Generally, when someone gets rhabdomyolysis (rhabdo), their physical symptoms tend to be similar to most others. But, this doesn't always happen. As you will read in this interview, sometimes the tell-tail signs of rhabdo (like intense pain) don't always show up. In this review, I interview “SY”, a woman from Malaysia who wishes to remain anonymous. As you read her story, also take notice of the meticulous notes she took on her rhabdo symptoms, dates when those symptoms appeared, creatine kinase levels and even the supplements she was using.
Additional Rhabdomyolysis Resources
- Interview: Rhabdo from Crossfit and other activities
- 5 Reasons Rhabdomyolysis Happens in The Gym
- Rhabdo and personal training
- Can You Die From Rhabdomyolysis?
- Mild Case of Rhabdo: Fact or Fiction?
- My interview on Super Human Radio
- My interview on the GymWits Podcast
How did you get rhabdo?
SY. I joined a group Crossfit workout named Murph that consists of 100 pull-ups, 200 push-ups, and 300 squats.
The trainer scaled it down for some of us, and in my case, I did
- 100 box pull-ups (without the negatives)
- 200 box push-ups
- 300 squats (normal) in 20 reps of 5 – 10 – 15
and completed all reps within 39 minutes.
Describe your rhabdo symptoms
SY. So here’s the thing – I did not have any of the ‘typical’ rhabdomyolysis symptoms (extreme pain, dark-colored urine). Neither did I suspect I had rhabdo until a week later.
Here is the chronology of events:
17th March, Sunday: The above mentioned Murph workout in the morning. I felt fine for the rest of the day.
18th March, Monday: My arms felt a little achy, but nothing worse than after a night of rock climbing. The soreness started creeping in towards the evening, but it was still bearable.
19th March, Tuesday: I woke up with my upper arms feeling terribly sore. I couldn’t even bend them (I literally had trouble eating the whole day as I couldn’t bend my arm enough to bring a spoon to my mouth!). However, the soreness/pain only occurred when I tried to bend my arms. They felt fine otherwise. At that time, I attributed this to delayed onset muscle soreness (DOMS), as I would typically get this after indoor rock climbing.
20th March, Wednesday: My arms felt slightly better but still very ‘tight’, but in spite of this, I decided to go rock climbing at the gym in the evening. I had no pain or soreness while climbing; in fact, it felt good to stretch the upper arms, however, noticed that they were still slightly swollen.
21st March, Thursday: The soreness had pretty much dissipated, but my upper arms were still slightly swollen and felt tight when I bent them. I did a scaled Annie workout at night (300 single unders, 150 sit-ups).
22nd March, Friday: No more soreness, but swelling and tightness was still there.
23rd March, Saturday: No more soreness or tightness, but the swelling was still there. I went rollerblading in the morning.
24th March, Sunday: Went for Krav Maga class in the morning + another Annie workout. It was only on Sunday night that I noticed there was water retention in my upper arms, and pitting due to the edema. That was when I suspected it may be rhabdo and started reading up about it.
One particular thing that stood out for me was that there were three articles about rhabdomyolysis which mentioned that the patient had performed many reps of push-ups, and there were also articles that stated that eccentric movements coupled with high-intensity volumes could put the body at a higher risk of rhabdo.
Did anything make your pain worse?
SY. I only felt sore on Tuesday, 2 days after the workout. It was painful whenever I tried to bend my arms (it felt like the skin was being stretched!). Otherwise, I felt OK.
How long did your pain last?
SY. Throughout Tuesday (19th March) and the first half of Wednesday (20th March).
What was the scariest part for you?
SY. Firstly, it was not knowing if it was rhabdo or if it was just DOMS, and the thought that I may have kidney damage due to this if it was rhabdo. I only started to get really worried when I noticed the edema in my upper arms on Sunday night.
But, in a funny way, I felt relieved once I saw the elevated CK levels after receiving my blood test results. At least I knew what it was and what could be done to treat it.
How has rhabdomyolysis impacted your ability to work?
SY. I was off work for four days after the blood test. The doctor recommended for me to stay home, rest and take plenty of fluids.
Have you heard of rhabdo before this happened to you?
SY. The trainer did mention in passing that if we did the workout all in one go (eg. 100 pull-ups in a row), there may be a risk of rhabdo, hence breaking it down into reps would reduce the risk. This was the first time I heard of rhabdomyolysis.
Did you go to the hospital?
SY. Yes, I went in on Monday (25th March, a week after the workout) for a blood and urine test at the Accident & Emergency department. My CK levels were elevated (7,733 U/L), my neutrophils and LDH levels were also elevated, possibly indicating tissue damage and acute inflammation.
Did the doctors recognize it was rhabdo?
