Updated 7/9/19. I've been investigating rhabdomyolysis and teaching about it for over 10 years. I'm the author of the first book on rhabdo. I've lectured to thousands of fitness trainers and I'm here to tell you personal trainers are causing rhabdo in their clients. Rhabdomyolysis refers to a medical condition where your muscles die from too much exercise. Basically, the muscle cells rupture and release their cellular contents into the blood. This can not only be dangerous, but it can also be deadly! If you are a personal trainer or the client of a fitness trainer, here are the facts you need to know. Read the comments section too.
Other Rhabdo Posts
- Interview: rhabdomyolysis from spinning class
- Interview: rhabdomyolysis with non-typical side effects
- Is it DOMS or Rhabdo
- Can You Have a Mild Case of Rhabdo?
- Can Spinning Cause Rhabdo
- Can You Die From Rhabdo
- Top 5 Reasons Rhabdo Happens In Fitness Centers
- My Rhabdo Book
- My interview on SuperHuman Radio
- My interview on GymWits Podcast
What Is Rhabdomyolysis?
Rhabdomyolysis (Rab-doe-my-o-lie-sis) (sometimes abbreviated as “rhabdo”) literally means “skeletal muscle fiber death” can occur following a variety of scenarios ranging from but not limited to car crashes, snake bites, anexorea Nervosa, weight loss supplements like Hydroxycut and some cholesterol-lowering drugs and supplements that lower cholesterol like red yeast rice.
Too much exercise is also known to induce rhabdomyolysis.
When exercise causes the disorder, it's called exertional rhabdomyolysis. It is this type of disorder that will be the focus of this review.
Rhabdomyolysis On TV
“If you experience any pain or weakness, see your doctor as this could be a sign of a rare but serious disorder.” Do these words sound familiar? They should because you have heard them almost every day. Every TV commercial for cholesterol-lowering drugs gives this warning – which is a reference to rhabdomyolysis. Rhabdo is a rare side effect of cholesterol-lowering drugs. See, you've heard about “rhabdo” every day and just never knew it.
Rhabdomyolysis Caused By Exercise
In the past, rhabdomyolysis was, for the most part, relegated to extreme physical exertions like military training or other very demanding situations (police academy, fireman training, etc.). In recent years, however, rhabdo has – unfortunately – also been documented in those who exercise in the gym.
Tip. Break the word down: rhabdo-myo-lysis. The letters “myo” means muscle and “lysis” means death. Translation: muscle cell death.
Technically called exertional rhabdomyolysis (exercise-induced), this form of the disorder occurs when people increase the intensity of exercise too quickly. This overwhelms the body's ability to adapt. It's important for people to understand that rhabdomyolysis can happen after only 1 workout.
Many reports of rhabdomyolysis in people who exercise do exist. For example, in one report, a 24-year-old male induced rhabdomyolysis in himself after increasing the intensity of his workout. Rhabdomyolysis is also more likely when the exercise is unaccustomed – like for example, jumping right into an intense exercise class at the gym that you have never done before.
In others, rhabdomyolysis has occurred after a spinning class. See the comments below, for more info on spinning classes and rhabdomyolysis.
Low-intensity exercise can also cause rhabdomyolysis. In another case report, rhabdomyolysis was observed in a healthy, 29-year-old untrained man who performed 30-40 sit-ups a day for one week.
Let me repeat that. He only did 30-40 sit-ups a day for a week! Here is a report on 32-year-old man who developed rhabdomyolysis after swimming (click to download PDF) – only twice!
Who Gets Rhabdo?
Anyone can get rhabdomyolysis. It does not discriminate. You can be a professional athlete or a novice, doing his/her first gym workout. You can't look at somebody and tell how much exercise would cause rhabdomyolysis. Some people can train to be a Navy Seal and never get it. In others, performing only 30 sit-ups a day for a week might cause it. Because of this, it appears that some people might be more susceptible to rhabdo from exercise than others.
How Long Does It Take To Occur?
Rhabdo can happen after just 1 workout. This is not something that takes days or weeks to show up. Case reports do exist of it occurring after too many intense workouts too close together, without adequate rest. That said, I believe most cases show up after 1 intense workout that overwhelms the body.
Rhabdomyolysis Signs And Symptoms
While doctors can easily diagnose rhabdomyolysis with a blood test, some of the physical signs and symptoms of rhabdo include:
- Heartbeat irregularities
- kidney failure
- severe muscle pain/swelling/ weakness/fatigue
- dark color urine – think dark brown “coke-a-cola” color
These symptoms – especially the first two – highlight the seriousness of rhabdomyolysis. As the kidneys stop working, there are alterations in electrolytes which can cause heart rhythm abnormalities. In theory, this might lead to heart attacks. The dark color urine is caused by myoglobin in the urine. Myoglobin helps transport oxygen in the muscle cell. This is good however too much can damage the kidneys. This can cause the person to need dialysis in an attempt to help the kidneys recover.
If you ever hear of anybody whose kidneys stopped working after they exercised, it's probably rhabdomyolysis that caused it!
The pain of rhabdomyolysis happens fast – immediately after exercise, up to 24 hours later. This pain happens more rapidly than delayed muscle soreness (DOMS) which typically happens 24-72 hours after exercise.
Also, the muscle pain often hurts when people are not moving. Remembering this sign – as well as dark urine color – can sometimes help you identify rhabdo. The color of the urine has a reddish-tint to it and is often described as looking like iced tea or cola-colored. The color is due to myoglobin being excreted in the urine. Not everyone experiences dark color urine so it should not be used as a litmus test for rhabdo.
Is It DOMS Or Rhabdo?
Rhabdo is often confused with Delayed Onset Muscle Soreness (DOMS) especially in novices. For more on how to tell the difference between these two conditions to see the video I created:
Click here to watch this video on YouTube
Rhabdo And Advil
Some people take pain killers – like aspirin or Advil (Ibuprofen) to alleviate muscle soreness but people need to understand that because these pain killers can affect how the kidneys work, using pain killers may increase the chances of rhabdomyolysis occurring. If you think you have rhabdo it's safest to get to the ER rather than take over-the-counter pain killer medications.
Rhabdo And Swelling
After exercise, you should never see swelling in your arms or legs as this can also be a sign of rhabdomyolysis. With tissue injury, fluid flows into the damaged limbs. This increases the pressure in the limbs which can cut off the circulation, resulting in further tissue death. This in turn, adds insult to injury by releasing even more kidney-damaging cellular contents into the bloodstream.
In medical circles, this is sometimes called compartment syndrome. In extreme cases, doctors may need to amputate the limb. It was compartment syndrome that caused CNN science reporter Miles Obrien to lose his left arm. He didn't get compartment syndrome from exercise. I use him as an example to drive him the fact of how serious this condition can be.
Rhabdo And Water Intake
In the gym, I often hear people talking about staying hydrated. This warning is especially loud among those who take part in high-intensity boot-camp-like workouts. I believe one of the reasons people advocate water during high-intensity exercise is because of rhabdo. Drinking water helps reduce the chances of the kidneys from shutting down. While dehydration does not usually lead to rhabdo, being dehydrated can make rhabdo worse or increase the chances of it happening.
That said, drinking water will NOT stop muscle fiber death, from too much exercise. While the water may reduce the severity of rhabdo, it won't stop rhabdo-induced muscle fiber death. I think this is a very important point to keep in mind. Exercising is healthy but if you are working out so hard that your muscle fibers are dying, are you not being healthy.
Drinking water to reduce the severity of unhealthy behavior is basically sticking your head in the sand trying to ignore the larger issue you're being confronted with.
Rhabdo And Negatives
One aspect of rhabdomyolysis and exercise that does not get the attention it deserves is its relationship to eccentric muscle actions (“negatives“). These types of muscle contractions occur when the muscle is lengthened as force is applied to it. An example would be the lowering phase of a dumbbell curl.
Negatives put more stress on the muscle and cause more muscle damage, hence their connection to rhabdo. Exercises that involve lots of negatives (like plyometrics) have a greater chance of causing rhabdomyolysis.
Eccentric muscle actions (negatives) do result in greater strength and elevations of resting metabolic rate. This is why you hear so many people in the gym saying “get the negative.” But, performing intense exercises that involve a lot of negatives in someone who is not used to – or increasing the intensity of the workout too fast – it can be a recipe for disaster.
With that said, it's not normally possible to take eccentric muscle actions out of the exercise. Exercise-induced rhabdo most likely is caused by exercise that puts too much stress on the muscles. Focus instead on the amount of exercise you are doing (how many sets and how many reps) rather than how many negatives you are doing.
Personal Trainers And Rhabdomyolysis
Personal trainers have – unfortunately – also been the cause of rhabdomyolysis. How many personal trainers have caused rhabdo? This is unknown because rhabdo is not always fatal (thank goodness!) and many people don't go to the doctor/hospital when it happens – because they don't recognize its symptoms.
That said, I am personally aware of several cases of personal trainer-induced rhabdomyolysis that have arisen within the past few years. I believe the incidence of personal trainer-induced rhabdomyolysis is under-reported in the medical literature.
Read the comments below for more cases of trainers causing rhabdo.
If anything is going to cause U.S. personal trainers to one day get a personal trainer license, it will be a personal trainer causing rhabdomyolysis in a high profile individual.
I believe personal trainers cause rhabdomyolysis in their clients for several reasons including:
1. Never having been educated about it
2. Thinking that more sets /greater intensity is best for everybody
3. Being shy about stopping a training session when the client has had enough
4. Failure to recognize the benefits of circuit training
If you are a personal trainer, you need personal trainer liability insurance. I have spoken to attorneys who are suing trainers who caused rhabdo.
An unfortunate fact is that rhabdomyolysis is not discussed in many personal trainer certification textbooks. In fact, my personal trainer textbook was one of the first personal training books in the US (and maybe THE first!) to educate fitness trainers about this condition. My book is also the official textbook for the Interactive Fitness Trainers of America.
PE teachers also need to know about rhabdomyolysis because there is some evidence of young children getting rhabdo from gym class.
Personal Trainers: With Great Power…
Personal trainers need to understand that they have a power over others. Nobody talks about it but it's there. The power is that most of their clients will never tell a personal trainer “no.” In other words, most people will never tell the personal trainer when they think they have had enough. Most will keep working out as long as the trainer gives them things to do, for as long as the training session lasts!
This power is great and as Peter Parker (aka Spider-Man) says “with great power, comes great responsibility.” If you're a personal trainer with big, hulking muscles or a boisterous personality, you need to know that you might intimidate your clients – without even trying to – leading, unintentionally, to a greater risk of rhabdo.
One case report of personal trainer-induced rhabdo occurred in a doctor. Doctors are VERY well aware of rhabdomyolysis yet this physician allowed the personal trainer to push him to the point of muscle cell death.
Of all personal trainers out there, female personal trainers have the greatest power. I say this because most men will never tell a woman they can't do what the woman can do! No man wants to appear weak in the eyes of a woman. Female personal trainers must be aware of this power when they train male clients. When you think somebody has had had enough. End the training session.
Gyms Causing Rhabdo
I believe gyms can contribute to rhabdo without knowing it. Here’s why I say this. When people join a gym, they usually get a free/complimentary personal training session. I’ve been told on several occasions that personal trainers are instructed to beat the daylights out of the person who gets the free session. Why? Because, by making the person “think” they are out of shape, they are more likely to sign up for more personal training sessions.
I just made some people mad by telling this dirty little secret, but I don't care. Don't let ANYONE push you beyond your limits with exercise.
By subjecting people to lots of exercise (lots of volume) that the person is likely not used to doing, gyms – and personal trainers – run the risk of causing rhabdo in their members.
Here are my top 5 reasons why gyms are causing rhabdo.
The 30 Minute Workout
At most gyms, personal training sessions are only 30 minutes long. Gyms do this because:
1. Most beginners may lack the endurance and desire to last longer than this
2. The trainer can make more money by theoretically training 2 people per hour
That said, the 30-minute training session might increase the risk of rhabdo. Here’s why: The personal trainer, wanting people to get the most for their money, thinks they have to do the best job they can in 30 minutes.
Thinking like this – as well-meaning as it is – might lead the trainer to fall back on aggressive training programs like super sets. In beginners,
supersets, drop sets, interval training etc. might cause rhabdo in some people.
Beginners are best suited with a full-body circuit training workout. This keeps the overall exercise stress low, reducing the risk of rhabdo. Circuits also cause less DOMS than more intense workouts and allow the trainer to put the person through a wider variety of exercises. When you only have 30 minutes, circuits are the most efficient way to train someone.
Rhabdo And Cholesterol Drugs
It is well known that in some people, cholesterol-lowering drugs (statins) can increase the risk of rhabdomyolysis. This is why they give that warning in TV commercials for these drugs. Intense exercise – esp those that contain negatives – can also increase rhabdomyolysis risk. Therefore, would people who take statin drugs have a greater risk of rhabdo when they exercise intensely? Yes. There is some evidence that people taking statins have more rhabdomyolysis than those not taking statins.
I believe personal trainers who do fitness bootcamp classes should consider statin use when they work with people and tailor exercise intensity accordingly to reduce its risk.
Rhabdo And Sickle Cell Anemia
The risk of rhabdomyolysis seems to be increased in people who have sickle cell anemia and those who are carriers of the sickle cell anemia gene (these people don't have sickle cell anemia. They just have the gene for it). In 2010 a healthy, 19-year-old college football player with sickle cell trait developed rhabdo during training, which contributed to his death. This is but one of several incidences of sickle cell trait contributing to the occurrence of rhabdomyolysis.
The presence of sickle cell trait does not mean that exercise-induced rhabdomyolysis will occur and it does not mean that people with this genetic marker can not exercise. Rather it only means that the risk of rhabo is increased. To reduce the risk, fitness trainers may want to ask about sickle cell trait (and sickle cell anemia) in their health history questionnaires. This will allow the personal trainer to modify the exercise intensity to reduce the risk.
Rhabdomyolysis And McArdle Disease
McArdle disorder is a genetic condition where people do not store glycogen, our bodies reserve storage form of carbohydrates. People who have this condition have an elevated risk of rhabdomyolysis.
How To Reduce The Risk?
The easiest way to reduce the risk of exercise-induced rhabdomyolysis is to introduce exercise slowly and give the body time to adapt between workout sessions. Tossing a novice into a fitness boot camp class and on the first day, having her do 250 lunges, crunches and squats is a recipe for rhabdomyolysis. This is actually a true story told to me by the woman this happened to. She got rhabdo from this workout.
The easiest way to reduce the risk of rhabdo is to not overload the person with too much exercise. When exercising, one way to achieve this
Everything you need to know about exercise causing rhabdomyolysis
is to follow this rule:
- First increase the reps you can do
- Then increase the sets you can do
- Then increase the weight you can lift
For example, when you can do 1 set of 15 reps, then do 2 sets of 15 reps. Then do 3 sets of 15 reps. After that, then try increasing the weight you can lift by a little bit (5-10 pounds for example). By increasing the weight, this should decrease the reps you can do. So again, start at one set and progress to 3 sets, before increasing the weight again.
In this step-wise progression, you are giving the body the time it needs to adapt to the exercise. Remember, rhabdo occurs when people do too much exercise that they are not used to doing.
Rhabdo And CrossFit
Crossfit, the popular hard-core exercise program, has also resulted in rhabdomyolysis in some of its participants. Among CrossFit trainers, the syndrome is often referred to as “Uncle Rhabdo” however I don't like this term. I feel calling it “Uncle Rhabdo” undervalues and water-downs this serious disorder.
In the June 2011 CrossFit Journal, they likened the phrase Uncle Rhabdo to Smokey The Bear because Smokey reminds us about forest fires while Uncle Rhabdo reminds us of rhabdomyolysis. I disagree totally with this analogy. Referring to a potentially life-threatening disorder with a euphemism like Uncle Rhabdo, downplays the significance and, I feel, leads CrossFit trainers to think rhabdo not such a big deal.
I feel rhabdomyolysis is one of the most serious disorders facing fitness bootcamp trainers today. It should not be made fun of. Anyone who has found themselves in the hospital knows how serious it is.
Crossfit trainers: is rhabdomyolysis covered in the Crossfit certification exam? Please let me know.
Update. I was informed by a cross-fit personal trainer that there are are 10 pages devoted to rhabdomyolysis in the cross fit manual (the manual is 117 pages in length). I was informed also that there are 2 questions about rhabdo on the cross fit exam. It appears that Cross Fit is taking rhabdo much more seriously and I commend them for this.
My #1 question test for ALL personal trainers: “Tell me what rhabdomyolysis is.” If they can't tell you or only give you a superficial description, walk away. That is not the person you should entrust your health to.
Let me be clear. I am not beating up on CrossFit. I am aware of rhabdomyolysis occurring in other lesser known fitness boot-camp facilities as well. Heck, personal trainers – not doing boot camp workouts – have caused rhabdo too. To their credit – Cross Fit has discussed this disorder openly in their Crossfit journal.
The fact is that ANY extreme workout – P90X, Insanity, plyometrics, football combine camps – or other intense exercise routines can cause rhabdomyolysis. Here are some tips on how to set up a safe exercise program.
If you are going to take part in CrossFit, P90X, Insanity or any boot camp-type fitness program, I recommend starting with only 1 session per week. Start with 1 session per week for the first week or two. Then 2x per week in the second or 3rd week and so on.
Remember, the body needs time to adapt to intense exercise. I don't feel Cross Fit or other intense programs should be done more than 3 times per week. In my opinion, anyone who recommends beginners start intense exercise programs 2-3 or more times per week, does not know what they are talking about.
How Likely Is Rhabdo?
I wish I could tell you what the odds are rhabdo are. I can't. I don't know – and nobody else does either right now. Unfortunately, the CDC has not released any recent statistics on this condition. Its sometimes estimated that there are 26,000 cases of rhabdo in the US each year but that is an older statistic from the 1990s and it considers ALL the causes – not just exercise.
Back then, they estimated that half of those rhabdo cases – 13,000 – were due to exercise. Here's the thing; the 1990s predates most of the boot-camp style workouts that are popular today. Is rhabdo more or less likely today? I can't tell you.
Hopefully, the CDC will eventually put out some better statistics on rhabdo.
Can You Have A Mild Case Of Rhabdo?
When we remember what rhabdo is – muscle fiber death – I don't think there is such a thing as a “mild case.” Once those muscle fibers die, they dont grow back. That said, there are people who have gotten rhabdo who never went to the hospital or seen their doctor. They had all the tell tail signs and symptoms but they just grinned through the pain and dealt with it. I believe those people just got lucky.
Read the post on Mild Cases of Rhabdo too.
What To Do If Rhabdo Occurs?
Personal trainers basically only have 2 ways of “seeing” rhabdo.
1. Somebody has very intense muscle soreness which hurts even when the person is not moving and which happens very fast (immediately after exercise up to 24 hrs later).
2. The person's urine looks dark brown colored – like maple syrup or cola-colored.
If you are a personal trainer and these symptoms are brought up in conversation, I recommend you stay calm – and call an ambulance. I can't stress this more. This is the safest course of action.
Telling somebody to “go to the hospital” might make things worse – if the person got into an accident or passed out on the way to the hospital.
I know for some, calling an ambulance may seem over the top. Heck, I'd bet most personal trainers working in gyms today have not even been told about the gym's emergency procedures! I'm sorry but being a personal trainer means that you may have to “take the bull by the horns” from time to time.
I look at it this way: At the end of the day, I want to be able to look at myself in the mirror and say I did my best. I tried to do good.
All personal trainers and group fitness instructors need to be aware of rhabdomyolysis and work to reduce its risk. ANY personal trainer or other individual who doesn't know what he/she is doing can accidentally cause this disorder. This is one reason why I feel ALL trainers should have personal trainer insurance.
Reducing exercise-induced rhabdomyolysis is best done by considering the health of the person and by slowly increasing exercise intensity and frequency where appropriate, and knowing that no single exercise routine or program is best for everybody. Remember, they call it personal training for a reason.
Here is my book on Rhabdo which goes beyond what was covered in this review. It may be the most important book you ever read.
Please share this review with your friends so they know these facts too.
Thank you for making people more aware about this. I’m a 26-year-old who has lived a mostly sedentary life, but decided it was time I start working out to get in better shape. I signed up for a planet fitness membership and went to see the trainer there. Despite me making it clear that I was new to exercise, he seemed confident that a full routine would be good for me and that I don’t need to ease into it.
Two days later and I’m experiencing the worst pain or my life and have been admitted to the hospital for rhabdo with CK levels at 58000. The doctors here said I worked at least 10x harder than I should have when I worked out.
My kidneys are fine, but there’s excess liver enzyme in my system. I’m hoping that I can get out of here tomorrow with all the fluids I’m getting.
Hi Cory, first let me say how sorry I am to learn what happened to you. Im sure the hospital is not what you thought would happen when you joined Planet Fitness. I hope when you feel better you will let the planet fitness personal trainer know what happened. hopefully, that will get to the person to investigate rhabdo (send him/her to my site) or at least give him/her reason to listen better to clients who say they are beginners.
I don’t know why fitness trainers push people harder than they need to. It saddens me to hear things like this but I do appreciate you taking the time to write. My hope is fitness trainers read your words and learn from this.
If it helps, I have several other rhabdo reviews which you may have seen
http://joe-cannon.com/category/rhabdo-articles/
And I’ve interviewed people on my podcast too
http://joe-cannon.com/category/podcast/
My hunch is the liver enzymes that are elevated are called AST and ALT. While these enzymes are indeed found in your liver they are also found in your muscle cells too. As rhabdo occurs muscle fibers release AST and ALT enzymes. This may be why your enzymes are higher than normal. You can ask your doctor about this as a double-check.
I do hope you feel better soon and are out of the hospital tomorrow and Im glad to hear your kidneys are doing well. Try to have a good night and feel free to write back with any updates or if you have any other questions.
I’ll say a prayer for you tonight for your speedy recovery.
Hi, Joe. I was wondering if you knew about any cases where rhabdomyolysis was caused by Electrical Muscle Stimulation (EMS) devices.
Also, how likely is using one of those devices 2 or 3 times a week to cause rhabdomyolysis?
Thanks for the information,
-John
John, while I think the risk is low overall, I think to reduce rhabdo from happening, start slowly. For example, start with 5 minutes rather than 30 minutes and 1 day a week before doing 2 or 3 days a week.
Hello Joe ! I was diagnosed with Rhabdo around a year and a half ago. I was in a karate belt test and it was 90 degrees outside, we ran about 5 miles plus doing techniques for a while in this heat. Also doing fighting drills inside for a few more hours. We also have to do push ups when the team is wrong.
That night my heart rate went crazy when I tried to sleep and I went to the ER. They didn’t diagnose me there until a few days later when I had a follow-up with my doc. Long story short I have and still have major anxiety about getting this again. I’m back to a regular workout program, but I’m wanting to finish getting my black belt. How can I test without getting it again? Or should I even try!?
I really want to fulfill my dreams but also I’m not sure how to navigate this because not a lot of people know how to stop it. My teacher says he can modify the testing but still anxious, help, please!!!!! Thank you
Hi Chelsea, I’m really sorry to hear you developed rhabdo. I’m surprised the ER didn’t diagnose you but let’s not dwell on that. Since you are working out again without any issues, I feel that’s a good sign. While I’m not familiar with what it takes to qualify for a black belt, I don’t think it is necessary to punish people with pushups when someone on your team did something wrong. Regardless, I’m glad to hear your instructor can modify your testing. Why not discuss with your instructor what kind of modifications he/she would do to help you get your black belt. Maybe leave out the pushups and 5-mile run? Is that possible?
Here are my other reviews, videos and podcasts about rhabdo in case you missed them:
Is your instructor familiar with what rhabdo is? I’m sure this has caused you quite a lot of stress and anxiety. Keep me posted on what happens.
Hi Joe, I myself had rhabdo after returning to the gym after the end of a national lockdown in England due to the pandemic. I had been powerlifting for three years before this but had done very little exercise this year due to the pandemic.
At the end of lockdown, I decided to follow a more bodybuilding style training with more isolation exercises and lots of slowed eccentrics. I’m pretty confident that it was the slow eccentric dumbbell curls that pushed my biceps to their limit – especially after I had already done some rows and a few sets of lat pulldowns.
My blood CK levels peaked at about 56,000. I took 3 months away from lifting and have now started easing back into it and so far I feel no pain in my arms (where the damage was). Though I’ve destroyed some muscle fibres I’m really hoping that new ones can grow to replace them and that this episode of rhabdo won’t affect my training long-term?
So far there’s no trouble but I’d like to eventually return to powerlifting.
Cliniton yes my guess is your rhabdo was caused by the pandemic closing the gyms down and just starting back too much. As you know bodyuidling is different than powerlifting in terms of volume (weight x reps x sets). It makes sense to me that all that extra volume coupled with the gym closings due to the pandemic caused the rhabdo.
I’ve been predicting an uptick in rhabdo cases as the gyms open up post pandemic. Here is my podcast episode on this topic
Avoiding rhabdo after the pandemic
The good news is I believe you can eventually start powerlifting again. Odds are this was just a fluke that probably won’t happen again as you gradually progress your exercise routine.
Keep me posted on your progress.:)
Just got out of 1 week hospitalization following CPK 103,000, urine almost black, and excruciating pain after a 1 hour workout with a new trainer! Finding this website and hearing everyone’s experience is so helpful definitely going to read the book but I have to say I definitely have PTSD and very scared to work out every again!! Thanks for having this information out there!
Sara, first let me say I’m so sorry to hear that you got rhabdo. I can only imagine how scary and painful this has been for you. Can I ask you a few questions:
did you tell the personal trainer /gym that you got rhabdo and what happened?
Was this the very first workout you’d done in a while?
Can you descirbe what the personal trainer had you doing?
I have several other articles on rhabdo here which I hope you saw. I have some podcasts too. Here are links
Rhabdo articles
My podcast Joe Cannon Health
Hi Joe,
Thanks it was definitely scary I didn’t anticipate being there a whole week and everyone was saying 100,000 was the highest they’d personally seen!
I did tell the trainer, I don’t think he’s certified or anything my friend found him on Instagram he trains a lot of women. He didn’t do an assessment or ask about anything but I told him I hadn’t worked out in years and am very out of shape. When replying to me he just said that he used the same “beginner” workout he does with everyone he trains and that rhabdo is super rare and that there’s no way he can anticipate who will get it but was very apologetic and said that he did the easiest session.
We basically spent the hour doing different squats first against a yoga ball against a wall then just with body weight then while standing on a flat weight while holding a dumbbell, and i forget all what else but towards the end I was definitely experiencing muscle failure and he kept pushing so I kept going.
Immediately after I felt a lot of pain, but just thought I was being weak. Wasn’t until 3 days later I noticed my urine start to darken then I went to urgent care and the next day my urine was like black coffee and the urgent care said my CK was critical and I needed to go to the ER… where I spent 6 days got discharged with CK 6,600 and just today found out 3 weeks later I’m finally at a normal level.
Still have some pain especially in the right leg that was the one that got super super swollen and can’t stand for that long or do stairs.. I’m worried about ever walking normally and am terrified of working out! I have been all over your website and am going to get your book I will definitely check out your podcast!
Thanks again so much for all of this info and for making it so accessible!
Sara
so sorry to hear all that happened to you!! I’ve heard about personal trainers advertising on social media. There’s been a rise in online training since the pandemic. I’m sure there are qualified people out and there are also not-so qualified too. Since you told the guy you had not worked out in a long time, it makes no sense for him to do an hour of mostly leg exercises. Exercise programs need to be tailored to the individual (based on fitness, injuries, etc) so when he said he put you on the SAME exercise program as he’s used with other beginners, makes no sense.
Regardless, your CK levels are back to normal so I’m sure that is a big relief for you. You are home again and on the road to recovery! Being scared to exercise again is normal. Give it time. Don’t do any exercise for at least a month and not until your symptoms have gone away. I’d also suggest you keep all your text messages and other communications with that trainer for your records.
I’m mailing to the book to you now. Feel free to reach out if you have any questions and do keep me posted on how you are doing.
I got diagnosed with rhabdo in December of 2018. Long story short I was hospitalized a day or two after working out, (i can’t remember the workout that put me in the hospital but I was admitted Christmas Day).
My left arm felt super weird the day before Christmas and Christmas Day. I couldn’t extend it all the way and it was just super sore. My mom saw that my left arm was way more puffy and swollen than my right, and I went to the hospital. My CK was at 8,000. After being released my PCP told me to take the next two months off from any activity.
Flash forward to February 2019, I go back to the gym and I remember doing pull-ups. I woke up the next morning with the same thing in my arm. I get admitted to the hospital again and my CK is at 7,500.
Flash forward again to current day, June 2020 and I still feel like my arm is just so weak. I really haven’t worked out consistently since February of 2019 over the fear that my arm is going to swell and I’ll have to be admitted to a hospital after every workout.
Since I’ve basically taken over a year off from lifting weights, I figured my arm would be back to normal. I’m not sure if it’s a psycho-somatic issue, but my arm is on my mind 24/7 and I can just feel that feeling in it when I do anything remotely active with my left arm.
The Drs. have straight up told me they don’t know why it happened twice and don’t know if it will keep happening. I’m not even that intense when I workout so I feel like I don’t have any answers to fix this. I would hate for this to be recurrent rhabdo because not being active has definitely affected me physically and mentally.
Do you have any advice or insight as to how to get back into working out? The constant anxiety of my CK going up and arm puffing up is so nerve wracking… Is my arm at a lost cause or is it all on my head?
Will I ever be able to workout without it flaring up?
Hi Jackie, I feel your frustration. I’ve heard similar questions from others In the over 10 years I’ve been speaking out about the dangers of rhabdo. One thing I’d say is I would avoid pull-ups all together. I’ve heard from several who told me they have gotten rhabdomyolysis from pull-ups. Based on what you said, I think pull-ups should be avoided.
If your arms are still feeling week, I’d suggest refraining from strength training until they are feeling better. When you do start back up with gym workouts again, modifying the working out to put as less strain on your arms. For example, focus on big muscle movements. Avoid smaller muscle movements like biceps curls. Remember your arms are already being used when you perform exercises like chest press and lat pull down at a lighter resistance. Doing exercises specifically for the arms (like biceps curls) might be just too much for you at this time.
I dont feel your arm is a lost cause. It’s just going to take time to heal. I can’t say how long that will be. Have you been ever tested for genetic traits that might raise your risk of rhabdo? Heres my podcast on rhabdomyolysis genetics.
I can’t stress its best to wait until your arms are feeling better again before doing this. Since your legs seem to be ok, do cardio and lower-body movements like the leg press.
I do understand your frustration over this. I do believe you will be able to do resistance training again but it till just take time. I can’t say how long it will be. Time and patience are our friends when it comes to recovering from rhabdo.
I have several articles on rhabdo too if it helps
I hope you will keep me posted on how your recovery is going.
Hi Joe, I ran in a 24-hour ultra run event November 1 and 24 hours later had the dark urine and extreme muscle pain in my legs. Long story short, I am now, a month later, walking on my own fine and most of the pain has subsided. However, I still have extreme tightness/soreness in my groin and occasionally my butt. I didn’t feel like a tore a muscle when I woke up after my race. I have been able to do light workouts at the gym but cannot run without pain.
