Rhabdo, also known as rhabdomyolysis, is a topic I've devoted over 10 years of my life investigating. Over the years, I've lectured to thousands of people – even NASA – spoken to sufferers in and out of the hospital and I'm also the author of the first book on this topic too. While the side effects from this condition can be quite serious, one question I've been asked several times is whether or not someone can have a “mild case” of rhabdo. Is it possible? If you are wondering if you have a mild case or not, let's see if I can help answer your question.
Additional Rhabdo Reviews
- Spinning and rhabdomyolysis
- Interview: She got rhabdo from spinning class
- 5 reasons rhabdo occurs in the gym
- Fitness trainers causing rhabdo
- Is it Rhabdo or Muscle Soreness?
- Can You Die From Rhabdo?
- Do Creatine supplements cause rhabdomyolysis
- Non-typical symptoms of rhabdomyolysis
- My Interview on the GymWitts Podcast
- Podcast: Rhabdo Genetic Traits
- Podcast: Rhabdo Myths Exposed
- Arrested With Rhabdo (podcast)
What Is Rhabdomyolysis?
Rhabdomyolysis (rab-doe-my-oh-lie-sis) refers to skeletal muscle fiber death. When the muscles die, the contents inside of those muscle cells get into the bloodstream. Because some of the things in muscle cells should not be present in the blood in high concentrations, their presence can lead to some very serious outcomes just a few of which can include:
- Heart rhythm changes (ex: skipping beats/heart attack)
- Intense muscle pain
- Swelling of the muscles
- Loss of feeling in body limbs
- Amputation
- Dark-colored urine
- Kidney failure
- Liver failure
As you may be aware some of these side effects are serious and require medical attention. Sometimes dialysis and even surgery are required.
Who Asks If They Have A Mild Case Of Rhabdo?
The people who have asked me this question in the past often to fall into the following categories:
- Those wondering if they have rhabdo or just muscle soreness (DOMS)
- Those who think they have the condition and wondering if they need to go to the hospital
Is It Rhabdo Or Muscle Soreness?
Both rhabdo and delayed muscle soreness (DOMS) share in common the fact that both usually follow doing exercise or activities you are not used to doing. If you do enough unfamiliar activities, it increases the risk of both conditions. It's also important to know that the activity/exercise does not have to be hard-core either.
When someone tells me they think they have rhabdo, the first question I ask them is “do your muscles hurt when you are not moving?” Because regular muscle soreness (DOMS) doesn't hurt until you move, if you do have muscle pain when stationary, that is a sign it's not muscle soreness.
It might be something more serious than DOMS.
The pain often starts relatively soon after exercise stops and gets worse as the hours go by. How bad can the pain get? One women I know once told me her pain was worse than giving birth to 3 kids!
Another difference between the two conditions is that normal delayed muscle soreness often shows up 24-48 hours after exercise. Rhabdomyolysis pain often -but not always -pops up quicker, sometimes within an hour or so after exercise stops.
So, if you do have muscle pain when you are not moving – and the pain started pretty quickly after exercise -that could be a sign it's not normal , delayed muscle soreness that we've all experienced from time to time.
Here's my video review on DOMS vs. rhabdomyolysis:
The Myth of Dark Colored Urine
By now, many people have heard about dark-colored urine is a sign of this condition. It's often described as looking reddish-brown, like ice tea or cola-colored. The dark color is the result of a component of your muscles (called myoglobin) being filtered through the kidneys. In reality, there is a spectrum of colors the urine can look. In other words, it doesn't have to look very dark.
But more than this, it's important to know that many people do NOT get dark-colored urine. It's possible to have rhabdo -and have a bad case of it – and have perfectly normal looking pee.
Read my book about rhabdomyolysis.
Trivia: if your urine has turned to a darker color, it means you've lost at least 3.5 oz (100g) of muscle.
I need to bring this up because dark-colored urine has been over-hyped on the internet and TV shows. I'd agree that if your urine does look dark, that's not a good sign; but if it's not dark-colored, that doesn't mean you're in the clear either.
Bottom line: Don't rely on the color of your pee when determining if you have rhabdo or not.
Video: The Biggest Rhabdo Myths
Here's a video I created to dispel the 5 biggest rhabdo myths
Rhabdo: Can It Really Be Mild?
If we remember that rhabdomyolysis literally means muscle fiber death, I don't know if I would call any case “mild.” That said, if you've previously had many of the symptoms described above but just bit the bullet, dealt with the pain and other issues, and never went to the hospital, then I guess one way of looking at is to say you had a mild case.
Personally, I'd say you just got lucky.
To be honest, I don't like calling any case of this serious medical condition mild. My fear is that a person who thinks they have rhabdo, jumps on the web to do research, finds one of those so-called experts, and talks themselves into thinking their case isn't serious. The only way to know for sure how bad your case might be is to go to the hospital and get checked out.
Any Questions or Comments?
Hello! thank you for writing this informative article.
I just learned about Rhabdo now, and I am extremely worried.
4 days ago, I went back to gym to try build muscles by lifting, after 3 years.
The other night, I noticed that the color of my urine looks like a soda. Initially, I thought it was because of the Protein Shake that I am taking, So I drank a lot of water to flush it out.
Yesterday afternoon, I got a clear urine but last night, the soda color urine was back.
I am still drinking a lot of water and occasionally getting some normal urine color.
The muscle sore I feel is on the chest area and elbow pit, which I think is pretty normal for someone who just got back to working out.
Other than that, I am not feeling other symptoms.
.
I’ll be stopping by the hospital first thing tomorrow to have my numbers checked.
So, I read that your recommended timeline for getting back to exercising is when all the symptoms are gone.
So in my case, if my lab number goes well, once the urine color have constantly cleared up and muscle soreness is gone, can I hit the gym back?
In the meantime, Is it safe doing some running?
Hi Jay, lets see what the hospital says after you get checked out. Also ask the doctor when he/she feels you can go back to working out again. Rhabdo effects more than your kidneys and it may take some time to feel better and that’s why you can’t always go by the color of your urine. You said you had not worked out in 3 years. If that is the case then you don’t need to workout hard in the gym to build muscle. Performing one set of an exercise is all you need. Your ligaments and tendons take longer to get stronger than your muscles. Lifting too much can lead to an injury like tennis elbow. Also it will take your brain and nervous system about 3 months to “remember” how to lift the weights property. You cant speed that up by doing more sets.
Since you have not worked out in a long time begin with walking before running. Its best to ease your body back into working out regularly. If it helps I cover returning to exercise after rhabdo in my book which you can get here and Ill mail it to you myself.
Hi Joe, so during my first laboratory test, My CK level was at 126,000 (normal range at 30-200) but kidney function was normal. Liver function though was 11x higher than the normal range.
Since kidney function was normal, my doctor didn’t seem too concerned and just told me to just continue drinking lots of water and further monitor my numbers thru repeat testing.
I have been tested twice after that and on the most recent test, my CK is at 400 and liver function is just 3x higher than the normal range, kidney function is consistent to be at normal range.
My doctor doesn’t think it’s Rhabdo since kidney function is normal and my CK and Liver function are on a downtrend track.
I’ve been told as well that I can already go back to lifting but I am still worried and decided to just wait another 2 weeks before going back.
I don’t feel anything unusual, and my urine’s color has been normal since March 04.
Hi Jay, when you say your liver function is higher, do you mean the liver enzymes? Liver enzymes sometimes go up with rhabdo because those same enzymes (they are called AST and ALT) are also found in muscle cells. While Im not a doctor, I’ve heard from people who had said their liver enzymes went up after a time when prior to that, they were normal. That said, several things can trigger elevation in liver enzymes (an infection can too). Why not wait a few more weeks before going back to the gym and until your liver enzymes/function is back to normal.
Hi Joe, thank you for the research and information you provide.
My 16 year old son was diagnosed with RABDO 2 weeks ago, he is In Season wrestling and has been lifting a lot. We were told it was a mild case. His urine was discolored and went to the ER. CK Levels were 350 and kidney function was fine. Post bloodwork 3 days later everything looked good and 1 week after the incident the Dr cleared him for return to wrestling and light/low rep lifting.
We talked with coaches and eased him back to practice during the week, with limited live wrestling the first couple days.
He wrestled his first match last night, it was a tough match, but my son looked exhausted (he did miss a week of practice), and afterward felt more exhausted than he ever has before.
He said he still feels somewhat weak, but he never had/doesn’t have muscle pain.
Is this something to have a higher level of concern about or would this be considered to be “normal” until he fully “recovered”.
Or do we pull him back out of practice/competition until strength comes back?
He will not be wrestling in a tournament this weekend, to help him recover a bit more.
Thank you,
Matt
Hi Matt, so sorry to hear about your son. When someone gets rhabdo, my suggestion is that before returning to exercise, one should be able to be free of all signs and symptoms and be able to perform normal daily activities (walking, going up stairs, shopping etc) without problems. I also often suggest taking at least a month off from exercise. It sounds to me like he went back to wrestling a bit to soon. I know it’s not what your son wants to hear but I’d suggest taking more time away from wrestling and working out.
Thank you for the response. There aren’t really any problems with any day to day activities. It is more or less, wrestling itself, lifting, more of the athletic activities. He has been sore/achy, and been getting therapy. He went from Football to Wrestling, along with lifting pretty hard, so in his world, his muscles are always kind of sore/achy.