SY. After I explained that I suspected the workout I did caused the swelling in the upper arms, the doctor did not explicitly say or confirm that it was rhabdo. But he ordered the blood test to include a test for creatine kinase levels.
It was only after the results came back was he able to confirm it was rhabdo.
I visited an orthopaedic specialist centre after leaving the hospital with my blood test results for a second opinion, and the doctor there also confirmed it was rhabdomyolysis.
What your CK levels?
25th March, Monday: CK 7,733 U/L; neutrophil 78.2%; LDH 592 U/L (edema in upper arms)
27th March, Wednesday: CK 1,821 U/L; neutrophil 60.9%; LDH 421 U/L (edema spread to lower arms)
1st April, Monday: CK 216 U/L (arms back to normal since 30th March, Saturday)
What medical advice did you receive?
SY. The medical examiner at the hospital gave me a choice of going home but ensuring I keep taking fluids or staying at the hospital for fluids to be administered intravenously (I decided to go home).
The orthopedic specialist prescribed a pain medicine called Arcoxia (90mg) and also repeated the same advice about drinking a lot of water.
Both doctors advised against workouts such as the one I participated in. They said it’s too much, too soon, and brings about a very high risk of muscle damage.
I was asked to come back for a follow up a week later; however, I went back to the Accident and Emergency department two days later to check if my CK levels were on a downward trend, as I noticed the edema progressing to my lower arms as well.
Luckily, the levels had come down, and the edema fully dissipated by Sunday (31st March).
What supplements were you taking?
On a daily basis:
- 5 x 1000mg MAPS (Master Amino Acid Pattern)
- 2 x 420mg capsules of cordyceps sinensis
- 2 x 400mg capsules of rice bran powder
Right after the workout on Sunday (18th March), I took another:
- 5 x 1000mg MAPS (Master Amino Acid Pattern)
- 2 x 420mg capsules of cordyceps sinensis
- 2 x 400mg capsules of rice bran powder
On the following Monday and Tuesday after the workout, I continued with double the daily dosage of MAPS and cordyceps, after which I reduced it to the usual daily intake mentioned above.
After the diagnosis on Monday (25th March), I took 90mg of Arcoxia on Tuesday and Wednesday (prescribed by the orthopaedic specialist).
My nutritionist also started me on 100mg of pure ubiquinol from Tuesday (26th March) to Sunday (31st March).
I suspect that the additional dosage of MAPS helped with muscle recovery, while cordyceps traditionally is believed to help strengthen the lungs and the kidneys. Rice bran powder may have helped with inflammation, while ubiquinol is also a strong antioxidant that helps neutralize free radicals in the body that was caused by oxidative stress.
I am by no means medically trained and am not recommending anyone to self-medicate (please go straight to the hospital if you suspect you have rhabdo!). But I feel that these supplements may have helped my body to recover faster/prevented a much more serious case of rhabdomyolysis that would’ve otherwise affected the kidneys.
I also went for acupuncture on Tuesday 26th March. This would’ve helped in increasing blood circulation in the arms and accelerating the movement/drainage of the fluids causing the edema.
Do you have any advice for people who have rhabdo now?
SY. If you suspect you have rhabdomyolysis (and like my case, you may not have the usual symptoms), please get someone to take you to the hospital as soon as possible and insist that your blood test includes a test for creatine kinase. Joe gave me very good advice – even if it’s for peace of mind, just get a test to be sure. If you can’t get to the hospital, please try to keep hydrated until you can.
For those who have never experienced this, please listen to your body. If you’re tired, stop. If it starts to hurt, stop. From the accounts that I’ve read of people who have lived through serious cases of rhabdo (CK levels over 100,000 U/L!!), recovery for some took months and some still experience side effects such as swelling.
It’s not worth it at all to damage your health for the sake of finishing an intense workout. There are plenty of ways to stay healthy. And hydrate, hydrate, hydrate!
Read my rhabdo book and learn the facts
Have you ever encountered an instance when someone has all of the classic symptoms of rhabdomyolysis and only has lab testing done eight days later and CK levels are normal?
Hi Jason yes I have. CK levels start to decline after a few days. It’s possible you waited too long to get your CK levels measured. What did the doctor say about this?
When I noticed my plight I began drinking about one and a half to 2 gallons of water per day and night and resting.
By the Time I figured it was probably rhabdo, eight days had passed, normal urine color, so I waited. But my Muscles were still burning. Not DOMS. And had Roving fasciculations. Very fatigued. Easy muscle fatigue. And the burning was concerning, yet slightly improved. I never had noticeable swelling.