Do I need to get an MRI or is physical therapy the best option? I’m trying to be patient/conservative but it is difficult. What precautions can I take as I get back into the gym to avoid a re-occurance? Aside from not doing a 24-hour race. Ordering your book. Thank you in advance.
Hi Jason, so sorry to hear you got rhabdo! Since you say you still have extreme soreness a month later makes me want to suggest you see a doctor. Regular muscle soreness usually goes away after a few days. It’s hard to say if your pain is due to residual effects of rhabdo or if something else is going on. I think seeing your doctor is your best option to find out what’s going on. I would avoid working out until you see your doctor.
I wish I had a better answer for you than that. Given what you said I think thats the best advice I can give. Do let me know what your doctor says.
Thank you Joe for your response. I’m going to wait 1 more week and see if it subsides at all. I will keep you posted.
I have been attending Crossfit for about a year, and about 6 months ago my arms became really swollen from a workout and I was told to go to the hospital if my urine became darker but it didn’t. Since then my arms swell during most crossfit arm workouts, and I recently did a workout and felt much weaker than I usually do. An athletic trainer I know said it sounds like exertional compartment syndrome and just to lower the intensity of my workouts.
Can I go to the Doctor to get tested for Rhabdo on a day my arms aren’t swollen and I haven’t worked out? I have not been sure if the same results would occur in my blood test if it wasn’t right after working out.
Hi Charlotte, One thing to remember about rhabdomyolysis is that the urine color change does not have to occur. That’s a common myth. Its possible to have rhabdo but not see a change in urine color. for more on this see this review
Rhabdo Myths
I talked about this also in my podcast too here is the link: Joe Cannon Health Rhabdo Facts and Myths My podcast is called Joe Cannon Health. Just search for that title in Apple, Google etc if you prefer to listen that way.
One of the tests your doctor will do is check your creatine kinase levels. your CK levels go up with muscle damage (and rhabdo) but they generally tend to go back down again after a few days. Therefore Im not sure if this test would help if your arms were not swollen. That said Id say go to the doctor anyway. It can’t hurt and may shed light on what is going on.
How long do your arms stay swollen after CrossFit?
I was diagnosed with Rhabdo back in June of 2018. My CPK levels were out of this world. My kidneys did take a hit. I had this all happen after a Spartan 14 mile obstacle course race. I went in dehydrated and it definitely made the Rhabdo worse.
My question to you is, “Have you ever seen a correlation between rhabdo and enlarged lymph nodes?” I recently had surgery to have some enlarged lymph nodes from my armpit. The doctor hasn’t received results yet; however, he mentioned this could be from the rhabdo incident. I just wasn’t sure if you ever came across this while doing your research.
Thanks so much.
Hi Ashley, many things can cause /contribute to rhabdo. I have not heard of enlarged lymph nodes increasing the risk of exercise-induced rhabdo. Other forms of rhabdo maybe, but related to exercise, I cannot say.
Can you let me know what happens when you get the report back from the doctor?
I’m currently in the process of recovering from rhabdomyolysis. I’m still being monitored and I’ll give you a timeline of what I think was the perfect storm that caused my rhabdo.
-June 2018 tore my rotator cuff and rehabbed, slow ramp-up until about December 2018.
-November 2018-January 2019, I’ve felt stronger than ever and shoulder wasn’t bothering me as much anymore. Was able to bench press, shoulder press, do some pull-ups, push-ups but not to the same extent as I did before I tore my rotator cuff.
-(DAY 1)January 2018 the WOD was Angie (100 pull-ups, 100 push-ups, 100 sit-ups, 100 air squats) and we did 20 squats before that. (recipe 1: eccentric movements, many reps)
-Rainy day and cold. I didn’t feel as thirsty as I normally would be. Did not hydrate that much (recipe 2; hydration)
-Finished the work out successfully but immediately felt the pump and felt “swole.”
-That same night played in a sports league but didn’t use the same muscles that I used for the workout. Again, cold and rainy night and did not drink that much water.
-Soreness persisted to the point where it was hard to sleep but didn’t think much of it.
-(DAY 2) Extremely sore. Complained about soreness and was fatigued. Rested and noticed that I was not peeing that much (recipe 3: infrequent urination). I used the Hypervolt on my arms thinking it was just sore. (Could this be the 4th recipe, a heavy duty massager?)
-(DAY 3) Still sore and can’t fully extend arms without pain. Rested and didn’t work out. Massaged my arms again with hypervolt and manually. Drank a protein shake thinking it would improve recovery (Recipe 5. Protein affect kidney function. Specially during a bout of rhabdo). At one point on this day, I think I may have noticed a darker colored urine but didn’t think much of it.
-(DAY 4) Felt a little less sore. Bad Idea. I went back and worked out 70-80% effort. 50 Cals on the bike, 50 burpees, 50 cals row, 50 KB swings at 35 lbs, 50 cals bikes, 50 cals burpees, 50 cal row, 27 KB swings. Noticed darkish colored urine again. I massaged the area again to make it feel better but that probably was exacerbating the problem even more.
I was getting concerned and looked up the symptoms and rhabdo popped up. I contemplated going to the ER that night but decided to sleep it off and go to Urgent Care the following morning.
-(DAY 5): Reported to Urgent Care and told them about Rhabdo and symptoms. CK was 75K. Had 2 bags of IV in Urgent Care before getting admitted that night. AST/ALT levels were also high.
-(DAY 6): Many bags of fluid administered. Urine output normal. No need to see Nephrologist. CK:59K. AST/ALT went down. Creatinine back down to 1.1
-(DAY 7): More bags of fluid. Urine output and color normal. CK: 54K. At this point, I was in the hospital getting treated with IV for 3 days now. I felt fine, urine output normal, renal functions okay, no soreness, but still very high CK levels. They did not want to discharge me but I felt I can continue my monitoring and hydration at home. I left that night.
-(DAY 8): Rested and uneventful. No scheduled labs until the following day. Kept hydrating. No soreness or pain.
-(DAY 9): AST/ALT down. Creatinine level normal. Still waiting for CK level. I have an appointment with my PCP in 2 days.
…I’ll keep updating as I get my results.
QUESTIONS:
1. If my CK level doesn’t drop drastically, should that be a concern? Or is any form of downtrending okay?
2. Do you think the Hypervolt and manual massage caused my CK to rise even higher?
3. Should there be more emphasis on drinking water not only when it’s hot outside but also when it’s cold because that’s when people tend to drink less?
4. Would immediately icing have stopped the muscle lysis from releasing myoglobin in the bloodstream therefore, reducing the effects of rhabdo?
5. Do you think people get mild rhabdo all the time and recover from it without hospitalization just because they rested?
6. Is there a way to contact you personally and set-up a workout program once I’m all cleared to exercise again?
Thank you so much for this forum! It’s been very helpful and all of us feel lucky to have a resource like you.
Leo,
So sorry to hear all you have been dealing with. Few thoughts:
1 Im glad you went to urgent care and the hospital. Urgent Care seems to be getting a lot of rhabdo cases from the people Ive run into.
2 CK levels can stay elevated for up to 5 days after the event which caused rhabdo. It does sound like they are going down but do keep in contact with the doctor to make sure they are.
2. You are urinating yes? Hydration gets a lot of attention when it comes to rhabdo but if your not urinating, its best to speak to a doctor.
3. I would not use the Hypervolt. I’ve never used it but depending on the intensity, I don’t know what effect it would have on muscle damage or creatine kinase levels.
4. Dehydration can make rhabdo worse but drinking water does not prevent muscle fiber death – which is what rhabdo is. Hydration is important but I feel its emphasized too much in the rhabdo community. I often wonder about that person who only hears “drink more water’ and over-hydrates. The condition is called hyponatremia (water overload) and it can be serious. Drink the amount of fluids your doctor tells you to.
Outside of rhabdo, dehydration can occur in cold temps too so what you say about emphasizing fluids when working out in cold temps would be in wise in my opinion.
5 I’m not aware of any proof icing the muscles immediately after exercise would have stopped rhabdo. There isn’t much research in this area but at least one study has noted rhabdo occurring from ice water baths. Its good to remember rhabdomyolysis can occur from many things – its not just exercise.
6. I have met people who have had rhabdomyolysis – but never knew they had it, because they did not know what rhabdo was. They basically got lucky in my opinion. I don’t know if I would call this a mild case of rhabdo because I think all cases are something to take seriously.
See my Mild Case of Rhabdo Review for more insights.
7. Sure, once you are cleared we can do a consult if you like. You have my email. Just make sure your doctor has cleared you for exercise.
I hope some of this helps Leo. When it comes to recovering from rhabdo, patience and time is your friend.
Keep me posted on your progress and listen to your doctors.
-(DAY 10) CK results back from yesterday and I was shocked. Went back up to 65K. I started blaming myself for leaving the hospital so soon and against their advice. I was nervous when I saw the result. My doctor was out of the office so I called her back up and asked to re-do a CK test on day 10.
They originally said I don’t need it. The Nurse Practicioner ended up ordering it for me. I went and got my blood drawn and got my results. Went down to 10,000 today.
I was happy for the drastic drop. I’m gonna keep oral hydration at home and I have an appointment with my PCP tomorrow. I’ll see what the next course of action is.
I’m definitely going to wait until all my levels are within normal range before I even think about anything strenuous. I’m learning to enjoy this rest and relaxation journey.
Joe, I will definitely email you about re-introduction to strenuous exercise once I get the clearance from my PCP.
Thank you!
Leo, glad hear your CK levels are dropping. Im sure that spike in CK was quite a shock to you. What you are going through is normal in my experience. People often don’t take rhabdo seriously and want to leave the hospital before they are ready or they return to exercise before they are medically cleared. Just rest and keep in touch with the doctor for now 🙂
Hi everybody, in case you were not aware, I’ve written the following other reviews on rhabdo I think you will find helpful
Can You Die From Rhabdo?
Is Is Rhabdo or Just Muscle Soreness (DOMS)?
Spinning and Rhabdo: Review of Research
Can You Have A Mild Case of Rhabdo?
5 Rhabdo Is Occurring in Fitness Centers
As always I hope you all have been doing well. 🙂
No not that I can recall.
that’s good. My hunch is it may have been a cumulative effect of all the work you were doing. But, if it happens again, do go back to the dr and get that blood test. That will tell for sure if its rhabdo or not.
I’m glad I came across your wonderful article. Five days ago (wed), while at work I seemed to pull both of my inner thigh muscles. The right one is worse than the left by a noticeable about. The pain was pretty severe until Friday afternoon when it started to lessen up. When It was at it’s worst I could walk okay but had severe pain when lifting my legs like to get into a car or go up stairs.
I went to the doctor yesterday and she looked at me for a few minutes and wanted to take a blood sample for CPK. stupidly I refused due to my tendency to pass out during blood work. Ever since then I’ve been reading up on this and am worried that I may have it. My pain is 90 percent gone but still there a little bit. The pain only comes on when using the muscle not at rest so it sounds like DOMS.
my urine is mostly clear due to me drinking lots of water. Do you think that I could have Rhabdo? I have pretty bad health anxiety and I’m worried about my kidneys. The thing that has gotten me is I wasn’t working out or doing anything strenuous that I can remember. It started out as a twinge of pain then by the end of Wednesday night I couldn’t hardly lift my legs. Could I just be out of shape.
The only thing I could have done to cause this is I ran up a small flight of stairs about two hours before the pain started.
Hi Joshua, sorry to hear about your problems last week. Its hard to tell if you had rhabdo or not. the blood test might have shed light on this. In theory its possible but its also possible you may just have had delayed muscle soreness (DOMS). How many times did you run up the small flight of steps? was that something you usually do not do? I do not think the pain you experienced is because you are out of shape. The good news is the pain is mostly gone.
See my post Did you have a mild case of rhabdo for more info
It was only once that I ran up them.
Joshua, that probably would not do it then. Is your work very physical usually or did you do anything different/out of the ordinary that day – and do it a lot?
It’s somewhat physical. I’m on my feet for 7-8 hours and lifting 5-50 pound boxes throughout the day but nothing that bothers me. But nothing I did that day was out of the ordinary.
Joshua, it sounds pretty physical to me if your on your feet 7-8 hrs a day. it could have been a case of over exertion. were you doing anything that day that was different than you usually do and did it over and over again?
Thank you for all of this information. I was hospitalized with Rhabdo in October 2017 after a resistance band workout with a trainer I worked with for the first time. I’m in the military, Reserves, and have to maintain my level of fitness and this article has given me the confidence to jump back in, slowly and with rest.
Hi Pink, I am so glad what I wrote has benefited you. Thank you for serving in the military and helping protect the rest of us. If you ever have any other questions for me, just ask and I will try to help.
Hi Joe, I read your book on rhabdo. Thank you for writing it!!! Like most others commenting, I have never heard of rhabdomyolysis before. I got rhabdo after a workout with a trainer at a local gym. This was the worst pain I’ve ever experienced! I was in the hospital for a week afterward. I never wanted to experience that again and I found your book on Amazon searching for advice on how to exercise after someone gets rhabdo.
All I can say is THANK YOU! Your book was so easy to read and answered ALL my questions (the chapter on personal trainers was eye-opening!).
Anyway, I wanted to reach out and say I so appreciate you writing it. You are helping MANY people. I just wanted you to know that. 🙂
Hi Stephanie, thank you so much for writing and letting me know. I often never know who reads my books so I’m always glad to hear from readers. While I am very sorry you got rhabdo, I’m happy that my book was of some help to you. Glad you were able to find it on Amazon!
For those who don’t know, they can also get the book directly from me too. Here’s the link: Get rhabdo book. Ill even autograph it if they like 🙂
Keep me posted on how your post-rhabdo workouts are going.
Joe:
in 2015 my husband ran Rim to Rim in the Grand Canyon. He ended up with Rhabdomyolysis. He was in the hospital for 15 days with total kidney failure. His CK levers were 42K and he had to have dialysis 3 times in hopes of restarting his kidneys. It took 3 months for his levels to return to normal, but thankfully he recovered.
In July of 2017, he ended up in the hospital again with Rhabdo. His doctor this time told him he could never run over 3 miles but did not say how to go about getting back into shape. I have been searching for this sort of information for a long time. Only recently has information been available about Rhabdo and there is not very much out there to help you after Rhabdo. I am interested to read your book and hope it will help my husband.
I recently went to a gym and asked the personal trainers about Rhabdo and they didn’t know anything.
Hi Kelly that must have been some run your husband did at the grand canyon. I dont think Ive ever heard of anyone doing that before. About the running again after rhabdo:I’ve never seen anything in the literature that caps how far someone can run after getting rhabdo. My guess is the doctor was being ultra conservative with no more than 3 miles or running after rhabdo. Since your husband has had rhabdo 2x, he is at an increased risk of getting again. Staying hydrated and not over heating (running the grand canyon can do that) and progressing slowly will surly reduce rhabdo. Let’s hope he never gets it again.
I think you’ll like my book, I wrote it to be a quick/easy read that gets right to the point. I also address how to exercise again after rhabdo.
You can get it from me personally and its on amazon too. Here’s the links:
Get the rhabdo book from me
Get it from Amazon
I write this from my third day in a hospital bed.
This is my fifth time being hospitalized for Rhabdo. Mine was brought on by exercise, but nothing crazy like running a marathon or doing cross fit. I have always worked out (cardio and weights). I’ve even recently done a few NPC body building competitions last year, bikini division, without an episode.
It comes on randomly usually after taking a few weeks off. Certain workouts, always leg day, bring this on. I haven’t been training for a competition, but have been working out regularly. This was a normal, average intensity 45-60 min workout. Lunges without weight, or using 5-10 pound dumbbells, as well as a few other leg exercises caused extreme soreness. It was painful to walk.
I never got the dark colored urine, but my CK levels this last time were at 10,000. My nephrologist told me I’m very lucky my kidneys have not shut down or been damaged. You don’t need the dark urine for it to be a serious case of Rhabdo. The dark urine can come on in a flip of a switch.
It gets worse each episode I have, even though I try to take all the preventive measures. Following up with specialists who believe it could be a metabolic cell disorder. There are so many reasons Rhabdo can occur, I hope more people become aware of the symptoms and stop thinking they have to push through extreme soreness.
Thanks for posting this article. I plan to share.
Hi Lisa, first let me say I am so very sorry that you are writing me from your hospital bed. If you look through the comments you will see that you are not the first. You bring up some very good points that people should know about such as dark colored urine does not have to occur for someone to have rhabdo (I was just saying that to a TV producer this week – I’m doing an interview about rhabdo soon).
You are also very correct that it does not have to take a lot of exercise to cause rhabdo either. There are some disorders what can make rhabdo more likely (McArdle syndrome etc). I hope you will let me know what the specialist says about why you keep getting rhabdo. While rhabdo can occur after taking a period of time off from working out, its unusual that only 3 weeks off would trigger it.
Regardless of what happens I know you CAN continue to workout. Lets not let this stop you. We’ll just need to modify things a wee bit. Again, do let me know what the specialist says.
BTW, I like your website. It’s very well done 🙂
This is the most comprehensive post I have ever come across discussing Rhabdo.
Kudos to the author for putting up this article.
Thanks Nino, much appreciate you saying that. Rhabdo is a topic I am dedicated to helping people understand – and avoid getting.
Joe, I appreciate your write-up a lot because When I started training to lose fat and build up muscle, I realized I kept on pushing myself because I was intimidated by my physical fitness instructor’s physique. I wanted to look like him as soon as possible, but whenever I get home, I have severe muscle pain and weakness with swellings around my legs, I also found it difficult to move around.
Even though I did not go to the ER, and I could not comprehend what it was, I, however, took some pain medications after which I felt better. Now I think I have a better understand about my condition which could have just been a minor case of Rhabdo as explained by your article which is really enlightening.
Hi Javier, thanks for sharing your experiences and you bring up a couple of good points I want to comment on:
1 dont feel intimidated by personal trainers who are all muscles. I train personal trainers. It’s my experience that many trainers spend too much time in the gym and not enough time in the library educating themselves.
2. While I dont know if you had rhabdo or not, I would caution people who think they do have rhabdo from taking over the counter pain meds. Some pain medications can reduce how well the kidneys work. Since rhabdo can also reduce kidney function, the combination can be especially bad.
Either way, I’m glad you are doing well now.
Have I had Rhabdo in the past, Yes! Have I read about it before the incident, definitely No!
This article is a life saver for dozens of people who may be trainers, athletes or want to engage in any overzealous exercise. It is not a fun condition to deal with and based on my experience; I do not wish to anyone, always pay attention to the warning signs articulated in this article and save yourself the stress that comes with having Rhabdo.
In all, thanks Joe for taking your time to put this engaging but educative article together about Rhabdo, It is indeed a good read, and I am recommending it to my friends.
Hi Emmanuel, thanks so much I’m glad you found my review of rhabdo helpful. So sorry that you had previously had problems with rhabdo. Hopefully you are all better now.
This is a well put together article; I’m gonna have to reduce the way I work out from now on, more people need to read this so I shared it on my page. Thanks a lot for this!
Hi Henry, thanks so much for sharing my rhabdo review with others. Education is the best defense against getting rhabdo. Much appreciated 🙂
So I read about through your article on rhabdo and I could not help but notice the point about water intake, I partially thought drinking lots of water while working out eliminates the risks of any Rhabdo disease or anything happening to one’s kidney, this is the common thought among people in my gym, now I better enlightened. Nice article!
Hi Joe, thanks for mentioning that. Water is great and being dehydrated can make rhabdo worse. but the idea that drinking water prevents rhabdo is a myth. It may reduce the risk of kidney damage but it does not stop the process. There are many “internet experts” now talking about water as if its the cure for rhabdo. Unfortunately its not. yes drink water but the best way to reduce rhabdo from happening -or happening again – is to progress slowly with exercise and give the body the time it needs to adapt.
So glad you found my review useful 🙂
Thanks for this superb article, I have a male friend of about 31 years old who is recovering from Rhabdomyolysis which I now clearly understand thanks to your article that he probably got from his extensive workout routine. I remember him complaining of severe muscle pain and swelling thighs, he went to the hospital and found out his cla was 106,000. He was shocked; He said he would stop working out after he recovers. I am spreading the word about this painful condition by seconding and endorsing the contents of your article as accurate enough for everything about Rhabdomyolysis.
Hi Klauss, I thank you for your kind words. For your friend, Id tell him that he can workout again. He just has to ease himself into it. Thats the key for all people starting an exercise program who want to avoid getting rhabdo.
While I am glad Rhabdo is finally starting to get the attention of the news media (im quoted in this New York Times article https://www.nytimes.com/2017/07/17/well/move/as-workouts-intensify-a-harmful-side-effect-grows-more-common.html), what I dont want to happen is for that attention to scare people from working out. The benefits of exercise FAR outweigh the risks of getting rhabdo.
If your friend has any other questions, just tell him to leave a comment here and Ill be glad to help him.
This is a very informative post. I was recently discharged from the hospital after recovering from Rhabdomyolysis, my CPK level was 196,000, but it has gotten down to about 150,000. I normally do regular exercise, but I bought some dumb bells and other personal training equipment to work out more at my convenience.
I work out for about 2-hours per session until I started experiencing muscle pain and swelling. Initially, I thought it was nothing, so I took some aspirin tablets, rested a day and then continued with my regular workout routine. It wasn’t until the pain persisted and increased that I eventually decided to see my doctor who diagnosed me for Rhabdo, a condition I had never heard of until I suffered from it.
I was admitted and given constant IV fluids. I was also lectured about the disease of rhabdo and its risk. I have resolved not to do intense workouts anymore, that is one reason why I am here to seek further reasons to stay away.
Hi George, thanks so much for sharing. For reference, working out 2 hours a day is more than most people need especially when its something you have not done before. I am glad you got the help you need.
This is the best article on rhabdo I’ve seen! I am so glad I stumbled up on it because I’m about to start a weight loss classes. I will be asking my trainer what he knows about rhabdo before we start. I just want to lose weight and not end up in a hospital bed. Thanks, I will keep you updated as my training goes on.
Hi ALana, thanks so much I appreciate you saying that – and much success with your class! 🙂
Thanks Joe for this wonderful put together article on rhabdo, I call it a silent killer because most people are not aware of the enormous damage it can cause, it can even lead to death in severe cases if not properly handled or in late presentation. As a medical practitioner am impressed at the in depth knowledge this article contains, following rhabdo (which is muscle death) there is a release of muscle contents into the bloodstream, which could overburden the kidneys and cause them to shut down.
In some patients who have rhabdo it’s important to note that they might present even without any muscle related symptoms, so you must be ready to volunteer information to your doctors.
Thanks Dr. Gary, I appreciate you chiming in on this topic. Rhabdo education is so needed in the general population and you are correct, not everybody will present with the classic symptoms. My litmus test are usually 1. muscle pain when not moving, 2, recent participation in exercise especially activity that’s unaccustomed and 3, any visible muscle swelling. Dark colored urine may not always be present.
I’m a 50 year old female who was just released this week after 4 days in hospital with Rhabdo. Never heard of it before. Hadn’t worked out in a long time and hired a trainer to help me get back into the gym. Two years ago I got a pacemaker and felt I needed supervision.
I’m prior military and never had an issue in bootcamp or other physical fitness activities. This past week did have a big emphasis on arms, however, and both my arms began swelling within an hour of my 3rd workout last week.
hi Lynette, oh I am so very sorry this happened to you! Uneducated personal trainers often spend too much time on the “mirror muscles” (those we can see in the mirror). It sounds like the trainer did not spread the exercise out over more muscles and/or put way too much emphasis on one body part (in your case, the arms).
Either way, this never should have happened to you. what did your doctors say about you going back to work out?
I hope you tell the personal trainer what happened to you. she/he needs to be aware of rhabdo. The odds are very good she/he has never heard of it.
Do let me know if you have any questions and I hope will let us all know how you are getting along.
Hi Joe! I got rhabdomyolysis about 3 years ago from an upper body workout date with an Olympic power lifter. First date. It was my brilliant idea…
I had bi-lateral hip surgery (torn labrums) approx. 6 months before and had been concentrating on physical therapy for that, so my upper body workouts were spotty. My date knew my condition, but he pushed me and perhaps wanted to show-off a little. I am also one to push myself, so I didn’t back down from the challenge.
We started off with assisted pull-ups. (I had told him a goal of mine was to do unassisted pull-ups). When I could no longer do those, he had me do a lot of negatives. At that point, I probably should have stopped, but no… We continued on with various other exercises that were new to me and increased the weight on a couple that I had been doing. I drank water throughout, but I was bit dehydrated to begin with. It turned out to be a recipe for disaster.
I was completely spent after our hour and a half upper body sesh. That was on a Wednesday evening. I figured I over did it a little, but I didn’t think it was that serious. I remember dreading the 2 day DOMS, as I was already feeling sore, particularly in my arms. Soon after, I was nauseous, weak, and had a general feeling of malaise. I figured I just needed to rehydrate and get some rest. I took some over the counter pain medicine and went to bed, but I didn’t sleep well.
The next day, things continued to decline. I was extremely sore and increasingly stiff. It was hard to straighten my arms all the way, and they were swollen. I took some more pain meds, continued to drink a lot of water, replenished my electrolytes, and tried some heat therapy. I would normally ice, but I thought heat was better for sore muscles. Also, I don’t recall if it was that day or the next, but I got a massage – thinking it would help loosen my arms and relieve some of the pain. Wrong.
By Saturday night, my pain was unbearable. I tried taking left-over Percocet from my surgery, and it didn’t make a dent. My arms had continued to swell, and I couldn’t straighten them at all. At this point, I knew something was wrong, as I could no longer try to explain away the pain as DOMS. It was supposed to get better not worse, and it hurt when I didn’t move.
I recalled reading an article on rhabdomyolysis a few years earlier, so I googled it, but there wasn’t a lot of info. I texted my date and told him my concern. He asked me if my urine was coke colored. It wasn’t. He didn’t seem to take me seriously. I also texted my best friend who was an RN, but she wasn’t familiar with it. I decided to wait until the next day, and things weren’t better, I would go the hospital.
So, Sunday I drove myself to the ER – probably not the smartest idea, but I’m pretty independent. I have a high tolerance for pain, but I was holding back tears, as I told the guy my complaint and the sequence of events over the last 4 days. At first, he was skeptical, but he listened to me, looked at my arms and thankfully didn’t dismiss me.
A short wait later, I was getting my bloodwork done. Part of me wondered if I was overreacting. I felt dumb. Another part of me wanted it to be nothing serious. Then, I waited for what seemed like an eternity for the test results. A nurse finally hooked me up to an IV, as I waited in a small private room. Later, she told me she had one of the results back, but they were still waiting on some of the others. I asked her if I would be able to leave that night. She told me that I was getting admitted. (At this point, I regretted not having my phone charger and telling anyone I was going to the ER).
It turns out my CK level was over 49,000. Thankfully, my kidneys were ok, but they continued to monitor them closely. They also brought in a specialist to see if I had compartment syndrome for my arms. Thankfully, they didn’t have to cut me open. Apparently, I was the first case of exercise induced rhabdomyolysis at this hospital. I was known as the girl on the floor that worked out too hard. The best part was that my best friend was one of my nurses for one of the nights. I was finally released the following Thursday, which was Thanksgiving Day, so I missed my trip home to see my family.
Since then, I’ve struggled to work out my upper body, especially my arms. I’ve lost muscle, strength, and definition I worked hard for. I get discouraged and scared, and it has felt like I triggered it again on a few occasions. It’s so frustrating and my passion for working out is dwindling– not to mention that my hip surgery was unsuccessful. That’s a whole different issue though.
Anyway, I found this page because I was searching for a protocol to follow, as I admit I’m not the best at easing back in, even when I think I am. I wish I had found it years ago. I want to overcome this. It seems silly that something so serious and preventable gets such little attention. Thanks for your time and the great info!
Hi Savannah, thank you so much for writing and sharing your story of how you got rhabdo. I know your words are helping others! I am so sorry to hear how you got rhabdo. I can only imaging the fear of being overnight in a hospital with your phone battery running on empty. I’m so glad your friend, the nurse was there to help comfort you.
You are not alone with struggling to regain the muscle you lost after suffering through this. what I can say is that you can make progress, just take it slowly. Start with a circuit training program of light weights and start with 10-12 reps (no drop sets or negative training). This will take time but the good news is that you should regain your strength the 2nd time faster than you did originally (its that “muscle memory” thing).
If you ever have any questions about rhabdo or progressing just let me know and I’ll try to help.
I’m sure everybody reading this is wondering too so I’ll ask, how did it go with your workout date? Do you still see him?
Hi Joe,
Thank you for the thoughtful reply. Just seeing this. Haha, nope! At some point I told him I was in the hospital, and then I pretty much never heard from him again.
Savannah, wow he sounds like a real “you know what.” You are better off without having that goober in your life 🙂
Hi everyone, the New York Times is looking to interview a man who got rhabdomyolysis from exercise. If you would like to be interviewed, email me your contact information and I will forward it to him.
Hope everybody has been well.
Can Rhabdo just never really go away?
Back in 2011 my arm just gave out while carrying something not very heavy. The next day it was really swollen in the triceps area and my side.
I went to numerous drs and no one could figure out what was wrong or why this happened.
Ever since then when I do certain movements with my arm it gets swollen. Even something such as painting a wall can flare it up. The arm just gets really fatigued feeling.
I recently heard about rhabdo from a personal trainer when I was doing an initial evaluation. I am glad she told me about it. I really want to work on a program with her but am also worried about my arm being swollen. There is not really actual pain, just more uncomfortableness due to the swelling.
Should I avoid all arm exercises while the arm is swollen? It seems to take a long time to go down because its my dominant hand I use for everything in daily life.
Do I have to worry about leg exercises causing problems?
Should I get a CK test done to see if I have any actual increase in levels? Over all this time I have never seen dark urine.
Would mono cause the rhabdo to “flare up”?
Thanks for keeping these comments open for so long!
Hi A, The swelling could be a sign of compartment syndrome which can be a part of rhabdo. have you ever discussed rhabdo or compartment syndrome with your doctor? is your arm in any pain when its swelled? There are cases of people who get rhabdo over and over again, but Im not sure if you are one of those people. Have you ever consulted a physical therapist about this? That might be an option too.
I would do that and ask for a CK test just to see what it says. Do it after a basic non strenuous workout. CK levels will go up but Im curious what they would be after a non strenuous -1 set -workout (curious if they go higher than normal). I’ve really not heard of something like this going on as long as it is for you. It makes me wonder if there is some lympth drainage problem. I’d imagine the doctors you saw ruled that out though.
Why dont you try the workout with the trainer but only do 1 set of each exercise and dont do any triceps exercise. Dont go heavy either. use a lighter weight. lets see if that makes your triceps swell up. Let me know what happens.
So glad your personal trainer told you about rhabdo! I means the message is finally getting out to the fitness community. 🙂 Do me a favor and share my review on facebook etc. So many people like to write about rahbdo now -because its trendy. I’ve been discussing it here and classes I teach for over 10 years.
Hi,
I am a newbie to working out. I have always been a weakling, I recently started CrossFit about 4 months and I’ve started off very slowly. my trainers have been excellent scaling everything down. I have gone from 0 pushups to about 10 or 12 in a row.
