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. Also see my review of mild case of rhabdo and spinning and rhabdo.
What Is DOMS?
Delayed Onset Muscle Soreness (DOMS) is the feeling of pain and discomfort we've all felt at one time or anther. 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?
Rhabdo-like DOMS – also occurs after performing unfamiliar activities. This can be workout-related or non-workout related activities such as household chores or gardening. Activities which cause rhabdo are also rhytymic in nature. In other words, activities where the same movement pattern is 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 rhabdo and DOMS share things in common, there are some key differences which most overlook. They are:
- Rhabdo pain starts to hurt quicker than DOMS
- Rhabdo pain hurts when you are not moving
Lets 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, rhabdo pain can begin almost immediately after someone ceases the activity. So if you stop your exercise or activity and start feeling muscle pain/sore within minutes, it may be rhabdo. Sometimes however the pain can take up to 24 hours before it kicks in.
The pain is a slow burn; in other words, it 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 1 am before they decided to start researching 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
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 rhabdo hurts even when you are motionless. 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 rhabdo.
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 Rhabdo Urine Color?
Many people these days discuss how rhabdo is accompanied by a change in the color of the urine. The urine is darker than normal and described as looking like 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 visual sign of rhabdo. This is because many people with rhabdo and have perfectly normal looking urine.
The rhabdo pee test doesn't always work. So, you can still have rhabdomyolysis even if your urine appears normal looking. I agree however, if your pee does look darker than normal, you may have rhabdo.
Do I have Rhabdo?
OK, lets sum this up. If I were with you right now and you told me you through 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 rhabdo 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, I'd call 911.
Why Do I Recommend Calling 911?
There are two reasons I recommend calling 911 if you think you have rhabdo:
1. Because by now you are probably freaking out over all the stuff you've read on the internet about how bad rhabdo can be. Because you are not thinking normally, it's possible you might have a car accident as you raced to the hospital.
2. Rhabdo 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 worse 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 recommencing having someone drive you to the hospital or calling 911.
Will I Be Ok After Rhabdo?
Rhabdo 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.