Rhabdomyolysis is a topic I've been sounding the alarm about for over a decade. Now, finally, others are starting to take this medical disorder seriously. While that's good news, the downside is there's still a lot of misunderstandings out there. I continue to see websites, magazine articles and videos providing simple answers to complex questions. Some people don't even pronounce the word correctly. As THE authority on exercise-induced rhabdo, let me address what I believe are the biggest myths and misunderstandings about this health disorder. Please share this with your friends so they know these facts too.
Also, See These Other Reviews
- Can You Die From Rhabdo?
- Mild Case of Rhabdo: Fact or Fiction?
- Can Spinning Cause Rhabdo?
- Personal Trainers & Rhabdomyolysis
- Is it Muscle Soreness or Rhabdo?
- Why Gyms Are Causing Rhabdo?
- Podcast: Rhabdo Myths and Facts
- Podcast: Rhabdo Genetic Traits
Myth 1: Drinking Water Prevents Rhabdomyolysis
The idea with this half-truth is if you just stay hydrated while you exercise, you won't get rhabdomyolysis. This a total myth. As I often tell people, water does not stop muscle fiber death. That's what rhabdo is – the destruction of your skeletal muscle fibers.
I do understand why people say this, however- because there is some truth to it. Rhabdo can cause kidney failure. This occurs because a protein, called myoglobin, is toxic to kidneys in high concentrations. Drinking fluids can help dilute the myoglobin and reduce its damaging effects on the kidneys.
But, drinking water does not stop rhabdomyolysis from occurring.
When it comes to the hydration myth, my fear is the individual who only hears the “drink water mantra” and stays home, trying to self-treat their symptoms.
I think this is a mistake.
In theory, drinking too much water could lead to hyponatremia (water intoxication), a medical problem that can be just as serious as rhabdo. While rare, hyponatremia may even cause rhabdo.
Getting medical attention – rather than treating yourself – is the best thing to do if you think you have rhabdo.
Myth 2: Rhabdo Only Damages The Kidneys
It's a common misconception to believe rhabdomyolysis only leads to kidney failure. This is why so many “experts” recommend drinking water to alleviate the problem. But, what most do not realize is rhabdo is complicated and can also cause other health problems too such as:
- heart attacks /abnormal heart rhythms
- elevated liver enzymes
- muscle swelling which cuts off the blood supply
- very intense muscle pain
Hydration alone does not treat these other issues. In some cases, drinking too much water can make these other problems worse.
I understand why people place such an emphasis on kidney problems – It's serious and people often hear about kidney failure while in the hospital. But, I feel this leads to an overemphasis on just one symptom.
I think that's a mistake.
Myth 3: Your Urine Must Change Color
By far, the most commonly known side effect of rhabdomyolysis a change in the color of your urine. This is due to myoglobin being filtered through the kidneys. Often, the urine is described as looking like ice tea or cola-colored.
In reality, a spectrum of color changes is possible. For example, the urine may look lighter than ice tea or as dark as the darkest cola-colored beverage.
Dark urine from rhabdomyolysis
While often considered a “litmus test” for rhabdo, the fact is you can develop rhabdomyolysis and not see any change in the color of your urine.
Over the years, I've talked to several people who did not see a change in urine color – yet they still had rhabdo. That said, if your urine does look darker, it means you've lost at least 3.5 oz of muscle. It takes at least 3.5 oz (100 g) of muscle destruction to see a visible change in urine color.
Myth 4: Rhabdo Is A Short Term Problem
Judging from #rhabdo on social media, I've concluded most people don't take this disorder seriously. Some may even consider it a badge of honor. Their thinking is the condition is no big deal; you just spend a few days in the hospital and then return to normal activity.
This doesn't always happen.
Over the years, I've encountered those who have dealt with long-term problems after getting out of the hospital. Some have told me when they return to exercise, their limbs start to swell up again.
Still, others have told me they experience fatigue, which limits their ability to exercise and perform daily activities. Sometimes these symptoms can last several months AFTER being discharged from the hospital.
Related to this, I also believe some individuals experience PTSD – post-traumatic stress disorder- after getting rhabdo. Many people tell me the same thing:
- I've never heard of this medical condition before
- It was the worst pain I've ever experienced
- I'm terrified of getting it again
And so they stop working out.
For the person who enjoys exercise – but now can't – this can cause a lot of life stress. Some have told me depression sets in at the thought of never being able to exercise like they used to. One individual told me he was so depressed at not being able to exercise again, he had thoughts of suicide.
Another long term problem is the burden of having to pay off the medical bills. I remember one woman telling me she received a bill for over $20,000 after getting rhabdomyolysis and spending several days in the hospital. Ironically, these expensive bills may result after a free personal training session at a gym.
Regardless, these unexpected medical bills only add to the trauma of this disorder.
