As anyone who has had rhabdomyolysis (rhabdo) will tell you, it's no joke. I've heard from many people over the years from all over the world who, unfortunately, have developed rhabdo after working out too much too soon. Rhabdo has occurred in men, women, and kids, and in both athletes and non-athletes. One of the most common questions I am asked is when can I go back to the gym and start exercising again? This is a difficult question to answer because it depends on how severe your case was. While I do not believe there is any such thing as a “mild case of rhabdo,” there are different degrees in severity.
While your doctor can give you more personalized advice, as a general rule I feel taking about two months off from working out is appropriate. I understand that's not what some people want to hear but let's remember, rhabdo is an insult to the body. It takes time to recover. This is especially true, if you have spent time in the hospital, gone through dialysis or had surgeries to address compartment syndrome swelling.
Before you go back to the gym, I feel you should be able to perform your daily life activities without problems or flair-ups. Your daily life activities include things such as:
- food shopping
- taking out the trash
- walking and walking up and down stairs
- working all day at your job
If you are not having any issues and your blood work is showing no problems, then starting back slowly may be ok for you. While some may advocate for pool exercise because it does not contain eccentric (negative) muscle actions, not everyone will have access to a pool. So, start with just a simple 10 min walk through your neighborhood and gauge how you feel several hours later and the next day. Walk just one or two times for the first week to see how you feel. After a week or two, try walking for a bit longer, for example, 15 or 20 minutes.
As a rule, increasing the time you exercise before the intensity of exercise will be safer. For example, you would begin with walking before jogging or running. See if you can eventually work yourself up to walking 30 minutes three or four times a week. If you can do that consistently without any flair-ups or pain or swelling, or dark urine, then you may be ready to return to the gym.
Post Rhabdo Gym Routine
When you return to the gym, you should not start with the same type and intensity of a workout you performed before you had rhabdo. Depending on how long its, been you may have experienced atrophy of your muscles and cardiovascular system. your ligament and tendon strength are less too. You are a beginner. You need to take things slowly. So there should be:
- No arm day
- No chest day
- No chest and back day
- No split routines
- No high-intensity interval training (HIIT) or interval training of any kind
Returning To Exercise After Rhabdo
Watch on my Youtube channel if you prefer.
I believe one of the safest ways to train after getting Rhabdo is a full-body circuit strength training program. Circuit training programs involve just 1 set per body part. They usually involve relatively light resistances that you can lift between 12 to 20 times. You should not go to muscle failure when training.
If you had rhabdo in the arms (a common place for it to occur), avoid biceps and triceps exercises in the beginning. If you feel bad about not training arms, remember that all upper-body exercises involve the arms, so you are already hitting these muscle groups in your workout.
Begin with just one gym workout per week. I know that does not seem like much, but it's wise to do it this way because it'll cut down on the amount of muscle soreness your experience, and it also gives your body time to adapt to training again. Remember, rhabdo happens when we do a lot of stuff we're not used to doing. We're not trying to trigger it again. Rather we're trying to slowly overload your body so it can best adapt to the rigors of regular training again.
I go into this in more detail in my rhabdo book, but when progressing with strength training exercises, a good rule of thumb to remember is:
- First increase the reps you can do.
- Then increase the sets you can do.
- Then increase the weight you are lifting.
For example, start with one set of 10 repetitions. Then slowly increase that to 12 and 15 repetitions. Then build two sets of 15 repetitions. When you can do three sets of 15 repetitions without any issues, think about increasing the weight a little bit.
For upper body exercises, increase the weight by about five or 10 pounds. For lower body exercises consider increasing the way you live by 10 to 20 pounds. Mind you; these are just the rules of thumb and not engraved in stone tablets. Work within your comfort level.
If you will be doing cardio in the gym again, slow, progressive overload is the way to go. Even though you've been walking in your neighborhood regularly, walking on a treadmill is different. When you are walking outside, you are moving. When you are on the treadmill, you are not moving – the treadmill is. Your body is smart enough to tell the difference. So when you use the cardio equipment in the gym, start with less than you think you can do. For example, start again on the treadmill with just 10 or 15 minutes at a light pace. That's all you need to do at first.
Your first workout in the gym after getting Rhabdo should not last a long time. I don't suggest you spend an hour in the gym. What I'm suggesting is that your initial workouts should last only about 15 or 20 minutes at most. I understand some people reading this will think I'm being overly conservative- and they are right. I would rather you do less than you're able than you overdo it too soon and get rhabdo again.
Should I Hire a Personal Trainer?
I've conducted over 900 live and virtual personal trainer classes. I can tell you that most fitness trainers are not familiar with rhabdomyolysis. It is better now than when I first started talking about rhabdo many years ago; however, there are still large gaps in their rhabdo knowledge base. For example, I have met people with master's degrees in exercise science who are never taught about Rhabdo. While there are some very good personal trainers out there, if you're considering hiring one, absolutely ask them what they know about rhabdomyolysis and how to safely return to exercise after rhabdo. If they are not immediately familiar with this condition, then I suggest you look for another personal trainer.
The Psychological of Rhabdomyolysis
Another reason I'm suggesting a very slow return to exercise is that I know some people who have developed rhabdo are afraid to exercise again. Years ago, when I first started to speak out about rhabdo, I heard from many people who told me the same thing. They all said these words to me:
- I've never heard of this condition before (rhabdo).
- It was the worst pain I've ever experienced.
- Im terrified to exercise again.
“Terrified” is the actual word they all used. This said to me that rhabdo was triggering a post-traumatic stress syndrome-like phenomenon in individuals. I have not seen any research on rhabdo and PTSD, but I do believe it is a real thing. If this is something that you have been experiencing, then my hope is that a slow return to exercise can assuage those feelings of fear and anxiety and give you confidence that you can exercise again.
When it comes to returning to exercise after rhabdomyolysis, I believe time and patience are your best friends. Rhabdo occurs when people do too much of unfamiliar types of exercises and activities too soon for the body to adapt to. So, progressing slowly should reduce the risk of it occurring again. Please share this with your friends. Education is the best defense against rhabdo.