Obviously the 1 month is a shocker. Is this all about feel? He has been in pretty good condition/shape. Any return to wrestling after a time off he is going to feel weak and not have stamina.
Thank you again for your help
Matt, The 1-month suggestion is just that, a suggestion rather based on hard science. While some may bounce back sooner, I’ve heard from others who told me it took longer than a month. Being an athlete I know he doesn’t want to take time off and yes, there will be some strength loss in that time. Look at whats worse – some strength/stamina loss or getting rhabdo again from pushing too much too soon? I know thats frustrating. I don’t think a week or so is enough time to fully recover. I guess you could all just play it by ear and take things day to day. I just would not like another flair-up. If he’s in therapy now that should help you all gauge how he’s progressing and when he could start back.
Joe, I want to thank you again for the advice. After a month of rest and recovery, my son got back to wrestling. It was quite the uphill battle getting back into shape and fighting off injuries, but in the end a successful season, capped off with a trip to the state tournament. I am not sure if we would have let him rush back that would have happened.
Thanks again.
Matt
Hey Matt, thank you for letting me know, and BIG congrats to your son for making the state tournament! Im so glad to learn he is doing well 🙂
Hi Joe,
I did the Murph last Monday, had swelling in my arms (outer elbow area) on Wednesday night and found it concerning. I googled it and found out about rhabdo. I went to the ER the next morning to be checked out. They said my CK levels were just under 3000 and gave me two bags of fluids and sent me home. The next day I had more blood work done and my numbers went up over 4000 and I also had elevated liver numbers as well.
My doctor didn’t seem too concerned and told me to continue drinking lots of water and that we would follow up in two weeks. My arms are feeling much better with still some soreness but I can use them pretty well now.
What is your advice as far as resuming exercise? Would I be safe to do some running or lower body exercises after a week or so? Or should I hold off on things like that for a while? I didn’t know if doing exercises like that could raise the CK levels in my bloodstream again.
Thanks!
Danielle
Danielle, so sorry to hear what happened to you! I’ve heard from others who have gotten rhabdo from the Murph. It’s strange they sent you home when your CK levels were still going up but the good news is that you are feeling better. I suggest being free of all symptoms before returning to exercise and you should also have no issues doing your daily activities (walking, going to the store carrying groceries etc).
I do address this in more detail in my book too. The key as I see it is to start back slow, give it time and have patience. CK levels go up when we exercise so I would not start back with running. Walk before running. Im more conservative than most when it comes to returning to exercise. This is an insult on your body and you should take time to heal and recover.
If it helps, I’ve interviewed several who have had rhabdo on my podcast and have several articles on rhabdo too
Keep me posted on how you are doing Danielle. Hopefully, soon, rhabdo will be a distant memory for you.
Hi. I was diagnosed with mild rhabdo on Thursday after playing heavy tennis for the prior 3 days.. I normally play a lot to begin with — usually 5 days a week and multiple times a day. I also work out daily, with weights. On Monday however, I played 3 hours of clinic during the day and then 3 hours of a singles match in the evening (I’m used to 3 hours a day). My legs began cramping at the start of my second set and I played through it. But other than fatigue and soreness, I felt fine the next day. I played Tues and then again another 5-6 hours on Wed and then it hit that night.
My blood came back on Friday showing my CK levels were higher than normal, at 570. The doctor called to confirm it’s a mild case as it would need to be in the thousands to be dangerous. I was told to drink plenty of fluids, return for blood work in a few days (going today) and no tennis for a week After reading the posts here, it does sound like it’s a mild case but I was trying to determine, is there such a thing as a mild case of rhabdo?
I’m going back for blood work today but I still have some stomach cramps on the middle top of my abdomen, but most recently have a pain on the left side of my abdomen. My urine and stool looks normal (stool was yellow until yesterday) and I have been feeling better each day (besides the pain I sometimes get on the left side).
Is my case truly mild? Was it right for me to stay home and hydrate? Is there anything else I should be looking out for now? and is one week enough to return to tennis? When do you think I can return to my exercises too (I weight lift)? I’m itching to exercise and play tennis again but I’m also afraid to return to it as I feel lucky it wasn’t worse and don’t want to push my luck again.
Thank you for sharing your thoughts.
Hi Maggie, so sorry to hear this! So it sounds like what you experienced may not be bad of a case as Ive heard others experience. Im not a fan of using the phrase “mild case” of rhabdo because we’re talking about muscle destruction and I dont consider any case “mild.” In the fitness world many dont take rhabdo seriously and thats why I take the stance that there’s no such thing as a mild case although I’d say there are different degrees to rhabdo.
Since you are still having issues I think its wise to lay off tennis and other exercise until you are feeling no other symptoms. I am glad your urine did not change color. Not everyone’s does.
I hope you are back on the tennis court soon. Any other questions Maggie, just ask.
The L side abd pain I got after having rhabdo remains – spleen?
Hi Mary, its hard to say. how long since you had rhabdo?
I am wondering if I could be affected by this … I am training for a half marathon & generally run 8-20k 5-6 times per week (tapering now)…I had a deep, thai, remedial massage 5 days ago & as soon as I got up off the table experienced dizziness/vertigo, nausea & fatigue…still experiencing these symptoms albeit to a much lesser degree. Never had this before & have seen this same therapist a couple of times in recent weeks without a problem. Could this be related to Rhabdo?
Hi Nicky, It’s hard to say from what you said. while there are some cases of massage causing rhabdo, the reports I’ve seen involved using a different massage therapist or having a more intense massage than normal. Sometimes when we get up too fast it can cause dizziness. Have you been hydrating well? while some with rhabdo can experience nausea and fatigue so too can other things. If this is something you are concerned about, consider getting checked out medically.
Hi, Joe.
I was wondering if you know of any cases of rhabdomyolysis that were caused by using over the counter Electrical Muscle Stimulation (EMS) devices.
How likely is it for one of these devices to cause rhabdomyolysis?
I just got one of these devices and I’m wondering how risky it is.
Thanks for the information.
Hi Jon, there are reports of rhabdo being caused by electrocution. That includes TASERS causing rhabdo too. I’ve seen some reports – not many – on TENS units too. For most people, I think the risk is low overall. One way to possibly reduce the risk of it happening is to start slowly with TENS units. For example, don’t start with 30 minutes but rather 5 to 10 minutes. Let me know what happens when you start using it.
Hello! This article is very insightful. So I did the murph workout (1m run, 100 pullups 200 pushups, 300 squats, 1mile run) on Monday for memorial day. I was fine for the day. The next morning i had typically soreness that was expected in my biceps because of the pull ups, then “second day soreness and third. I cannot fully extend my arm and the muscle does feel tight.
A girl I hit the Murph workout with is currently in the hospital for rhabdo. She went in yesterday. I am having slight swelling in my forearms. And there is pain when trying to straighten my arm or to do anything (unless I am sitting still) her urine was dark, that is why she went in. Mine is still yellow/clear.
I have been researching to know if this is DOMS or rhabdo. I have been working out for over 15 years. I have had DOMS and have been sore on countless occasions. No, I have never done 100 pull ups in less than 15 minutes but I definitely have not felt like this before. I am trying not to take any anti-inflammatory drugs. Should I be seen? or continue to roll them out? Thank you!
Lia, if it were me, I’d get checked out by a doctor. You said your friend is in the hospital with rhabdo from the same workout. You also said you had never done 100 pull-ups in 15 minutes before. You do not have to have the dark urine color to have rhabdo. Unaccustomed exercise – such as doing 100 pull-ups in 15 minutes for the first time – could be a trigger. At the very least you will have peace of mind knowing what is happening. Please let me know what happens.
Lia,
I also did the Murph challenge this year and complete it for the first time. I had the same symptoms you are describing, and by Friday (5 days later) I was at my doctor’s office getting my CK levels and a metabolic panel checked. Several hours later, I got a call that I needed to go the the emergency room and tell them I have had lab work completed and I have Rhabdomyolysis.
I bypassed the waiting room and was hooked up to IV fluid within 15 minutes. I spent 2 nights in the hospital getting IV fluids. My CK level at the doctor’s office was 17,921. The normal high is 142. My liver enzymes were also really high. Thankfully no kidney damage. My urine was never a dark color, looked “healthy”. It was just the severe pain when I tried to move my arms, still gave trouble 2 weeks later lifting them over my head.
Definitely think you should’ve sought medical attention with your symptoms. I had never heard of Rhabdo even working with trainers and going through the police academy. Now I know about it and will be careful when it comes to my exercises and knowing my body well enough to know if it’s DOMS or Rhabdo.
Kate, sorry you did not hear about rhabdo in the police academy. I know some police officers are aware of it and have gotten rhabdo in the academy. I’ve been trying to find statistics of rhabdo in the police and fire departments but so far have not found any other than isolated reports. I do hope you are feeling better now.
Hello!
Thank you so much for writing such a great article and all these comments are extremely interesting!
I am a 31 year old female, i am pretty fit and have always exercised regularly. Two weeks ago i started CrossFit for the first time. In my third class we did kipping chest to bars, i did them slightly differently with my feet on the ground and kind of jumping up to the bar. The high reps and strain on my forearms though think is what led me to not being able to straighten my arms for 4 days afterwards… now it wasn’t that painful as such, just felt stiff and tight in my forearms.