Myth 5: Only Intense Exercise Causes Rhabdomyolysis
Many mistakenly believe you have to work out like a Navy Seal or Army Ranger to develop this disorder. While the condition has occurred in many physically demanding occupations like:
My Rhabdomyolysis Book
I've encountered those who developed rhabdo from activities that were not “intense.” For example, the condition has been documented to occur from gardening. Another report tells of a woman developing rhabdomyolysis from performing biceps curls with dumbbells, weighing only 10-15 pounds.
In this report, a 29-year-old man developed the condition after doing 30-40 sit-ups for a week. Most people would agree, that's not a lot of sit-ups especially when spread out over 5 days.
In another report, a 23-year-old woman developed rhabdo after performing 108 sit-ups during an exercise class. In this report, they called it White Collar rhabdomyolysis because the condition is starting to show up in white-collar office workers
One individual told me she developed rhabdo after painting a room. While neither gardening or painting may be considered “intense exertion,” one thread of commonality is the condition is often triggered after performing unusual /unaccustomed and repetitive movements.
To put it simply, rhabdo often happens after we do a lot of stuff we are not used to doing.
If the activity is repetitive (like cycling classes) and you are not used to doing it, the risk increases.
Myth 6: Personal Trainers Know About Rhabdo
Unfortunately, those who most need to know about this condition, often don't. I know this is true because I train personal trainers. The inconvenient truth is there has been and continues to be a system-wide failure to educate fitness professionals about rhabdomyolysis.
It does not matter who they are certified by. Fitness instructors either are not aware of this disorder or only have a faint idea about it.
As I write these words, major fitness organizations still do not address this important condition in their textbooks. Colleges are not off the hook either. I have met college graduates – with Master's degrees in exercise science – who have never been educated about this condition.
In today's age of intense exercise, there is no excuse for this oversight.
Ironically, in spite of the great need for rhabdo education in the health and wellness community, I've been told in private my rhabdo book is “not popular.” This is unfortunate in light of the fact lawyers retain me as a consultant during rhabdomyolysis lawsuits against personal trainers who accidentally trigger the condition.
Stopping Rhabdomyolysis Before It Starts
As I often say, the best defense against rhabdo is education. To that end, I sincerely hope this quick review helped you. If you want to contribute any rhabdomyolysis facts, myths or misunderstanding that I did not address- or want to share your personal story– leave a comment below.
Let's together help others avoid getting this medical condition.
Here is my Rhabdo Book on Amazon
I was hospitalized with rhabo levels of 81,000 u/L on 1/17/20 after performing a 45 minute workout consisting of chest and bicep work. My damage is to the biceps, with the left (non-dominant side) being worse. I am constantly fatigued and have lost considerable strength. I believe the PTSD post-rhabdo is absolutely real.
I love working out and being strong, but I am absolutely terrified of having this happen to me again. I did everything you are supposed to do, listening to my body, taking things slowly, adjusting or stopping if things felt like they were too much… My doctors are no help with post care and even sent me straight back to work the day after I was discharged from the hospital. I just want to feel normal again.
Amber, first let me say I am SO very sorry to hear what happened to you! I also want you to know that while it may seem like you have lost strength this is just the post rhabdo effects you are going through. You can bounce back again. While its hard to say what’s causing your fatigue after getting rhabdo, this could be part of the detox process from the medications they gave you when you were in the hospital. Sometimes this takes time so try to have patience (I know that’s hard to do).
So sad the doctors sent you back to work! That makes no sense to me and I’m sure only adds to the PTSD trauma you are going through. Did you see your primary doctor about this? Just a thought but maybe she/he can get you some time off work if this is interfering with your ability to do your job?
If it helps, here’s a podcast interview I did with someone whos not only had rhabdo but has indeed bounced back from it: https://joe-cannon.com/rhabdo-alexandra-feszko-podcast-28/ My hope is her words give you some comfort that you can regain your fitness level again.
When you got rhabdo, were you working out on your own or with a personal trainer? Just curious. Also, tell me more about this 45-minute workout you did. Was this a work out you had done before or was it something new or have new exercises (or more sets/reps) than you had done before? Maybe I can help shed some light on what happened.
My primary did not have any appointments open until March, so I was sent to another family practitioner for follow up. She also did not recommend that I take time off of work. I just attribute this to the lack of knowledge surrounding all things rhabdo.
As far as the workout, I was working alone, using a program designed by a personal trainer. It consisted of the following:
Barbell bench press (45lbs bar) – 4 sets of 12-16
Floor dumbell chest press (15lbs) – 3 sets of 9-14
Push-up supersets – 3 sets of 7-10 (on an incline)
Machine seated chest fly (40lbs/55lbs/70lbs) – 3 sets of 16
Med. resistance band chest fly – 3 sets of 25
Bicep curl w/ “w” bar – 4 sets (25@30/ 25@20 / 20@20 / 17@20
Seated incline dumbell bicep curls(10lbs) – 3 sets of 10
Seating incline dumbell pulses (10lbs) – 3 sets of 12-14
Dumbell alternating hammer curls (10lbs) – 3 sets of 6
Barbell bicep curl dropsets (20lbs) – 3 sets of 10
This workout was new, definitely more bicep work than I have done in one session previously. I just worry about going back to start working out again and having a recurrence, because while my body felt tired, nothing felt glaringly like I was doing too much or pushing too hard.
