Exertional rhabdomyolysis is the phrase used for when rhabdo is related to exercise. While it's often considered to be something only exercise novices get, that's a myth. Even those who are very fit can get rhabdo. It's also a myth that people bounce back to normal quickly too. In this interview, Amy S, explains how she developed rhabdomyolysis following her CrossFit workout and other activities. She also describes what happened at the hospital and how long she was out of the gym.
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How did you get rhabdo?
Amy S. On a Saturday morning, I did the CrossFit Murph workout (1-mile run, 100 butterfly pull-ups, 200 push-ups, 300 air squats, 1-mile run). The workout was completed exactly as I have it written and not broken up into rounds as is sometimes done.
As I fully expected, Sunday morning I woke up sore but it just felt like DOMS so I went to the gym to lift weights as I normally do. The workout was mostly legs but did involve holding heavy dumbbells and barbells.
On Monday when I woke up the soreness had increased, especially my arms and I couldn't fully straighten them without pain. At that point, I slightly panicked that I had rhabdo since I was familiar with it, but didn’t know a lot, so started doing some research.
I read about the dark urine and saw a video about how muscles will hurt even when not moving but since neither of those scenarios applied, and as I started moving around some of the soreness diminished so I thought it was still just DOMS.
That day I did some landscaping that involved picking up heaving rocks and moving them to various places in my yard. My arms felt better when I was using them, but by the end of the day after working they felt worse. When I got up Tuesday morning I still couldn't straighten my arms without pain, but I went anyway and did a low-intensity CrossFit workout hoping it would loosen things up a bit.
My arms felt okay during the workout, but within a couple of hours after, they started swelling which is when I knew something definitely wasn't right and I likely had Rhabdo, so I went to the ER.
What symptoms did you have and when did they show up?
Amy S. The main symptom I had was that I couldn’t fully straighten my arms without significant pain. This didn’t start until 2 days after the Murph workout. The other symptom was that my arms (mainly biceps, but a little just below the elbow) started swelling up after doing another light CrossFit workout the third morning after Murph.
Did anything make your symptoms worse?
Amy S. Nothing seemed to make the pain feel worse, but the additional exercise probably compounded the issue.
How long did the pain last?
Amy S. I only had pain if I tried to straighten my arms fully. This started two days after the Murph workout and slowly started to get better each day in the hospital. By the fifth day (Friday) after it started, I could fully straighten my arms without pain.
What was the scariest part for you?
Amy S. The scariest part wasn’t until after I left the hospital and tests for kidney function started coming back abnormal which at times made wonder if I had done long term damage to them and might have kidney problems the rest of my life.
Also, as strange as this might sound, it was scary for me to think I wouldn’t be able to work out for several weeks, maybe longer.
Has rhabdo impacted your ability to work?
Amy S. Only during the time I was in the hospital.
Can you describe what happened at the hospital?
Amy S. The doctor asked me questions around what I had done that caused the soreness and swelling. She also asked about urine color and other general health questions. They then took blood to run some tests which came back positive for rhabdo (Creatine Kinase was 14,000 U/L) as well as kidney function, electrolytes, and other markers being abnormal.
At that point, they hooked me up to an IV of saline solution and tested blood again after one bag of solution, but CK had only dropped to 12,000 so they decided to admit me overnight to continue with fluids.
Unfortunately, my CK continued to rise (a sign my muscles were still breaking down) the next couple of days and peaked at 21,000 before it finally started to drop. Once doctors saw it consistently trending down they decided to let me leave even though it wasn't at a normal level (everything else they tested for had returned to normal after the first night in the hospital). The final blood test a couple of hours before being discharged showed CK at 9600.
Did the doctors recognize you had rhabdo?
Amy S. The doctor did discuss rhabdo with me but did not indicate whether they thought I had it until the blood test confirmed.
What were your CK levels?
Amy S. When I went to the ER, CK was at 14,000, then dropped to 12,000 after an IV of saline. The next couple of days while I was in the hospital they continued to rise to 21,000 before reversing.
Did you receive any advice when you were discharged from the hospital?
Amy S. I was instructed not to workout until I had another blood test to verify if CK had returned to normal and then I would have to ease back into workouts
Had you ever heard of rhabdo prior to this happening to you?
Amy S. Yes. I was familiar with rhabdo, just from hearing other stories about people getting it, and, in my opinion, CrossFit gets a bad rap for causing it. I wasn’t necessarily familiar with all the symptoms, however.
Did you tell the gym you got rhabdo?
Amy S. I told one of the coaches at the gym who then informed the owners (also coaches at the gym). They were very concerned about me. They also are aware of rhabdo and briefly talked about it before the workout, but mostly just warn people to stay very hydrated.
How long did you stop working out after getting rhabdomyolysis?
I was out of the gym for 6 weeks. I went to the ER on May 28. On July 8th, I was given permission to return to my normal activities at lower weight and intensity to ease back in.
Even after my CK levels returned to normal, my kidney function had not and my doctor warned it could take roughly a month for it to do so. I went through a series of phases during the 6 weeks, which included complete rest, stretching, bodyweight exercise, light biking and running for short periods and exercise with a very light weight.
At the end of each phase, CK was retested to ensure it didn't elevate too high. At the end of the last phase, CK was tested as well as kidney function. Because they both came back normal, I was given clearance.
If any tests came back abnormal during that time, I wouldn't have been able to proceed to the next phase, so it's possible it could have taken longer than 6 weeks.
Do you have advice for people who have rhabdo now?
Amy S. If you think you have it, go to the ER. If you have a high level of soreness that is abnormal for you, go have it checked out. The earlier you can catch it, the better off you will be. Don’t try to rush back into workouts (as hard as that may be) because you risk damaging kidneys as they are in a weakened state.