I couldn’t blow my nose well for example or straighten my arms in a push-up position well. Other than that I am ok, I did have a bit of swelling in the forearms which I only really noticed on day 5 and 6 after I could bend my arms again.
No other symptoms, arms feel ok now still a little weakness feeling in the forearms… I can only do one strict pull up for example before I could do 6.
I am not exactly sure what it is, could it just have been a strain? I did do a leg based worked involving box jumps and the air bike and everything feels fine.
I have made sure to drink a lot of water though.
Could it have been a mild case of Rhabdo?
It also didn’t hurt when I was not moving my arm
Thank you!
Hi Jessica, I’m sorry to hear you are going through all that you are. Even if you aren’t in pain, Im sure its concerning. Not everybody who gets rhabdo feels pain. For example, in this episode of my podcast the woman also only had swelling after doing cross fit.
I suggest getting checked out by a medical professional. Then at least you will know for sure what is happening. Swelling in the arms is not a normal reaction to exercise.
How are you feeling today? Question. when this swelling happened, were you eating a low carb/ keto/paleo diet? Just something I’m investigating.
Let me know what happens.
Hi Joe, just wondering your opinion or advice. I am a 32 yr old personal trainer. I exercise regularly, but in no means every day aggressively. Recently, On vacation, my BF and I got massages….3 days in a row. 60 min 1st day, 90 min next 2 days. I wouldn’t really consider them deep. (also, I’m very petite and have a low body fat percentage. I weigh about 100 lbs).
The first day, she went deep on my upper back and neck area as I was extremely tight. Next 2 days I would consider moderate and not too deep. The last massage was on a Wednesday.
A couple of days after, my Left shoulder felt very sore…I actually thought she may have bumped it out of whack. When I got home Saturday or Sunday I do remember having darker urine…however I chalked it up to the airborne / vitamin C I had been drinking every day.
By Monday my shoulder and bicep were getting really sore. I actually went to the chiropractor to have them adjust it because I thought it was out of place a bit. That was on Wednesday. (the intern who adjusted me also used a massage gun on my Left bicep for about 20 seconds or so- prob not the best thing)
By later that day my forearm and the bend of my elbow area were so sore and tender, it was uncomfortable to touch. It’s now Friday. The biggest thing I feel is that my Left shoulder and both biceps are SO sore…and I have not worked out in ANY way that would make them sore.
I actually haven’t even really done anything much. I literally couldn’t even lift my work bag to put on my shoulder without it hurting. I feel like I’ve done about 200 curls with heavy weight…starting earlier this week its even been hard to sleep on the left side or use my elbow to get out of bed.
This is an unusual soreness/tenderness. It feels achy at rest too. It’s tough to do everyday things like shut my car door or pick up my purse bc Bicep is so freakin sore!
I’ve been extremely tired this week too (sleeping almost 9-11 hours each night)…which I chalked up to exhaustion from traveling. Also had a tiny bit of a nausea feeling today and the other morning. My urine has been pretty clear lately minus the yellow from vitamins.
Today I bought some sports electrolytes and have been chugging water all day. I’m not sure what to do…should I get bloodwork and what would they do to treat if it is Rhabdo. It’s been 10 days since last massage. Thank you in advance for any advice.
Hi Linday, I think its possible you got rhabdo from the massage. Reports of massages causing rhabdomyolysis do exist. the fact you said your urine was dark makes me think you got rhabdo If it were me, Id get checked out by a doctor. They can run some tests and see what is going on. Even if your CK level has declined, there may be other things like liver enzymes that can still be elevated. What they would do would depend on what else is going on. Remember rhabdo doesn’t just effect the kidneys. It can harm the liver too and other organs. Heres one of my podcasts where I interview someone who had rhabdo. we discuss the other issues rhabdo can lead to
http://joe-cannon.com/rhabdomyolysis-with-normal-ck-levels-podcast-66/
You are in pain – both physically and emotionally. By getting evaluated by a doctor, you’ll have a better idea of what is happening.
I hope you will write back and let me know what is happening.
Thank you Joe. This was very helpful. I will take a listen to that podcast. What tests should I specifically request when I go to get blood work. With today being Saturday, would you say it’s fine to wait until Monday? I will say my arms feels better today, shoulder still feels achy (like I’ve been punched in the arm) and bends of the arm are still sore/tender. But I actually feel as if I could use my arms more normal. Bicep are feeling more normal
Lins, when you tell the doctor you think you have rhabdo they will know what to test for. They will likely check your creatine kinase level (CK) and liver enzymes and they may also check for myoglobin in your urine. Even though you are feeling better, give your self more time to heal. sometimes people get rhabdo flair ups when they resume exercise/activity too soon.
Sorry it took so long to respond. Had a PC crash and had to reinstall windows – just another thing that happened during 2020.
Keep me posted on your progress.
Howdy.
I appreciate all your work and information. Two days ago, I did a few sets of eccentric pullups, and it was my first time working out in about a year. I was squeezing pretty hard, and going quite slowly. I also didn’t do a warmup. My muscles just kind of gave out in the last few reps, so I couldn’t do them. I didn’t have any pain that day, but my arms and teres major were extremely tight, so my elbows were stuck in a bent position, and they were internally rotated, so it basically looked like I was holding my belly.
The next morning, I woke up with serious pain in said muscles (teres major, biceps, and the brachioradialis muscles). I wasn’t able to lift my arms overhead, but I would foam roll them and very slowly stretch them. This morning, my arms were swollen around the elbow and the lower part of my biceps, and slightly around the teres major region.
It’s very painful if I try to straighten my arms or pull something with them, but there’s no REAL pain when I’m not moving. It’s mainly just a slight ache or a bit of a tension from the swelling that I feel. Also, today I had darker urine (not brown, but just reddish yellow). I went to the doctor (the urologist), but she said she had never heard of rhabdomyolysis, and when I told her that I wanted a blood test for creatine kinase, she said, “You mean creatinine.”
*NOTE: I live in Ukraine. So things are different here, and I’m not sure about the measurements in blood.
So they tested my blood and urine. My creatinine was 114.7, and it says that the normal range is 53-97. I didn’t see a test for myoglobin, but I had slightly elevated levels of hemoglobin in my blood, and erythrocytes in my blood and urine. She said that I have some beginning of inflammation in my kidneys. They also did an ultrasound on my kidneys, but said it looks normal.
I don’t really know what to do. There’s a blood analysis center near my house, where I can have any tests done that I want. It’s very good, and quite cheap. So I’m thinking about going there tomorrow to have tests done for creatine kinase and myoglobin, and then just taking those results to my regular doctor. What do you think?
Thanks, again.
Hi Nathan
Based on what you said it sounds like you have rhabdo. you had not worked out in a year and started back to the gym doing something pretty difficult (eccentric pull-ups) that you were not familiar with. That, in addition to your urine looking reddish and swelling, makes me think you have rhabdo.
Im surprised the urologist was not familiar with rhabdomyolysis. I’d go to your regular doctor. I don’t know how the medical system works in the Ukraine. Bring the medical tests the urologist already did. that will help your main doctor. Your doctor can run the necessary blood tests. While its possible your creatine kinase level may be declining by the time you get the CK test, if you can get that test done, it may help you. Ask for a liver enzyme test too.
I hope some of this helps Nathan. Do let me know what happens.
Hello Joe,
Thank you for the information! If it is rhabdo is it possible for the pain to subside or decrease on its own? I last worked out 3 days ago, and have also been taking some Clonazepam for my anxiety. I read that drug induced rhabdo is also common. I woke up yesterday with intense pain in my left shoulder, tricep and forearm. Since then the pain has gone down but my muscle feels a bit weak and stiff. Is pain in rhabdo always increasing and or staying the same? Thanks
Joe, usually the pain from rhabdo gets worse for the first several hours. That said, people have told me some strange things over the years so I would not take that as Gospel. For example, some have told me they didn’t have any pain. Another thing is rhabdo pain and muscle soreness pain can happen around the same time which makes this hard to figure out on our own. That’s why I usually mention that rhabdo hurts when you are NOT moving (regular muscle soreness doesnt). Are your shoulder, triceps, and forearm hurting when you are not moving them?
Hi Joe. Firstly, just wanted to say I have found your website very helpful and informative.
I’m a reasonably healthy 33 year old female. I had exertional rhabdo in April 2019, induced by an intense weights-based workout after being out of the gym for several years. I spent several days in the hospital on IV fluids until my CK levels came down to an acceptable level (they were over 86000 on admission!).
Have you had any experience with people getting rhabdo a second time? Are we more prone to it after having it once?
I know that massage almost never causes rhabdo but that it certainly can. I just had a deep tissue massage which has left me with very sore shoulders immediately following the massage. No other symptoms as yet but I’m keeping a watchful eye and trying not to be too paranoid.
Hoping I haven’t got it a second time, do you think I will be at greater risk of getting it once I do get back to the gym? I’m terrified of doing any weights again in case it leads to rhabdo!