Recently, my friend in medical school was telling me how his professors have noted young healthy adults coming in from intense and extreme workouts with kidney damage – I seem to be progressing just fine though and I go 3 or 4 times per week with just standard soreness. that’s how I came across your website since I started googling it. I knew about the concept of working too hard I just didn’t know exactly what it was etc.
My legs are constantly sore though as almost everything in CrossFit seems to be centered around squattin or leg movements.
My questions are tho should I be worried about anything? I just have standard soreness that starts a couple of hrs after the workout although, most of the time the next day and even when I’m sore from previous workout i go in and still workout and feel fine. I mean I’ve basically been doing variations of squats for 4 months now lol.
2 or 3 days ago in our workout programming, we had Angie which I noticed you didn’t like from some of the comments. most of the class did a scaled version of Angie. I actually did
25 Ring rows
25 pushups, 25 knee pushups (supposed to be 50, but I could not complete 50 so switched in mid)
100 situps
100 air squats.
Should there be anything I need to worry about? they watch my form like a hawk and make me stop if my form breaks down. but all this talk about people getting it from spin class, or seemingly easy workouts like 30 situps has me nervous. tho i did google it and it seems rare.
sorry for rambling.
Hi Ezra, it sounds to me like you are did the right thing going into crossfit slowly. When rhabdo happens, its most often when people jump into a new activity full throttle and over do it way too much. It also sounds like your crossfit instructors are also doing a very good job at scaling the exercises to suit your abilities.
The only thing I’d say is that when new activities are introduced (Angie etc), just follow what you have been doing – go at your own pace and dont try to over do it too much at first. If you follow that rule, I think you will be ok from a rhabdo point of view.
One other thing I’d say though is that 4 days of cross fit per week is a lot especially if you say you are always feeling sore. Exercise doesn’t have to make you feel sore to be effective. Don’t be afraid to take a day or two off if you are very sore. You won’t lose any fitness and in fact you might just find you perform better when you go back. I’m a big fan of rest when it comes to intense exercise. Injuries do happen -and happen quickly -even when we are feeling good. While I’ve never had rhabdo, I have had my share of injuries and they came without warning. Some of those injuries were severe.
Just listen to your body. If you are really sore, take a few days off to give your body time to heal up and get stronger. Remember to sleep well (7-8 hours a night) and make sure you are eating well to give your body the nutrients it needs to repair.
I hope some of this helps Ezra. Also, your not a weakling if you went from 0 to 12 pushups. That is great!
Any other questions, just ask 🙂
Well, yeah. the scaled Angie was 25, 50, 100, 100 as opposed to them all being 100. and most of the people there, when I did it, did the scaled version. some did knee push-ups and ring rows.
I wasn’t so worried that I am not able to handle it – just semi-nervous lol especially since it seems that exercises such as sit-ups and air squats seem to be causing it in people who seem to be fit. and I can do those fairly easy even tho I was out of shape. I spoke to my coaches last night about being sore, they say as long as I can move fully and not in any pain it shouldn’t be so bad if it’s too sore take it easy on the workout, and generally its different muscle groups each day. so will see.
Thanks for quick reply this looks like an old article so wasn’t sure if i was gonna get a reply
Hi Ezra, While I wrote this review a while ago I do keep it current as new info becomes available. Many people like to talk about rhabdo now but Ive been educating people about it for 10 years and have written the first book in the US about it. I keep up to speed on the research and answer everybody who leaves comments on my websites 🙂
when people do air squats and sit ups to extreme, it can lead to rhabdo mostly because they are not used to it, although there might also be genetic factors at play too. About the feeling sore, if you are a little sore, I’m ok with working out but if you are really sore (or always sore), take a day or two off. It wont hurt you and it probably will help. Keep me posted on your progress 🙂
Hi Joe, and thanks for your article. I can tell you are genuinely interested in rhabdo, and I’d like to share my story with it in hopes it might help understand something better. Over the past few years, I’ve had it (at least I believe I’ve had it) on 4 separate occasions, each in somewhat similar situations.
It’s long winded, sorry, but I just want to be as thorough as possible.
The interesting thing in my case is that I never once felt in any real danger at all. I felt perfectly fine, in fact, better than fine. I felt great after having just exercised. My muscles were not sore at all, just tight, but in a good way, like after a workout and you’re feeling the ‘pump.’
My only symptom was dark brown urine for ONE SINGLE VOID immediately after doing some sort of exercise on my first day back into a gym after a lengthy period of an extremely sedentary lifestyle by sitting in a terrible chair and having bad posture working on a computer all the time. My back is typically sore from sitting so much so I suspect it’s compressed or something and that is what this is stemming from.
But anyways, after I’d see cola-colored urine, I’d continue drinking water (maybe a little more than usual) and my very next void would be perfectly fine. And I mean PERFECTLY fine; it wasn’t like my urine was gradually getting better, it was absolutely perfect on the very next void. No brown urine days later. It only happens immediately after the exercise and goes right back to normal.
So here’s my story.
I work on a computer all the time and I work from home, so I literally get up, and go on my computer and sit at it all day long, only getting up to eat and go to the bathroom. (I know that’s a terrible way to live.)
So every once in a while, I get motivated to start exercising, and one day I hit the gym. I didn’t go full-tilt half-dying passing out falling off a treadmill or anything. I just ran/jogged on a treadmill for about a mile and a half and did some weight training working up a nice little sweat and I drank water throughout the workout.
Afterwards, while still at the gym, I urinated and it was totally dark brown, maybe even slightly purplish, I don’t exactly remember. It was definitely dark though. Of course I panicked and started drinking water, and the next time I had to urinate an hour or so later, it was fine. Ok, that was weird. I chalked it up to dehydration, and I went back to the gym the next day, worked out at about the same intensity, and I was fine. I felt fine the entire time.
So I fell back into my old habits and again and got real sedentary, and again, I decided to ‘get back in shape’ and hit the gym. Did a similar workout and got the same exact results on my first day back. Brown urine; drank more water; went right back to normal.
Again, I never once felt in any pain at all. No nausea, no headaches, no extreme soreness, nothing. I felt great after my workout. This time, I was pretty sure this couldn’t be dehydration because I drank plenty of water the day before and during my workout, so this was a little concerning, but since my urine went right back to normal and I felt perfectly fine the whole time, I started second guessing myself, thinking that maybe it really was dehydration again.
So, of course, since I suck at life, I slip back into my old habits, and randomly (I don’t think this has any bearing on anything, but I figure I’ll throw it out there), I got a urinary tract infection. A male with a UTI. Weird. It was streptococcus b. After a few rounds of antibiotics, that was taken care of. Ever since, however, I feel like my urge to urinate has gone haywire, getting sudden, extreme urges and things like that. But I’m fine.
Again, after being sedentary, I get back in the gym. This time though, I ride a stationary bike instead of running to kind of test the waters, and I went semi-hard on that bike. Everything was fine. No brown urine at all.
So I’m suspecting something is going on with all of the high-impacts from running. My back is typically sore from sitting so much, so I was wondering if maybe when I run, I keep slamming my back over and over with every step, maybe I have bad form, etc. and that’s triggering something…I don’t know.
So I slip back into my habits of sitting on my computer again.
Here’s where things are a little interesting. At this point, I’ve been sedentary again, and my dad asks for help laying paver bricks in his driveway in August. Ok, with dehydration in the back of my mind, I make absolute certain I’m drinking water while doing this.
We worked for about 8 hours one day, bending over about 100 times, stooping down and pounding bricks into sand. No heavy lifting. Just lots and lots of bending over completely. I broke a sweat, but it wasn’t like it was dripping off my body or anything.
I probably urinated while we were working and didn’t notice anything, but afterwards, again…brown urine. My dad drank Pepsi the whole time and he’s a 65 year old man, and was fine. Now I’m getting annoyed because again, I STILL feel perfectly fine throughout all of this.
I continue drinking water, and it goes right back to normal. I even worked another 6 hours laying bricks the next day, drinking plenty of water, and I was fine the whole time. No brown urine.
So at this point, I’m researching online and reading about rhabdo and getting a bit worried. I’m thinking I’m playing with matches here and one of these times I’m not going to be so lucky. I didn’t have health insurance at the time, but I told myself ‘ok, you seem to be fine, but if this happens again, you’re going to see a doctor no matter what.’
Well, sure enough, the following year (2015) my dad asks for help cleaning his basement for Christmas. Another marathon of back-bending labor on December 17th. No real heavy lifting, just lots and lots of bending over, moving boxes around. I was drinking water the entire time, and again, brown urine.
I feel fine, so I keep drinking water, and it goes right back to normal, but I set up a doctor’s appointment anyways. Since it was Christmastime, they couldn’t get me in for over a week, and by then, I did a urine and blood test and everything was perfect. My doctor even checked CPK, and that was just fine too. I’m looking at the test results right now (taken on December 28th) and I see “CPK, Total = 70 IU/L. Standard Range = <250 IU/L"
If I truly had some hardcore rhabdo that caused really dark brown urine, and super elevated CPK levels, wouldn't you expect to still see somewhat elevated levels 10 days later?
So I'm telling my family doctor my concerns about rhabdo, myoglobin, and kidney damage so, to be on the safe side, he refers me to a nephrologist. She looks at my test results and also sees nothing at all wrong with me. She set up a future-dated urinalysis, gave me a cup, cleared me to exercise, and told me that if I see brown urine again, to finish in the cup and take it to the lab so we can figure out what's going on.
So that's where I'm at now. I've been sedentary ever since, paranoid to exercise, but it seems irrational because not only do I feel fine right now (except for a sore lower back from sitting so much), but even when I do exercise and get brown urine for a single void, I STILL seem to be perfectly fine. I'm sure that by always drinking plenty of water (so much so, that I'm probably over-hydrated, my urine is almost always clear), that I'm really helping create an 'ideal' situation with myolgobin in the blood and flushing it out completely in one void.
This is so weird because every website makes it sound like I should've died 4 times by now or at least needed to go to the ER and get an IV or something. I suspect my lower back skeletal muscle is compressed from sitting so much, and then I'm going and stretching it way too much, for too long or jarring it too much by running on day 1 at the gym.
I've read that it's not the myoglobin that damages the kidneys, but something else when the myoglobin breaks down from acidic urine. So by drinking water and staying hydrated, you're keeping the pH level of your urine up, so it doesn't break down in your kidneys…? Is there any truth to that? I don't remember where I read that and I don't want to spread any misinformation.
Is it possible to have myoglobin in the blood without elevated CPK and if so, while not good, is that at least a better situation? Any ideas on what might be going on here?
Anyways, if you made it this far, thanks for reading and thanks for your article. It's good to know there are others out there studying this. If it were possible, I would welcome exercising in the presence of a doctor and attempting to trigger it on purpose as long as it's in a controlled environment to help science understand it better!
Hi Nick, thanks for sharing your experiences. My guess would be that you did have rhabdo based on the color change in your urine. It does appear that there are various degrees of rhabdo and since you didnt have any of the other symptoms (thank goodness) you might have had a “mild case.” I dont like using the word “mild” but it sounds mild compared to many of the other people who have left comments here.
Rhabdo can occur after taking a long time off from working out, which it sounds like you did. Couple that with your sedentary lifestyle and this could be the “perfect storm” for rhabdo.
Remember, rhabdo happens when we do a lot of stuff that we are not used to. That sounds exactly like whats been going on with you. In this situation, the body doesn’t have the time it needs to adapt to physical activity. In the future, don’t push yourself too much too soon. When you do start working out, start with only 1 day per week, for no more than 30 minutes. Gradually build to 2-3 days. start with cardio only and slowly add in strength training after a few weeks of consistent working out. Don’t do more than 1 set of each strength exercise at first. As I mentioned in my Rhabdo Book, circuit strength training is one of the safest ways to workout after rhabdo and also one of the best all around ways as well. I think if you followed this conservative approach, you might not have these issues again.
My guess is if your urine changed color, your CK level went up too. It might just be that by the time you got to the doctor, it was back to normal. That is my guess though. As I understand this the urine color change is due to the myoglobin. Myoglobin has a red-ish color to it and it alters the urine color as it gets filtered through the kidneys.
I do like the idea of the doctor who gave you the cup to collect urine if this happens again. I would absolutely do that.
I hope this helps, Nick. keep me posted on your progress and if you have any other questions, just ask.
Joe, thanks for the great article. I once had done some long distance walking increasing every week and happened to have a routine physical done the day after a 30k walk. Liver panel was elevated so doc added a CK which came back at 9900. She asked if I’d been doing anything strenuous and I explained. I had no other symptoms, I don’t remember being in unusual pain or being weak.
Does this mean I had rhabdo and didn’t even know it?
Hi Albert, Thanks so much! CK levels do go up with exercise. If you read through the comments here several people report having CK levels far above what you report. I’m not sure of the cut off point where they say you got rhabdo or not. Your doctor sounds pretty smart 🙂
Just started back to the gym last week after about 4 months away (relocated for work). I’ve always had difficulty developing my shoulders (even more so following a rotator cuff tear a few years ago)–and decided that working with a personal trainer was the way to go.
The workout schedule he came up with for me is fairly intense, with a lot of “negatives,” which I have never done before. Now, I’m a big guy, and my previous workouts would include hammer curls with 45# weights. I started off with fairly light weight (25# for the first set of each of 3 types of curls, and decreasing by 5# each set) for a total of 5 sets. Also straight arm pull downs, chin ups, rear delts, and lateral raises. While tiring, I was able to do the complete number of reps for each of the 5 sets per exercise.
After leaving the gym that first night, I went to pick up a new printer for my home PC. I noted how sore my biceps and forearms were when I loaded it in the cart. By the time I got to checkout I could barely pick up a 15# box! (Prior to my move I was regularly doing squats with #300). I chalked up the pain to inertia over the past couple weeks, and called it a night.
The next day, I had “T-Rex arms”, and couldn’t straighten my arms at the elbow without extreme pain. I used to swim post workout, but don’t have a pool in my new location–and just decided it was lack of a cool down post workout.
This morning, I woke early with severe pain, and less range of motion in both arms, but no swelling. After work today, I picked up some topical rub for sore muscles, and decided to give that a try. Well, now that it is late at night, I am noticing some minor swelling around the biceps and the elbow–but nothing major. Urine output has been normal volume and color all along. (I drink about 1 gal. per day–or 2 when working outside).
After reading your article, I think a trip to the doctor tomorrow morning may be the best course of action, your thoughts?
Hi Al, yes please go to the doctor this morning. The thought of “T-Rex arms” concerns me. Tell the doctor about your 4 month lay off at the gym and the intense work out you did yesterday and that you suspect rhabdo.
About the personal trainer, I would not go back to that person. To start you off with 5 sets of negatives for biceps makes no sense for someone who has not been in the gym for 5 months. Negative training – alone -for someone who is just starting out after a layoff is very very wrong. Do you know who this personal trainer is certified by? Just curious. I like to know these things. Regardless I would tell this trainer what happened. Odds are this trainer has never heard of rhabdo.
Please let me know what happens at the doctor.
Joe,
Went to see the doctor yesterday morning, and told him about what was going on (new workout routine after several months away, and the onset of symptoms, and the continued issues). The doctor stated that he “hoped it was just severe muscle strain” but wanted to run a CPK test to make sure–which definitely let me know I went to a good doctor!
They put a rush on the lab work, but I still did not get results back until late afternoon. The CPK test showed a count of nearly 24,000. The doctors office called me as soon as they had the results and sent me directly to the ER.
I spent all evening in the ER, received multiple bags of IV fluids, as well as several doses of different medications. Fortunately my kidneys were still operating properly (which the ER doctor said was largely due to my increase in water intake following the incident–I went from 2.5-3L daily to 4L a day consumption).
The liver test showed some minor damage, but they decided to release me at this time. I have to go back for a follow up on Monday. Scary stuff! Thank you for your article. If it weren’t for your article and a couple similar postings–I’d probably still be “toughing it out”–and probably have gone back to the gym to try and work through the pain….
Hi Al, Thanks for getting back to me. I am SO glad you went to the doctor and got the attention you needed. When you are better, please inform the fitness director of that gym about what happened to you and suggest he/she educated all their trainers about rhabdo. My guess is none of them know what it is.
After having worked out and run for most of my life (I’m 51), I took a couple years off. Wasn’t “out” of shape but needed to start up again. Hired a personal trainer, went through typical medical/physical background. Had my first work out, which really only focused on resistance training and a bit of cross fit. Felt sore after leaving but just thought it was a good workout. Later that night, my biceps REALLY hurt. I honestly thought I was just so out of shape!
That night, the pain in my biceps woke me up and it waS painful to draw my arms down…..I could only draw them to my chest. Still thinking it was typical muscle fatigue, I ignored it. The next morning, I had a doctors appointment (not related to the pain) and i mentioned the pain and the swelling around the inside of my arms. They took my blood pressure which was quite elevated and THAT was not normal for me. I drove myself to be ER, gave my story, showed my arms and was dismissed as having anxiety and normal DOMS. ????
I came home and GOOGLED “unable to bend arms after workout” and BAM! There’s a picture if a woman’s arm that looked exactly like mine and she had rhabdomyolysis. I went to a different Kaiser ER and explained my concerns if rhabdomyolysis . She quickly blew me off and said she thought I tore my biceps. Really? Both of them? ???? I actually had to demand the blood test. My levels were at 30,000! Scary, scary stuff.
My arm muscles have never been be same since and I’m paranoid about any exertion because I’m afraid it will happen again. When my husband informed my trainer about my diagnosis, he was pretty freaked out because I actually showed him my arms and he said he has no idea what it was except DOMS.
I don’t blame him but people think you can ONLY get rhabdo if you’re a body builder a drunk or a drug addict. I’m a 51 year old woman and none of those things. Not even TWO ER doctors diagnosed it. GOOGLE DID and stories like these and I’m so grateful.
Hi Cara, first let me say I am so sorry that you got rhabdo. Over the years I’ve heard from quite a few people who told me ERs missed the rhabdo diagnosis (if you read the comments I believe some of those people are here), believing that one has to be in the military to get it (which is incorrect).
As for the personal trainer, well, the fitness industry has failed him. They have failed him because they dont do a good enough job of educating people about it. Most fitness organizations don’t even cover it in their textbooks so I’m not surprised he didn’t know about it. I’ve been following rhabdo for many years -its what inspired this blog post. I see very little mention of rhabdo in the fitness industry. Even when they do bring it up, it’s not to the level I’ve done so here.
Please show my review to that personal trainer so he understand what this is. Please share it on facebook too. I want to reduce this from happening. The only way to reduce rhabdo from occurring in the fitness community is by education.
I was hospitalized with rhabdo in my abdominal wall from doing crossfit, about 2 and a half years ago. I have gotten out of shape the last year and want to get back into shape, but am slightly nervous. The doctor told me that if I were to get it again, it would be a lot worse and once you’ve had it, you’re more likely to get it again.
So I am having a hard time figuring out what to do. If I don’t push myself, I won’t be able to lose the 15 pounds I need to. But of course do not want to get rhabdo again. I can’t afford a personal trainer, so was hoping to get help with a good workout routine
Hi Sarah, One thing to keep in mind is that exercise is not what has the biggest effect on weight loss. Rather its the number of calories we eat. Also, exercise is not what burns the most calories in a day either. Rather, most of the calories you burn are being used to keep you alive -its called resting metabolic rate (RMR).
Because of these things you do not have to push yourself hard to lose 15 pounds. As I outlined in my book about rhabdo, I believe a circuit routine is one of the best types of programs for people. It will improve strength, endurance and maximize your time in the gym. Circuits are also not boring either. Remember to to start back slowly and listen to your body about what you can and cant do.
I hope some of this helps. If you have any other questions, just ask.
Great article.
I just want to ask about the weight training progression that you suggested.
1. How many exercises should you do in one workout? I would like to do Squat, Romanian Deadlift, Bench Press, Overhead Press, Bentover Row, and Pullup all in one workout.
2. How many days per week do you suggest?
3. And can you really make great gains by just working up to one set of 15 reps, then adding a second set and working up to two sets of 15 reps, and finally adding a third set and working up to three sets of 15 reps, adding weight and repeating?
Chris V, thanks for your questions. When I wrote my review of rhabdo, my goal was to try to reduce rhabdo from occurring rather than offer an exercise path that everyone should adhere to forever.
Exercise induced rhabdo appears to be mostly caused by doing too much volume (too many rep,s sets and exercises per body part) too quickly for the body to adapt to. My suggestion of first increasing the reps, then sets and then weight is to help give the body the time it needs to avoid rhabdo and other injuries.
This is not to say that eventually, people can’t work up to greater amounts of exercise. They can certainly do so if they desire greater levels of strength, hypertrophy and/or endurance. They key is to work up to this slowly.
I believe if you are a beginner, one set per exercise is sufficient, 3 days per week. For those who are more advanced – which I define as someone who has been lifting consistently for at least 6 months -then more can be performed.
I understand what you say by “gains” but here, I define gains as not getting injuries. I am not saying that everybody should always do 15 reps or only 1 set or only 1 exercise per body part. I know many of us can do more. I do believe however that the desire of making gains in the gym – too quickly – can lead to injuries including rhabdo, in some people. We need to remember gains are best made through progressive overloading of the body – muscles, ligaments, tendons, bones, cardiovascular system etc. When progressive overload is logically administered, injuries go down.
If you pardon the analogy, the “fitness industrial complex” promotes fast gains to the public in almost everything it does, whether it’s selling exercise equipment, DVDs or work workout programs. This is a mistake in my opinion and I feel it brainwashes not only the public -but many personal trainers too – into thinking everybody should be engaging in high intensity types of exercise. At the end of the day, the movers and shakers in the fitness world, all need to take a step back and remember that fitness and health is something we should look at from the long term perspective.
I was hospitalized for over a week in a public hospital. An ambulance picked me up off the side of the road after I was found screaming in excruciating pain and on the verge of passing out. I had near renal failure and almost died. I should write my own story on this subject.
Eight years later, I still suffer from cramps and struggle with clinical depression as I have been unable to exercise like I used too. It saddens me how much I was not told about this condition and also the lack of information the hospital gave me upon my release.
It’s good to find information slowly staring to fill the void. I am now researching how to get back into exercise properly. I have failed so many times since my server outbreak eight years ago. I would like to see more info for those of us who struggle so many years after the event.
I was 38 years old at the time and now 46. Had I been able to access information as what is on offer here, I could of easily avoided what I now term as a disability. Obesity and depression has been somewhat disabling for me. Exercise used to be my only copping mechanism.
I think I will Blog my attempts.
Dave.
Dave, thanks for sharing your story and I agree it is good to have information slowly start to trickle in about rhabdo. I’ve been trying to spread the word about this condition for many years and so its nice to know people are starting to get up to speed on it.
I was wondering if you could give some insights into how you came to be found on the side of the road screaming in pain from rhabdo? What was your workout like back then? What do you think caused your rhabdo?
If you read through the comments, you can get some ideas on how you might be able to workout again.
Hi,
Many thanks for this article.
I am French, 36 years old male and Rhabdo got me 7 days ago.
I never heard about it before.
7 days ago I made the perfect recipe for Rhabdo :
* 1st session back to the crossift box after a 2 months break (I started crossfit in February this year) ;
* the workout of the day was Angie (100 pull up, 100 push up, 100 situp, 100 squat) ;
* I worked negative moves (eccentric) for all the pull-ups as I am not strong enough to make some many reps.
After the wod my biceps were sore but I was not worried, after all, crosfit hurts, everybody know that, right ?
Day 1 : terrible soreness, I can’t straighten my arms, not worried.
Day 2 : soreness + dark urine, not worried “let ‘s drink 2 liters of water it will be ok”
Day 3 : soreness + arms swelling + dark urine. 2 kilos more with no explanation… worried … i go to the urgence care for blood test. They do not have full results of blood test but as I seem ok , I go home.
Day 4 : hospital calls me to come back, they have got my bloodtest results,
CPK are 243 000 units/liter. it seems a bit uncommon.
I spend a few hours at the hospital, new tests, CPK at 200.000 , urine gets clear and doctor tells me to drink more than 3 liters a day and stay quiet.
Day 6 : new blood test, CPK at 41.000, transminase SGOT at 1100.
Day 7 (today) : new blood test, waiting for results.
My arms are less sore but are weak, still a bit inflated (like if I had water or fat below the skin of my forearms). Still drinking 3 to 4 liters a day + bicarbonate.
And I will keep you posted.
Chris
Chris, thanks for sharing what is happened to you. You are not the first person to get rhabdo after taking time off from working out. Yes, do keep me posted on how you are doing.
August 3, 2015 was my last post on my update since Rhabdo. It has been 2 months now since I had Rhabdo. All symptoms have subsided and I feel back to happy medium. I finally found a physical therapist that knows about Rhabdo. I found it funny I was like “well Joe said”.. He agreed with everything I said and gave me some key advise that I had read in some of your post before about water.
Many people think oh if I stay hydrated with water really well I will be fine. Not the case here with me. He really put emphasis on electrolytes.. I have to drink pedialyte, Gaterade or G2; 32oz a day.
My work out to start for me not for everyone but was given to me was:
m-w-f = walk 1 min jog 30sec for 10 min
t-thurs= lunge with weight 1/2 what you did before Rhabdo 10 total
pull down half weight before Rhabdo 10 total
full body squat 10 total
dumbbell press laying flat with half weight before Rhabdo 10 total
That is it for 2 weeks. any change at all call immediately to talk over symptoms and the go forward. This may not fit for everyone but it is helping me get over my fear of the gym again and to trust what my body is telling me. For the past month my mind tells me I am back to normal but my arms do not agree. I needed someone to tell me a limit and no more than that.
That is the hardest part knowing my mind is ready to hit the gym and my body repair is on another page. I hope this helps someone understand you can recover. Trust your body! It’s not just about the water. You have to eat well and give your body the foods and electrolytes it needs to repair; that was my downfall.
Shannon, Thanks for the follow up and I’m glad you are doing much better! Glad you found a PT – and it’s nice to know he agreed with me 🙂
I know its hard now to want to go back to the gym and do what you did before. Just know that your body is still healing. For what its worth, it sounds like the PT gave you a good/challenging workout. If you feel its getting easy for you -and you have no complications – just try doing the exercises slower. I find slower performed exercises pretty challenging.
Do keep me posted on your progress. You are one step closer to getting past rhabdo 🙂
I had Rhabdo 3 years ago and remember it like it was yesterday. I had been lazy and one Saturday saw the advertisement for P90X and I was convinced that it would work for me and that I was healthy enough i could jump right in.
The next week I did every session without missing a step. Sunday was my off-day and I went fishing. I became very ill…cold, clammy, with a terrible headache, aches, and a temperature. I thought it was a cold or flu. I took a couple of tylenol and took a nap and woke up feeling better. That night about 3 in the morning, same symptoms and same action. I went to work the next day and mid day it came back, but this time my symptoms would not go away.
i drove myself to the doctor and was throwing up the entire way there. They ran what seemed like hundreds of tests and finally diagnosed me with Rhabdo (i dont think the doctor had ever seen it before).
They made me wait at the doctors office for several hours and drink gatorade and water to try and flush my kidneys. They told me if I was feeling sick again to go straight to the hospital. I went home and rested for about a week and started feeling 100%. I was told that once you have it, you are more susceptible to it again (i dont know if that is true, but i tell every personal trainer that I have had it now).
Thanks for writing this article and making people aware of a VERY serious issue and one that not many people know about until its too late.
Justin, you are very welcome and I thank you for detailing your symptoms so others can learn first hand what rhabdo feels like. It is true, once you had rhabdo, you are more likely to get it again. I believe this relates to a possible genetic link to rhabdo.
Question for you. When you tell personal trainers you had rhabdo, how many of them know what rhabdo is?
I believe I ended up with Rhabdo after a hard workout and a long bike ride in 95 deg weather. I never did get checjked out and my urnine never did go dark but both of my legs hurt so bad I could hardly stand and I could barely straighten them for 2 day. that was 2+ months ago,
physically I feel ok but I am have a terrible time stopping my leg pain have tried to find information about it repairing damaged muscles from Rhabdo. My PT had heard of it but has never treated it. well the muscles heal complete?
Hi Gordon, fist off Ill recommend you go to your doctor. having leg pain for 2 months is not normal so let’s see nothing else is going on. I do believe rhabdo pain can get better eventually but how long might vary. The muscle fibers that died from rhabdo wont grow back but the muscle fibers that still are alive can grow stronger. Bottom line, go to your doctor and see what she/he said. Let me know what they say.
Hey Joe, I did end up going back to my Dr. he really did not know anything about Rhabdo, he had put me on meloxicam for the pain which had helped it but wasnt fixing anything, He sent me to another Dr. that said yep it sounds like Rhabdo,
she said it will take time but I should be able to get back to at least 95% of my leg strength. Its been 9 months and I finally don’t have any pain unless I overdo it on my workouts. so I am hope that I get back to normal… as normal as can be anyway .:) thanks for your input.
Hi Gordon, thanks for the reply and also happy you found a doctor who could give you a formal diagnosis.
My question that no doctor can seem to answer. I like many others have not worked out for awhile and after a mild arm workout and I had Rhabdo. I am 38 year old female fairly fit but just got out of it for a while.
I knew the next day something was wrong. It didn’t feel like DOMS. Two days later my urine was brown. Was in the hospital for 4 days IV bag every 2 hrs. After 2 1\2 days I begged for a number beside over 20,000 that is all they would tell me. They came back and said 70,000. Can’t imagine what it was if they would have told me the first day.
I now have the question; I have been out of the hospital 2 weeks this Thursday and have noticed in the last week my arms are loosing inched smaller than before Rhabdo. Is this a permanent thing? Will I regain muscle back? My arms are no where as muscular as they were.
Hi Shannon, my guess -and that is what this is – is that the reduction in your arms may be due to loss of glycogen/water in the muscles. Muscle contains carbohydrates, called glycogen. Glycogen contains a lot of water. For example, it’s often estimated that every gram of glycogen contains 2.5-3 grams of water. When you were in the hospital, you were not only not working out, you were likely not eating as normal either. This could lead to a depletion of muscle glycogen and with it, your arm size.
Whether I’m right or wrong I’m not sure, I think this is temporary. I think after you start working out again they will eventually go back to their regular size. That said, I feel its important to not return to your normal workout too fast. Even though you may feel better, you are still healing.
For what its worth, you are not the first person to get rhabdo after taking some time off. If you read the comments, others have said the same thing.
Thank you for your prompt response. I now have tingling in my arms that doesn’t get past a 2-3 on a pain scale. It feels like the beginning of how I felt when I got Rhabdo. I am back to work and use a computer and arms all day. No heavy lifting; just use. I had blood work done and it’s not back to normal but not something they want to treat.
At night it gets better and by mid day it’s back to tingling and annoying frankly. Will this go away as I heal or am I keeping the Rhado hibernating by the use of my arms just waiting to come back.
Shannon, its hard to say. I know you have to work and Im not sure if its contributing anything to the lingering effects you are experiencing. The good news is the tingling is only a 2-3 on a 0-10 scale. It sounds like you are doing all you can do at this point. I’d say just stay the course and give it time. If it starts feeling worse, go back to your doctor. Hopefully you start to feel better soon. Keep me posted on your progress.
As of today my symptoms of tingling and numbness in my arms that the Rhabdo centered on are feeling better. I am still weak but feel I am on the mends. Tomorrow will be 1 month since I was in the hospital. I want to start working out but am scared of what might come.