At day 8 I then had the gamut of labs tested to include CBC, CMP, LDH, CK, All of which returned normal with the exception of creatinine. It was about twice my normal. I continued to rest and hydrate with the above lab data. I followed up with Nephrology about five days later and all labs including autoimmune panels returned normal. Cr normal too. Thankfully.
I am still having varying degrees of muscle burning and fasciculations.
I’m overall steadily improving.
My anxiety is to know if the burning is something I’ve done now to reinitiate the process or just part of the healing process.
I am just doing my required daily activities.
To answer your question. Both physicians agreed that historically as per the clinical description, the best fit is rhabdo, despite the lack of elevated CK.
The story is longer and involves HIIT and CrossFit like workouts. But not particularly new.
I’d be grateful to continue a discussion. I am in the medical field, and there is a dearth of information about long term sequelae and recovery from rhabdo. There are some NATA publications with 4 phases. But not much longitudinal Information about what to expect.
Thank you.
Jason did the doctors give you any advice on what to do after diagnosing you with rhabdo? Different symptoms can subside at different rates. So even though your CK levels are back to normal, your muscles may not be fully recovered. I usually suggest not working out for at least 4-6 weeks after getting a rhabdo diagnosis but that can also vary according to how you are feeling. Where are you located? Interested in coming on the podcast to discuss what happened to you to help others?
I am interested. It would be nice to help. I’m located in Tennessee.
The only medical advice available (that we know of) is to hydrate and give the muscles a break, time to recover. Only the physical medicine and rehab docs (none of whom I’ve seen) might know about recovery information, I have not found any details beyond this:
Journal of Athletic Training 2016;51(5):406–409 doi: 10.4085/1062-6050-51.5.12 by the National Athletic Trainers’ Association, Inc
short report
“Return to Play After Exertional Rhabdomyolysis”
I would be interested in more
Information about how to participate in the podcast. Rhabdo (without the ck I’m 99% sure I had/have it) is horrible and if my participation will click the light on for someone to avoid it or correct it, that would be great.
Jason, Ive seen that article. Its good to see when others are addressing returning to exercise. I will send you a private email to set up a time to be on the podcast
Joe – and SY – thank you so much for this! I think I also have non-typical symptoms as well. I got rhabdo in 2017. I spent 4 days in the hospital after working out too much. My CK levels were 80K. Now I find that when I workout too much, I experience swelling in my muscles and I feel fatigue too.
I’ve met others who have rhabdo who said they recovered after a month or so and dont have any long-lasting effects.
As you can guess, this is all quite frustrating. This is the first Ive seen of others who had non-typical symptoms. I am glad to see I am not alone.
Kate, sorry to hear you’ve been dealing with rhabdo for longer than you’d like. For what its worth I have talked to others who seem to take a lot longer to fully recover after getting rhabdo. The only thing I can think of is your body is still trying to recover from the injury of rhabdo. It seems in some people, this takes longer to recover from.
See this interview too for another person who still deals with issues.
With CK levels of 80,000 did you at any point have to go on dialysis?
I’m currently in the hospital for Rhabdo with CK levels of 34,000 yesterday and now 36,000 today.
I’m worried about having to have dialysis.
Josh, I am SO SORRY to hear you are in the hospital but it sounds like you are in the best place right now so take comfort in that! Can you describe what happened to cause you to get rhabdo?
Thanks! I am hoping for the best!
I haven’t worked out really since college. So it’s been about 5 years or so. I decided to try to get back into working out. So I went to the gym one time. I worked out my Tris, Bis, and abs. Did each workout to failure. Was in the gym a total of 2 hours.
The next day I couldn’t bend my arms past 90 degrees. I wasn’t too concerned about that, because that can happen after a Workout. But a friend told me about rhabdo and that I should watch for symptoms of that.
The next day my urine was tea colored. So I decided to go to the hospital. CK was 34,000 when I arrived. Went up to 36,000 yesterday. Now it’s back down to 34,000 today.
If it wasn’t for a friend of mine telling me about rhabdo then I might not have went to a doctor and who knows what could have happened.
The symptoms seemed pretty typical, but I had never heard of the condition before. I didn’t know this was a possibility from working out.
Josh, Im really glad your friend mentioned rhabdo to you. I’ve been teaching people about the dangers of rhabdo from exercise for over 10 years. Its nice to know the message of awareness is spreading. Your scenario sounds typical of others I’ve heard from. When starting to work out again, its not necessary to focus on one or a few body parts doing multiple sets. 1 set per body part is enough. The good news is your CK levels sound like they are going down. I have a lot of rhabdo information on this website but since you are in the hospital now dealing with rhabdo, I hope that info doesn’t freak you out too much if you have seen it. The good news is you took your friend’s advice and got checked out. You are in the best place right now getting the attention you need. Hopefully, you will be able to go home soon.