Hi Jess, thanks for your kind words. Im glad you were able to find me. How are you doing today? terror is a word I have heard from others who’ve gotten rhabdo so I can appreciate the stress you are under. From the statistics I’ve seen, there is a risk of getting rhabdo again but that may be related to genetic susceptibility. In case you missed it, I covered several genetic things that can raise the risk of rhabdo in my podcast. Here is the link to that episode. If you prefer you can also get my podcast on Apple, Google etc. Just search for “Joe Cannon Health.
That said, I often wonder if someone who got rhabdo once would be LESS likely to get it again because they would be less likely to push themselves too far once more. At the end of the day I cant give you stats on relapse of rhabdo. I would say just try to listen to your body going forward, progress your workouts slowly.
Massage is unlikely to cause rhabdo but I have seen at least 1 report of it happening. That’s still a very low amount compared to all the people who get massages every day.
So how are you feeling today?
Have you heard about kids getting rhabdomyolysis after an influenza dx?
Both of my kids now have had this after having the flu. Both were quite sick for about a week, started to feel better and then had extreme muscle pain.
My son was 1st, a few years ago at I think 9 years old. He is a wrestler, but had been out for over a week when the muscle pain began. The Dr sent us directly to our local children’s hospital. They kept him 2 days and did a lot of IV fluids.
My daughter, 13 years old and a competitive gymnast had a very similar experience. 7 days off school and gym with a diagnosed case of influenza. Day 8 or 9 she complained of extreme muscle pain so I took her in. She had been feeling pretty good the day prior. Again, rhabdomyolysis was dx and we wre sent to the hospital. They kept her overnight giving fluids.
Just as we were going to be discharged they decided she should start Tamiflu because of the rhabdo. I made a case against knowing she ws now 9 days out from onset of flu symptoms but they really felt it was important. 30 minutes after that gave it she was vomiting and feeling worse than she had in days again. I opted not to fill the rx and we went home with anti nausea meds instead.
My question, do you often see it associated with influenza?
Should I be concerned both of my kids have now had this?
My daughter is just now finally getting her endurance and strength back 7 months later, is this normal?
Hi Jen, so sorry to hear about your kids getting rhabdo! I can only imagine how stressful this has been for all of you. To answer your question, there is some proof that rhabdo can occur in those who get the flu. Of it helps, here is a paper that discusses this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382767/
There is also at least 1 report of rhabdo happening after taking Tamiflu. Here is the report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029519/
Its intersting both of your kids developed rhabdo. Have you ever asked doctors if genetics may be involved? Just wondering.
While it may seem like only exercise can cause rhabdomyolysis, the truth is many things can cause it. One thing I would do is make sure your kids coaches know what rhabdo is. Its my expeirnce some do not. Here is an episode of my podcast where I discuss rhabdo myths: http://joe-cannon.com/podcast-rhabdo-myths-and-facts/ They can get my podcast on on both apple and google too.
I hope some of this helps Jen. keep me posted on how your kids are doing and do let me know if I can be of any further help.
Hi Joe, I had a possible case of rhabdo several months ago – Feb – although everything seems fine now and I have resumed training with no issues. However, since then my right forearm is noticeably bigger and less defined than the left, almost like it’s a little swollen. Is this normal? I cannot find much info on how long swelling can take to go back to normal.
Hi Dom, Some people have told me of arm and leg swelling returning after they return to working out again. This doesnt happen in everyone but Ive heard it enough to make me think its possible in some people. The only guess I can make is the body is still recovering from rhabdo. When you had rhabdo, did you go to the hospital and get checked out? did they measure your CK levels? What was your level?
When you are working out now, are you doing the same level of activity you were doing before you developed rhabdo? Have you had your CK levels tested again when your arm is swollen?
Hello, My boyfriend just got out of the hospital with CPK levels at 2,568. he initially was checked in at 550. He came in because he had bad cramps all over his body it was unbearable. They’ve just told him to go home relax and hydrate and will probably go down.
But now reading this I’m not sure if they did enough. All he was given was IV fluids because he was also severely dehydrated.
Hi Maria, did your boyfriend start having these pains after exercise? if yes can you describe the exercise program he was doing -and was this something he was not used to (more intense, different exercises, etc?).
He’s a roofer, but he’s been working as a roofer for more than a year now so I’m sure his body is use to it. The cramps also happened after he was done finishing his shift not during.
Maria, roofing is hard work. It’s hard to say if it was rhabdo but his levels were pretty high. Id say if hes not feeling better to see his primary doctor and get a second opinion. Hows he feeling today? did he go back to work?
He’s feeling better just still sore because of his cramp incident that happened tuesday. He won’t be going back till monday just to make sure everything is all right, but yeah will probably have to get a second opinion depending how he feels this weekend.
Maria, glad he’s feeling better. I’m glad he’s taking the weekend off and getting a second opinion. I hope you will let me know what happens.
Hi,
I had a really hard CrossFit class (2nd class ever!) and did something like 90 push ups! My arms were knackered and over the next few days I could barely lift/bend my arms (I struggled to even touch my own face!)
The pain subsided and I ran an ultra 5 days later (unlike CrossFit I am used to running). I then went to a CrossFit class 2 days later (although I couldn’t do any of the lifts as my arms had no strength at all)
2 days after this I noticed swelling in my left arm from elbow down the forearm. This swelling has been spreading and is now swelling to my hand (this swelling is not at all painful, just tight and uncomfortable)
I’m showing no other classical symptoms.
I went to Dr who sent me to emergency room at the hospital. I’ve had blood tests to rule out infection and clots. I mentioned that I was concerned about Rhabdo, but I’m not really sure the Dr paid attention to this. I’m not sure if my CK levels have been tested, and whether it would now be too late anyway.
Can you give me any advice as to what I should do?
Jenna, so sorry to hear this is happening to you! Id call the doctor and hospital to see if your CK levels and liver enzymes were checked (rhabdo can sometimes raise liver enzymes too). It sounds like what you are experiencing is a combination of both crossfit and doing the marathon. It also sounds to me like you did way too much exercise for just your 2nd crossfit class.
Did the hospital give you any advice on what to do when they discharged you? If you feel like your are getting worse, Id suggest going back to the hospital. I would not do any exercise until the swelling is gone and you know your CK levels and liver enzymes are normal.
Please let me know how you are doing and/or you have any other questions.
Joe:
Had Rhabdo last week but it resolved by the time I went to MD and my CK levels were down to like 620. But the only lingering symptom I have is still a week later some tenderness and tightness in both forearms leaving my grip at maybe 75-85%. Have you heard of anythihg like this? Thanks!
Dave
Hi David, yes I have. One issue most are not aware of is rhabdo can be associated with long term, lingering issues. Ive heard of muscle pain that does not go away quickly. Some report muscle swelling returns after they start exercising again. These issues can vary from person to person. Sometimes they resolve fairly quickly while others may deal with problems many months after getting out of the hospital.
Here’s an interview I did with someone who still deals with problems
CK levels decrease after a couple of days so that makes sense why your levels were low when you finally had them checked. My advice is dont workout again until you are fully recovered. when you do go back to the gym return to arm training slowly. Lets make sure your symptoms dont return. For what its worth, I believe many get rhabdo in the arms. Its a body part that is way over trained.
keep us posted on how you are doing.
Yes. They ache when I don’t move them. They actually don’t hurt at all really when I move them … and it’s an achy throbbing more then anything… I notice it after doing my weight class and we did lots of pushups and bicep curls… I have even started pushups on my knees and take breaks and instead of bar I use had weights- so I can use lighter resistance.
I don’t think I’m suffering from post traumatic symptoms.. thanks so much for all of your information- this is something (as you’ve motioned) not a lot of trainers are aware of or people that train .. scary stuff
Gina, my guess is the pain might go away temporarily when you move them. That’s just speculation. Its not something I see often. Glad you are not having any PTSD issues. That really is good news 🙂
About 2 years ago my daughter called me and said she’s going to emergency because her arms are very swollen and stuck like t-Rex and her urine is very dark. She had done a CrossFit rope climb 3 days prior. She even tried playing hockey on night 2 … anyway, her CK levels were over 120,000 …
she was rushed via ambulance to a renal hospital- best in our area.. and was in ICU for 4 days. I had never heard of this illness before!
So of course after lots of research and talking with her doctors I was fully educated on it. I do a boot camp type class and have for many years. I added weights not to long ago and in a class we were doing lots of upper body and lots of push ups.. I pushed myself too hard. The next day I felt something was wrong and on day 3 I was swollen and decide I better go to emergency to have blood drawn.. sure enough! CK Levels were 2500 …
I went home and drank lots of water to flush and stayed away from that class for 6 months. I’m back doing it all and the middle of my arms (other side of my elbows, front) get very sore and ache even when I’m not exercising and my groin area pains me regular too… I have 100% toned my exercise down and don’t go as hard at all.
A doctor friend thinks I need to get muscle biopsy done .. with my daughter having it and now me .. he is concerned. He calls it exertional rhabomyolysis and malignant hyperthermia – concerns are with having anesthesia and MH it has to be MH trigger free ie: no succinylcholine or volatile agents – anyway .. I’m more concerned with my sore inner arms (achy, pain / comes and goes.. tender) and sane feeling in my groin – mostly right side… just interested in your thoughts!
PS – daughter is fine. She is healthy and doing very well. But scary and the Drs have never seen numbers like her CK ever. She was lucky. They said if she would have waited another day she could have died.