I am sure this is common from the posts that I have read. One day at a time slowly. Just curious the workout that I should start and how long before I try weights on my arms. We have no resources here on Rhabdo. Out local physical therapy had briefly heard of it but never had a client go figure.
Shannon, glad to hear you are on the mend. I’ve covered working out after rhabdo several times in the comments so do read through that. I know there are a lot of comments but I think that will give you a lot of good info.
In the book I wrote about rhabdo, I also detailed what I think is safest after getting rhabdo. This might be something for your PTs to look at.
Remember, one day at a time. start exercising again very slowly. This can take a long time to recover from even though you are not in the hospital anymore. Do keep me posted on your progress.
I was diagnosed with Rhabdo last year, my muscles were hurting and i didn’t have any strength, I felt like I couldn’t breath, i started to have some pain under my right chest area and because of that i decided to get to the ER. They give me and IV many fluids and send me home.
Yesterday i got home from helping a family member to clean up her house, it was a all day thing i got home and i didn’t have strength my muscles hurt like before but not so bad, today all my muscles are sore and fatigue and the last time i went to the bathroom was at 10 in the morning and my urine was dark yellowish brown.
Every time i move my legs hurt bad and i feel weak. I don’t know if to go to the ER or not to pay attention at this time… what do u think what can happen if i dont go to the ER?
Valeska, I say go to the hospital. Having a brown color to your urine may mean rhabdo. I’m sorry to say that because thats not what you want to hear but I do think going to the hospital is the safest course of action. Rhabdo does not have to occur from “exercise” in the gym. People have got it from painting the house for example. Please let me know what happens. I will say a prayer for you today.
I agree. You should go to the ER. Better safe than sorry. Brown urine means there is blood in your urine which results from kidney failure. You want to catch it before it gets any worse! Good luck!
I literally just left the hospital on Monday, after being treated for Exercise-induced Rhabdo for 6 days! When I arrived at the hospital I had a CK level of 87,000! Currently I am at 4,200 and being monitored by a physician! Before this, I never knew what rhabdo was or the fact that I can be hospitalized after having severe “sore” muscles.
My only concern after reading your post is the “muscles fibers die and don’t grow back?” That is upsetting. So how does one recover and get back in the gym. Of course I am going to take it easy the next couple of weeks, but I would love to train again. Will having dead muscle fibers prevent me from working out again or put me at a higher risk of getting Rhabdo again?
Thanks for your post! It was helpful!
Hi Shamira, first let me say Im so sorry that you got rhabdo and were in the hospital. Im sure that alone was very frightening to you! It does sound like you are on the mend and I’m happy that your doctor is keeping an eye on you.
While rhabdo does cause the death of muscle fibers, remember that you have millions and millions of them left. There is no reason to think that you can not workout again. you can and you will come back stronger too – because you will have a better idea of how to pace yourself and listen to your body. Yes, you lost some muscle fibers but you have MANY left that can get stronger. This will not hamper you.
I hope this helps Shamira. keep me posted on how you are doing and if you have any other questions, just ask.
I’ve had Rhabdo twice…once I got away with it- grinned and bared it- then the last time, I grinned and beared it- but decided to go get some testing- and my kidneys and liver readings were so high- my Doctor was so mad at me for doing Crossfit! hahah Anyway—it’s been about 6 months since my last bout of Rhabdo- and I was wondering if my abs will ever be HARD again? The look okay- but there is just this layer of skin that won’t harden yet around them. PLEASE HELP!
Nikki, While cardio can help, what is your diet like? how many calories are you eating? I always remember one bodybuilder saying abs are made in the kitchen, not the gym.
Hi Joe,
I recently came upon your webpage while looking up Rhabdomyolysis. I suffer from anxiety disorder so I am not sure if I have this condition or just muscle soreness. Back in October of 2014 I started T25. 10 weeks of high interval training. Before that I was jogging 3.5 miles 2-4 times a week. While doing the T25 program I frequently would over work myself and under eat.
After the 10 weeks was over I took it easier and worked out maybe 4 times a week. March 7th I ended up having an emergency appendectomy. At 7 weeks post op I decided to try and get back into my exercise routine. I got through 4 days of T25 and my body was so sore. 2 weeks later (this week) I walked 1 mile on a walking trail. It has some hills. That was yesterday.
My calves are sore. Not so much when I am still but when I move I can feel the soreness. Today I did T25 ab workout. I am worried that I have Rhabdomyolysis in my calves. How would I know if it’s just muscle soreness or Rhabdomyolysis? My anxiety is through the roof
Nicole, with regular muscle soreness, the pain would not hurt when you are not moving. They would only hurt when you move or press on them. That is normal. When you are sitting at your computer, are your calves hurting?
With rhabdo Id expect to see:
1. swelling – you can see swelling of the affected areas
2. dark colored urine – like ice tea or cola-colored
4. pain the hurts when you are not moving
do you have any of that?
It sounds to me like you just have a case of muscle soreness. I can understand your anxiety over this. If you have any doubts about this though, go to your doctor and get checked out.
Keep me updated on how you are doing
Joe,
No swelling or colored urine. When sitting still or lying down my calves sometimes feel sore but not painful.
Nicole, when you are laying down there is some pressure on your calves. that could cause them to hurt, which is normal. with regular muscle soreness, the pain gets a bit worse 2-3 days after you workout and then starts to feel better.
The easy answer is its normal muscle soreness. if you start to feel worse or see your calves swelling (measure them with measuring tape if you can) or you have other odd symptoms, then that might mean its rhabdo. I wish I could give you a yes/no answer to this. My gut says its just regular muscle sorness but do keep an eye on it and how you feel. Let me know how you are doing too.
Well written article and some interesting points you have.
Although one thing bothers me a bit.. I think you should ease up a bit when making the claim that tough exercise has a causal relationship with kidney failure, heart attacks, etc. It could of course be the cause of it, but maybe there were a hundred other (perhaps invisible) factors that helped causing those problems? I think that blaming personal trainers, who’ve never heard of rhabdoyolysis, is a bit short-sighted and should be put into context a bit more.
Ralph, thanks for sharing. The human body is resilient, that is true. It really can take a beating a bounce back. That said, in the world of fitness, there is the unrelenting drumbeat of high intensity exercise, that it will solve peoples weight loss and fitness problems. Personal trainers need to know that there is a time and place for that type of activity, but not in most people – esp the beginners/novices who are most likely to hire personal trainers. They are best served with lower intensity exercise in the beginning.
I do recognize that I can come across as a bit over the top when it comes to rhabdo, but with respect, I see trainers pushing people too hard all the time. I’ve seen the light bulb go off up when they realize their own clients complained of having ice tea colored urine, but didn’t know what it was.
I also have spoken with the lawyers of those -who got rhabdo – who want me to testify against personal trainers who caused it.
The glaring omission of rhabdo in most personal trainer textbooks is another reason I am so outspoken on this topic. I don’t know why they don’t discuss it.
I want personal trainers to know what I know so they can avoid accidentally causing it. I hope that gives an idea of where I’m coming from.
Hey Joe, just wanted to chime in. I did cross fit 3 times in a 2 week period after little to no exercise for a few months. After the 3rd workout I had the super painful cramps in my arms and my urine was darker than coca cola only a few hours after my workout. The next day I went to the hospital where I stayed for 8 days. My CPK count was the highest ever in UPMC. When I can in 1 day after the work out I was at 60,000. That number increased steadily over a 5 day period until the tests only read > 200,000. They said I set the record which isn’t a good thing, clearly. Anyways, I spend 3 days coming down and they released me at 5,000 because I had a fast downward trend.
So yeah, if you are going to do crossfit, make sure you really work up to it. Otherwise you might be footing a large bill. Just for reference for what large is, before insurance my 8 day stay cost $108,000.
Thanks for the good info Joe,
Jim
Jim, Thanks for sharing and, wow I’m so sorry that happened to you! I hope your insurance pays most/all of that $108,000 medical bill. I hope you share your story with your crossfit trainers too so they know about it.
Jim,
I’m so sorry this happened to you. I was an intern in the US when this happened to me too. My medical bill back then was about 90.000$. My (travel) insurance didn’t want to cover it because of some weird excuses. I had to organize a lawyer from abroad and that cost me a lot of money. Fortunately my case got resolved (after nearly 6 months) and I have no remaining damages.
Jim,
I am out of the hospital after collapsing near the finish of a marathon-so close I was attempting to crawl. You have me beat at 200K. I was at 48K-the highest anyone in the hospital had personally seen. My collapse was sudden with no (to me) warning. I was running a marathon and in the groove. Just moving along perfectly as planned until a few hundred feet from the finish I fell off my pace to an 8 min/mile and then I just couldn’t keep moving. I stopped and came down gently.
I am a serious runner and I was trained for this event. It was my first full, but I have run close to marathons on weekend afternoons just for fun. I wasn’t expecting the temp to be in the 70’s, but I upped my sports drink intake. It wasn’t enough. My core temp was about 104 when I made it to the trauma room. I do tend to run hot and sweat a lot. Before races I have a no alcohol for a week rule and I focus on hydration. I had sports drinks in my stomach, and threw up several times, so my stomach and other organs had already shut down, miles before I crashed.
Several days in Critical Care and then stepped down. I was hydrated beyond belief for 6 days. I had two IVs flowing. At home now, with my CK probably below 200 I am happy to be here. This is no joke. I have lost most of my leg muscles–about 5 or more lbs. in muscle mass from what I can figure. I’m still guzzling fluids (medically supervised) to try to bring my liver and kidney (panel) blood numbers to normal.
At any sign of this in any heat or exercise related environment, get help. I was told several times that I am lucky to be here. Two weeks out to the day, I am a new man. Walking down the hall tires me. I have no idea when I’ll be able to return to running and when I do, I have serious questions to ask about how to do it safely.
Good article. I am reading this while relaxing with a CPK level of 16000. I was a certified personal trainer and never heard of rhabdo while a trainer, am 42 now, ex-military, excellent shape most of my life and had been doing crossfit for a few years and stopped about 6 months ago due to shoulder soreness due to age and over use. I decided to start some resistance training as I was missing the physical part of my workouts since stopping crossfit and after 30 minutes on the elliptical at fairly high intensity I decided I would just start my resistance training regimen with 2 exercises, 3 sets each with moderate weight for biceps and triceps.
Felt good, a little sore day after and then 48 hours post workout my left arm swelled to about 150% of its normal size and I couldn’t straighten it, went to doctor, diagnosis rhabdo. This can happen to anyone. I believe that my age has something to do with it after the break in strenuous activity but I did not push myself very hard at all compared to my historical workouts.
Everyone should take care when altering their exercise programs, particularly as you age. At 42 I am far from being “old” but realizing that we need to be aware of how our bodies change in respect to our ability to recover after strenuous activities.
Craig, really sorry this has happened to you. I’m not sure if your age plays a role in rhabdo or not. When I wrote my Rhabdo Book I discovered that there have been over 10 college football players who have died from rhabdo.
I hope you heal up quickly.
Hi Joe, you seem the most informed about this condition than anyone we have been going to. When my daughter was 17 in 2011 she had an eating disorder and her dr did a bunch of blood work and a cpk was one of them. it was 4400 and her liver functions were elevated also. she worked out everyday but really just running and spinning. she was seen by a rheumatologist, all tests came back negative. her levels went down to 700 with less exercising and more water. They ruled out her heart and liver being the problem also.
then in 2012 she had an episode severe pain in her lower right back that radiates to the front and had to go to the er. they pumped iv fluids in her and brought her numbers down to 700 again and discovered she had kidney stones and again last year she had the same pain no stones this time. just elevated cpk so they did another iv.
she is 20 now and at college she started lifting weights because she cant lose any more weight she is 5 7 120 pounds. took her to a new dr and again her cpks are now 4700 and her kidney tests came back high. she still has issues with food she says she doesn’t but she has little to no carbs and eats protein bars. and lots of coffee.
she is going for another ultrasound on her liver and going to see a neurologist. she is miserable if she cant exercise and she goes without food to make up for not burning calories. Any insight you have i would be very thankful.
Amy, as you know, I think we are dealing with more than just rhabdo here. I don’t think your daughter is overweight based on being 5’7″ 120 lbs. I think she needs to realize that being healthy is not about not eating carbs and exercising a lot. She’s got some issues with food and I think in addition to the doctors shes seeing, I think meeting regularly with a registered dietitian who specializes in eating disorders is something to consider. You can find RDs in your area by going to their website – http://www.EatRight.org here is the link http://www.eatright.org/programs/rdnfinder/ this link takes you to the “Find an RD” page of their site. just put your zip code in and they will show up (the page has a disclaimer. just click “I agree” I hate that they do that because it scares people off. That’s life in the 21st century…)
I think also a sports medicine doctor may be warranted as well. They are usually very well versed in not only rhabdo but also eating disorders.
I think if she hears messages about what shes doing wrong coming from people who are in authority, she might start to see the light.
I hope this helps Amy and also hope you keep me posted on how your daughter is doing. I will say a prayer for her tonight.
Hey Joe,
My situation is lengthy and would appreciate an email to discuss more in depth. In fact this may be up your alley as when we get to the bottom of this my wife (FNP) is going to do a case study on me.
In short: I am a 40 year old male who has been doing CrossFit for 6 years. I am a Phoenix Firefighter. I was at my fittest ever last year and my volume, work load and intensity was next to none. This year has become a nightmare for me. I was sick over the holidays with vomiting and diarrhea (December 2013). I also was only drinking coffee and no soda as I normally had.
I then got Rhabdo January 02, 2014. This was due to pullups and was admitted with CK = 15487 four days later. I decided to quit caffeine and try to drink water going forward. I also decreased the amount of Brazilian Jujitsu training I was doing and limited CrossFit to 3 days a week now.
Then in April I had another minor case of Rhabdo in my arms from Pullups. I let this resolve on its own and never got my levels checked. 3 weeks later I tested my blood work and my levels were high normal for everything. Then the beginning of May I developed Rhabdo again in the arms from a Push Press (I was lowering the weight slowly – eccentric) CrossFit workout. My CK levels this time were 16137 four days later.
I felt worse this time and mentally was killing me. My workload was less than the first time but my symptoms and labs were worse. I slowly got through this and felt it was due to tapering off drinking water. My water intake had depleted over the last month and I had not drank soda or coffee for 5 months. My initial thought is I was dehydrated and causing Rhabdo to occur. I then was going to internist and PCP and they were feeding me the same thing. They had even told me to go back to drinking soda as that had probably hydrated me in the past (and I am not a water drinker).
So I did go back to soda, coffee as well as try to drink water. I did not want to go through this again and ended up quitting BJJ. I decided to do CrossFit only 2 days a week and to really notch it down. I would drink water during the workout and even lessen the weight, workload and intensity. I started this 5 or 6 weeks after my 3rd bout with Rhabdo.
Then came Sept. 23, 2014. I did 21-18-15-12-9-6-3 of 100′ lunges, Pullups and Situps. Nothing crazy and I was very hydrated. 84 reps of each Pullups and Situps with lunges. This would be a easy high-high intensity workout for me a year ago. My time was 7 minutes slower than the last time I did it. I finished in 18:42 while last year did it in 11:52. Rhabdo hit again! The next day my arms were locked and extreme pain.
I went from 205 pounds to 240 pounds in a few days. My CK = 69212 four days later (9/27). My ALT = 284, AST = 906. I felt like I was dying. My levels were checked again 2 days later (9/29) and CK = 69053, ALT = 368, AST = 789. The doctors believe I peaked at CK = 110,000 (due to 1.5 day half life). The next day my labs were CK = 55098, Myoglobin, syrum = 1251, Myoglobin urine = 3884. This was 1 week later. I was fluid overloaded and feeling bad.
I went to a Rheumatologist and all labs came back negative! I went to see a Nephralogist and my kidneys are still functioning well! I continued to get my labs drawn every other day until my levels came back to normal. Also had a Chest Xray which was negative. I finally feel somewhat normal physically although I am weaker as this year has been very limited to physical activity. I HAVE AN APPOINTMENT NEXT MONTH WITH A NEURO MUSCULAR DOCTOR THAT TOOK MY CASE IMMEDIATELY. i HAVE A ELECTROMYOGRAPHY SCHEDULED.
I ended up getting a cough during this episode at the beginning. I would have to constantly clear my throat and it was sore. It feels like I have a golf ball in my throat and will not go away. I have since been to an ENT to scope my throat (I chewed for 20 years) and had an Ultra Sound to Lymph Nodes and Thyroid. This came back negative and ENT said I have an inflamed posterior trachea due to possible stress or GERD. No medicine has helped and won’t go away. I am seeing another ENT this Wednesday.
Test Test Tests! My wife thinks I have a CPT II deficiency. But everything I look up on the internet (including throat symptoms) mention other serious possibilities. It is stressing me out bad. This is horrible! I would really appreciate any insight and knowledge you may have.Why all of a sudden am I going through this? I think this is an unusual case. I will keep everybody posted and would greatly appreciate contact with you.
This is a general description to keep it short. Much more info can be shared.
Thanks for reading,
Paul
Fitness Website:
http://www.fitnessestrella.com
Paul, wow! Really sorry to hear you have been – and are still going through all of that! The stuff about not being hydrated is something I brought up in my book about rhabdo. Dehydration can make rhabdo worse but it doesn’t stop muscle fiber death.
Based on the other stuff you were saying, I wonder if you are also dealing with over training syndrome. Have you ever kept tabs of your resting heart rate? getting sick can be a sign of this syndrome.
My advice is to not do cross fit now until your cough gets better and you are feeling more like yourself again. That may not be what you wanted to hear but it cant hurt to try.
Yes my resting heart rate has always been in the 50’s. I do believe I did overtrain the last 6 years but the last year I have not. I have eliminated my workload and continue to get Rhabdo. It seems to be mainly with pullups and affect my arms and lats only so far.
Paul, pull ups are very difficult and Ive met others who’ve gotten rhabdo from pull ups. As for the CPT II deficiency, doctors can check for that. unless you’ve been diagnosed with it, Id think this is more about exercise than enzyme deficiency. Have you checked your RHR recently? is it still in the 50s?
Hi Everyone, I’ve written a Kindle book on rhabdo that I’m making available for free starting tomorrow 10/2/14 to 10/6/14.
It’s called Rhabdo: The Scary Side Effect of Exercise You’ve Never Heard Of
I’m telling all of you about it first because all of you who have commented here were my inspiration.
I believe this is the first Kindle book on rhabdo ever!
If you don’t have a Kindle reader, no worries, you can download the FREE Kindle for PC app here:
http://www.amazon.com/gp/help/customer/display.html?nodeId=201245960
If you have a Mac, here is the FREE kindle for mac app:
http://www.amazon.com/gp/kindle/mac/download
The book is about 55 pages long and goes beyond what I discussed in this blog post. I even covered how to exercise again AFTER getting rhabdo which is something many of you have asked about. There is a Q/A chapter too.
I hope you find this book helpful. Honestly, it would not have been written if it were not for all of you who have commented here in the past.
I also hope you all like the dedication too.
I did go to the doctor and was diagnosed (after X-Ray and MRI) with having High Hamstring Tendonopathy. Very painful. With treatment for inflammation and physical therapy (and time/rest) I’ve healed!!! WooHoo! Back to running! So glad it wasn’t rhabdomyolsis pain! Thanks for the info on this site, though.
Lisa, great news. Very happy for you 🙂
I suffered from this after jumping into an intense group personal training session. This was a professional training center and after 2 days of working out I was taken to the ER. Even after repeatedly telling my Personal Trainer that something was wrong and that I didn’t feel right, I was yelled at and seemingly forced to continue.
I eventually stopped the workout and walked out of the PT session. My kidneys began to shut down, my blood pressure dropped below a point of being able to be read. If it was not for the quick thinking of my personal doctor, who is very educated in these matters, I most likely would have died.
It has been almost 3 years since this has happened and I am finding myself terrified to step back into form of personal training. I absolutely need it.
I need to be healthy. But I am so fearful of trusting another personal trainer. I am terrified of them not understanding me when I say I can’t do it anymore or that I need to stop. Do you have any suggestions?
KS, I am SO sorry to hear about what happened to you and VERY disappointed at the stupid personal trainer who yelled at you and didn’t take you seriously when you said you didn’t feel right. Did you go back and tell this the training center what happened to you? What did they have to say about this?
As for starting back, know that its common to feel the way you do after getting rhabdo. Reading through the comments here and you’ll see several others have shared your feelings.
My thoughts on starting back first get your doctor OK and when you have that,basically just go slow. start with light activity and only do 1 workout for first week. don’t workout more than 20-30 min at first – in fact I think 20 min is best. you should not feel like you worked out afterwords. If you feel tired/exhausted then don’t work out until you feel ok again.
start with only light cardio at first. After your first workout I think its a good idea to see your doctor afterward and let them run tests to see if that first workout did anything indicative of rhabdo again. that can also give you some psychological benefits too and may ease some of your fears.
when you do lift weighs again, I feel using light weights and only 1 set per exercise is good to start with.
I do not recommend you go back to that personal trainer center. If you ever get a trainer again, your first question to them is to ask them what they can tell you about rhabdo.
I got “rhabdo” from taking a statin drug for only 6 months. It’s been nearly 3 1/2 months since I stopped the drug and I’m still experiencing severe muscle pain in my legs, hips, groin area and lower back. My urine was never dark brown and my physician did both blood and urine tests when I was at my worst and the metabolite and enzyme levels were within normal range. I also had knee replacement surgery during this period which magnified the trauma to my body, but I am getting better each day and hopefully will fully recover.
I am 69 yrs. old and have lifted weights since my early 20s. Rhabdo is very serious and if you are put on a statin to lower cholesterol, you need to be vigilant of any muscle pain and/or continued soreness especially if you do weight training.
Joe,
Thank you very much for your article. I am from Austria and I was doing an internship abroad in L.A. I was working out with my roommate (who was in a very good shape) after I didn’t do any work out for many weeks and I pushed it over my limits (combined with dehydration).
The night after the two workout sessions on Saturday and Sunday, I couldn’t even lift my blanket or turn myself around in bed. I stayed in bed all Monday with high temperature and slept (I didn’t know that there was something like rhabdo). On Tuesday I went to the bathroom and recognized my dark urine. My roommate took me to urgent care, but they told me that I need an ER.
In the hospital, they did a blood test and my CK-value was 70,000. In the following days I got high fevers and which did not respond well to medication combined with a pneumonia.
A big “issue” was my mental situation, as this happened thousands of miles from home and I didn’t know what exactly happened to me, as the doctors said that my kidneys and liver are in danger.
It took me around 6 days to get my CK-value under 10,000 (that was the value where the doctors said that my kidneys are not in danger anymore) and some more days for the fevers to vanish.
It was an extremely hard and life-changing situation for me (I would have never thought that this could happen to me, as I am a young and healthy person). People should be more aware of this threat.
Robert, I am VERY glad you are ok! I can only imagine what that must have been like for you going though all of this so far away from home and family. I’m just really thankful that you are well today.
should you sue your trainer if you get Rhabdo ? even if it was a demo exercise session ?
Larry, Only you can answer that question. I do know personal trainers have been sued from causing rhabdo. Some of their lawyers have contacted me because of this this. You got rhabdo after a demo session with a trainer?
actually, i was the trainer,
Larry, oh, I’m really sorry that occurred! You are not alone. If you read the comments here, you’ll see people report that their personal trainers caused rhabdo accidentally also.
Can you share with me -and others -what happened and how you learned your client had rhabdo? what kind of workout caused this? You are anonymous here so no worries.
thx Joe, it’s an ongoing thing is there a # i could call to discuss this?
Larry, I’d rather discuss it here so that others might learn from what happened. you dont have to name names etc and as I said you can remain totally anonymous.
Hi Joe,
Thanks for the great article.
I agree with Barry, the condition seems less well-known here in the UK than in the US. I hope you managed to get treatment Barry, as it certainly did sound like rhabdo.
I was in hospital last week with rhabdo following a PT session with a new PT.
My CK when I went in was 66000 and gradually decreased while I was on IV fluids. Today it is 214 and my Creatinine is normal.
I had been weight-training quite intensively since February but this new PT had me do an exercise new to me – the chin-up or pull-up. I cannot even do one pull-up so he had me jumping in to them and then lowering myself slowly for the eccentric contraction.
My arms swelled up and I couldn’t straighten my elbows the next day. Two days later my urine turned brown. I went straight to hospital but I had to fight all the way to convince the doctors and nurses what was wrong with me. One nurse in the emergency department laughed and said “You don’t look like a rhabdo patient to me” and left me waiting 3.5 hours and another nurse had never heard of the condition.
I am now thinking about how to start exercising again when that time comes and your advice is very useful.
I have shared my story on social media to try and raise awareness as I am so glad I was able to find what it was on the internet and fight for the right treatment. It probably saved my life!
Louise, I am so happy you are doing well today and that you got the medical attention you needed! I hope you told the new personal trainer about what happened. Please share my review with that personal trainer. he/she needs to read it to avoid accidentally causing rhabdo in others.
Joe
Great article, I am from the UK and I think we are a bit behind in acknowledging Rhabdo as I have been searching for information as I believe I am suffering from it now.
I did P90X for the first time on Saturday and Sunday, Saturday was chest and back which mostly involves pushups and chin-ups. Sunday was plyometrics.
Monday I could hardly move and the muscles at the very top of my thighs are very sore as are the lower part of my biceps just above the elbow joint, I just put this pain down to overdoing it and didn’t think any more of it.
Tuesday morning I was even worse to the point where the pain was making me feel sick, I went to the toilet for a pee and it was dark brown almost black. Straight away I thought I must be very dehydrated so I drank a litre of water. As the day progressed I continued to drink lots of water but my pee was still brown it had got lighter but was still very brown,
I knew by this point that it was not dehydration that was causing the problem so I turned to Google. After 15min of researching “Brown urine after exercise” I was pretty sure I had Rhabdo so off I went to the hospital. I was seen to by a doctor who took a urine sample and it tested positive for haemoglobin or myoglobin (he told me that the test can’t differentiate between the two).
I asked him if it was Rhabdomyolosis and he said it was more likely that I had burst some blood vessels in my feet and this was ending up in my urine, when I pushed him further he took to the computer and checked Rhabdo symptoms against mine and agreed that it could also Rhabdo. He then said I would need to rest from exercise for the next 2 weeks and booked me in for a blood and urine test in 2 week’s time and sent me on my way.
Now it is Wednesday and I am feeling very weak and still sore although not as bad as yesterday but the weak feeling has defiantly got worse. My urine was a lighter brown this morning and through the course of today it is almost clear now but it still has a brown tint to it.
The bit that still concerns me is the fact that I am to only take a blood test in 2 weeks to see if I am better, everything I have read says that treatment and diagnosis should be immediate and you should be returning to normal after a week? As my pee is slowly returning to normal does this mean that I am recovering and don’t need any treatment?
Any advice would be great, I would go back to the doctors but as soon as you mention “I read on the internet” they quickly dismiss pretty much anything you say after that.
Sorry for the essay.
Barry
Barry, you are not alone because over here in the US some people report that doctors dismiss rhabdo also. My advice is to go back to the hospital again. I’d rather be safe than sorry.
keep me posted on what happens and Im sorry this happened to you. Please consider posting my review on your social media pages, just in case you are right and people in the UK are not aware of what rhabo is.
Hi Joe
It turns out that I did have Rhabdo, it took some persistence but I eventually got a blood test taken on the Friday evening (6 days post exercise), My CPK was 34634.
I was kept in for 5 days and on the day of my release it had gone down to 1340.
It is now about a month later and over the last few weeks and everything has pretty much returned to normal my CPK is now 172 and my doctor has said that I can start exercising again, he has booked me in for another blood test at the end of next week to see if there is any increase due to starting again.
I assume there would be a small increase anyway that would happen to anybody who is training?
Thanks for this article, without it I doubt very much that I would have persisted in getting a blood test and hence received no treatment.
Thanks
Barry
Barry, thanks SO much for letting me know how you are doing! I am so very glad you got to the doctor to be checked out. I also think its very wise to get another blood test the week you start working out as well. Yes I do think the exercise will increase your CPK levels a little but it should not be anywhere near 34634 it was when you had rhabdo.
when you start back, just do a light workout – some low intensity cardio and if you lift weights, a circuit training program using light weights. Try not to feel tired when you leave the gym.
let me know what the next blood test says too.
Really appreciate this site and all these stories! This has been the best source of info I have found so far in my online research about Rhabdo. My 17 year old daughter was just hospitalized last month with Rhabdo. I was shocked that a perfectly healthy teen could get something like this. We are now on a journey to find out why? I’ll tell her story here in the hope that it can help someone or help us get some answers.
On February 25th she began her lacrosse tryout/practices at school. Prior to this time she had been running 2 to 3 miles a day about 5 to 6 days per week for the few months prior to get and stay in shape. She also had just added in the T-25 workout tapes a few days per week for the week prior and regularly did her abs exercises and other mat work and arm exercises. So basically, she is was very good physical condition before starting lacrosse season.
During the first three days of lacrosse practices there was a lot of running, sprinting and drills. On the evening of February 27th after the third day of practice she had a hard time getting up the stairs to her room and later was laying in bed crying from the pain her leg muscles were in. Knowing how physically tough she is I knew this wasn’t normal.
I asked her if she had seen blood in her urine. (Several years ago my older son had experienced blood in his urine one time after a particularly grueling football practice so I knew it was possible for this to happen after extreme workouts.) She had never looked before so sure enough she checked on the next trip to the bathroom and she had the dark/bloody urine.
I made her a doctor appointment the next morning when she still had the dark urine and they checked all her levels and the CK level came back at over 20,000 – the highest level this small lab was able to read. Her pediatrician advised a trip to the local Children’s ER to get her an IV to hydrate. So off we went and they then ended up admitting her with CK levels then over 75,000!
She spent three nights there with two of them in ICU in case of kidney failure! Thankfully her kidneys were fine and all recent tests have shown no kidney damage that we know of.
The doctors suspect that her CK levels could have been as high as 100,000 when the first lab to test could only read up to 20,000. It seemed crazy how long it took the CK levels to come down. After three days in the hospital they had come down to 13,000 and they let us leave under the condition that she keep pounding the fluids and get her CK levels checked daily and periodically until they dropped to normal. By March 11th they had finally come back down around normal.
Because her levels got so high, her pediatrician and all the hospital docs suspect that there could be a genetic reason that this happened to her. I mean can this really be a normal thing for a 17 year old in peak physical condition? The only thing we thought could have played a role in this was that she had probably not been eating enough carbs for all the physical activity she was doing. She had been cutting back on those thinking it would help her get the shape and muscle definition she had been working for.
We have since been referred to a children’s geneticist and we are waiting for results from expensive genetic testing. They suspect that she has a CPT II deficiency. This would cause her body to not burn fat properly and go right to burning muscle.
In all the cases I have read here on this site….didn’t see any that mentioned this as a possible cause? What do you think? If she has this then we will need to work with a nutritionist to learn how she needs to fuel her body going forward.
She is having a hard time getting back to physical activity. She has started with 10 – 15 minute jogs but once when she ramped it up and went for a 3 mile jog (30 minutes) it wiped her out and she didn’t have the energy to workout for a couple of days. It’s been frustrating for her and hard coming to terms with the likelihood that her lacrosse season is over for this year!
