular muscle soreness which doesn’t hurt until you move.
Here is my review of exercise muscle sorneness for more info
Jim,
I recently got rhabdo from working out and spent four days in the hospital. My urine color was never the slightest bit dark or any different than what it normally looks like. There was no abdominal pain as you state there would be either. Had i not gone to the hospital, my kidneys may have been permanently damaged, so it’s not something to be taken lightly.
Since then, I’ve had many conversations with people in the fitness world and am finding rhabdo may not be as rare as some believe it is and many times it just goes undiagnosed. The information Joe Cannon provides on his site was incredibly helpful to me and he does know what he’s talking about.
Amy thanks for taking the time to reach out to Jim. For everyone reading this Amy’s interview whcih details how she got rhabdomyolysis will be posted on this site later today. I’ll circle back and link to it here so you can read it.
This video is complete bullshit and this guy is a complete moron. If your are sore after a workout not moving this is not rhabdo!!! Rhabdo is extremely rare and you would need to really work the muscle out to the point you can almost not contract the muscle. Extreme stiffness and pain after And if you have rhabdo your pee will not look normal at all! It will be tea colored and most likely serious abdominal pain.
Please dont go running to the hospital cause your sore being idle after a workout, dont waste your time or money. And again rhabdo is extremely rare . Do drink water throught the day filter out the myoglobin. But youll be fine im sure its not rhabdo.
Jim, Don’t attack who you don’t agree with. That said, you bring up some interesting points that I want to correct that should help others:
1. Rhabdo CAN happen even after exercise/activity that is NOT “extreme.” I’ve met those people. Some have gotten it from gardening and painting a room. It’s not just extreme / intense exercise that can cause rhabdo. There’s no debate on this fact.
2. DOMS hurts when you are not moving. Pain felt at rest is not normal. This is why I used pain at rest as a possible sign of rhabdo. It could also mean something else but if you feel pain when you are not moving, it’s a quick way to tell that its NOT just muscle soreness. It’s something atypical. Since most people cant differentiate between DOMS and rhabdo, this is a quick assessment tool. While this is not fool proof-I’ve encountered people who were not sore but still had rhabdo. Generally, people tend to report to me they are sore when they are not moving.
3. Rhabdo is probably very rare. Most people will not get it. But, rare or not, that’s little consolation to those in the hospital with rhabdo. I’ve get their emails and seen their social media posts almost daily. I cant say how rare it is because I have not seen any recent statistics for the general population. Some studies mention a statistic of about 26,000 cases per year but that stat seems to date to the 1990s.
4. Rhabdo does NOT ONLY impact the kidney. You are 100% wrong about this. It can cause heart attacks and liver failure. It can increase swelling in the limbs that may require surgery fix. Drinking water will NOT solve the these other issues. Water does not stop muscle fiber death, which is what rhabdo is.
In theory, drinking too much water could induce hyponatremia, which can be just as serious as rhabdo.
5. Not everybody with rhabdo gets dark colored looking urine. This is a common rhabdo myth.
Rhabdo is getting a lot of attention by the news-media these days. While I dont want a rhabdo-hysteria to occur, I also dont want people to suffer in silence. The safest course of action is to get checked out by a physician and not listening to anyone online whether it be you or me.
Will massage help? I answered yes to both questions.
Desiree, there are different kinds of massage. There is at least 1 report of massage causing rhabdo. I do think the odds depend on the kind of massage someone has (deep tissue vs Reiki for example). That said if you have rhabdo, I would not recommend massage. Massage causes muscle damage and this could compound the muscle damage you already have with rhabdo. In the past, some who had rhabdo -and got a massage -told me it made things worse.
Have you gone to the hospital yet to get checked out?
Hi Joe,
Thanks for this. I’m newbie to exercise and I’m scared i might have Rhabdo.
After a day in the gym, i started feeling muscle pains.
1. I DON’T FEEL PAIN UNLESS I MOVE MY BODY, ESPECIALLY MY ABDOMEN.
2. Gat a brown urine, but always Normal when i take lots of water.
What do you think?
Hi Mike, did you say you DO have brown urine?
how many sets of exercises are you doing? Since you stated you are a newbie, you only need 1 set per exercise for at least the first 3 months.You don’t need to do leg day or chest day or 3 sets of any exercise.