Hi Gina, The first thing I will say is I am VERY happy to hear your daughter is ok. I can only imagine how scary that must have been for her -and you – when she was rushed to the hospital.
rhabdo can be browken down into 3 broad categories:
1. Traumatic rhabdo: resulting from trauma like a car crash or falling down steps
2. Non traumatic: this may result from some medications (like cholesterol meds for example)
3. Exercise-induced. your doctor friend called it exertional rhabdomyolysis. Over exertion/ too much exercise causes it
My guess is your doctor friend is thinking there may be a genetic issue going on since both you and your daughter developed the condition. There are some genetic factors which can increase risk. in your research you may have heard of things like the sickle cell anemia trait and MCcArdles disease.
With malignant hyperthermia, that’s a condition -its rare- where people get very bad reactions to anesthesia. their body temperature goes up a lot and there can be really bad muscle contractions. These really bad muscle contractions might cause rhabdomyolysis in some people. There is some evidence people with MH are at a greater risk of getting exertional rhabdomyolsis. This is probably why your friend mentioned MH to you. It’s good to know you have MH before you have surgery. Here is a study which mentions the MH rhabdo connection:
https://www.ncbi.nlm.nih.gov/pubmed/28326467
Have you ever had surgery that required anesthesia before?
Thanks for the information Joe! Yes, I had to have anesthesia just a few weeks ago for an endoscopy. Light sedation, but none-the-less, anesthesia. My anaesthesiologist read my file and that is when the Rhabdo came up (because I did have it) When he asked me about it that is when I mentioned my daughters case.
That is what triggered the conversation about MH etc… and his recommendation for testing.
What do you think my sore achy arms are about? As I type this they are tender and achy… it is (i think) my Brachialis muscle that is sore and tender. I just worry that every time I do this class I get a case of Mild to Med Rhabdo…. 🙁
Hi Gina
are your arms sore when you are not moving? This is one way I often differentiate between regular muscle soreness and other types of injury. Regular muscle sorness does not hurt until we move the muscles or put pressure on them. Pain felt – when we are not moving – could be due to many things, including rhabdo, but other things also (tennis elbow for example).
Are your arms in pain when you are not moving?
After getting rhabdo, I do believe people go through a post traumatic stress syndrome (like PTSD) where they are afraid of getting rhabdo again. Some are afraid to exercise again also. I cant say if that’s what you are experiencing. You just got me thinking when you said you worry about rhabdo now when you exercise.
Hi Joe, tried several times to reply to your reply thread but it doesn’t get posted so I’m creating a new thread.
Thanks for the reply, Joe, appreciate it. Yes I went to the A&E early this morning to get a blood test, CK levels was 7733, but kidney readings were normal, luckily. So they sent me home and said lots of fluids and rest. I saw an orthopedic specialist in the afternoon and he diagnosed it as rhabdo based on the blood test results. I’m to go back for another test in a week’s time and no exercise in the meantime, as you have also advised. Thank you!
SY, Glad to hear you got the right medical attention. I’m glad you have an answer to your question. Now that we know you have rhabdo, we can move from there. For now just rest and stay hydrated. The doc may have said drink just water but I’d use a combination water and a sports drink like Gatorade so you are still getting some electrolytes. Rest is also best right now. Your CK levels are high but not as high as Ive seen. See CK levels of the girl who got rhabdo from spinning class.
It sounds like your CK levels are declining and Im glad to see you will be getting confirmation on that next week. Do keep me posted on how things go. For now, just watch TV and rest up 🙂
Hi, I came across your article while searching for more info about rhabdo. I did a pretty intense workout last Sunday (push-ups), felt fine until Tuesday when I woke and my upper arms were sore and very tight, but only painful when I try to bend it. It got better over the next few days and stopped feeling sore since Friday.
However, it’s still slightly swollen and there seems to be fluid retention. It seems similar to Kevin’s case above. I’m really not sure if I should go to the emergency room to test my CK levels, or go to a sports doctor, or just wait one or two more days to see if the edema goes away.
Urine output is fine, I’m keeping myself hydrated and there’s no swelling anywhere else, only the upper arm. Appreciate any advice you could give and thanks for the informative article!
Hi SY, I’d still go get checked out if it were me. Since this happened a week ago, my guess is your CK levels may no longer be elevated but if nothing else seeing your doctor may give you piece of mind. I would not go back to working out until you are all better.
Thank you, Joe for your quick reply and advice. I’m at the A&E now and the doctor is running a blood and urine test, I hope it’s nothing serious.
Thank you, Joe, for the quick reply. I’ve gone to the A&E for a blood and urine test and am waiting for the results now. I hope it’s nothing serious, but you are right, at the very least for peace of mind.
My Sons CPK numbers keep jumping around. From 100s to over 2000s.
Doesn’t anyone know what a normal CPK workout number should be for teenage kid after lifting and running?
Concerned, you ask a very important question. What are normal CK levels? I dont think there is a specific number we can point to and say this CK level is “normal” for everybody because creatine kinase levels go up with muscle damage. Different people may exercise at different intensities. And, there may also be some genetic differences too. In this article – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904530/ – the researchers mentioned 500-600 as normal but they also say this can vary a lot from person to person. They also noted some people may have CK levels over 1000.
When it comes to rhabdo, a general rule is to look for CK levels at least 10X higher than what they are at rest. Resting levels are low, usually 100-200 or so.
Is your son having rhabdo symptoms along with his elevated CK levels?
BTW, you called it CPK (creatine phosphokinase) and I called it CK (creatine kinase). CPK and CK are to abbreviations for the same thing 🙂
Yes, he has some pain in his abdominal area and did do squats at his high school a couple of days before.
I’m getting more and more frustrated with all we don’t know.
We don’t know if his CK levels is just abnormally high 500 to 2500 after workouts.
We had originally diagnosed for Rhabdo after a CK of 758 around 12/26 BUN went from 21 up to 30 by 1/5. Then he was fine until 1/23 where he had a CK of 1,065 and a BUN of 28 after he attended 2 days of wrestling practice. Then he took off until until early March and gradually came back and then he started to squat again and he jumped up to 2,473.
We don’t know what’s going on and neither does our doctor.
Thoughts?
Concerned, I understand your frustration. Rhabdo can be frustrating because not everybody fits into the classic diagnosis.
when it comes to CK levels, Ive seen people with much higher levels than 2500. This makes me wonder if your son’s CK levels after exercise may be something as a result of just his working out. You mentioned wrestling. Sometimes wrestlers restrict fluids to stay in their weight class. In theory this could have caused dehydration, making rhabdo more likely. I’m told restriction of fluids no longer occurs in wrestling but ask him to be sure.
When your son is squatting, how man sets and how much weight is he lifting? Abdominal pain could be due to many things.
When your son was in pain did the pain hurt when he was not moving or only when he was moving? If the pain hurts only when hes moving, then that could indicate regular muscle soreness. If hes in pain when hes not moving, then this could mean something else – maybe rhabdo or other things.
Hi, if your urine changes to a tea like color, is it definitely rhabdo?? The other symptoms seem more like DOMS than rhabdo.
Hi Rob, If someone told me their urine changed color – looking like iced tea or cola – I’d suspect rhabdo, specifically if they recently (like today/yesterday) did an exercise or activity they were not used to doing or was more strenuous than they had performed before.
One thing that can be different between rhabdo and DOMS is rhabdo pain hurts when you are not moving. Here’s my review on Rhabdo vs. DOMS
Is it DOMS or Rhabdo
Do you think you have rhabdo?
Hello,
I know this write up is older, but perhaps you can advise here.
1 week ago on Monday I began a workout routine, I worked my chest and triceps. By Wednesday I could not move my left arm it was so painful/swollen. I didn’t engage in any physical activities during this time due to the pain. By Saturday/Sunday all pain was gone, but swelling remained. It is now Friday, so the workout took place almost 2 weeks ago now.
My left arm is still very swollen. It swells from my upper arm down to my forearm at times. I went to an urgent care facility who performed an x-ray, and sent me to a sports medicine clinic where I saw an orthopedic doctor. This doctor recommended ultrasound around my elbow. Not much results from this.
No complete tears or muscle separation.
I was then ordered to have an MRI done on my left arm. This had similar results. No muscle tears or separation. The MRI write-up described my swelling as indicative of Rhabdo/DOMS. The orthopedic doctor didn’t seem concerned with this. I was advised to elevate the limb, wrap the limb, and take plenty of fluids.
Should there have been testing done to confirm Rhabdo? Should I be worried about my kidney health?
Hi Kevin, it sounds like they took pretty good care of you with all those tests. Since its been 2 weeks, your myoglobin and creatine kinase levels are probably back to normal for the most part – doctors use those as tests for rhabdo.
While I cant give you medical advice, here are some thoughts:
Inform your primary doctor you got rhabdo. She/he may not have gotten the info from the hospital.
If the doctors weren’t too concerned it may be you are through the worst of it. To play it safe I would talk to your doctor before using any pain meds like aspirin, Advil, Tylenol etc. These meds can effect the kidneys and liver which may have been strained from rhabdo.
It might be wise to refrain from exercise for at least a month after your arm swelling goes away and when you do go back, I would not specifically work the arms.