Lisa, I am SO sorry this happened to your daughter! I do think there is a genetic link involved with rhabdo in some people. In my review I linked to a case study of someone who had rhabdo many times. So, I do feel that once someone gets rhabdo that they may be more likely to get it again. Since you said your son may have had something similar in the past, it’s possible that something genetic could have contributed to your daughters rhabdo.
That said, I wonder if this might be due to the increase in exercise intensity too quickly. It sounds like she went from running a few times a week, to doing the T25 workout a few times a week and then pretty intense lacrosse workouts in a short time period. Either way, its hard to say at this point until the genetic testing results come in, so please do let me know what that says.
I know your daughter is frustrated and wants to get back to what she was doing before but tell your daughter that she needs to give her self time before ramping up the intensity of exercise. It is too soon in my view to go back to what she was doing. As I write this, its only been a month since your daughter developed rhabdo. I believe that’s too soon to go back to running again, let alone trying to increase the intensity of her runs. I would not do lacrosse again this season.
Did the doctors give you any guidance on when she can start working out again? if not consult your family doctor.
Even though she is 17, I would advise her to take 3-6 months of low intensity exercise, such as what I advised others here, before increasing the intensity of her workouts. Some may say I’m being overly conservative -and I am – but that’s what I feel is best for her.
As an aside, do tell your daughter that it sounds like she was not eating enough carbs when she was doing all that exercise. Tell her she needs carbs when she exercises. Carbs are her primary fuel source during exercise. I’m not sure if the lack of carbs contributed to her rhabdo but either way, when she goes back to working out, those carbs will help her workout better.
I would also report what happened to the school so the coaches know about rhabdo. I have a feeling some coaches may still not be familiar with it.
I hope some of this helps Lisa. Do keep me posted on how your daughter is doing.
Wanted to follow up and let you know that we did in fact learn that my daughter has CPT II deficiency. (we also had my other two kids tested and they don’t have it thank goodness.) We have had multiple follow ups to the geneticist and the nutritionist who are now monitoring her case. It has been an education process for her to learn and accept that she needs to pay close attention to what she eats and when before working out and after.
She seems to notice if she gets the rhabdo kind of fatigue and it is usually always in her legs which is where she had it the first time. We had her blood tested a month ago and she did have minor elevated levels of CK (312) so I am always worried that she is on the edge of getting Rhabdo again.
It has been a challenge for her since she is concerned about body image and surrounded by all this high protein, low carb diet information which is not good for her particular case. I feel like I hound her about needing to take in more carbs! She still works out probably six days per week but the real test will be when lacrosse season begins in February to see if she will be able to handle the intensity of the tryout week.
I will probably ask her doctors to test her blood frequently those first days and weeks. It’s her senior year and she is hopeful she will be able to play through the entire season this year since she had to sit out most all of last year’s season.
Lisa, thanks for the follow up. Do her lacrosse coaches and team doctor know she has a CPT II deficiency? if not, Id call them and let them know. Fatigue is something many with rhabdo have said. I wonder if that is due to the rhabdo itself or related to the CPT II deficiency? I can imagine how stressful this must be for your daughter especially at her young age. Try to make her realize that there will be life after lacrosse and high school. Let me know what happens when Lacrosse season starts.
Well, Now, I’m confused and slightly concerned.
I’m training for my fifth 1/2-marathon. I’m not an elite runner (shooting for 1 or 2 1/2-marathons a year) turned 50 years old and have about 10-extra pounds which I expect will disappear as my training continues.
I increased my run yesterday from 8-miles the week before to 10 miles yesterday. My last 8-mile run the week prior was pretty easy and I wanted to run a particular route yesterday regardless of the distance.
Well, today, I’m feeling wiped out fatigued. I’m not feeling too much pain or stiffness except for my hamstring which has felt some pain since last week’s zumba class (slight hamstring pull). It’s a slight pain and doesn’t affect my running (just painful when sitting for any length of time). I’m scheduled for a massage tomorrow by my sports massage therapist.
My concern is because of my extreme fatigue today, and my confusion is – how can I train for a 1/2-marathon which means my distance will continue to increase? I’m running 4-1/2 miles 3 times during the week and try to throw in Zumba at least once, then do the one long run on the weekend.
I think I’m increasing the distance slowly enough – I have 4 weeks to go and am at 10 miles now….. and want to hit 11-miles this weekend. But, boy am I fatigued today… I DON’T like how I feel. I can’t remember what color my urine was, but I had very pitch black very watery bowel movements last night. And, now am worried I may have done something wrong… Ugh.
Actually, my hamstring hurts all the time, but really bothers me when sitting. I just don’t feel pain when running, just when using the hamstring in the intense mode – raising my foot (hamstring pull) or putting pressure on my heal (like launching)…. it just seems hamstring pain is kind of normal for my type of training….
Old Lady, its hard to tell if you have rhabdo or not based on what you said. It could be that you are over training and just having a bad day coupled with an injury to your hamstring. It could be that you are just over training.
Does the pain hurt when you are not moving? if so thats not good.
Dark color urine doesnt show up all the time in cases of rhabdo but the pain usualy happens fast – zero to 24 hours after the workout.
How are you feeling today? Did the massage help?
BTW, you are not “old.” We are basically the same age and if I’m not old, neither are you 🙂
Thanks, Joe.
Actually, since my original post, things went downhill pretty quickly. I Continued to run – increased my distance 10-12 miles and ran a 10K for “fun”. The pain continued to increase. Over those couple of weeks I had massage therapy hoping to loosen things up, we worked the hamstring tightness out until we got all the way to the bone, where I realized there was something more severe going on.
I had X-ray to rule out hairline fracture so I could keep running (thru the pain) then an MRI. Results were high-hamstring tendonopathy at the ischial tuberosity with associated bone marrow and soft tissue edema. Not fun.
Needless to say, I’m not running (well, I did run one 10K since I couldn’t run the 1/2-marathon). But, that was three weeks ago (before my diagnosis) and haven’t run since.
I’m on anti-inflammatory and ice regemine and start physical therapy soon. I’m not a happy camper. But, I think I’m on the road to recovery. The pain is subsiding – still hurts when I sit (and driving), but I can walk better now. Thanks for your time and support.
Old Lady, thanks for the update and sorry about your diagnosis but I am glad that you got an answer to your problem. I can understand and relate to how you are feeling. One thing that keeps me motivated is that we do eventually bounce back. I also tell myself that even though I may prefer some types of exercises, there is no “best” activity and that rotating (walking, running, biking, elliptical etc) is actually healthy and can help keep us doing what we really like doing for a longer time period.
I hope that is some solace for you and I do pray for your continued improvement. It sounds like you are already getting better…
I got Rhabdo the second week of December 2013. I had been doing CrossFit for 10 months prior to this incident and am in great shape. I had gone home on vacation for a week and a half to visit family. also no properly hydrated like I normally am and definitely not eating clean like I normally do.
I decided to try out a girlfriends box with her where they were doing one of the CrossFit girl workouts called “Nicole” which consists of a 20 min AMRAP of your max rep pull ups (as many pull ups as you can do until you drop to the ground) and a 400meter run every time you drop. I had done this workout before and did 73 reps and was perfectly fine. This time I did 101 reps.
I clearly did not ease into the workout as I thought i would be fine since I had been doing crossfit for a while and had already done this workout. I was okay the next day but that night and the following couple of days I was so sore I couldn’t straighten my arms out they were somewhat stuck at 90 degrees and i couldn’t lift my hands over my head it was so painful. I thought i was just extremely sore since it had been a while since my last physical activity.
A week and a half goes by and were flying back home. That night as we get home and I take my jacket off I notice my arms are swollen and continuing to get bigger. I knew then it was time to take a trip to the ER. All the nurses and even the doctor rolled their eyes at me as I told them I thought I had Rhabdo. I am very small 5’2″ and about 108lbs they are thought I was crazy.
One blood test later and the doctor comes back to apologize because I did in fact have Rhabdo. It was at the ending stage and I was starting to recover but my Levels were still around 8000 so they admitted me and I was pumped with fluids for 12 hours where they did another blood test and my levels dropped to 2000 so I was allowed to go home. 2 weeks later I had a follow up blood test and all my levels were back to normal.
i was scared to go back to CrossFit for sure but I had a sit down with the owners and coaches and they helped me back into a slow routine with minimal weights. and if they ever saw me trying to do anything more they would yell at me.
It is now March and I “thought” I was in the clear as I had gotten back to my previous weights and was doing everything I had done before. Then I did a crossfit open workout friday that consisted of Overhead Squats and Pull ups and i think I may have over done it just a tad.
Since it was using the same muscle groups I had Rhabdo in before I should have taken it a tad easier. I was still pretty sore come Tuesday so my doctor had me go for another blood test just to see and yeeep my CK levels are elevated again but are only around 1999…..still she told me to rest and now I am feeling defeated.
I am frustrated and I know I shouldn’t be but this is my lifestyle and I absolutely love it. I know I need to continue to take it easy because this is super serious but its hard when this is everything you love.
Britt, really sorry that happened to you! I understand this is a lifestyle for you. At the heart of the cross fit name is “cross training” which basically refers to doing different things on different days to reduce injury. So, if we only do cross fit we takes the “cross” out of cross training.
That said, can I suggest that when you do go back to working out, that you bag cross fit for the next several months and just do some less intense circuit training. I know it’s stressful not to do what you want to do – and love to do too – but it may be the best advice for now.
Hi Joe I have recently upped my running distance from 6km to 10km , the last 3 runs I have done have all been 10k ( Thurs, Sun,tues) on the last run I finished the run 4mins quicker than previous runs , it was 3degrees outside . After wards I was so shiverey and cold and felt like I was coming down with the flu , I have leg ache for 24hrs now and was wondering if that is something to do with rhabo?
Cheers
Dave, its hard to say based on what you said but I recommend you go to your doctor today and get checked out. Its possible its rhabdo or something else. Your doctor can tell if its rhabdo or not. Go today and let me know what happens.
Thanks for in informative article, but you state that the Rhabdo can also be casued with even low impact exercise. You also give some suggestions on PT preventing Rhabdo. Would it be safe to say that it is impossible for PT to prevent Rhabso sometimes?
Liz, I think its impossible for a personal trainer look at someone and exactly gauge their risk of getting rhabdo. That said being knowledgeable about the state of the clients current health and health issues and applying the proper use of progressive overload principle should reduce its risk significantly. I think most personal trainers will never cause rhabdo in their clients. Personal trainers who prescribe high intensity type workouts have a higher risk of causing it accidentally but even in those, if they are conservative in their application of the exercise they prescribe, and include enough rest and education for their clients, they dont have to cross that line.
Thank you for this article! I was recently diagnosed with Rhabdo on Friday, 1/5/14 after doing an AMRAP at my CrossFit Gym consisting of 42-30-18 Ring Rows 21-15-9 Barbell Back Squats. Ring Rows are when you hold onto two rings, lean back while keeping body straight, then pulling your body up towards the rings, essentially pulling up some of your body weight with only your arms, then back down to starting position.
Previous to this I had some nerve issues in my left arm, which caused weakness in my biceps and tingling in my fingers, so I took it easy with upper body work for a month, not lifting anything overhead. Then I did the ring rows workout as a substitution for pull-ups (without my regular coach there) because I thought I felt okay. Turns out I was wrong!
My arms were stiff the next day, but I thought that was just typical soreness. My arms got progressively more sore, I couldn’t straight them out, and got even worse on Sunday when my biceps started to swell up. I knew I had Rhabdo by just looking at my arms.
When I was admitted to the ER my CPK count was at 8000. Day 1 I was at 11,000, Day 2 at 13,000, Day 3 at 16,000, then back down to 12,000, and when I was released from the hospital on Day 5, I was at 7000. My urine throughout my hospital stay was clear and my kidneys were fine. The day after I was released I took another CPK test and was at 3,000. 2 weeks after I was admitted I am now in the normal levels at 129.
I love what CrossFit did for me physically. It made me more lean, muscular, and I became a lot toner and stronger. BUT with that said, I have SERIOUS anxiety about going back, and even lifting heavy with my upper body. I don’t even know where to begin working out when I start back up again in a week or two. Any suggestions on workout I can do as far as time/reps goes that will help me build my strength back up in my arms? Thanks!
Dawn, I’m glad I was able to help. Question, did your cross fit trainers inform you about rhabdo before you started? I just like to know these things and in doing so, hope to help other cross fit trainers who may be reading this. Have you told your cross fit trainers what happened? If not, please do so. They need to be aware that this happened so they can better reduce the chances of it happening in others.
Did your doctor say it was ok to work out again? if not, get his/her approval first before you do anything. I know many people are afraid to workout after they get rhabdo, but you can workout again. We will have to take it slowly.
I would not go back to cross fit right now.
If you do get your doctors OK, here are some general ideas that you can use as a guide for when you do start to workout again.
1. I would start back with just light cardio (like walking on the treadmill or easy eliptical work) for a few weeks to see how you feel. Id say start wiht 15-20 minutes of cardio 1 or 2 x for the first week. Increase the time you exercise before you increase the # of days you workout. That will be safe est and give your body more time to recover from workouts.
2. when you do start lifting weights again (give it a few weeks to see how the cardio only effects you) I recommend a circuit training program that uses light weights – something you can lift comfortably for about 15-20 times.
3. I dont want you to push to failure on any set.
4. Start with only 1 set and I would only begin with 3 different exercises -legs, chest and back. For example you could do 1 set of leg press for 15 reps, followed by 1 set of chest press for 15 reps and then 1 set of a seated row (or lat pull down) for 15 reps. If you do only those 3 exercises, you also hit most of the muscles in your body so its efficient and yet also means you dont have to spend a lot of time in the gym either.
4. Do that for a few weeks and monitor how you are feeling -muscle sorceress, swelling, change in urine color etc. I dont want you to spend more than 30-45 min in the gym for a while -again to give your body time to workout. Again, I would only spend about 15-20 min in the gym at first, only doing light cardio.
This is of course after you get your doctors ok.
I know a lot of cross fit is about the speed you do the reps. I dont care about how fast you do the reps. in fact I want you to lift nominally – like 1 second up and 2 seconds down.
Dont be go back to wokring out harder out of a fear that you will be “losing all your gains” because they can be obtained again. You will not be going back to square one anyway so take comfort in that. Having patience with your workout is important at this stage of the game.
Rhabdo happens when we push ourselves too hard, too fast. Giving yourself ample rest between exercise sessions will help this to not happen again. If you ever do cross fit again (I wouldn’t if it happened to me), the trainers need to modify the intensity of what you do to help reduce this from happening again. Do read through the comments also as others have asked similar questions.
If you have any other questions, just ask and I will try to help.
Hi Joe! I actually heard about Rhabdo from my CrossFit coach a few months ago because he posted an article about it for us to read. I never in a million years would have thought I would get it. I was the first person my Coach has ever seen with Rhabdo. He actually came by my hospital room a couple days to see me.
I asked my doctor when I can workout again and he gave me the OK as long as I start SLOW. Since Rhabdo occurred in my arms, do you think jogging, squats, lunges will be ok? Light reps of course. I don’t want to go to failure.
I’m definitely a little bit traumatized when it comes to returning to CrossFit again. IF (and that’s a big “if”) I do return to CF, it won’t be for a LONG time. I do miss it, but I keep thinking about Rhabdo and I’m emotionally, mentally, and definitely physically not ready to return. It may take me a while to get over this whole experience.
Thanks for your input!
Dawn, good I’m glad they informed you about rhabdo – and kudos to your cross fit trainer for coming to the hospital to check up on you!
You are not alone and feeling traumatized after getting rhabdo. Many people do and while the news media is finally starting to talk about this more (I think because they have never heard of it before, as I was told by a reporter who interviewed me on TV about it a while ago) none of them yet are talking about the toll it takes on people who are afraid to work out again afterward.
I would agree that SLOW is the thing to focus on right now. At this point I wouldn’t do squats etc. Just follow the outline I gave you for a few weeks and lets see how you do with it. I know eventually you will be able to do squats etc. but right now, since its only been a few weeks, I just would rather you get comfortable with working out. I’d rather you take it slow now and be able to sleep at night without the worry of “oh did I do it again?” thoughts that I think might pop up as you begin to get back into working out.
Do keep me posted on how you are progressing too Dawn 🙂
Thank you! Really great article here that I’ve shared on all of my facebook pages. The hardest part as a group ex instructor is getting students to modify their movements and go at their own pace…when they don’t seem to WANT TO! I stress modifying movements and slowing pace, over and over, ad nauseam. It doesn’t always work. Students need to understand the risks as well. Thanks again for writing this so clearly.
Liz, THANK YOU for sharing my review on your facebook pages. It is my hope that everybody who works our or who is a personal trainer understands what rhabdo is and what it can do.
Thank you for writing and I am glad I could help in some small way.
Joe,
In your opinion, if you hydrate, eat, take or don’t take certain supplements/medications appropriate for the exercise you do, regardless of intensity can you avoid Rhabd?
Hi Damon, unfortunately no. While having enough fluid can reduce the damages of rhabdo, water will not stop muscle fiber death. Likewise for supplements. I’m not aware of any supplement that will reduce the risk of rhabdo. No herb, amino acid, vitamin, mineral etc. will do it. I hope that helps.
Hi Joe,
Thanks for sharing this article. I am currently recovering from my first case of Rhabdo. I cannot tell you how many people told me (and tried to force this statement on me) that I worked too hard, and that is why this happened to me. But now, I can direct them to your article so they can see for themselves that Rhabdo can occur after one workout, and it can happen to any one with ranging abilities.
Thank you for helping me to be more confident in the information I give to people who are hell bent on believing that I brought this on myself.
Francesca.
Francesca, I’m glad I was able to help and so sorry you got rhabdo. My prayers to you for a speedy recovery. Let me know if I can be of any other help.
Thanks for this article Joe! It’s good information.
What recommendations do you have for folks who aren’t sure if they had rhabdo? I’m guessing there are a number of us that have experienced severe DOMS and are now wondering if we could have had a mild case of rhabdo.
For example, if a person has muscle soreness and swelling, but does not have cola colored pee, is it safe to say they did not have rhabdo?
To take it a step further. If someone had a slight case of Rhabdo (I don’t even know if that’s possible) and didn’t get it treated and is just now reading this article, are there things that they can look for? Is the lack of definition in their affected muscles permanent? Is there an increased risk of swelling after working out? Can a person return to pre-rhabdo fitness? Can they get stronger or is there lasting damage?
I seems to me that, if it’s possible to have a mild case of rhabdo, maybe there is something we could be looking for, other than dark urine.
Bless you for answering all these comments!
-Adam
Hi Adam, I think its possible to mistake a really bad case of DOMS for rhabdo. The thing that I look for is that DOMS does not hurt when you are not moving. Rhabdo pain does hurt when you are not moving. That said, I think the best way to know if you have rhabdo or not is to get checked by your doctor. dark colored urine does not always show up. If I remember correctly, it only occurs in about 30-50% of cases of rhabdo.
The things that I’d look for would be
1. quick onset of pain -usually zero to 24 hours after the activity
2. the pain hurts -a lot – even when you are not moving
3. swelling of the muscle.
That’s not always foolproof though which is why I recommend seeing your doctor.
exercise induced rhabdo usually occurs when the intensity of exercise is increased too quickly for the body to adapt to. That said I do believe you can return to “pre rhabdo fitness levels” eventually. It depends on the severity of the condition.
The news in the US is starting to pick up on rhabdo mostly because articles in the the NY Post and Huffington Post. Because of that and because most people have never heard of rhabdo, it’s likely that people will start seeing a LOT of stuff about it on TV etc.
while I am glad about the awareness the condition getting, its possible that the blitz of media attention might scare some people in to wondering if they have it or not. This is why I recommend for those who think they might have rhabdo to see their doctor. They can best advise people and help them get the help they need.
Joe,
Great information and really the only detailed information on Rhabdo I can find. I got Rhabdo back in July. I was doing Zumba -3 times a week, working out with a trainer once a week and training for the 2 day 39 mile Avonwalk on weekends. I had done the walk last year with no problems. I had been on Lipitor for 7 years with no issues.
On this particular weekend, I walked 12 miles on a Saturday and it was pretty hot (around 90 degrees) but thought I was pretty hydrated with water and Gatorade. That afternoon I was tired and had a little shortness of breath but I have asthma so didn’t think much of it. The next day I was supposed to walk 6 miles for my training. By the 4th mile I was exhausted and was experiencing the shortness of breath again so I cut walk short at 5 miles.
Over the next few hours I experienced more muscle pains and the breathing issues. Finally by the evening my husband said I looked really pale so we ended up in ER. At first they thought it could be a heart attack. Fortunately my heart and kidneys were fine. They said that my CPK levels were 10 times normal and suspected Rhabdo and was lucky that I had come in. They said the condition exacerbated by Asthma. They gave me IV fluids, prednisone and sent me home.
ER told me not to do any exercise until I saw my regular doctor a few days later. I did this. My regular doctor told me to take the next 3 months off of exercise, took me off Lipitor, and ran my CPK levels again a week later which were now normal.
After a few weeks I still felt like crap so I decided to get a 2nd opinion and saw a Rheumotologist (since I wasn’t sure where to go). She ran a whole bunch more tests and said that in addition to the Rhabdo (which levels were still normal) I also have Fibromyalgia which can present some similar symptoms.
She pretty much agreed with my doctor but told me to slowly work into exercise since my blood levels were normal and by the time I saw her it had been over 6 weeks. I started off slowly with just walking my dog 2-3 miles and that seemed fine but then one day I went back to the gym and did treadmill for only 30 minutes and started having that weird pain in my back and shortness of breath again. This lasted a few days so I saw doctor. She ran more tests but all levels were normal.
We have talked about a muscle biopsy and some other tests but will decide on these when I go back next week.
I feel like this doctor just like my other one really doesn’t understand Rhabdo. I know my blood tests show normal levels but not sure why when I exercise I still have those symptoms. Do you or any of your readers here know of any doctor that specializes in Rhabdo cases. I am in Southern California.
I feel like I am going crazy since before this I was so active and now am afraid to just do basic walking and exercise. It has been almost 3 months so I feel like I should be able to resume a normal life again. Any feedback or guidance you can provide is much appreciated.
Jaenene
Jaenene, you are not crazy but from what you said it sounded almost like the “perfect storm” for rhabdo to me. I do agree you should go back to exercise slowly (2-3 mile dog walk is more than Id recommend though. Id start with just 1 mile).
I don’t know of any doctors who specialize in rhabdo but an I’d guess someone who specializes in internal medicine or sports medicine would be good to connect with. Sports medicine doctors are very aware of rhabdo and internal med doctors are pretty much well rounded in a bunch of stuff.
Interesting the diagnosis of fibromyalgia. I thought they diagnosed this if you were in widespread pain for 3 months and the pain was localized to 11 of 18 known “tender points” – and after everything else has been ruled out. I’ll assume that applies to you.
Im glad you were able to find me. If I can help anymore, just ask.
Thanks Joe…appreciate the feedback and the help. I know you are not a doctor and every case is different but in your experience how long do people that have had Rhabdo (and that have normal levels again like me) take before they can regain “normal activities”? Or have you seen that they don’t resume normal activities again?
You are correct about the Fibro…the doctor has been monitoring me for 2 months now but I’ve had symptoms consistent with the illness for around a year but because other doctors were treating the individual symptoms it was not until I saw the specialist that she put the puzzle pieces together. She said the Rhabdo could have exacerbated or brought the Fibro to the forefront. I do know a sports medicine doctor so think I will go that route.
Thanks again
Jaenene, You will be able to work out again but I cant not give you a time frame. If you have fibromyalgia that might add an extra something into the equation but it wont prevent you from working out. My best advice is to resume your activities slowly and get feedback from your doctors who Im sure have run a bunch of tests and can advise you on best. Do keep me posted on how you are doing also!
Hi Joe,
Found this article after reading about your smoothie. Anyways I have never heard of rhabdo before. I have exercised my whole life and am currently in the military (25). Well my wife and I have started doing the insanity program about a week ago because we want to tone up, but she was never one to exercise growing up just ate healthy so she has very little experience in that area.
I was wondering, since we jumped straight into a program like insanity (very tough) and she is struggling through it like I am, I was wondering what the risks were. We take it slow doing what we can and taking more breaks in the middle of the exercises compared to the people on the DVD.
If it has already been over a week since we started and she seems to be fine besides some normal muscle soreness, would she still be at risk for a disease like this even though we have done every cd at least once last week (month 1 phase)? Is this something I need to be watching out for while she does insanity with me even though she has been fine all last week?
Or is she more or less safe because she has been working at this high intensity for over a week already and has been fine? Sorry for the long post, but after seeing this article it freaked me out for her safety I don’t want her to get hospitalized trying to keep the pace I am keeping.
Thank you for this great article and getting me a bit more educated on fitness.
Brian, I think that moving at your own pace – rather than trying to keep up with Shawn T on the DVD – is the best way to avoid getting rhabdo. While rhabdo usually does occur quickly, I did recently read a report about a “delayed” rhabdo that appeard to occur 5 days after working out intensely. Here’s the link http://www.cmaj.ca/content/183/16/E1222.full
that said, I think most cases of rhabdo Ive heard of happen quickly after exercise and if you are doing what you say you both are doing, I think the odds of getting rhabdo are small. Just listen to your body and dont push yourselves too much. Rhabdo seems to occur when people push behind their breaking point- not just their physical breaking point but mental breaking point as well. if you know your limits and dont exceed by much your physical limits too much (a little is usually ok for healthy people) I think you might not have to worry about rhabdo.
Injuries – joint injuries etc – stemming from high intensity exercise programs are another story so again, pace yourself and remember that the body gets stronger when it has had rest.
So glad I found this article. I am a 40 something year old woman currently recovering from exercise induced rhabdo. If I had not advocated for myself and asked my physician to test for it, I would have fluffed it off as DOMS. My CPK was 24,000 after doing strenuous arm routines which included pull ups, I am finding this to be a common factor.
I had swelling in one arm so much that I resembled Popeye. Thankfully my kidneys were not affected. I have not spoken to the folks at my gym yet, but I am petrified of restarting exercise. Thanks for the great info!
LB glad you got checked out for rhabdo! Im also hearing others mentioning how pull ups were related to inducing rhabdo, probaly because they are difficult, and they have a pretty intense negative (eccentric muscle action/ the lowering part of the pull up).
listen to what your doctor says about when you can work out again. A lot of people here have told me how they were afraid to work out again after getting rhabdo. you are not alone.
thanks for the article! It will be go to guide for those wishing to seek further reading.
E$, thanks, I appreciate that 🙂
I’ve really enjoyed this article and these responses. I have been doing additional research on Rhabdo lately in light of an article making the rounds “CrossFit’s Dirty Little Secret” which is a horrid slash at CrossFit via the risk of Rhabdo. Not a secret at all…Glassman addressed it in 2005 (um, EIGHT years ago) and a follow up was done that I think was written very well in 2011. The offending author has been in academia too long… But I digress…
Full disclosure – affiliate owner and long time CrossFit athlete here.
Here is the other side of the story:
I understand the risks, causes, symptoms and treatment for Rhabdo. The minute I became aware of this condition (several years before opening my own affiliate) it scared the shit out of me and I did my homework.
Much to my surprise, I found case after case after case of Rhabdo occurring in non-crossfit contexts. Lots of stuff in college athletes; a high school kid punished with squats; police, fire and rescue stories; and, most surprisingly of all, prison initiation exercise routines.
What I didn’t find was an out pour of folks lamenting their experience contracting rhabdo after a CrossFit workout. The first commenter in this blog counts as my first. Given the exponential growth of CrossFit, you would think reports detailing the hordes of afflicted would be easy to find. So far…not really. I think the risk and prevalence is overblown. This perception (and I will admit, I could be easily swayed with the right data) does not mitigate my responsibility in discussing this topic with my members.
Thus far we have probably entertained 200 individuals at our gym since opening, none of which have gotten rhabdo. What does this mean? Little, except that there are affiliates out there taking care of their athletes. We provide a full 1.5 minute rundown of rhabdo. “1.5 MINUTES!?” You say…”that is BARELY enough to scratch the surface!” yes, we talk at the person’s blank face for a whole minute about what it is, how you get it and what to look for.
The impact…nothing. We live in a society where there is danger, warning and caution everywhere. We are completely insulated to this message. I must have initialed my name next to DEATH a dozen times when I went scuba diving and sky diving. For that matter, we discuss how our building is known to contain asbestos…FUCKING ASBESTOS…and no one seems to care (granted, we did all the correct things to get it cleaned up upon detection). There is a REAL, non-zero, risk of rhabdo when performing crossfit. When I snowboard, I see, without fail, some poor sap getting hauled down the mountain in a stretcher. There is also a non-zero risk of breaking your neck once you get off that chair lift – and people merrily participate by the 1000’s without a care in the world. If it’s not a snake with dripping fangs rattling menacingly, I’ve found that people are horrendously insulated to what real risks lie ahead as compared to the action they take.
Now hopefully, having been exposed to our lecture, someone experiencing the telltale signs will rush themselves to the hospital. However, when I explain the signs, I say with some levity, “as if those symptoms weren’t enough to get you to go to the hospital anyway, right?!”
But, every single case and study I’ve come across is how people ACTIVELY DON’T go to the hospital once outside the care of their coach, trainer or whoever last saw them in working order. The thing that gets them to the hospital is appearing to be on the brink of death.
Fortunately for sufferers of Rhabdo, “4 days later” is considered early treatment (what do you get for a rattler bite…4 hours?). Now, the trainers clearly bear a large portion of this blame because they themselves are not educated on the topic and/or failed to disclose the risks and signs that might ordinarily initiate that trip to the Doc.
Please, please, please do not take this frustration as that oriented at any of the contributors here. My complete astonishment comes at this breakdown of communication. If one of my clients came back 2 weeks later and said, “yea, I had really, REALLY stiff muscles and had dark pee and really felt awful, but now I’m back!” I would say, “…uh, why the hell didn’t you tell me?”
To me it is unconscionable that someone would pay me for expertise and I end up hurting them. Likewise, I would do everything I could to help their recovery…which would include free personal training…lol (what a scammer at your CF gym lost_princess, im sorry…) to make up lost ground.
By the way, lost_princess, I would also recommend your husband not do crossfit…at least in the immediate future. It literally sounds too intense for him. He needs 1 on 1 exercise supervision closely monitored by a doctor (good luck finding a trainer who can pull that off…) because all that heart and arthritis stuff…uh uh, don’t want to touch that with a 10 foot pole. Your CrossFit instructors are crazy.
When I hear of the FIRST workout that people are doing, it blows my mind out the back of my head with shotgun force. Murph!? Helen?! I’m sorry, are you attempting to kill your friends? The first workout that most of our members complete is via our free trial – and it’s the same every time:
6 minute amrap
10 burpee box jumps
16 walking lunges
10 situps
The eccentric load is minimal (seeing that 90% of the time is spent doing burpee box jumps) the pattern is short and the opportunity for rest (once again, right after each burpee box jump) is built right in. Not to mention its only 6 minutes. The result? This workout still CRUSHES people. If you are new to exercise, the burpees get you. If you are a fit hulking badass…the burpees get you. It is win, win, win, win, win, win, win….win. The tendency for CrossFitters to try and “impress” neophytes with some monster, brutal workout is a rookie mistake itself.