I went for a massage last night, fairly light pressure and had her skip my arms all together. I have noticed that my body just hurts today…not sure if that is all a mental game because of my fears now 🙁
Amber, so it sounds like what triggered rhabdo was this new workout. Are you training for anything specific? I ask because your workout consisted of 5 different chest exercises and 5 different bicep exercises. That’s a lot of emphasis on chest and arms. Are you training for something specific (bodybuilding)? Just trying to figure out why the trainer created this kind of workout for you.
I’m glad you did not have the massage therapist do the arms. Let’s let them heal. I’d also hold off on massages until your pain goes away. Keep drinking fluids too.
Did you tell the trainer this happened to you? If yes how did she/he say respond?
I’m actually surprised a doctor would say it’s ok go to back to work. How long were you in the hospital with rhabdo?
The good news is you are home and are on the mend. I know rhabdo really freaks people out and it’s easy to let our fears run away from us. Do you know what your CK levels were when you were released from the hospital?
I’m sure it probably hurts to even type right now.
Great article. I read a piece by someone in the medical field who said that bad cases of DOMS are likely a mild case of rhabdo. Do you happen to know the creatine kinase levels with bad DOMS that isn’t rhabdo?
Hi Jeff, thanks so much! Both DOMS and rhabdo can be traced back doing activities are are not used to. Ive never seen a bad case of DOMS likened to a mild case of rhabdo in th literature. Rhabod may be diagnosed when creatine kinase levels are usually at leatse 5X higher than normal, although that may differ between physicans. The degree in CK elevation in DOMS would likely vary by how intense the activiity was. In intense activity, its possible CK levels could be similar to those see with rhabdo. In this study CK levels were 220X higher than normal after intense eccentric exercise (“negatives”) https://www.ncbi.nlm.nih.gov/pubmed/9475858/
Here is my review on mild case of rhabdo in case you missed it Can you have a mild case of rhabdo?
I dont believe we can rely on just CK levels when diagnosing rhabdo. Other things to consider include pain during rest and the presense of myoglobin in the urine.
I read your book on Rhabdomyolysis a while back, and I found it very informative. I’m an RN, BSN, so I was slightly familiar with Rhabdo, I THOUGHT, only to find out that I hardly knew a thing.
You had mentioned muscle swelling that results in extreme pressure on blood vessels. I’m familiar with this syndrome, which as you know (and mention in your book) is called Compartment Syndrome. This is a very serious emergency condition that could lead to amputation of a limb if not caught early enough to be treated!
I believe EVERY personal trainer should read your book and be familiar with Rhabdo. Doing so not only may save a client’s life or limb, but it may also prevent lawsuits and the loss of a career. My Anatomy course in college wasn’t “popular” either, but it was necessary to becoming a nurse and helping my patients.
At least every Health Club and gym should have one of your books as a resource guide, and the owners should make sure that each trainer has read it. It also would be of great benefit to have as a resource in Emergency departments.
I believe your book has and will save lives, limbs, and careers if people just purchased and read it. It is very easy to understand.
Hi Roseann, thanks so much for saying that! Since I started writing about rhabdo, Ive gotten emails from people all over the world – some from the ER! Almost daily I get messages on Instagram from people with rhabdo. That said, I still rarely meet a fitness trainer who has heard of rhabdo or if they have heard of it, that’s the extent of it.
I can tell you many people have told me its been nurses who often diagnosed rhabdo. Nurses are often on the front lines and see people in mini clinics which are getting their share of rhabdo cases.
Hooray to Nurses and to you, Joe! It is shameful that personal trainers aren’t aware of Rhabdo and know its symptoms and what to do about them. As Jackie mentioned, at least the ACSM course mentions it. But if trainers you’ve talked to still don’t know about it, the industry has a long way to go.
Roseann, rhabdo is definitely something the industry has been lagging behind. It’s getting better and I like to think I’ve had something to do with this. I recently wrote an article on rhabdo for a fitness-industry trade journal I know their interst is picking up.
Joe, great article! The danger of rhabdomyolysis cannot be understated. Not only does it endanger clients’ health, it’s also a huge potential legal liability for trainers and gyms. I can’t speak to other training courses, but rhabdo IS addressed in the ACSM course materials, albeit briefly. I think I recall a rhabdo question on the ACSM certification exam as well.
Jackie, thanks so much! I also posted this as a YouTube video too: https://www.youtube.com/watch?v=0H4TtlNg96g&t=1s
Thanks for the info about ACSM. Im glad to hear this. Even when its discussed in colleges, it’s usually just in passing. While any information is step in the right direction, it’s not happening quick enough for me.