You did not say if you were a novice in the gym or not. if you are just starting out -or going back to the gym after a while – I would not do a split routine (chest/triceps etc). I believe a total body exercise program is best. What you did is more advanced and I don’t recommend it.
People seem to recover from rhabdo at different rates. Time and patience are your friends when it comes to recovery.
Keep me posted on how you are doing.
My son is a 16 year old high school wrestler who had an unusual tough workout involving sprints/intense wrestling sessions. Later he complained of stomach pain in his upper abdominal. We took him to the emergency room where he was diagnosed with rhabdomyolysis with a ck level around 750. We received IV fluids and he was released in a couple hours. The next day he tried to drink whey protein isolate of 28 grams in water and had severe abdominal pains again.
Now we have questions about if the supplements could do more harm then good and who to see to find out. My doctor suggested a nutritionist but I would want someone more knowledgeable of rhabdomyolysis then a common nutritionist.
What kind of doctor do you see to help with prevention, monitoring as well as diet and supplement strategy?
What suggestions would you have on finding a knowledgeable person that could help?
Concerned Parent, I do not recommend protein shakes for anyone with rhabdomyolysis. The reason is rhabdo can hurt the kidneys. Protein stresses the kidneys too. While protein shakes are safe in healthy people, in those who have kidney issues-like someone with rhabdomyolysis – this can lead to more kidney damage.
Be careful with over the counter pain meds like Aspirin, Advil, Naproxen or other NSAIDs. They can also hurt the kidneys.
I suggest your son stop taking all supplements until he is cleared by his doctor. I’ve been investigating dietary supplements since the 1990s. Tell your son he does not need any dietary supplements. He is 16 and already has what no supplement can give him – youth! Tell him to save his money on the supplements. That includes creatine supplements too.
I would not use creatine when he has rhabdo. This supplement might also over stress his damaged kidneys.
My supplement review website is SupplementClarity.com . I have hundreds of unbiased reviews posted there.
As for doctors, the first thing I suggest is go to your general doctor and let them know your son has rhabdo. He/she should be aware of this and can keep tabs on how its progressing and give you suggestions for specialists if needed. Depending on how he recovers – people recover at different paces – kidney doctors and liver doctors may be involved.
As far as diet and rhabdo, there isn’t much research on this. A registered dietitian who specialists in kidneys may be able to give you insights on foods your son can eat. Remember rhabdo does not only effect the kidneys. People often make this mistake.
As I said, everyone seems to recover differently from rhabdo. For some, it takes a long time to recover. Your sons wrestling coach needs to be aware this happened too.
Here is my rhabdomyolysis book which can help too.
I hope this helps. If you or your son have any other questions just ask and I’ll try to help.
I did go to my doctor who suggested a nutritionist if I wanted. What classification of doctor would suggest for liver or kidneys. I only see doctors that look at kidney disease not both.
Concerned Parent, if they did not say there was any liver problems, then kidney doctor. They are called nephrologists.
Hi-
I am a 39 year old woman, very active, powerlifter. I participated in an ab workout out my gym, which has a ton of volume in a short amount of time. I was sore the next day, but incredibly sore 2 and 3 days later in the upper abdomen. So much so that I could not stand up straight.
The intense pain has subsided and now have lingering pain in my lower abdomen; 7 days later. What is concerning me the most is that my abdomen is really swollen. I can’t feel my ribs, I have lost any definition that I had in the ab area, and waistbands of loose fitting pants are leaving indents on my stomach.
Is this just extra fluid hanging out from the workout? Should I be concerned that I still have significant swelling 7 days later?
Also, I can’t even sit up out of bed without rolling onto my side and pushing myself up, it’s like my abdominals are non-existent.
Hi Jami, please go to the hospital and get checked out. the swelling in your abs concerns me. Abs can be a place where rhabdo can occur. As you said you did a lot of volume in a little bit of time and that’s something that can cause rhabdo. Even a fit powerlifter like yourself can get rhabdo if you do a lot of stuff you are not used to – like lots of ab work that you usually dont perform.
You should be in significant pain 7 days after exercise. I do not believe this is delayed muscle soreness (DOMS). If you are taking pain meds like Advil, I suggest you stop as this can decline your kidney function. Go to the hospital and have a friend drive you. Dont drive yourself. It does not sound like you are able to do it safely.
Sorry it has taken me a day to get back to you. I really hope you are ok. Im going to email you privately too to make sure you see this. Do let me know what happens.
Hi,
I’m a woman (54 years) from Finland, used to exercise. I had a core exercise class at the gym about seven weeks ago. The class lasted only half an hour. We did much exercises for the flanks, which I was not used to in that extent. Next morning my muscels felt a little stiff and strangely uncomfortable.
After a day I had to take some painkillers for releaf. I though I had muscle inflammation. After few days of taking painkillers the pain got worse. I could not sleep at night because of the pain. I went to the doctor and got stronger painkillers. They helped for a while but the pain did not go away.
Then I also got a fever for few days. My skin was also very sore around the whole core. I did not notice any swelling though. I went to see a doctor again and they took a blood test, but my guess is they did not look for myoglogin though. The tests showed that everything is ok. I just got a different type of anti-inflammatory drug. As they did not help, I went to an other doctor.
This was in the second week after my work out. She prescribed me codein. I took one at night but it didn’t help with the pain either. In the same night I went in the to the hospital and after a long wait I got some pain injections to my back. They took the pain away, but after the effect was over, the pain came back.
Maybe with a little releif, because I finally had got some rest with the injections. I then went to sea a doctor once again and she too a urine test but the test was ok. I continued with an other kind of anti-inflammatory drug and some strong antihistamine, which made me sleepy, since my skin was sore and also itchy. (The itchines may have been a result of some-kind of an allergic reaction earlier I noticed few weeks before the incident).
Now it’s the seventh week after the workout. Though not in much pain anymore, my core muscles have not recuperated. I can feel my muscles in the back, side and abdomen as someone would have put something there that doesn’t belong. In the morning my lower back muscles feel partially numb. The muscles feel week and I wouldn’t dare to do any exercise.
Now I wonder, did I have rhabdo? I have never experienced anything like this before. Normal muscle pain I have had many times. This was different. I’m wondering, because you said that the pain starts usually quite soon after the exercise. Mine started with stiff and numb muscles on the next day and got slowly worse. My muscled did hurt while not moving so this points to rhabdo.
An other question, if I did have rhabdo and nothing was done, has it harmed my muscles permanently? Is there something to do to make the situation better? Can I find out afterward has it been rhabdo?
Hi Joanne, sorry to hear you went through all of this. Im sure it was not only painful but frustrating too. Since you were not used to doing that much exercise as you did in class and your muscles were hurting when you were not moving, its possible you had rhabdo. It is hard to know now though since its been so long. My guess is your creatine kinase level would probably be back to normal after 7 weeks.
My guess is your doctors also tested your liver enzymes -which can also be a sign of rhabdo – and didnt see anything, so that is good.
Have you gone back to your doctor and asked them if its possible to check your creatine kinase levels (CK levels) to test for rhabdo? I’m not sure if elevated levels would show up after 7 weeks or not but its worth having the conversation with your doctor, in case rhabdo never occurred to him/her.
I would also tell the person who ran the core class you attended what happened to you. It’s my experience most fitness trainers do not know what rhabdo is. You’ll be doing them a favor telling them about it. Show them my reviews. I have several here.
One thing Id say is some pain drugs can reduce kidney function. Since rhabdo can also reduce kidney function, some pain killer meds can make the stress on the kidneys worse. It sounds like you are through this stage of things but I wanted to point this out in case something like this ever happens again (lets hope not!).
Remember you have trillions of muscle fibers. You have a LOT left. Sometimes rhabdo takes a long time to get over. Everybody is different so I cant give you an exact time frame unfortunately. The good news is you are not in pain any more. I can imagine though how discomforting it must be to still have those odd sensations.
Do keep me updated on your progress Joanne and feel free to ask if you have any other questions.
Thanks a lot for your long and encouraging answer. I have given feedback to the gym.
You are right about the tests. I took a new look at the results and the doctor tested the liver enzymes as well as the CK levels. They didn’t show any traces, but it was almost two weeks after the exercise. Maybe this has been then something else then or very close to rhabdo. That’s why I googled “mild” rhabdo, if such thing occurs. And I should interview the doctor.
I’ll keep you posted about the progress. It’s great to find such expertise over the internet so thanks again for being there.
Have all a beautiful autumn!
Joanne, sounds good and Im happy to help. Yes do keep me posted and I hope you are soon fully back to normal again. Have a great autumn also 🙂
I have had very light cola-colored urine about twice in the last couple of days. I drank a lot of water and gatorades and my urine has turned back to light yellow and clear. I haven’t had any soreness or fatigue.
The back and forth of the urine is something I’ve never seen. I haven’t had any alcohol in 3 days and this started Monday mid morning. It is Wednesday. Not sure what to do as I monitor it. Thank you.
Hi Adam, lets play it safe and go to your doctor and get checked out. Rhabdo is complicated you dont know what else is going on in your body until they run the tests. Rhabdo is more than just kidney problems. It can effect your heart and liver too for example. Over-drinking water can also induce hyponatremia (water intoxication) which can be just as serious.