Ok, so at this point this uncontrolled stream of consciousness has really gotten out of hand. Great article! Perhaps we can dialogue in regards to some of the content ejaculated here.
e money, thanks for writing. Im aware of the “cross fit dirty little secret’ article as well as others recently, as they have resulted in MANY extra visits to my website from people looking for more info on rhabdo.
Like you, I am aware of several cases of rhabdo resulting from high intensity workouts that were not associated with cross fit. I think cross fit was named in recent articles because it is the most well known high intensity workout out there. I did link to case reports of other incidences, not associated with cross fit.
I also would like to know the actual injury rates or rhabdo associated with cross fit, but I’m not sure if those statistics are known. This I think is partly because most people might just “grin and bear it” and never go to the hospital, and as such never know they had rhabdo. In a nutshell, they got lucky (as far as kidney damage etc. that might have resulted from rhabdo). That said, I have met personal trainers who caused rhabdo after prescribing too much exercise to clients (cross fit and non cross fit related) and I have been told of one death following a cross fit workout.
I’ve also been personalty contacted by lawyers who represent people who developed rhabdo following exercise prescribed by personal trainers.
I think that the rate of rhabdo attributed to fitness trainers can be greatly reduced by :
1. better education by the fitness industry (I believe I wrote the first book in the US that discussed rhabdo and personal training) I’ve even met people with college degrees – in exercise – who have not been taught about rhabdo.
2. Better screening of those who take part in high intensity exercise classes. I applaud you for telling your people about rhabdo but as far as I can tell, this does not seem to happen universally from what people have told me. I’ve also been told that trainers who conduct cross fit classes do no pre screening of members before those members do cross fit workouts. I’m sure cross fit must have policies on this but it appears to be lacking at some locations. I believe in addition to a talk about rhabdo, that the use of the “PAR-Q” or other health history screening form would greatly cut back on people who are better served by a lower intensity of exercise.
I know the recent articles on cross fit/rhabdo have resulted in a lot of anger from those who do cross fit and have never had a problem. I’ve been discussing rhabdo in classes I teach for several years – and as far as I knew, I was one of the few who talked about it. My hope is that the recent articles – as painful as they are to personal trainers (cross fit and not) result in a more widespread understanding of rhabdo, not only among trainers – but people in general. That, I feel will ultimately reduce the incidence of this condition.
Yes, we employ a Par-Q and a general physical activity questionnaire. We have been fortunate to not have to address any serious issues from those interested in CrossFit (mostly just wear and tear joint stuff). You would be right! Not ONE gym I have walked into has asked me to perform movements, asked about my health or otherwise done due diligence in making sure I don’t collapse mid workout. Perhaps because I always disclose I am an affiliate owner, but that doesn’t necessarily imply anything. The libertarian nature of CrossFit, Inc. lends itself to sort of loose, at your own risk, type controls. This itself is a whole other discussion…lol.
I have toured to many different CrossFit gyms and most set you up with a text wall, which I am happy to sign, but it doesn’t lend itself to the understanding that CrossFit does pose risks and Rhabdo is real – especially for the newbie. I went to two CrossFit gyms in south korea (whole different can of worms, of course) and there wasn’t any waiver/information/pre-screening AT ALL.
Actually, whenever we do our rhabdo spiel, I am floored by the amount of people who don’t just have inadequate knowledge of rhabdo, but have NEVER heard of it AND have significant CrossFit experience. There is a serious deficiency in communication and/or education somewhere.
I agree with your recommendations for reduction. In having this discussion, I am quickly realizing that this is not a problem central to CrossFit (and that is not for want of mitigating the perception of the blame placed on CrossFit). The industry as a whole has progressed towards “intensity” (in its various interpretations) – probably because that is where you can achieve quick and serious results. There is Insanity, P90x, SickFit and all of those weekend warrior type challenge runs that, if the information I have seen is in fact true, pose a threat due to the average “challenger” being grossly unprepared for the often highly demanding challenge ahead.
A quick aside: I did a “Zombie Run” where I saw people PUKING after about .5 miles. Needless to say, there is a gross disconnect between perception of abilities, real risks and information.
I am glad you are making this information present and taking an interest in this topic! I suspect that once the industry at large catches on, it will become an ever present, but well managed, risk.
Greatly appreciate the conversation – it’s rare to have a level headed one via the interwebs!
E$, thanks again for your insights. I am sure people reading this have been well educated about what they should expect to have done when they do a cross fit work out.
I don’t know much about crossfit – I’m a competetive tennis player in South Florida. I’m a 51 year old female in great shape. I work out most days with a long walk and series of many repetitional exercises to train for tennis, play tennis or hit with a pro 3-4 days a week, and often do a mini bike-walk-swim just for pleasure on Sunday – I love being outdoors and am indifferent to high heat, sunshine and humidity. I also do all my own heavy yard work and walk my big dog constantly.
Well, this jolly sportif lifestyle has done bit me on the tail! After some intense 3 days of training in really hot weather in advance of my season starting 2 Tuesdays ago, I won my first match then started to feel bad. I thought I was just worn out with DOMS and having an andrenaline crash, coming down after competition. My muscles and joints felt increasingly tense, achy and sore and I was incredibly fatigued with strong facial flushing. Everything went downhill for the next many days then.
I couldn’t move from bed, I had recurrent fever and chills,heavy night sweats, whole body aches. The weird “backwash” of lactic-burn-like feeling through the major muscles after the slightest movement was bizarre! But the lack of certain other symptoms had me mystified. No sore throat, no vomiting, clear eyes, clear urine, no real headache. So what kind of “virus” did I have? If only I had ever seen the “tell” of dark urine – but I never had it. Hot stiff neck feeling swollen, hot eyes. But no rash, no respiratory symptoms, no appetite loss. Some waves of an almost syncope feeling.
Then it was then long holiday weekend so I never went to the doctor, but luckily my self treatment of loads of salt, carbs, gallons and gallons and gallons of water and total bed rest were exactly spot-on. Also supportive family members so I never moved. I went to the doctor Tuesday, a week after it all started. Everything checked out perfect except slightly elevated liver values and elevated CK.
Now that I have read so much more, I have a call into him to get rechecked next week, not in 3 months. I am a little worried about Compartment Syndrome as the back of my left leg feels crampy and still bothers me, but nothing was ever swollen anywhere. Now 9 days later I am still on mostly bedrest and still feel kind of crappy but better each day. Minimal activity and no heat. D
own to one round of otc pain reliever a day usually around 4 or 8 pm when I feel worst.I have no idea when I will resume anything – just won’t know until I really feel normal, and it feels safe to slowly start back.
Kathleen, sorry that happened to you! I think you are doing the right thing esp keeping on contact with your doctor. I hope you start to feel better soon.
Hey Joe,
My name is James and im 24. I just wanted to write and share my story in hopes of seeking advice. I first suffered from rhabdo a year ago, when I first moved to California from Chicago. I had just started back at a gym with a personal trainer (who had no knowledge of rhabdo). I did some basic warmups and weight training sessions along with pull-ups. I admit, I wasn’t as hydrated as I should have been but that has never really caused damaged to me before.
After the workout, I felt tightness and fatigue but figured it was normal for a post workout esp after not lifting for some time. But I admit prior to this I attended collage at a university where I was active, did a weight lifting class and strength training as well as the fun of drinking and partying each night which I can I still never developed rhabdo.
Not until after this stated workout, over a year later from college, I realized a after 2 days my soreness was getting worse and Epsom salt baths didn’t help. (I also tried Korean BBQ for the first time that night, tons of extra protein). The workout was Friday, by that Sunday I could not physically move my upper body much at all not even to extend my arms.
I panicked and my friend rushed me to the ER on Easter Sunday. At first, they thought maybe a tear or over exertion or DOMS. Then a nurse (who happened to be n amateur bodybuilder) informed me that after seeing my urine color, which was coca cola colored, that what I had was fatal and I was gonna be admitted into the hospital.
They found out my heart was fine but my cpk was at an amazing (100,000+) which scared me after hearing the normal. The doctor thought I was a fighter trying to bulk up my muscles as saying some bodybuilders do it to get bigger arms. and after a week of hydrating my cpk level was still in the thousands but it had dropped significantly. After 2 weeks I felt normal again.
After a month I tried working out and drinking socially after 2. A year passes, and I’ve done minor cardio like running and walking and then push ups and pull ups at home with a bar, on and off.
Until one day, after having my mouth wired for 2 months because of a broken jaw and bad dental job extracting a wisdom tooth, I was at home and decided to do some push ups when the next morning, I had felt tightness again. This time going to the urgent care and once again my cpk was up, not as high only raised to 15,000 max and was back down in a week. But I got hit with rhabdo twice and now I’m 3 months in the clear and I’m terrified to even lift heavy objects or run or drink or do anything really as I’m afraid to reawaken the horror.
My arms doesn’t always feel strong at times and I just feel weaker and sluggish and any weight that was off from the wires came back and it almost feels as if I don’t have any muscle to keep fat burning.
I don’t know what to do and no doctor can seem to give me any direct answer just to hydrate and don’t overdue it. But there really needs to be more awareness and group meeting for this because it’s scary and physically draining and now I may never be able to become physically active again as most men my age.
So I don’t work out at all just try to eat right and I’m so paranoid I watch my urine color everyday just to make sure it’s not dark, in which sometimes it’s a darker yellow then I drink water and Gatorade in hopes it’ll clear up. Sad way To live and why me?
James, your fears are similar to what a lot of people who had rhabdo go through so you are not alone. I feel its very common to be afraid to work out after getting rhabdo. Im sure depression is part of this as well. You mentioned about not having muscle to burn fat. This I can tell you, you do not have to worry about. You are burning a LOT of fat right now reading this. So dont worry about this.
About working out, few general ideas I’d recommend:
1. I’m going to recommend you do not drink to excess at parties anymore. I’m guessing you are not doing this anymore but just in case, Id say stop it as drinking close to workouts might increase your rhabdo risk. I have no proof of this mind you. I just feel that for you the drinking is an added stress you don’t need. if you do drink, Id wait at least 24-48 hours before you work out. This is just my personal opinion but I want to be conservative about this with you.
2. Good job on eating healthy! Eat lots of fruits and veggies and healthy sources of proteins. Don’t load up on protein though and I would not use a lot of protein right after working out. Since rhabdo effects the kidneys I dont feel eating a lot of protein after working out (which is common for exercisers because they want to “feed the muscle”) is something you need. Same thing goes for those high protein shakes that are common – dont use them after working out. You might want to meet with a registered dietitian about nutrition for exercise-induced rhabdo. you can find RDs in your area by going to EatRight.org. Id guess RDs who specialize in sports nutrition would be the best to talk to.
3. Staying hydrated will help you but it wont stop rhabdo from occurring. Just want to mention that because there seems to be this idea in fitness (and among some fitness trainers) that drinking water prevents rhabdo. it doesn’t. Let the color of your pee be your guide. if its clear, you are generally ok.
3. You didn’t say how many push ups you did when you got rhabdo again. So, with that in mind, Im going to recommend you write down what you do when you work out. This will help you not forget what you did so you dont over do it. It will also give you an idea of what might cause rhabdo if you ever get it again.
4. When you workout, the goal really is to progress slowly. I feel circuit training is the best mode of strength training for you. this entails one set per exercise. Circuits usually entail 8-12 different exercises but they can be as few as you like.
5. Aim for a resistance that you can lift comfortably for 15 repetitions per exercise station
6. Start with just a few exercise stations and focus mostly on the big muscle groups first – legs, chest and back. Dont worry about the little muscles like biceps. little muscles are already being used during the big muscle exercises.
7. If you ever say to yourself (I want to do 2 sets of this exercise), just remember this general rule:
First increase the reps you lift
Then increase the sets you do. And then – and only then –
Increase the weight you lift
So, if you are lifting a weight for 15 reps, aim for lifting it for 20 reps, before you progress to 2 sets and then make it a goal of doing 2 sets of 20 reps before progressing to 3 sets. Mind you, I don’t feel you need to do this, but I wanted to give you some basic guidelines on how to progress in a way that might reduce the chances of rhabdo happening again. Also, the goal is not always to be able to do 2 or 3 sets. The goal is to be healthy, and not get rhabdo again.
8. When you workout start with only 1 day per week for the first month or so. This should give your body time to adjust slowly. Dont workout more than 20-30 min at first. I don’t feel you ever need to work out more than 60 minutes. Work up to this very slowly (add 5 min per week for example) if you decide to increase the length of the workout.
9. Don’t workout 2 days in a row back to back. give yourself at least 48 hours (or even 72 hrs) between workouts. Never work the same muscle group more than 2x per week (I recommend for the next several months you stay to only 1 time per week)
10. If you ever decide to get a personal trainer again, quiz them on what they know about rhabdo. If they don’t know anything or only have a vague idea about it -and are not willing to learn about it before they work with you, get another trainer.
James you can workout and you don’t ever have to get rhabdo again. Just listen to your body and progress slowly, as your doctor said. There really are not any official guidelines on not getting rhabdo which I’m sure adds to your confusion and fears. I do hope some of this helps. If you have any other questions, just ask.
Hi Joe! I am so thankful that I stumbled across your website! I am a 26-year-old female in good health and have working out (cardio mostly) consistently for several years. About 2 months ago, I decided to get back into weight lifting and bought some personal training sessions. I had been doing an average of two 60 min training sessions each week plus 30 min to an hour of lifting on my own. I usually did an upper body push workout, an upper body pull workout, and a leg workout each week in addition to 2-3 days of cardio.
Well, about 3 weeks ago I did an hour long upper body pull workout with my trainer. I did negative chin ups, lat pull downs, bicep curls, rows etc. I think the chin ups did it to me since the next 2 days my biceps and brachioradialis were in extreme pain and I could barely straighten my arms! I thought it was just an extreme case of DOMS but got concerned when the pain didn’t subside and even woke me up at night!
I had heard about rhabdo before and did some research on it but didn’t have the tell take signs such as dark urine. I tend to be on the overly cautious side though and requested my doctor test my CPK levels for peace of mind. Of course, everyone thought I was crazy and way overreacting. Well, the results came back and my CPK levels were at 16,000!! I was told to go to the ER immediately but unfortunately it had already been 2 days since my labs and I had done an hour heavy weights leg workout and hour long Zumba class between then since I was unaware of my diagnosis.
I went to the ER and fortunately my levels had decreased to 2800 and my liver enzymes were elevated. They gave me 2 bags of IV fluids and released me but said to get labs checked again in a few days. I slept like a baby and hydrated a lot over the weekend and by Monday my CPK levels were in the 300s.
I went to the doctor yet again on Thursday and fortunately my CPK levels were normal and my liver enzymes were also normal! I am SO thankful for this and realize health is something we should never take for granted! My doctor put me on complete exercise restriction for 2 weeks (not even light walking on the treadmill!) and wants me to get labs done again in 2 weeks after I do a moderate cardio workout. I feel like this is very conservative but following the doctor’s orders even though I am struggling with exercise withdrawals.
I’m not sure when I will be allowed to lift weights again but now I have developed an intense fear of getting rhabdo once I start. Exercise is an important part of my life and I just want to be fit and healthy and stay out f the hospital!
Do you have any recommendations on when it is ok to start lifting again (of course I plan to start out lightly)? Also, why is my doctor concerned about cardio when I am certain the rhabdo was caused by weights? I LOVE taking Zumba classes which can be pretty vigorous at times and don’t want to give this up!
Thanks so much for your suggestions and for writing such a great and much needed article!!!
Alison, its possinb for both cardio and weights to cause rhabdo (if you look through the comments you will see someone who said he got rhabdo from a spinning class). I have a feeling it was the pullups that caused your rhabdo (eccentric movements are more correlated with rhabdo) but regardless, listen to your doctor. when you are starting to work out again, I recommend a circuit strength training program – light weights/ 1 set per exercise. Don’t do that and zumba or other cardio in the same session at first. the goal is to ease your way into this. when you do take a zumba class again, don’t do the whole class at first. See how you feel after 1/3rd of a class for example. I do think being conservative is the way to go here.
Being fearful of getting rhabdo again is a common theme I hear from peopel who have experienced this. Its common. I think in time you can resume most of your activities again because you were working out hard before this happened. It will just take some time. Don’t worry, listen to your doctor and have patience. you will be ok.
please show my review to your personal trainer. I have a feeling he/she is not aware of rhabdo.
Thanks so much for the quick reply, Joe! I already informed my personal trainer about getting rhabdo and he was actually familiar with it but never thought I would have gotten it from an hour of upper body weights! He said he is going to talk to the other trainers at my gym and make them aware of rhabdo, which is much needed!
Do you think rhabdo is a lot more common than people realize since most people don’t go to the doctor unless they have extreme symptoms? After reading other people’s stories, I’m beginning to think that it is! I’m just thankful that I found out I had rhabdo and could take the proper action to recover.
I agree that starting out slowly is the best way to go, especially with weights! Maybe I shouldn’t do any personal training sessions.
Alison, glad your personal trainer was aware of rhabdo! I would go it alone for a bit and just let yourself be your guide on what you think is appropriate. Sometimes when people have personal trainers, they give up their personal power to the trainer and in doing so might push themselves more than they are able. Because of that I think listening to your doctor and going easy on yourself when you do start back again is probably a good thing. I’m pretty sure you wont push yourself beyond your boundaries when you first start back.
I do think rhabdo is more prevalent than some realize if the comments here are any indication. I was aware of a quite a few cases myself, told to me by trainers, before I wrote my review.
keep me posted on your progress and do let me know if you have any other questions 🙂
Thanks Joe! 😀
You’ve been SO helpful. So glad I found this site.
An updated from “Jason February 7, 2013 at 8:17 am.”
After I was released my the hospital I visited my doctor a few times for blood work. Once my CPK came back to normal he released me to exercise and get on with normal life. My arms have atrophied quite a bit.
I went back to CrossFit and my trainers programmed a specific routine for me to follow. It was basically a three month rehabilitation. I started with very light strength work; no metabolic conditioning. Key was keeping my heart rate in control and building the CNS/neuro-muscular pathways back to where they should be. I stuck with the program and came out well.
I’m stronger now than ever and focus more on balancing strength and metabolic conditioning. I will not do workouts from the CrossFit main site or any of the high repetition WODs; they promote bad form and drive the risk of injury (rhabdo and more). I was pretty upset about CrossFit for a while, but I realized it is not “CrossFit” that is to blame. It is individual gyms that do not provide adequate oversight.
CrossFit has done a lot for me (and many others) personally and physically — so I give great credit to great coaches who care for their athletes. Just be careful where you go and always maintain a buyer beware attitude. You can get hurt (rhabdo and other injuries) from any sport, gym, race, or whatever. Don’t jump in too fast; we all have goals and will never reach them injured.
Stay hydrated and rest smart. Volume does not correlate with growth/progress. Thanks, Joe, for this great website.
Jason, thanks for the update. I am glad you are doing ok.
Heya Joe..
Definitely not going to do anything against what the doctor said. I had just read your first reply and noted where you said “For your husband. I would not do cross fit again – ever!” I was a little shocked since one doc (from the hospital) said its ok as long as he takes it really slow. But then after that, we went to eat lunch, and hubby got a call from his regular arthritis doctor and he said the exact same thing you did. “Whatever you did, do not do it again. You will get it again.” That sealed the deal with us. He also told hubby that he should do 3 days of cardio and 2 days of weight lifting. But lol, thats so freaking vague..
Yeah, I was a little put off too by the fact that after we have already paid $400 bucks for the beginners classes, that we could now pay an additional $150 bucks for 6 personal training sessions. We were considering it because there is one coach there that sort of took us under his wing and we felt comfy with right away, reminding us to breathe and would tell us to rest and catch our breath and would scale down the reps as well. (He wasn’t there that night this happened) Im not sure of his certifications though, however, the more we think about their “deal” ….. the more annoyed that offer makes us.
And of course, you and the doc’s say no go so we aren’t considering that anymore. Just need to figure out where to start exactly now. A small walk and swimming? Or can we start with personal training at another gym?
I believe the pdf’s are from Crossfit Corporation sent to its affiliates… but Im not sure. Its from the “Crossfit Journal”. Ill put them here for you, hopefully it will work.
http://library.crossfit.com/free/pdf/CFJ_Ray_rhabdo1.pdf
http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf
lost_princess, yes Ive seen those cross fit PDF files before. They are from Cross Fit. While I am glad they are doing something to educate their trainers, I think more can be done.
now that you told me your husband sees an arthritis doctor, I definitely would not do cross fit because I feel it would probably make his arthritis worse.
3 days of cardio and 2 days of wt lifting is close to the basic exercise recommendations for health and basic fitness. That’s why he mentioned it.
Nope, no one has ever mentioned it to us before. I used to do an extreme bootcamp 5 days a week for an hour a day for 2 1/2 years and I even trained and ran for a half marathon, and never had it or heard of it. But now.. it all makes sense. When you hear about people having heart attacks during marathons and everyone says ” so crazy, they were soo healthy” .. .well yeah, but what they didn’t know was their muscles were poisoning their bodies the whole time.
He started to feel it (chest pain and said his whole rib cage sort of hurt) during our work out.. and stopped for a bit, took a small walk around the gym, then felt better so he continued the rest of the work out. After it was over, i could tell he was exhausted and super hot.. so i poured my water bottle on him and he said he was feeling a little better…
I told him to switch me seats with me and I drove us home, only 2 miles away. On the way home he said he was feeling a bit better…. but as soon as we got out of the car and made it halfway down the sidewalk to our place it came back, full force. So we weren’t at the gym when it happened.
Since then though, they have been all over us.. checking in on him, calling us, emailing, setting up meetings and doing everything they can to accommodate our situation with our 6 month contracts.
They insist that we do not give up on Crossfit and said that we can pay more for personal training as my husband will definitely need to take it slower and be paid more attention to. Which we were considering, however one of my husbands doctor called today after finding out he was hospitalized and told him never ever to do what he was doing again, that it will happen to him again if he does. So we are a bit lost as to what to do next.
I dont know if you are going to publish this on your site or not so Id rather not give the exact name of the gym we go to, I dont want to cause anyone problems when all we are trying to do is just find answers, yanno?
I did forward your article to the people in charge and they sent me back a couple pdf’s from their headquarters that they all receive on Rhabdo. They told me that it is very rare but also said that they would take your article and forward it on to their coaches for a reminder and refresher.
Thank you so much for the well wishes and encouragement, I appreciate all the effort and information you put into this subject and helping people become aware.
lost_princess, I can only imagine how scarey all of that must have been for you both. I’m glad you both are doing better.
Few thoughts based on what you said:
I am 100% in agreement with your doctor – your husband should NEVER do cross fit again! I can’t believe the gym wants has said that your husband should keep up with cross fit. Exercise isn’t supposed to put people in the hospital!
The gym said they receive pdfs on rhabdo – but why then did nobody not tell you about rhabdo before you both started cross fit?
Who put out the pdf forms on rhabdo – was it cross fit?
I’m also quite surprised that the gym management said that your husband could PAY for personal training – after a workout sanctioned by the gym put him in the hospital. I would not pay for personal training at that gym. If you do, I believe it is imperative that you pick that personal trainer wisely. I personally would only accept a personal trainer who is certified by either ACSM (American college of sports medicine) or NSCA (national strength and conditioning association). These certifications tend to be harder to obtain than others and so those who have them, tend to know a bit more about exercise (esp those certified by ACSM). I’d also want a personal trainer who has – at least – a BS in exercise science. If you need more info on how to pick a good personal trainer, just ask.
Before your husband works out again, please get the OK from your husbands doctor first. If the doctor can give guidelines on what to do/ not do, that would be even better.
I appreciate you not wanting to stir up any problems with gym. I just want you both to be safe. I’ll continue to keep you both in my prayers.
Never do crossfit again? Okay, EVERYTHING in crossfit can be scaled back. You do not have to do the insanely tough WODs, you can make it fit your athletic level and you don’t have to push yourself as hard. Talk to your crossfit trainers about this and they will make it work. Don’t give up on exercise or crossfit, just be careful to not push yourself too hard.
ashlyn, I know you mean well but wouldn’t you feel it be best for people to be healthy even if they do not do cross fit, insanity or other really high intensity exercise programs since there is a possibility of rhabdo happening again? I think you would. You mentioned that people should talk to their cross fit trainers about rhabdo but since most people have never heard about rhabdo, I dont know how likely this is to happen.
Hi Joe,
Thank you for this article. It is by far the most informative page I have read regarding Rhabdo, and trust me, I have read it all! lol.
I have been working out in extreme bootcamps and personal trainers for a few years now and have never experienced this nor ever heard of it.
One day three weeks ago my husband, who has refused to join me in any of my fitness endeavors came home from work and asked me about Crossfit. I was elated that he was interested in joining a program together and we quickly ran over to our nearest one, signed up for 6 months and got started on our beginner classes the very next night.
After the first class…he complained of being sore. Barely could walk ect. and we giggled over all this because we knew he had just experienced what everyone says after a work out. How were we to know his was different than anyone else’s soreness? More importantly, how will we ever know again?
After our third beginner class, (these are just the beginner classes mind you) my husband was extremely dizzy, was having tunnel vision, chest pains across his chest and heading down his left arm, was trying to collapse on the sidewalk and was barely responding to me when asking him questions. I called 911.
Im actually getting anxious again just writing about this. Was so scary.
Needless to say, he was admitted into the hospital and in ER we were told that he had had a mini heart attack. Day 2 his levels were in the 35k range and they were running all kinds of tests on his heart. Ultimately they said his heart was fine, but that he had Rhabdo due to his new work out program. They said luckily we went in and got a hold of this early on, that there was no kidney damage and he will fully recover within 2 to 3 weeks.
We are both very scared to continue to work out. Everything I read says its ok to work out again, to just take it easy.. but how do we know what is “taking it easy” and when its ok to push a little bit? Where do we start? And how do we handle having a bit of ptsd after all this?
Thank you for your time and information!
lost_princess, oh my goodness I am SO SORRY to learn what happened to your husband – and to all the stress that YOU ALSO have been going through.
Did anyboy at Cross Fit ever tell you about rhabdo? Im shocked that some cross fit trainers do not tell people about this possibility. Do the cross fit trainers know what happened to your husband? Please tell them and PLEASE show them my rhabdo review so they can read it.
Were you outside the gym when your husband collapsed? did the gym help you in anyway when you called 911? What gym was this? This is for my own information. I like to know how gyms respond to medical emergencies.
For your husband. I would not do cross fit again – ever! listen to your husbands doctor and what they feel is OK for when your husband can work out again. And when he does workout, I recommend only walking in the beginning. Eventually if he dose ever workout with weights again (and I think he can do this eventually also), circuit strength training is likely safest for him.
I will say a prayer today for your husband and you. I cant imagine the stress -both physical and psychological – you both have been going through over the last few weeks.
Joe,
My muscles hurt when I am not moving, but it comes and goes, sometimes more with activity or having my arms raised at the keyboard or driving. It was more severe pain in the evening and I didn’t rest well until I took a muscle relaxer last night. Would my ck elevation of 42x normal limit and elevated liver enzymes be more consistent with DOMS or rhabdo?
Todd, Id think rhabdo but exercise can also raise CK levels. it shouldn’t normally alter liver enzymes that I’m aware of. your doctor did not give you a diagnosis at all?
Joe,
I was NOT diagnosed with Rhabdo by my doctor after I suspecting it. My symptoms following a max effort push-ups and hand-stand push-ups wod (Friday night) was severe soreness and pain in my triceps (and lesser degree in chest)in the first 24hrs (Saturday) followed similarly in the deltoids in 48hrs (Sunday), with no relief by 72hrs (Monday). I went to the doctor yesterday (Tuesday) and blood work has revealed elevated levels of the following: ck = 8,481 creatinine = 1.4 BUN =28 Liver enzymes AST = 220 and ALT = 78. Again, I was NOT diagnosed with Rhabdo and was told to repeat blood-work in 2 weeks, hydrate and decrease protein intake.
Any advice on what to do other than that?
Todd, do your muscles hurt when you are not moving? if yes it could just be a bad case of DOMS. Other than that I say do what your doctor says to do.
Went to the beach last week and ran 30-40 minutes each morning in pretty warm, humid weather. Sweated a lot. Had dark brown urine 3 days in a row. Days 1-2 were a one time occurrence. Day 3, discoloration lasted about 4 hours, getting less and less each time. Exerted lots of effort body surfing in pretty heavy waves day before all this. No pain, no swelling, no other symptoms, just dark brown urine.
This happened twice previously about 3 and 6 months ago, but to a much lesser degree – doing Insanity workout at that time. Have been on Statins for 10+ years with no previous side effects. Family doctor found no blood or infection in urine. Urologist appointment scheduled for next week. Reluctant to go running again.
Does this sound like a mild case of rhabdo? Everything back to normal since those 3 days. 54 years old and have always been pretty active.
Mike, hard to say but it could be exercise-induced rhabdo. Do mention to the urlogist your past dark colored urine while you were doing intense exercise. Statins might increase your risk of rhabdo and past rhabdo might raise the risk of getting it again. did they measure your CK levels? that is something I’m sure the doctor will do as soon as you mention rhabdo. Let me me know what happens and good luck.
Hello again Joe,
As much as I hope my dark colored urine after jogging on a very hot, humid beach was a slight case of Rhado, it turned out to be a very small bladder tumor; probably cancerous. I just had it removed six hours ago and doing pretty good considering. Sitting at my kitchen table emailing you. Urologist said on a scale of 1-10 this was less than 1. Easily treatable and caught very early. I think it is important for your readers to realize dark colored urine needs to be looked at by a doctor. Damn glad today that I did.
Mike SO GLAD you got the treatment you needed and are doing well today! Yes, anytime the urine looks dark coloried its always good to get it checked out. We are so complex beings, that alone, its very difficult to know what is going on. I am so happy you are doing well! Thanks for the update 🙂
I read an article a couple of years back regarding the dangers of rhabdo during crossfit. I am 32 years old, I am corrections officer and a member of the departments SERT team (basically the jails equivalent to a SWAT team), I’ve been an athlete my whole life and work out on average 2-4 days a week.
I took a few weeks off of crossfit and the gym recently doing work around the house, working overtime, vacation etc…then jumped back into the gym full force. 2 days of crossfit in a row. The second day wasn’t anything too crazy it was the angle workout (100 each of pull-ups, push-ups, sit-ups, and squats for time). I didn’t have any immediate pain, but the next day I couldn’t extend my arms without pain.
I chalked it up to muscle soreness and went about my work week. However after 4 days of soreness and swelling I started to get concerned. I remembered your article from 2011 and started poking around the Internet for symptoms. I didn’t have any discoloration in my urine, nor did I have pain unless I tried to extend my arms, but the swelling persisted so my convinced me to go to the E.R. for the enzyme test. Normal range is supposed to be between 55-170. Mine was 53,470! 24 hrs later and 6 IV bags later and my levels dropped to 40k.
I’m still in the hospital waiting to go home, probably gonna be another day or 2, but my doc said I’m lucky I came in before any kidney damage or failure occurred. Hope you continue to educate athletes and regular joes like me of the potential dangers of working out and things to look for that could seem innocuous but can be very harmful.
Thanks,
Rick M.
Rocky Point, NY
Rick, thanks for sharing and glad you go to the hospital when you did! Having watched my share of Saturday night MSNBC prison documentaries, I’m familiar with SERT teams – you guys rock!
Heal up fast!
Hi, I was hospitalised with rhabdo about 5 weeks ago. I have been training hard for the past 4 years. From childhood until about years 4 ago (I am now 40), I was overweight. When I say overweight, I mean over fat. My body fat levels have always been high. So years ago I decided to stop concentrating on my bodyweight and start decreasing my body fat. This is when I was introduced to weight training. I have always been told the only way you are going to change your body shape and be tight and toned is by pushing your body at each session and keep increasing the weights and intensity.
Doctors are still trying to figure out what caused my rhadbo but now after seeing this forum, I believe it has been from the exercise I have been doing. My CK levels got to 110k, my kidneys failed, told last week they are now back to normal. My heart has been effected with a chamber being inflamed and my liver has a lesion on it. I am back to the cardiologist in Aug and once kidneys get stronger they will do a CT on my liver. I am still very weak and have been to an exercise physiologist to help me with a program to just help with the muscle weakness.
I am only doing 5 reps with body weight and this is still a huge challenge for me. What makes me sad is that I am too scared to get back to weight training and it worries me that I cant combat the flab any other way. I don’t want to lose any weight, I just want to know when I can eventually get back to exercise is there any other exercise I can do that will give me a toned body. I want to look strong and healthy not skinny and soft.
I also want to say a huge thank to everyone on this site & Joe. I will be telling the specialist that I have to go back to in Aug that I believe it has been the exercise that caused my rhabdo.
Debbie, so sorry you went through all of this! I am glad you are on the road to recovery. The idea that people have to push your body at each session and keep increasing weight lifted is wrong. People can make progress without pushing themselves at each workout with more weights.
I completely undersand your reluctance to workout again. many here have said the same thing. I liken it to a kind of a post traumatic stress syndrome. you did go through a tramua so this makes sense to me. explain your feelings to the exercise physiologist when you see him/her and see if they can offer some advice. you can go back to the gym Debbie. it will just take time. Your exercise physiologist can educate you on the proper way to workout and avoid rhabdo from happening again.
Please keep me posted on your progress.
Hi there….. Great article! I’m so glad to see that Rhabdo is getting more attention!! I’m 33 not in terrible shape but after I had my daughter allowed myself to let myself go…I have always been a workout person my whole life so 3 years ago when I went to a family friend who personal trains I followed suit thinking I could pick right back up….
After 80 half burped and a full crossfit type workout my arms were swollen like Popeyes! I went back to her the next day asked her about it and she said you’re just sore keys do some more to make you feel better…. I was in the ER that night.
It took about an other 24 hrs to diagnose my and I was in the Hospital for a week flushing my system out. My CPK levels were at 6500. I think it’s so important for people to know about this and also that it can come back…my brother just got certified as a crossfit trainer and I was glad to hear that they do cover it however he kept telling me as long as I’m hydrated, we went back and forth but i thought it was at least good that they were now talking about it lol but anyway great article!!
Thanks,
Andy
Andrea, thanks for writing and Im glad you were able to find me! Im guessing your brother got the “hydration prevents rhabdo” mantra from CrossFit. I don’t buy it. Thanks for the heads up on this. Glad you are better 🙂
Hi Joe, Thanks for posting all of this information about rhabdo. 12 days ago, I did a CrossFit workout, which included jump pull ups and decline push ups. I was quite surprised to learn that I overworked myself so much with that one workout.
I couldn’t straighten my arms, and my arms were swollen on Day 4 after the workout. Day 5, I went to the doctor and asked for urine and blood tests. As it turned out, my CK levels were over 20,000, but apparently my urine (and therefore kidneys) were fine.
On Day 8, I started experiencing some pressure in my chest/sternum, which made it a bit difficult to breathe and I had been feeling dizzy for a couple of days. I went to the ER and they did an ECG, listened to my heart, and tested my blood and urine again. They said my heart sounded and looked fine, my CK levels were down to 7000, and myoglobin was a bit elevated in my urine, but not an alarming level.
It has now been 12 days since that workout and I still feel a sense of heaviness/tightness in my sternum/chest which makes it a bit difficult to breathe.
Have you heard of this symptom connected to rhabdo before? Any ideas on why this might be happening?
Hi Natasha, The decline push ups you did do work the chest muscle and so its possible that is what is causing the chest pain you are experiencing. Here is link to an article that mentions chest pain/angina and rhabdo
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175909/
Did your cross fit trainer ever explain rhabdo? Just curious. They should have.
Sorry you gt rhabdo Natasha. I’ll say a prayer for you tonight that you get a speedy recovery.
This is why all personal trainers and spin instructors should be appropriately qualified in their repected discipline and have adequate first aid training
Helly Ditto to that!! 🙂
Joe, i did my first ultra marathon event which was a 12hr race and I was able to do 51.1 miles. After a few hours of starting the event I started to have symptoms which I can only describe as in like a UTI (bladder infection) i.e. the urge to pee frequently, hardly any liquids coming out, very dark color by the end of the day when I could pee, and slight pinkish hue when I would wipe (sorry to be graphic).
My legs are sore, actually my whole body but not as bad as I expected. I felt very bloated during the race and I feel like I hydrated and fueled properly. I have been drinking lots of water with added electrolytes since the race JUNE 8th and my urine has returned to regular bright yellow not as cloudy but I still have that feeling such as the urge to pee and have to urinate frequently.
I experienced similar symptoms when doing a one day bike ride called RAIN in IN two years ago (10hrs/160miles) but it went away. What am I doing wrong here? I have recently been diagnosed with narcolepsy without cateplexy due to extreme fatigue and sudden sleep onset. So I take the medication called Provigil (modafnil) as well as 50mg zoloft.
For the most part I eat a high protein diet. What can you tell me about this… what kind of doctor should I see? Internal medicine? Seems like most people I talk to don’t know or have heard about this.
Mary, any doctor can diagnose rhabdo with a simple blood test. cut back on protein as it works your kidneys hard and your kidneys are being worked over time with rhabdo. But, please dont take my word for this – PLEASE go to your doctor. if they are closed, go to the ER. Please. I would feel much better if you get proper attention to whats going on.
My daughter (age 16) also got rhabdomyolysis from doing calf raises with her personal trainer. She is a high school athlete, not overweight, and had been training for weeks with her trainer. She experienced intense pain and swelling in her legs. Her pediatrician gave her a high dose of NSAIDS ~ not a good idea. I noticed her ankles swelling and took her to the emergency dept. She had a CK of over 22,000 at day 6 after her workout. Her liver enzymes were also off the chart.On the bright side, her kidneys didn’t miss a beat, but she was in the hospital for 3 days receiving lots of IV fluids.
Pat, sorry to hear about your daughter but glad shes ok. Please show my review of rhabdo to her personal trainer. Im sure he/she has never heard of rhabdo. I dont want what happened to your daughter to happen to somebody else.
I just participated in the Barn Burner 104 as a solo geared rider. I was towards the end of lap 2 out 4 and my right calf cramped/seized up bad enough to kill the race. A few days later my calf my still swollen and painful and since I have a family history of blood clots I went into the ER to get checked out. No clots, but was diagnosed as having rhabdomyolysis.
The kidney test showed levels at 65 which i assume is mild. They filled me with 2 bags of solution and told me to drink lots of water. Not sure what the future holds in mountain bike racing, but just going to rest up and see what happens…kind of concerned that now I have a disposition to it.
Joe,
Im a personal trainer, what steps could I take to ensure that I don’t cause a case of rhabdo besides slowly easing de-conditioned clients into workouts. From the article Ive read above, it seems just a few minutes of exercise can cause rhabdo.
Maybe I could offer 30 and 45 minute session prices to especially deconditioned clients?
Jeff Decker
NASM CPT/CES
Hi Jeff, I think the best thing you can do is explain to clients that the first 2-3 months of strength gains is the result mostly of neurological factors and because of that, you will be focusing mostly on form and muscle endurance during that time. If you do that I think your risk of causing rhabdo is pretty low.
stick to one set programs like circuit training for the first few months. that will cause less DOMS and rhabdo. circuits are also safest for many special population groups (high blood pressure etc)
I think if you did that then the risk of causing rhabdo in your clients would be quite low.
Joe,
Thanks for your quick reply, this seems to be a very serious issue. I have always taken it easy on clients regardless of how intense of a session they wanted, and now I have more concrete evidence on why they should take things easier, i have never been one of the over the top trainers that are so common today. Maybe there should be a rhabdo safety cert?
Jeff Decker
NASM CPT/CES
Jeff, sounds like you will never see rhabdo in any of your clients. Id just be happy if the different organizations would start putting info about rhabdo in their certification books. I believe my book was the first personal trainer book in the US to include this information.
Wow! A great article; thank you! and such a ‘rhabdo’ community here!
My first exercise induced bout was in 2010; I was doing my personal trainer certification and the instructor told me to do 180 calf raises, no rest, so the competitive athlete in me said sure no problem (i’m an idiot…). Did it, felt like a superstar, then had my military boyfriend carry me to the ER 2 days later.
Like most of you, CK levels were highly elevated; the highest all the doctors and specialists had ever seen and the words ‘kidney failure’ still haunt me! As a Kinesiology student I was super excited to be the med interns favourite patient, and I went rhabdo crazy with the published journal research, studying it in all my related courses.
Unfortunately, my first relapse was 4 months after i was out of the hospital. Doing simple bodyweight exercises and very little, being VERY careful, i got rhabdo in my triceps and biceps. The same doctors were working and thought it was very interesting that this happened with little exertion. (I’m talking like 10 pushups here and 10 triceps dips. all assisted..) CK levels were only about 10,000 so i was out of the hospital in a day.
5 months later, same thing, but in my lower back. I exercised regularly following the doctors very light exercise prescription. At this point the doctors were puzzled. After a week in the hospital (at Christmas time…) they decided that something beyond a simple bout of rhabdo was occurring.
I kinda went rhabdo crazy, doing lots of research etc. and there really isn’t a lot of published research out there on the topic. (Relatively speaking) I’m still all my xfit friends, ‘friend who actually got rhabdo’. I do have to be careful for i never know if i’m going to get it. I’m very active, always have been, but now can’t be the way i used to.
Since i’ve been dubbed a ‘medical mystery’ by the dozens of specialists i’ve seen, it’s difficult not knowing what’s triggering it. The doctors say that they should all be isolated bouts, but with me they’re puzzled because it’s not the case. They suspect that something about the first bout, damaged ‘something’ in my metabolism, ‘maybe???’
Three years later, and I haven’t been in the hospital. But I’m sitting here with throbbing calves that have been resting all day (hence me coming across this article). I’m hoping more people will read articles like this and educate themselves about it.
For those of you who have gotten it in the past or are recovering, please still be careful! I was told and read in the research that each case is isolated, but this is not the case for me. I’m lucky I have great parents, an amazing spouse, and free healthcare that got me through it all.
Hannah, thanks for writing and wow I am so sorry you went though all of that! The idea that the initial bout of rhabdo damaged your metabolism is a new one on me but its as good of a theory as any to explain why people sometimes get rhabdo more than once.
I do hope your calves feel better soon.
I am an experienced ultra runner of over 20 years. Recently I was only 10 hours into an ultra race, running very slowly and became very weak, nauseous, sleepy. I rested a bit and got up feeling even worse, was sick, peed cola colour pee, walked a bit feel weak and then stopped. I drank well and normal colour pee resumed. I returned home (I was in another country), my doctor said I had a virus and would not give me a blood test. Two week later I ran 3 miles, after a mile I felt weak, after 2 my legs felt shaky like jelly, I walked the last mile and felt nauseous.
A week later my doctor gave me a blood test but normal creatinine levels – could this have been Rhabd please? 9 days previous I had a corticosteroid injection in my hamstring close to the insertion due to teninopathy, could this have caused this please? Thanks
Sharon, its hard to say because exercise alone will increase creatinine levels. The fact that you said you had cola-colored pee makes me think you may have had rhabdo. Run this past your doctor and see what he/she thinks.
What a great resource, Joe! Kudos for taking the time to create this AND to respond to all of your commenters.
With good reason, you are a bit critical of CrossFit gyms here. Because of CrossFit’s affiliate model there are certainly variations in the quality of CF gyms from one to the next. A McDonald’s Big Mac (which I don’t recommend eating) in Los Angeles probably tastes the same as a Big Mac in New York. In contrast, a CF affiliate gym in Santa Barbara might be totally different than a CF gym in Pittsburgh because there is less enforcement of standards from “headquarters.” The quality of a CF gym can depend heavily on who’s running it.
As an anecdote, and in defense of the good CF gyms out there, the CF gym I worked out at for 1.5 years knew what rhabdo was and educated its athletes about it. That’s why I knew to seek immediate medical attention when I gave myself rhabdo with my own workout outside of the gym. I was at risk because I had taken an extended break from high intensity workouts and tried to jump back in too quickly.
I wrote my own blog about how I hospitalized myself with rhabdo after a break from CrossFit. My CK count topped out at 165k! I’m very thankful to have not permanently damaged my kidneys.
There are CF gyms out there who take rhabdo seriously and take action to prevent it. I think your advice about evaluating personal trainers also could also apply to CF gyms – only trust one that can tell you what rhabdo is and how they ensure their athletes don’t get it.
Thanks Joe!
Marc, thanks for writing and THANKS for writing your own blog on how you got rhabdo! Sorry it happened to you but so glad you turned it into a positive by helping to educate others. This is what I love about us bloggers – everything can be a blog to help others!! I really appreciated the pictures you posted while you were in the hospital too.
Hi,
I am a 32 yr old female cyclist training and competing at an elite level. Last year, after a week long intense training phase, I had a 3 day rest period where I didn’t do any exercise except walking (it was Christmas day/boxing day). It was flipping hot (being Australia). On my 3rd day off the bike, I Suddenly developed the most violent cramping and pain in primarily my L) quads that I could barely manage to walk, drawing me to tears with the pain. I was just walking to catch a plane. The pain lasted about 3 weeks, with fluctuations in pain and I was unable to ride the bike for probably a good 3 weeks to a month.
I recovered slowly (from what I thought was a serious muscle strain) and have been training ok until a week ago when I did a quick 630km ride over a few days. Exactly the same symptoms. Only when a vet mentioned rhabo did the lights turn on.
Is this a familiar story? The delayed onset is something I don’t read much about people suffering from.
I mentioned it to the GP who said to drink more and that its not worth doing bloods. (good old NHS)…Otherwise I am well..
Whats your thoughts?
Alexis, interesting stuff. Usually rahbdo pain happen 0 to 24 hrs later. Im not sure if it could pop up 72 hours later (I would not rule it out because Im not aware of this). Its possible it was rhabdo but without blood work its really hard to say for sure.
the good news is you are feeling better now! 🙂
Hi Joe,
My name is Jessy, from Auckland, New Zealand.
I’m currently in hospital for rhabdo. Ive been here for 5 days now.
The cause was due to a heavy leg workout that I done with friends. What hit me was the fact I hadn’t trained legs for at least 2 months and then to suddenly hit them with the most intense leg workout I’ve ever done caused the rhabdo.
A day after the workout I was extremely painful, but I was thinking that this was a good thing, the fact that I was so sore was going to lead to better gains. The following day my urine turned a coca cola colour. I didn’t think much of it, and could of easily brushed it off, thinking it will be alright.
Shortly after I did a quick google search for “cola colour pee after workout”and got info for the rhabdo. I went to the hospital thinking I’d just get some pain killers. They took a routine blood test. A hour later, Doctors and nurses came out with very serious faces and said that my ck levels were at 147,000, straight they put me on a iv which i have been constantly on for the last 5 days, yesterday I was down to 40,000.
No sign of kidney damage, which they are all sayin is amazing. Im a bit scared now to step back into the gym and yo really push myself which I previously loved doing.
Jessy, I’m just glad you did a Google search and made the right decision to go to the hospital! I know it stinks now to be in the hospital with rhabdo but the good news is that you say that you don’t seem to have any kidney damage! You will be able to work out again but the thing to do is listen to when your doctor says its ok and dont work out until he/she says its ok to do so. Also when you do go back to the gym, start back really slowly. I suggest you start with low intensity circuit training as its likely to be the least stressful. Moving forward remember the idea of “no pain no gain” is a big myth and that you do not have to be sore after working out to become stronger. Have patience Jessy. Listen to your body and I think eventually you will be ok.
keep me posted on how you are progressing also.
Hi, my name is Michael after two years of almost no exercise I hired a PT to train me and I was pushed FAR too hard. One 20 minute gym session involving me throwing up led to a CK level of 184000. This took about 1 and a half month to decrease.
I was told to wait 3 months and go slow, I waited 6 months and had one gym session and obviously went too hard as I was back in hospital with a CK level of 50000. Again I was told to wait 3 months ( once it was normal) to begin gyming again, I waited 6 months and did 3 sets of 25LB each arm (curls) which led to a CK level of 16000.
After reading this blog I feel although I still went far to hard and I am trying for my last time with extreme caution.
My questions are ( if you can answer with only this vague information) What intensity should I exercise with? Does 3 months 12 months or 18 months make a difference?
I wish I could sit down and talk to you… Essentially exercise has been a HUGE part of my life for the longest time and I’m terrified it has been stripped away from me.
Any advice would be wonderful.
Hi Michael, I think its best to work out again when your doctor says its ok. That said when you do work out again, try a simple circuit training program. This is less likely to cause rhabdo than more extreme workouts. when you are trying to figure out how hard you are working out, ask yourself how you feel on a scale of “zero to 10” where zero means “its really really easy” and a “10” is “really really hard -you are going to poop out any second.” For you, I’d recommend you stick to the lower numbers.
I can understand the frustration you are feeling right now. I understand the feelings that your fitness has been “ripped away from you” but you can get it back again. it will just take time. Focus on health first and athletic performance / getting ripped etc second.
If you ever do get a personal trainer again, don’t hire anybody who can’t tell you what rhabdo is.
Hi,
I have previously had rhabdo twice, both times quite serverly resulting me to be in intensive care.
Once was a 15 minute workout with a pt and the other was a pump class, i have been working with doctors for around 2 years and still no diagnosis.
They tested me for Mcardles disease, but nothing.
I have recently been doing exercise but my condition doesn’t seem as bad, i am slowly working into it.
I have had test and apparently when they did the test which was sticking needles into my muscles and seeing the contractions, the could tell that there was something wrong but they still are yet to confirm it.
Do you know anything else this could possibly be, and what sort of diet i should be on the try and reduce any further episodes?
Hi Sophie, I can imaging how frustrating that can be! Have you ever consulted a dietitian about this? you can search the EatRight.org website and try to locate a dietitian who knows about rhabdo. Id start by looking at RDs who specialize in either sports nutrition or kidney issues. They might be able to give you some dietary recommendations that might reduce your rhabdo risk.
I just finished my first week of CrossFit, it was recommended that I go 5 days/wk… I am currently in the hospital with Rhabdo and have a myoglobin level of 20,800 (compared to the max of 192). I was never warned of this, nor asked to slow down my training. Clearly, there is a significant flaw in a gym that does not explicitly explain a disorder that they so blatantly use as a mascot.
Blaire, my god, Was this a crossfit certified trainer who said to start with 5 days per week? When you get out of the hospital, go and scream at that person as loud as you can – and report them to the crossfit organization! If this happened at a gym, please tell the gym what happened – the owner, GM or manager. Show them my rhabdo my review. I would not be surprised if the gym owners/managers had no idea about rhabdo!
I really want to try to be impartial when it comes to cross fit trainers but when I hear stuff like this it just makes me mad! I know Cross Fit has been trying to better educate their trainers about rhabdo but I feel they need to do more.
I feel so bad that this happened to you Blaire. I can only imagine the pain, frustration and fear you are going through right now. Please keep me updated on how you are doing Blaire. I will say a prayer tonight that you get better quickly.
I have made the gym aware, which resulted in a note that Rhabdo is rare but serious, and they are very sorry it happened to me. They recommend that I cut down to 4 days per week, described as 2 on 1 off… I was also given a carb elimination diet as a recommendation, which help excel state my condition.
It’s clear that they are aware, but never mentioned it. I don’t think saying ‘listen to your body’ is enough… I was told if I wanted to see results, 5 times per week. I guess they see so many people come in and out they lose interest in laboring over personal progress at first…
I’m so on the fence about what to do, I’m not trying to hurt anyone’s business or a mistake out of proportion, but I don’t think the recommendations were good nor personalized. I already had good muscle tone, so they should have been instantly worried and watchful!
Blaire, this is amazing to me. Even though you are in the hospital with rhabdomyolysis, the gym says to cut cross fit down to” 4 days per week”! They obviously have no idea what they are doing. You’ve already had rhabdo so you are at risk of getting it again. So for them to say to only do 4 days per week is irresponsible in my opinion.
So the gym also gave you a low carb diet too? Did the gym give you the low carb diet or did the cross fit personal trainer give it to you? Since cross fit workouts rely heavily on carbohydrates as a fuel source, it makes no sense to me that they would also advise you to eat fewer carbs. You need those carbs to workout!
I appreciate you not wanting to hurt anyone’s business but this is not out of proportion. This was a fitness facility which did not properly educate you on what could happen if you did that class. You trusted them and only after you complained did they issue a note about rhabdo. If this happened to me, I would seek out an attorney. I still cant get over that they told you to “cut back to 4 days per week” even after you got rhabdo!
Blaire, is this a well known gym franchise or is it a “mom and pop” local gym?
Mom and Pop local; I really don’t think they really understand the severity… the female owner has been emailing me and attempting to be helpful, I told her if I were to come back, we would need to talk more about Rhabdo and how to avoid it and diet in a more personalized setting.
These recommendations and diet suggestions (130 grams of protein, high vegetables, low carb) were given to me in an On Ramp series that lasted three days and featured learning moves. I have suggested to her that she give a small lecture on Rhabdo during this series, and she says she will consider my suggestion.
I am very upset with the circumstance, but I signed a waiver that limits their responsibility for my injuries when I signed up… The gym seems to maintain an attitude of not showing personal interest until people have proven that they are going to stick around. I am not sure what to do, but I do take some responsibility for pushing myself when I knew I should rest. However, it is hard to avoid an illness you know nothing about.
Blaire, gym waivers are not totally ironclad. While I am not a lawyer and don’t know the waiver you signed, I think the idea of legal action would make the gym owners think twice about what they do in the future. The bottom line is that it would not hurt to speak to someone about this.
I would be very upset also.
That’s an interesting website you have 🙂
Ha, my food blog? Now you see why I need to exercise! Good news, I’m being let go from the hospital with a CK of 10,000 with the promise of no exercise for a week and that I drink water like it’s my job. I’ll keep all your advice in mind in the coming days as I process all of this… I feel super let down, I was really lookin forward to a challenging, motivated group workout environment and, despite the owners, getting to know all the people at the gym. I had already made a few friends… 🙁 boo!
Hey Blaire, that’s really great news. I’m sure you will heal a lot faster when you are home, with your friends and family. Yes I understand how you would feel, making new friends and all. I feel for ya. Just take it slow when you do work out again.
Yes your food blog looks great – I like food too LOL 🙂
Hi my name is ridge,I just got out of the hospital about 4 days ago for rhabdo i was taking some metabolism boosters called meltdown vpx and i also did p90x while taking them and i ended up in the hospital, my ck levels peaked at 115,000, today i got my blood checked again and it is now down to 490
i was wondering when i would be able to start working out again and what kind of workouts would i be able to do. Like would i be able to do the p90x again but just take it easy this time, cuz when i first did it i pushed myself over the limit, i will not be taking the metabolism boosters anymore. thanks.
Ridge, I looked at Meltdown VPX (thanks for the heads up – Ive added it to my list of thigns to review at my other site,
SupplementClarity.com
Meltdown VPX looks like it has a lot of stimulants. The combination of extreme exercise (like P90x) and stimulants can raise the risk of Rhabdo
Did your doctor give you any guidance on when you can work out again? If not, go back and ask. also ask them what types of exercise they recommend for you. Also, I recommend starting slowly and not doing 90x immediately again. I want you to ease back into exercise – start with a walking program. When you do begin P90x again, don’t do the whole workout at first. only do about 15 minutes of it at first and slowly increase the time.
Please dont take any more metabolism boosters or weight loss supplements that contain stimulants. Trust me. Read my thoughts on weight loss supplements here
I am so sorry this happened to you – more than you know.
Hi, I am only 20 years old. I am a student at the University of Mississippi. I work out maybe twice a week. One day after a light jog, I my body started aching Intensely. I went to the emergency room and my ck levels were 10,000. My doctor told me I am at risk of rhabdo when working out because I have the sickle cell trait.
I was admitted and put on IV. I am well now but, emotionally I feel horrible. My whole body looks different. My legs are no longer defined, my skin is not firm and tight, and I can barely walk to class. I hate that this happened to me. I don’t know when I’ll ever feel normal again.
Jasmaine, yes the sickle cell trait can raise your risk of rhabdo. I know its little solace Jasamine but I do feel your frustration. The good news is that you will get better Jasmine. Im just glad you had the inner strength to go to the emergency room. So many would try to grin and bear it. I am so glad you are different than that!
Jasmine, I sure you dont look anywhere as bad as you think you do. Even though you have an elevated risk of rhabdo, it doesn’t mean you have to get it and it doesnt mean you cant work out. you can. Just be aware of your body and progress slowly. Rhabdo or not our bodies are amazingly built, designed to last a lifetime and can handle a lot. Your body is no different Jasmaine. We all have to work within our limitations. This risk is one of yours but in the grand scheme of life, its not too bad considering all the other things out there.
Have patience Jasmaine, workout when the doctor says you can. progress slowly and you will get there. I know you will.
Thank you for this article. I am currently sitting in the hospital with Rhabdo. Been here 4 days. I worked out with my trainer on a Wednesday and by Thursday I could not move my arms. Upon reading your article I understand now what may have caused this to happen to me. Lots of “negatives “. It was my first normal workout after weeks of light sessions due to a rib injury. I was using the TRX. Guess I jumped in too fast. Thank you for the information.
Becki, thank you for writing and I am so sorry to learn you are in the hospital! Please give my rhabo review to your personal trainer. He/she needs to read it and understand what happened to you so that it doesn’t happen to anyone else. I will say a prayer tonight that you get better soon.
Joe,
Wow. I never dreamed that there would be a physiological negative like this with too much (or too rapidly) exercising.
It is comparable to my discovering the problems of too much Vitamin B.
Or my discovering the problems of excess refraction. (www.dyop.org.)
And it explains much of why the statin drugs I was taking for borderline elevated cholesterol caused so much muscle pain (that led to the inactivity that led to the pneumonia last year). It is also likely that the elevated cholesterol was CAUSED by the excess vitamin B.
Reading this article, however, justifies the value of Spunk (junk email and webpages that seemingly are a waste of time) in my other reply to you.
However, I do need to exercise though, to get away from my 60+ hours per week of face-time on my computer working on my vision test.
As a senior citizen i also have a free gym membership.
I am going to stop what I am doing now and go work out for an hour at the gym 1 mile away. And I am going to print out this article (without the well deserved rational comments that I am sure are there) and give it to the manager of the fitness center, who I think will find it of interest.
One more time, THANK YOU.
-Allan Hytowitz
Allan, I am really happy I was able to help and I hope my rhabdo review helps the staff of your fitness center too 🙂
Hi Joe,
I had exercise induced Rhabdo with CK levels standing at >120.000 (no typo) and just got out of the hospital yesterday after a 10-day hospitalization.
I feel fine now (no kidney failure or anything, just a bit tired and weak, the CK levels are now at about 200), but I’m concerned about my recovery diet.
Do you have any recommendations regarding nutrition after an episode of Rhabdo?
Thanks,
Doru
Doru, great question. Did your doctor give you any dietary recommendations for after rhabdo? As I understand it, generally people who have rhabdo are often advised to eat a low potassium diet. Potassium is found in fruits and vegetables. If your doctor didnt give you specific recommendations, Id ask him/her about this.
what did you do that caused rhabdo? just working out yourself or was it a specific exercise program?
My friend is literally in the hospital as we speak getting fluids pumped into to her because of Rhabdo. She did an intense Crossfit workout on her own at a gym, which wasn’t smart. Yesterday while on a bike ride with her she complained of not being able to stretch out her arms, we just thought it was funny. Later that night she was peeing blood. Not so funny.
Hopefully she will be okay. I think she is getting the fluids in her just in the nick of time.
How should we know how hard we can push ourselves?
Hi Whitney, This is a hard question to answer because on one side, we are very resilient and on the other hand, some of us have a lower breaking point than others. Here is a few things I suggest:
1. when in a group setting like cross fit, don’t pay attention to what the others are doing and do NOT worry about disappointing the personal trainer or let that personal trainer push you beyond what you think you can handle. People give up their personal power in fitness situations and thats something I never want to happen.
2. I like people to use a 0-10 scale when they work out to see how hard they are exercising. This is called the “RPE scale.” basically “zero” is a piece of cake and a “10” rating means an all out effort that you will totally poop out on any second. Most healthy people do not need to be at a 10 in fact, for health and fitness, Id say staying at a level of 5-8 (moderate to pretty hard intensity) is ok for most healthy people (for those with health issues, a rating of 3-5 would be better).
I’m curious was this cross fit class conducted by cross fit trainers? Did they tell your friend about the possibility of rhabdo?
Tell your friend not to work out again until her doctor says its ok and I do not recommend she ever do cross fit again. She will be able to work out again in time. again listen to the doctor.
I really hope your friend is ok and it does sound like she got to the hospital in time. Your a good friend Whitney.
Hi Joe,
I just found out about Rhabdo early today and dove in it and of course your advice column. I’m now 60, have been active all my life with sports, working out, cardio including working out the last year with a 21 yr old future PT who’s 5% BF. Great work outs with the kid and staying up with him.
Last October I went on my annual extended wknd hunt where I knew I was going to hike. I prepped in the gym to get ready with various leg & squat exercise and of course good doses of the treadmill using the higher incline rates.
Here’s the scoop. When I got out to the ranch, the 2nd day I elected to hike with my gear and I was gone for 4hrs, obviously far more demanding than what I became accustomed to in the gym.
I felt great and gained & lost quite a bit of elevation. I decided to hike off trail up a mountain that I hadn’t been before. I pushed myself and once I got to the top I was spent and getting sore, real sore. Now I had to come down on what turned out to be a long grueling decent to the valley and back to camp, hurting with each step.
I’ve been hurting since, especially in both hamstrings & quads. I don’t ever recall having any discoloration in my urine. I felt I took plenty of water with me.
A few weeks later I consulted with the trainer at the college where I work , he advised that I look up a top notch Chiropractor, which I did. He thoroughly checked me out, took a few Xrays of my lower spine and explained that I exhausted myself to the point that I was an inch out of line & my hips were thrown forward. He made adjustments over the next seven visits that helped, but I knew there was some other problems and moved on.
I was referred to a top flight Primary Care Oncologist. He checked me out for an hour, took seven samples of blood for a wide variety of issues which I felt included exposure to Haunta Virus, Valley Fever & even Triconosis. This is now nearly three months after the hike. My legs are still hurting bad, never had any swelling, but difficult to stand up from the pain from a sitting position, which is also effecting the way I walk.