How did this happen to you? Were you working out?
It was sudden onset. I don’t believe I was working out hard enough to do this. I went to the doctor yesterday, ruled out STD’s, but do believe I have an infection. The symptoms came on very slowly.
My only symptom, starting Monday was the brown urine. Now I’ve been sweating and feel very faint flu-like symptoms and very slight pain in my lower abdomen/groin. Thank you for your response.
Adam, glad they ruled out a lot of stuff. About the exercise, many are under the impression only intense exercise can cause rhabdo. What is intense for one person is different than another person. For example, here’s a case of rhabdo in a fit 29 yr old man who only did 30 sit-ups a day for a week
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1756111/
I’ve also met people who developed rhabdo after using 8 pound dumbbells in an exercise class.
Sometimes flu-like symptoms can accompany rhabdo too. But, as the doctor knows, that’s a vague symptom so its good they looked at everything else too. Theres so much talk these days about dark urine = rhabdo that we sometimes assume it always must mean rhabdo, when that’s not the case. Again, it sounds like your doctor is looking at this from different angles so that’s good.
When you were working out, were you doing anything different- new exercise program or did you increase the weight/reps/sets more than you normally do? It’s unusual types of activities which are most associated with rhabdo.
Have you heard that massage can result in Rhabdo? I had a 90 minute intense deep tissue massage. I have had several deep tissue massage sessions in the past, but never have I hurt afterward. Most intense areas of the massage were my shoulders, low back and calves.
The massage was on a Wednesday. By the time I got home my shoulder muscles and low back hurt. I tried relaxing and taking it easy for a couple of days. I had also had a flu shot that day after the massage. I thought that I must be having the pseudo flu.
By Sunday I was pretty bad with low back pain right side and abdominal pain right and very low abdominally. My shoulder muscles also still hurt. I explained the lower back and abdominal to my doctor. He thought I might have appendicitis and told me that to be safe to go to the emergency room.
They took blood and had me wait in the waiting room. About 39 minutes later they took me down for a cat scan. The results showed no appendix issues. I then signed myself out AMA since I had been there for so many hrs. (7) they said I should wait for the dr for a more thorough exam. I went home, went to bed and stayed there for two days.
It’s now a week later and I am feeling much better.
Hi Patricia, there is at least one case of rhabdo occurring after a massage: https://www.ncbi.nlm.nih.gov/pubmed/16204282
I do see some massage therapies talking about this possibly online also.
Deep tissue/intensive massage does make sense as it causes muscle damage. This can result in muscle fiber death which is what rhabdo is.
It sounds like your doctors did the appropriate steps. While Ive never seen statistics on rhabdo after getting a massage, I do think its rare. I dont hear this from many people.
On the plus side I am very glad you are feeling better now.
I’m a big fan of education. have you told the massage therapist what happened to you? Its possible your massage therapist may not be aware of rhabdo or that intense massages can cause it.
I’m so sorry to hear this happened to you but am happy you are feeling better now.
If I can be of any other help just ask.
My friend told me a story about how her husband had a deep tissue massage and hours later he had intense abdominal pain, iced tea-colored urine, etc. He went to the hospital and after a couple days of getting worse they sent him to Washington (we are in Alaska) and everyone thought it was his liver but they found nothing actually wrong with it.
Point being, I wonder if it happens after massage more than we think because mild rhabdo symptoms are couched by the massage/naturopathic profession as “built up toxins leaving your body” so people think it’s normal… and healthy even!
Hi Meg, over the years, Have Ive seen 1, maybe 2 published cases of massage causing rhabdo. Its a possibility with intense deep tissue massage. I have heard from a couple of people who said it happened to them too. Its possible the incidence is under-reported as many have not heard of rhabdo and may not seek treatment.
Yes, the “toxins leaving the body” is a myth I wish they would stop saying. Sorry to hear this happened to your friend’s husband. I hope he is doing well now.
Hi, I just returned from a 2 day backpacking trip in the mountains of Utah on Monday. The hike was Friday through Sunday. We did about 20 miles with heavy packs full of camping gear and lots of elevation gain. I had some lower back pain for weeks prior to the trip but I went anyway. I was a little sore in the legs and shoulders Monday and Tuesday, but nothing more than I have experienced in the past from weight lifting and my back seemed to handle it pretty well. I had no swelling and I was able to walk just fine. Decided to do an upper body workout Tuesday night. Wed rolled around and my back was hurting more than usual, it was difficult to move around the shop. I took an Ibuprofen and went about my day.
That night ( Wed ) I urinated that dark cola color. I was freaked out, did some research and assumed Rhabdo. I started drinking water and went to the ER 1 hour after that urination. I was given a urinalysis and blood was drawn. My urine came back positive for blood. Urine blood = large , RBC’s = 5-10 and WBC’s = 3-5 on urinalysis. However my CPK result was only 177, well withing the normal range. Doc said she suspected I had a case of Rhabdo but I am not sure how she can give that diagnosis with CPK results that were perfectly normal.
Is it possible to have Rhabdo and have brown urine, positive for blood, but perfectly normal CPK results? I am now wondering if I even had it at all or if I may have just had some bleeding due to the Ibuprofen I took. Also it was the first time I took any kind of pain medication in about 5 years, so its strange that it happened on the same day. Any thoughts on that?
Hi Mike, that is an interesting case to say but I agree with the doctor. It sounds like rhabdo to me. While creatine kinase is the go-to thing when trying to diagnose rhabdo, its not the only thing doctors will look at. They may have looked your liver enzymes too. liver problems can accompany rhabdo. They may have also looked at your blood levels of potassium and calcium.
Rhabdo is complicated and while most people I run into have elevated CK levels, I would not rule out rhabdo because your CK was normal. Your dark colored urine coupled with all the physical activity you were doing makes the rhabdo diagnosis sound plausible to me.
About the pain meds,they can reduce kidney function too and can make rhabdo worse. Something to think about if this ever happens again. I do like how you went to the hospital quickly. So many people wait for hours before making the decision.
Hopefully you will be feeling better soon. If you have any other questions, just ask.
Hi and thanks for your response. I have been taking it easy since my trip to the hospital. I have recently been doing some light exercise and a lot of stretching to help loosen things up. Since the Rhabdo incident I now have a case of piriformis syndrome. I have been experiencing some intense muscle spasms deep in the left glute, tightness in the hamstring and some pretty intense sciatica pains down the left leg.
I am wondering if my rhabdo could have been isolated to the piriformis muscle which is pretty small and that is why I didn’t see any high ck readings and the brown urine only happening once.
Hi Mike, glad you are on the road to recovery. Hard to say about the piriformis problem but its possible. Make sure to go very light with the exercise. I’ve known people who did too much too soon and ended up getting it again. Patience is the way to go with recovery. Keep me posted on how you are doing.
I found this article after researching”overtraining”. I’ve been doing barre classes for the past couple months, but increased intensity during the month of July. My last class was on Friday (a week ago). After class my quads twitched for hours after, I felt fatigued, and had lower GI symptoms.
On Monday my right quad had constant twitching. Today, a week later, my legs still feel heavy, sore when I massage/foam roll. I had a massage and cryotherapy on Thursday. Urinary output is normal in frequency and color. I still feel very fatigued.
How do you know the difference between overtraining and rhabdo? My question, should I have my levels checked for rhabdo?
Hi Tracy, so glad you were able to find my rhabdo review. It sounds to me like there may be more than over-training and muscle soreness going on. Over training syndrome normally takes weeks to months to kick in. Rhabdo often happens after 1 workout. While fatigue can be associated with over-training, I’ve talked to people with rhabdo who also felt this way too.
It’s been over a week and your quads still feel heavy and sore, so that says to me there may be more than delayed muscle soreness happening. Regular muscle soreness often feels better after 4-5 days.
Don’t go by urine color alone. Urine color can look normal and you can still have rhabdo. Dark colored urine doesn’t always happen with rhabdo.
I dont want to alarm you but if it were me, I’d get checked out by a doctor. A blood test will tell whats going on. I would not do any exercise until you are cleared and feel better.
Do your quads hurt when you are not moving them?
Please do let me know what happens.
Hi Tracy, I updated my review of overtraining syndrome to address rhabdo vs overtraining.
Here’s the link : overtraining syndrome review
Hi Tracy,
I was in a similar boat and had similar fears, but now believe that the twitches were the result of an electrolyte imbalance. An electrolyte supplement of potassium magnesium and sodium may help.
JJ, if the twitching were do to electrolyte imbalances, taking extra electrolytes could in theory make the symptoms worse by hyper concentrating the minerals. I obviously cant know for sure but its something to consider.
Hi,
I have just started a keto diet and am on the 7th day. However, I read about people who had rhabdo after going on it. This morning I woke up with a tight achey calf, which made me think I may have it.
I have done very little exercise in the past few days. It may also have been caused by low potassium and magnesium levels, so I have ordered some electrolyte supplements. Should I be worried?
Jaspal, I have never heard of a case of someone getting rhabdo after starting the ketogenic diet. based on what you said it sounds like you may have been dehydrated. Cramping is difficult to pinpoint because it can be due to under or over hydration.
Id think you could get by with basic gatorade or 1/2 and /12 water. Is rhabdo something people in the keto community discuss regularly?
Hi,
Thanks for the reply, i think the elctrolytes and water helped. Keto and rhabdo is not commonly discussed, but there is a reddit post on it that has been seen many times
JJ, sure thing anytime. Im glad the water/electrolytes helped. In your case I think I can see how an electrolyte might help. Keto may be lacking some minerals. I didn’t see the reddit post. can you post it here so I can check it out?
Does everyone have to be hospitalized or given fluids? My son who is 17 went to dr yesterday we were concerned about this. They called back and said one of his levels they are concerned about and what it repeated on Tuesday. He had the dark urine but now it is fine.
The doctor said no exercising and keep drinking water and if he notices a decrease in his urine go to ER. I am just concerned with everything I been reading.
Hi Carri, sorry to hear about your son. Im sure you were scared after all the reading you did about rhabdo. Not everybody with rhabdo has to go to the hospital. I’m sure if your son was bad enough the dr would have sent him there. I agree if his pee gets darker or he doesn’t pee as much as normal, its good to go to be safe. I also agree with not exercising now.
How is your son today? May I ask what your son was doing when he got rhabdo?
I’ve often questioned whether what I have is “mild rhabdo” because my symptoms never commpletely make sense. I have woken up with pain in my calves (this is where I notice it the most) and other muscles usually after some sort of trigger (one was yoga, one was drinking a few beers the night before…etc).
The things that make me question the possibility of rhabdo, however, is that while I do have the coca-cola colered urine, it’s always been hemoglobin and not myoglobin when checked under the microscope (as the dipstick tests will read myoglobin as hemoglobin).
I have also only ever had mildly elevated CK levels. Nothing ever above 400. But these events have happened quite often with me, and I do have an underlying genetic condition called Loeys-Dietz Syndrome so am more prone to fragile tissues.
I’m not sure if this would be considered “mild rhabdo” or if I should be looking into something else entirely.
Hi Ashlee, interesting question. I did a quick search for “Loeys-Dietz Syndrome rhabdomyolysis” and nothing showed up in my quick search. That doesn’t mean it cant elevate the risk as rhabdo can be linked to several things.
Have you ever asked doctors if your symptoms could be connected to rhabdo?
Hi, thank you for the response! Loeys-Dietz Syndrome is relatively newly discovered (with my type being identified in 2012) so there’s not much research on it in general yet.
My cardiologist, when asked, said that it sounds like exercise-induced rhabdo. The rest of my doctors are a bit stumped, due to the hemoglobin vs myoglobin issues and it hasn’t really been investigated because the symptoms have not yet been severe. Right now the doctors are waiting on a severe attack of it to do tests during an acute phase of it.
Hi Ashlee, thanks for letting me know. I’ve never heard of Loeys-Dietz Syndrome before. When I looked it up, it reminded me a bit of Ehlers-Danlos syndrome. I’m glad your cardiologist brought up exercise-induced rhabdo. Kudos to her/him! The good thing is the symptoms have not been severe yet so that is good. The bad is the waiting game it sounds like you all are playing now. I’ll say a prayer you find an answer soon.
do let me know what happens as you move forward with this. I’m very curious.
Hello, I just left the hospital and diagnosed with this condition. My creatine kinase levels were 583 at the last reading. The doctor told me not to exercise for the next few days and drink lots of fluids. They also administered an IV. I only went to the hospital because I was having some chest pain, but my heart was fine and they discovered this.
I came back from a short jog last night and got straight in a hot tub. I had an extremely painful muscle spasm in my calf when i got out of the bath and it’s still a little sore. Could the elevated CK levels be from that muscle spasm?
Hi Eric, Both exercise you did as well as the muscle spasm could have raised your CK levels – but my hunch is it was mostly the run. I would also not rule out the hot tub either as a contributing factor to your rhabdo.
You bring up a good point about chest pains being a sign of rhabdo. While most dont think of this, it can happen. Here’s a report A VA Beach man suffered a heart attack after doing a half marathon :
https://www.13newsnow.com/article/news/local/mycity/virginia-beach/runner-awake-after-collapsing-at-half-marathon-being-put-in-medically-induced-coma/291-530993796
his condition was at least partially due to rhabdomyolysis. I do feel heart attacks are rare though. In over 10 years of investigating rhabdo, I don’t hear of many heart attacks thank goodness.
Thanks for the reply joe! Still feeling some soreness but overall much better. I had my CK levels checks 2 days later and they were down to 270, so still above normal but way down.
Hi Eric, it sounds like you are on the road to recovery. So glad to hear 🙂
I am 68 years old. I finished a 12 week cross fit program 5 weeks ago. I have done the same program 8 to 10 times before. Within days I experienced unusual hamstring pain, adductor pain to the extent that it was very uncomfortable to put on my pants, and lower abdominal pain.
After a week, I stopped taking pravastatin. CPI readings since then have been 647, 600 and 610, My LDH was also elevated x 3. The pain is now bilateral in my lower abdomen. It hurts mildly when at rest and is noticeable with activity. I walked today 3 miles for the first time in over a month.
My urine is a fairly bright yellow particularly in the morning but it is not cola colored and has not been. A sonogram and CT were essentially negative other than mesentery nodes adjacent to areas of diverticulitis. I would welcome your thoughts the lower ab symptoms are not improving. The pain discomfort is essentially above the pubic area.
Hi James, your urine does not have to be dark colored to have rhabdo. Because you say you feel pain even at rest makes me think what you are experiencing is not DOMS. You had your LDH levels checked but what about CK levels? Did they check for myoglobin in your urine?
Hi, about 2 years ago I went to my first masters swimming class and threw myself into it swimming about 100 lengths from not doing much at all for years. About 4 hrs later I woke in so much pain all across my chest, down my arms and could not seem to shift it.
I was in agony and took anti-inflammatories. About 10 hrs later it had subsided and was manageable. I then avoided any harsh workouts in fear of the same thing.
However, on a few more occasions even mild exersion gave me the same symptoms after swimming.
I have recently been referred to a nephrologist for low kidney function and am awaiting an appointment. Yesterday I borrowed a kayak and spent about an hour kayaking not really exerting myself and then about 4 hrs later I noticed the familiar feeling in my arms and chest and last night had a dreadful night because I could not get my arms in a position where they weren’t painful. Touching or rubbing the muscles only make it worse.
I was looking on the Internet to see what this could be because it is not like DOMs. I saw your article and wondered if it could be connected to Rabdo and maybe my declining kidney function is linked?
I’m 43 and my creatine was coming back over 100 and the function calculated as 56 when it should be about 90 for my age. Would be really interested to see what your thoughts are.
Hi Jenny, so doing lots of activities that we are not used to can trigger rhabdo in some people. While swimming is less likely to do so (because it has less eccentric muscle actions than land-based exercise) there are a few reports of intense pool exercise causing it. Based on what you stated, I wonder if you developed rhabdo the first time and maybe after kyacking, but only a doctor can know for sure after running tests. I would be careful with anti-inflammatory meds as they can reduce kidney function. I would refrain from exercise until you get seen by the doctor. if you feel worse today or have any weird symptoms (dark urine,intense muscle pain, swelling) it might be a good idea to go to the hospital and get some tests.
I hope some of this helps Jenny and that you will let me now what happens.
I started a pretty intense workout this past week and my last workout was Thursday. I was sore immediately afterward and this has only worsened to the point I was unable to get out of the bed on my own this morning (Saturday). My legs burn even when I’m not moving them. I feel tired and almost anxious like. Right leg is slightly swollen. No change in urine color. I’m going back in forth in my mind between DOMS and rhabdo. Not sure what to think.
Hi Brooke, I hate to say it but I think it may be rhabdo. I say this because you told me your muscles were hurting when you were not moving. DOMS usually does not hurt until you start to move. The fact you said the soreness began almost immediately after you stooped also makes me think its rhabdo. Your urine does not have to change color with rhabdo. The best way to know for sure is go to the hospital and get a blood test.
I’m sorry if this is late in getting to you. It is Sunday now. I hate to say it but I think someone should drive you to the hospital.
Please let me know how things go.
Hi I had a case in 1998 when my calves went hard as a rock and virtually couldn’t walk up and down stairs and it took months to settle down The Doctors did not know what was wrong so I just stopped exercise until it subsided.
My question is does this episode leave you with restless legs and aching legs in my calves and is that because there is some muscle damage? Also whenever I have a urine test they say that’s there’s blood in my urine and ask me if I have my period which is not the case I went to a kidney specialist who told my after several tests that I was just 1 in 100,000 people who have blood in there urine and not to worry about it.
Hi Kathy, yes back in the 1990s rhabdo was not on anyone’s radar so Im not surprised they didn’t know what was happening. What you had sounded pretty severe to me. Do you remember what you were doing back in 1998 that might have caused it? It sounds like you made the right choice to stop exercise until it subsided.
Until you brought it up, I’ve never heard of restless leg syndrome following rhabdomyolysis although a quick online search reveals websites talking about it. What I could not tell from the other websites is whether rhabdo puts someone at greater risk of restless leg syndrome. I will have to do some further digging into this and see if I can find out if a connection exists.
Do you exercise a lot? Sometimes intense exercise can cause blood in the urine. If your kidney doc said its nothing to worry about, thats at least some comfort.