The only issue he found in the blood panels was a high Inflammation Rate of 49.4 which should be 3.5 and the Sedimentation Index of 20, which should be less than 10. He said that I have some kind of virus.
He sent me over to an infectious Disease Doctor who looked at that 1st Docs blood work and sent me over to take additional samples for more tests. He couldn’t find anything and further me over to a Neurologist who looked at those samples and had me take a couple of more.
On my return visit to him, I was put thru a battery of electrical tests on both hands, arms & legs by his tech. He further ran tests on my left arm & leg which involved a needle in the muscles where an audible sound came over a speaker that changed pitch when I moved my limbs.
He said I checked out fine, but also said that he doesn’t know what I have, but has seen this before and that it may take six or twelve months for it to go away.
I also was advised that I not work out anymore and when I pressed him, he advised to just use the treadmill, but at a low level. And when I do, such as yesterday of just one mile, my upper legs will give me fits the next day of more pain. Difficulty getting out of bed to stand and of course using the toilet is painful.
I also have some milder discomfort in my chest & back that has come on during all of this. I hardly workout which is discomforting and when I do, it’s worse. Squating to get down is difficult and painful and I need my arms to get me back up. Lots of strength has been lost.
Earlier today A friend who is an RD discussed my condition with a Therapist at his hospital who suggested that I may have Rhabdo.
What’s your spin on what may be ailing me?
Thanx, jim
Jim, that’s quite an ordeal you went through! I am honestly not sure how long the effects of rhabdo could last but it does sound like that hike was a doosy! Waking downhill is an eccentric action and eccentrics (negatives) put more stress on the muscle, cause more muscle damage and are more associated with rhabdo.
Did anybody check your CK levels? I’d expect they would go up after exercise but I’d be curious if they are still elevated. Again I don’t know how long CK would stay elevated with rhabdo. Id discuss the possibility of rhabdo with your doctor and see what he/she thinks. At the least they could run some blood tests to see what your CK levels are.
If you get an answer on this, please do let me know. I’m really curious whats going on myself.
Joe,
I’m 51, in average office-worker shape and was holding my new years resolution of eating right, losing weight and getting exercise. I even found a local personal trainer I liked. First two weeks were very light as I got used to the movement. Last week we increased my upper-body and arms workout both Mon and Weds to include more reps of lighter weight and focused on the negative movement. It was NOT excessive by any means.
By Friday my arms were swollen and my urine was dark. Saturday morning I found your website, saw my Dr. as your recommended and was admitted to the ER with a CK of 55,300. Treatment included a hospital stay and six 1,000ml of IV soulution at full speed. Blood work every four hours ot make sure I was flushing and my kidneys were keeping up. I was released home at a CK score of 27,000 with the promise to hydrate and return every 24 hours for another blood test until I am normal.
Thanks for the info here. It caused me to go to the hospital. Most importantly I wanted to share that I DID NOT lift very hard or very much. Also, my trainer had never heard of rhabdo before.
Keep up your good work.
Dave S, glad you are feeling better and sorry you are going through all that. I think that personal trainers need to realize that when working with beginners, that the first 8-12 weeks of strength improvements is mostly neurological – in other words, the muscles get a little stronger, but its mostly because of changes in the way the nervous system “talks” to the muscles that results in most strength gains during this period. As such, there is no need to focus on negatives or anything like that so soon after starting an exercise program.
I know your personal trainer meant fell and feels terrible about what happened. Please share my post with him so he is more aware of rhabdo.
Thanks for the reply Joe. My last CK level was 1027. Coming down nicely. My personal trainer was absolutely mortified as you guessed. She has followed up almost daily and I am sure her confidence is shot. I meet with a physical therapist from the hospital who will get me going on a slow return to exercise. Again, great site.
Dave S thanks for the follow up and Im really glad you are progressing well!
Hi Joe, I recently got rhabdo and am recovering now. My cause was from doing 8×8 squats, 30sec rest at 60%, following a big weekend out with the lads – the cause behind dehydration. My ck levels hit ~125000 before coming down. I was released from hospital after 4 days when it came down to 15000, and after 7 days it was at 2500. Its now day 10 and I’m wondering whether I can start training (low intensity) again. In general I feel fine now, my legs feel a tad weak but it feels more from not moving much than anything else. Could you let me know your thoughts?
Jay, dont work out until your doctor says its ok. your muscles are still recovering and exercise causes more muscle damage and increases CK levels. Id rather you not overtax your body so soon after this happening. I dont have a time table for you on this. Please talk to your doctor before you do anything.
Thanks for your reply Joe. Your website and forum has provided a lot of helpful information on rhabdo. Is one more susceptible to getting rhabdo again once they’ve had it before?
Jay, I think that yes if you got it before, you may be more likely to get it again although I don’t know the odds of re-occurrence. There is at least one case report of someone who got it several times. Im sure all this depends on several factors including how hard one is working out. This is also sometime to run past your doctor to get his/her impute.
I was in police academy and got rhabdo
Sandra, you’re not alone. I’ve heard of others in the police academy who got rhabdo. Unlike most people who do cross fit ect for fun, I can understand intense exercise programs in the police academy, military etc. Still, its a sad thing when it happens and I do hope you are better now.
Hi Joe- I am recovering from rhabdo. I was in the cardiac ICU for 4 days with a CPK of > 80,000. I have been out of the hospital for close to 4 weeks. My kidney and liver tests have all been normal since 3 days after discharge.
My question concerns working out. My muscles are still very weak, especially my legs, abs and arms. From what I have read, this is normal. How hard should I be working out? Should I be working out hard to regain my muscle strength, or should I be taking it easy? I normally do 1 hour of cardio on climbing stairs and another hour of traditional weight lifting.
My family has made me quit Crossfit, so I won’t be doing that anymore. BTW, it was the GHD sit ups that brought the rhabdo on and I was doing CF in a friends garage, as opposed to a CF gym.
Brian, I say take it easy and do not work out again until your doctor says its ok to do so. While eventually – several months from now – I think you may be able to work out harder again – that is not your goal for now and I dont recommend you ever do cross fit again. Talk to your doctor about when you can workout again and ask his/her thoughts on when you can do back and the types of activities they recommend when you do first start back.
did your friend ever mention rhabdo to you? was this friend a personal trainer?
He hadn’t heard of it until I got it. He’s been doing CF for about 3 years and has not had any problems. He is not a PT. I had never heard of rhabdo until I woke up with the tell tale brown urine and did a google search. I belong to a chain health club and asked one of the PT’s about rhabdo this morning and he looked at me like I had 3 heads and asked what rhabdo was.
As a funny aside, I found out that my internist belongs to a CF club and does it 3x’s/week. He is all for me doing it again, but I’m terrified of getting rhabdo again.
Brian, Im not surprised the personal trainer didn’t know about it. Most don’t. Please show my rhabdo review to that personal trainer. All of them need to know what it is.
I’m also surprised the doctor said it was ok to do cross fit again. Then again, he is doing cross fit at a club (that might have experienced staff) and not with a buddy who isn’t cross fit trained and knows nothing about exercise science… Still, I disagree with him/her on this. I wouldn’t do it again.
Brian, I don’t want you to be afraid of working out again. you can and you can even workout hard again. As I said it will take time. There are cases of people who get rhabdo multiple times. this is what leads me to believe there may be some “genetic tipping point “that some have that contributes to rhabdo. It could be for you, that the intensity of cross fit might be that “tipping point.” other hard workout programs, which might be less intense than CF, might be fine for you. Its a hard call either way to make for sure but I will prefer to be conservative on this and say steer clear of it.
Just listen to your body, and the doctor and when you do workout again, just remember that none of us, is bullet proof. that’s something I need to keep reminding myself of as well.
Hi,4 days ago I did 6 minutes exercise with a Kettle Bell.Have not exercised in years,due to my husband’s illness.I must have done about 50 lifts or more. Now my upper arms are swollen and sore and also quite hard.After reading the posts here am worried,should I go to my Doc?
Denise, yes go to your doctor now. Tell them the exercise you did. Please let me know what happens.
Hi Joe,thank you for your reply.Today the swelling has gone down by half,right arm still quite sore.My urine is normal and I feel ok.Believe me living in Ireland I know the doc will dismiss this as just over use,do you think if the swelling has gone down it is ok?Sorry I know you’re not a Doctor
Denise, its a good sign its going down but I would still love it if you went to your doctor. I just want you to be able to sleep at night without worrying if anything is going on inside you besides the swelling. the doctor can measure your CK levels to see whats going on as far as rhabdo. I say go to the doctor or the ER.
This article may have saved my life. I have rhabd and am currently in er they also found my liver enzymes are extremely high. Glad i read this and came to the er. Thank you
Brett, thanks for letting me know and Im really glad you found me also! What caused you to get Rhabdo? I really hope you are doing better. keep me posted.
I used to power lift heavily back in high school. That was 5 years ago now I work at my home office daily and am out of shape. I went with my brother to the gym on this past Monday we did upper body bench incline bench curls etc. I stayed with him but wasn’t putting up his weight I didn’t wanna push to hard. Well apparently I did anyway.
I was sore but to me it wasn’t different from any time you stop lifting and begin again. This past Tuesday I noticed my urine was dark didn’t think much of it. Yesterday my pee was so dark it was like looking at coke a cola.
Looked up on Google and found your article rushed to er. I had to stay over night and now have to stay tonight to as they flush the stuff out of me.
Brett, thanks for letting me know. Im glad you got the medical attention you needed. It stinks you are in the hospital but you are in the best place right now to get the help you need.
Generally when we start to work out -or go back after a long time off – its best to start with circuit training because its safest. Do ask your doctor when its ok for you to start working out again.
I wish I would have known about this disease before hand but I much appreciate your advice. And I will ask before I get discharged.
Brett, yes I know. its not something that is talked about much outside of medical school or college. I have faith that you will be ok Brett. Just listen to your doctors. you will be able to work out again. I know you will.
Hi..Not sure if this has been covered but here goes: I had exercise induced rhabdo two years ago. I had always worked-out but was just coming back after a surgery and decided to get a trainer at my gym. I was doing really heavy squats….my husband didn’t even lift that much.
One night at work (charge nurse in our local ER), I started having “palpitations”. I had been extremely sore in my glutes/hamstrings for a day and was literally walking on tip-toe and could not sit down. After my shift, I checked in…and a cardiac workup was done. My CPKs were over 12000 and my doc originally thought I was having an MI. Anyway I stayed for a few days with IVFs. Oh, and I have had recurring PVC’s ever since. Never had them before!
My QUESTION is…..I am trying SO hard to get back into running. I still go to the gym and do P90X but I want to run. Hills kill me. I feel like I have absolutely no strength in my glutes/hamstrings.
What are the long-term effects of rhabo? I thought I had heard that the muscles calcify? Will this have any lasting effect on the strength or elasticity of these muscles? Thank you for any information…..
Beth, wow! sorry you went through that but very glad you were at the hospital and were able to get the help you needed! Ive never heard of muscles calcifying from rhabdo. You did lose some muscle cells but you still have a LOT left that can bounce back.
you are free of rhabdo now right – no heart palpitations etc?
My question for your personal trainer is why did he/she having you squatting so heavy if your goal is to get back into running again? If your goal is running, you should lifting mostly lighter weights (say 12-15 repetition maximum) with short rest periods. Lifting very heavy (more than your husband as you say) is training for power! Nothing wrong with power and Id even say runners could do that sometimes as well, but its not the primary way I would work your muscles. Do you know who this personal trainer is certified by? I always like to know these things?
Did you get rhabdo at a big box gym? Its ok to say the name of the gym.
I’m wondering if the P90X workout is just kicking your butt so much (no pun intended) that when you do try to run up hills you have no more gas in your gas tank? Why dont you try this. Take 2 weeks off everything. you wont lose any fitness in 2 weeks. Then start running again and see how that goes. if you want to do P90X again, only do it on days that are not just before you go for a run and dont do it on the day after you go for a run either. Its possible that the combo of running and P90X is just overworking your body a little too much. Remember there is a condition called over training syndrome. Check out my review to see if you have any of the symptoms.
Thanks for the reply! The gym is just a local gym in Maryland and I’m not sure about the trainer. I will say at the time, I was not running. I just wanted to get back into shape after a surgery. I’ve just last month started a couch to 5 k running program so I’m really not even running all that much. I just know going up even small hills is difficult and I feel that my hamstrings are very weak.
I might take your suggestion of the two weeks off…thanks!
Thanks Beth keep me posted on your progress.
My brother had his first training session Wednesday night with a personal trainer who pushed him to his limits & he is in hospital now with Rhabdomyolysis! His levels are dangerously high & dr’s have never seen anything like it! They say his progress is good though, still doing tests to see kidney damage etc 🙁 i still can’t believe it!!!! Mimi Australia
Mimi, SO sorry to hear about this! Can you tell me the name of the gym?. Can you find out the organization that the personal trainer is certified by. I like to know these things. Please tell the gym that this happens to your brother. They need to know what one of their employees did – and that personal trainer needs to know too.
I really hope your brother is ok…
Joe ? for you. Ive been doing Cf for almost a year now i participated in a workout with 2 movements Power Cleans and Pullups 55 of each.
No onset pain immediately but 3 days later i couldn’t fully straighten/extend my arm the pain was super intense even resting. like i said Ive been doing it for a while its been 9 days now and they soreness is still there Ive noticed the last couple of week Ive had DOMS!? any ideas or information would be greatly appreciated!
Jason, I think you may have rhabdo but I’m not a doctor so Im going to recommend strongly that you go to your doctor today and if you cant get an appointment, go to the hospital. They can run a blood test and see whats going on. Tell them what you did exercise wise and tell them you suspect rhabdo. Do let me know what happens.
On January 29, 2013 I completed a CrossFit workout called Angie (100 pullups, pushups, situps, and squats – in order) as prescribed and felt crummy after; nothing abnormal for a CrossFit workout. My arms began to swell on January 30th and by the morning of February 1st I had dark colored urine.
I immediately slammed two 24 ounce bottles of water and headed to the Emergency Room. My blood was tested and my CPK levels were 84,400 (703x greater than normal). I was admitted to the hospital with Rhabdo and put on aggressive IV fluids.
The next morning my levels were 94,400, then 101,400. A day later they dropped to 69,610 only to spike back to 103,100 (caused by stretching my arms). Levels began to fall on February 4th (70,550), then February 5th (33,100), and finally February 6th (12,857).
I was released on February 6th with CPK levels still 100x greater than normal. While I felt little pain during the entire process, the number of labs, IVs, fluids, and other medical necessities began to weigh on me. A very experienced and highly regarded nurse practitioner told me that in her 25 year career, she’s only seen level above 100,000 twice. Both in men less than 25 years old. Both are dead as a result.
My general health, fitness, diet, and young age saved my life. My kidneys remained healthy through the treatment. My liver enzymes (ALT/AST) were very high as a result of the Rhabdo, but they fell with the CPK levels.
In my effort to expand my fitness, I could have lost everything. 6 days in the hospital, $100,000+, at least 6 weeks rest, and potential permanent muscle damage. Was it worth “Rx’ing” that workout? No. Go ahead… say it can’t happen to you.
Buy in to the CrossFit extremes while ignoring your body like I did. Rhabdo is a hell of a way to learn a lesson in humility. Please, learn from my experience.
Jason, thank you for writing. Did the cross fit trainers ever mention the possibility of rhabdomyolysis to you? Just curious. Whether they did or didn’t is irrelevant. I’m coming to the conclusion that cross fit is dangerous.
Thankfully trainers introduced us to Rhabdo during our introductory classes. In fact, I give great credit to the local Madison, AL CrossFit community for their focus on health, fitness, and potential dangers. Where I agree with you, however, is the general CrossFit mentality to push through pain to get a good time or do something “Rx’d”. I mean… GHD bench press? GHD wall ball toss?
There is simply no need to do these things; they’re not only dangerous but likely not effective in producing better athletic performance. When 90% of CrossFitters cannot complete a workout as prescribed… the programmers need to reevaluate the workout’s intensity.
Program for the average person and not only the top 10% and save some people their physical abilities. Let those with greater abilities scale up; no one said scaling had to be unidirectional.
Hi I’m new to this site for the reason of a strenuous workout. I had just finished my third class of the day and by the next morning I was sore but went to a heavy weight training session as I’m training for a figure contest.
Within 24hrs I had pain like i have never experienced, swelling and unable to use my arms or shoulders. It’s been a week and they have tested me for a dvt (negative) I returned to the gym today for a leg workout only to recognize that I am extremely fatigued and accompanied with heart palpatations. Urine is normal.
It has been a 8 days and still cannot use arms normally. Feel like I have been beaten all over my upper body and arms.
Any ideas??
Tracey, did the doctors test you for rhabdomyolysis? One test they usually run is to look for elevations in creatine kinase (CK). Im not sure what you have but I am going to STRONGLY suggest you not workout until your doctor says its ok AND your symptoms are 100% gone. Thats not what you want to hear but I think this is safest. I dont like the heart palpitations and your swelling makes me think it might be rhabdo.
I’ve been hearing that some doctors don’t suspect rhabdo in people who workout because they have been conditioned to believe it can only happen in super extreme conditions. If you read the other comments you saw where this happened to some people here.
I recommend you go to your doctor TODAY and tell them you feel you may have “exercise induced rhabdo.” Print up my review and show it to them if they don’t believe you.
I hope Im wrong Tracy but I think this is best. I don’t want you to keep working out and making this worse.
Please let me know what happens.
Hi Joe
I’ve been training with weights and cardio for 5 years now. On the 18th of this month I performed deadlifts at 10 sets of 10 reps. The workload for the first 5 sets was 205lbs, then 135lbs for the 5last sets. Immediately I began to feel extreme tightness and pain in my lower back and hamstrings. My first thought was DOMS. The following morning the pain and swelling increased.
I Layed in bed all day and night until 2.am the 20th I could no longer take the pain. I called 911 and was rushed to the ER. At 9:20 am my first report showed my CK at 51,000, and urine coloured like cola. My AST was also elevated to 536. I was given 200ml/hour by IV and followed that till my release on the 25th Jan with a ck of 5100. My Creatinine never elevated to abnormal readings. What exactly saved me from Renal Failure?
To know I had ck levels that high and my kidneys were not taxed blew the docs minds away. My creatinine levels were 91 on the 20th, then 84 by the 25th.
Joe I am in absolute love with resistance training. I’m afraid I won’t ever want to lift weights after what I went through. I’m 25 years old,male,5 foot 10in, 175lbs. Any questions or thoughts would be greatly appreciated. Im Glad to have found this page. I feel a lot less stressed now.
Cheers
Amir
Amir, first I am glad you are ok and also glad you had the sense to call 911! You are on the road to recovery. Several others have said that they were afraid to workout again after they got rhabdo. I liken this almost to a type of post traumatic stress syndrome.
I suggest you keep in contact with your doc and ask him/her when they think you can workout again. when they say its ok its important to start slowly. As an exercise physiologist I can tell you that 10 sets of any exercise is too much for most people. Remember the injuries you cause now when you are young (Im not talking rhabdo but joint problems etc) will come back to hurt you decades from now and actual hinder your ability to lift weights. Its when you are 60 that I really want you to lift weights! Thats when its going to make a LOT of difference in your life.
The key is that you will be able to lift again and you dont have to get rhabdo ever again. Just remember that moderation is the key. The day will come when you can even lift heavy again. Just remember that too much of anything isnt a good thing.
Keep me posted on your progress Amir and Im glad I was able to reduce some of your stress.
I recently began working out after more than a year of real, consistent exercise. I worked very hard doing a “cross-fit”-like routine. 20 min per day for 2 days. The next day I had the root beer urine. I also had real muscle pain but I associated that with the intense workout. Obviously the brown urine worried me. I began hydrating very diligently.
Later that day urine was returning to that old familiar color. The next day (today) it seems to be back to normal. I still have some soreness in my muscles but that too seems to be going away. Should I be concerned, even though the symptoms are dissipating, that I am still suffering from Rhabdo?
Thanks.
Jared, to be safe I recommend you go to your doctor and tell him/her what you just told me and that you suspect rhabdo. they will run a blood test and see what is going on. They can then give you a better idea of whats going on and when you are able to go back to working out again. Just because your urine is back to its normal color does not mean you are out of the woods and have a green light to go back your intense workouts. I think this is the best and safest course of action.
Hi Joe,
I’ve been reading up on this since a friend from my crossfit gym was just admitted to the hospital after GHD sit-ups, crazy stuff! Now, I might be paranoid but I have been bloated for several months now. Dr’s are unsure at this point what it is- we’ve done numerous blood tests, ultra-sound etc. Could this bloating be some form of rhabdo? Is that possible and do I need to get tested?
Hi Leah, Id think that if you had rhabdo, the doctors would have figured it out by now. Its often easily seen by measuring various enzymes. You can mention rhabdo to them and your taking part in cross fit and see what they think. I’m not sure what could be causing your bloating. Anybody ever mention PCOS? Just a thought out of left field that occurred to me. I wish I had a better idea for you. I would be surprised if you had rhabdo.
Sorry to hear about your friend. Im curious, did the cross fit trainers know about rhabdo a did they warn people about rhabdo symptoms?
Hi joe
I’ve had my second test and the CK Level is down to 187 now which is good news, the doc has said she wants me to come back ad do another test in 4weeks time, guess it must be to monitor what’s happened and see why it was initially so high.
Cheers for your Help and advice
Dave, thats great news! Glad things are getting better for ya 🙂
Hi I’m sitting in a hospital getting IV pushed through me. I have rhabdo from pushing too hard on a Monday night workout and then getting up and working out at 6am the next day. Wednesday night another arm workout. The thurs morning more of an core workout.
The Monday workout we did a ton of tricep reps until we couldn’t even lift our arms. Then tues am was a series of seven exercises reports at 40, 30, 20, 15, 10 then 5. Anyways, My arms have been swollen and sore ever since and I had brown urine Thursday at about 11am. Now my ck levels are above 15000. Dr. said to lay off all exercise or muscle work until levels are normal.
Kevin, I am SO sorry this happened to you! I am glad you made it to the hospital and am getting the treatment you need. I will say a pray for you that you have a speedy recovery. Please do tell others what happened to you when you go back to the gym. That way I hope you can help others from getting rhabdo.
Hi Joe
I recently did my first work out for 3 months, for 6 days after all my upper body ached and I couldn’t lift my arms above my head, on the 6 day I had had a couple of beers the night before and then on the morning had a lot of coffee and no water and started feeling dizzy, I was sent from work to ER were my CK levels were 20,000 ,
I am now one week on and arms still ache and I feel a little dizzy, I have to have weekly blood tests until the CK LEVEL comes down, I have had no issues with kidneys but I’m so paranoid and anxious in case it’s some thing worse like a stroke or heart attack waiting to happen,
also what if I have wrecked my muscles so much that I have started Muscular Dystrophy. I am very paranoid as all of this was a massive shock.
Hi Dave, I dont think you have to worry about getting muscular dystrophy from rhabdomyolysis. The thing to remember is that you have billions of muscle cells. Ok some of those did get killed off from rhabdo but you still have a LOT of muscle fibers left. I think the thing to remember is that you got rhabdo because you pushed yourself too hard and too fast. This doesnt necessarily mean you will get it again especially if you work out more aware the next time.
So when your doctor says its ok to work out and you are feeling better than you are not, just start out slowly. for example, a few things to think about include:
Start out with only 1 day per week, no more than 30 minutes per exercise session.
Don’t do more than 1 set per exercise at first.
Increase the number of reps you do before you increase the weight you lift.
Increase reps, then sets performed and finally weight you can lift.
Know that you don’t have to feel sore to improve with fitness.
Remember that your body gets stronger when you are resting after working out.
Do talk to your doctor about your fears. at the very least he/she can help you sleep better at night and can also give you good tips on how to avoid rhabdo in the future.
Thanks joe much appreciated.
Hi Joe,
Great info here! I’m a crossfitter, been at it consistently for about 9 months with a fairly recent (Nov. 7) ovarian laparoscopic surgery where I took about 3 weeks off and came back slowly. I’m also nursing some knee tendinitis so have been focusing on arms for a bit.
Tonight I subbed (240 reps) for squats, along with pushups and pullups (fewer reps for those) and my abs started feeling sore about an hour later (typically I’d feel sore tomorrow afternoon); however, I’m not feeling pain while just sitting around, and from your info that is a key sign.
Would you recommend seeing my GP for a blood test tomorrow just in case? Or just increase water intake and monitor urine for awhile? Thanks so much, sorry for all the background info but thought it might be useful. Appreciate your work!
Katherine
Katherine, I recommend you go to your doctor and get checked out. Tell your doctor what you did and that you suspect rhabdo since the pain came on super fast. Sorry for taking so long to get to you about this. My site’s been getting some updates. I do hope that this has not caused you to not get treated. I do hope you are ok now. Do let me know how you are doing!
Hi Joe!
Thanks for the reply. I gave it a couple of days and am doing great. I think I just over-worked myself a bit, so have been taking it easy on the abs!
Thanks again! All of your info was so helpful.
~Katherine
Katherine, great I am glad you are ok!!!
I’m currently recovering from something very close to rhabdo, after a moderate-intensity free weights workout, undertaken after not doing weight training for approximately 18 months.
It was a really hot day which didn’t help (I live in Australia, summer here). I noticed extreme muscle stiffness and soreness in the days following the workout that didn’t seem to be diminishing as it normally would- I could barely straighten my arms and stretching didn’t help at all.
I wouldn’t even have found out were it not for a cholesterol test I had about 5 days after the workout which detected CK levels of 12 000 and compromised liver function.
I’m very lucky that my kidneys appear unaffected (hence the lack of cola-urine, fortunately). I hate to think what my CK levels would have been in the days immediately following the workout.
I kind of feel lost as to what to do now- I want to keep weight training (after my doctor-imposed exercise ban is over- one more week!) but am scared of this happening again!
Fiona, listen to your doctor. you will not lose ANY fitness in week or even 2-3 weeks. When you do start to work out again, you will regain your strength, endurance and cardiovascular fitness faster than you got it the first time. So don’t worry. You need to give your body time to recover from this. I do agree that you were very lucky that you had a cholesterol test after getting rhabdo to identify this. That test may have helped you more than you realize.
I know for people who like to work out, being told to hold off on working out for a time can be a nightmare however look at this as something you need to do to give your body time to get stronger. If you work out now, in the compromised position you are in now – you’ll make things worse.
Keep in close contact with your doctor on this. He/she will be able to tell you when its OK to workout again. And when you do start to workout, start slowly (As a general guideline, my personal recommendation: 1 set per exercise, light weights, low intensity. no more than 30 minutes per workout total. No more than 30 minutes for cardio too. Don’t work out more than 1x per week at first).
Ask your doctor about your risk of getting rhabdo again. its possible it may happen again (I’m not sure) but if you follow my guidelines of going slowly I think the risk of it happening again is low.
If you ever do experience anything like you did before, see your doctor immediately.
I’m currently recovering from Rhabdo. I had done crossfit for a year took two months off to recover a sore shoulder and went back at it. Within two weeks of being back at the crossfit gym I tackled a workout that meant doing 78 pullups and 78 burpees in 20 minutes. For most people that sounds crazy.
I had already built myself up to that level just two months previous. I was crazy sore the next day but went back for another workout. I felt fine after warming up and did 5 rounds of 3 snatch 135 lbs, 20 situps and 200m sprint. Again I was sore that night. The next morning I was still very sore and now my morning urine looked like cola.
I knew immediately what I had done to myself. I couldn’t believe I had pushed myself that hard. My CK level when I checked into the ER was 155,000. The next day it was 183,000 then 187,000 and several days later I finally got to go home with level of 18,000. two weeks later I’m weak.
My kidneys hurt most of the time (depending on how well I hydrate). I still am supposed to wait another two weeks before I do any type of exercise at all.
Rhabdo is no joke and it has wiped me out. I only hope that being a little bit wiser I’ll be able to go back to crossfit and ease my way back to the fitness level I was at and where I want to be.
Doug, please go slow and give yourself a lot of time before you do cross fit again. I advise you to not do cross fit again. I’ve heard of people who have lost their kidneys from rhabdo. Please be VERY CAREFUL!
No worries. I will be very careful. I do not want to spend another week in the hospital or worse lose my kidneys. I really like having them. You could say I’m attached to them.
It was the negative rep I was unintentionally doing that caused me to get Rhabdo. I will definitely ease into it. My goal written in sand is to get back to where I was by June. I’ll take it slow. The trainers at the gym that I go to are very careful. I got away with getting Rhabdo because I have been going there for quite a while. I do not plan on doing any high rep pull ups or heavy high rep workouts for quite some time. I’ll probably focus on strength and mobility.
Sounds good Doug. keep me posted on your progress.
Joe, twice you made the following comment about how rhabdo can cause muscle pain [immediately after exercise up to 24 hrs later]. Forgive me for a little confusion but do you mean ‘immediately after exercise OR up to 24 hours later?’ To me 24 hours later is not immediately, so please straighten me out on this. Thanks.
Jim, the pain can happen immediately after exercise while others may have pain up to 24 hours later. Also the pain hurts even though people are not moving (regular muscle soreness doesn’t hurt when we aren’t moving).
Rhabdo may also cause a lot of swelling in limbs. it may stop the person from flexing their arms for example. this is a scary sign that needs immediate medical attention (go to the ER!) because in extreme cases, doctors may need to amputate limbs to save the persons life.
I am recovering from a slight case of rhabdo currently…my levels 4700. I am have been doing Crossfit for about a year and a half and LOVE it. I am totally addicted and the gym is like a family to me. My trainers all knew of Rhabdo and have talked about it before.
After a relatively “easier” workout on Sat (deadlift/ pushups) my arms started swelling up. Went to doc and drank tons of water all weekend and the swelling is almost gone now. My point is that not all crossfit gyms push people too hard.
When I started we started out very slow (my gym has different levels of classes) The trainers have all been educated on Rhabdo in their Crossfit training. I agree more people need to know what Rhabdo is. It can hit you if you are new to working out or if you have been working out for a long time.
Sara, glad you’re ok and also glad the crossfit trainers educated you about rhabdo. Do keep in mind that the arm swelling is a sign that you should go to the ER. its called compartment syndrome. Check it out http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002204/
There are people who have had limbs amputated because of this if its really bad.
My friend’s 27 year old daughter participated in an extreme CrossFit session and was admitted to the hospital within 24hrs diagnosed with rhabdomyolysis; her CK at 88,000, normal range is <125; severe upper body swelling and kidney failure.
Almost lost her.
She is on complete bed rest for a week. Hard lesson. Not one of the trainers knew what rhabdo was. "Personal Trainers" vs. a good Exercise Physiologist would have prevented that. Dumb asses.
Chris, I’m glad she survived! The lack of information on rhabdo to fitness trainers I say is a complete and utter failure on the part of the fitness industry as a whole. I know some may say I’m being extreme and a bomb thrower by saying that however, if that is the case, then why is rhabdo not mentioned in hardly ANY personal trainer textbook?
Until the day occurs when the leaders of the industry re-write their textbooks and start educating people about this, I think everybody needs to ask fitness trainers what they know about rhabdo, before they entrust that person with their health.
I will say that if those Crossfit trainers didn’t know what Rhabdo is then they aren’t staying current in the Crossfit world. The several gyms that I go to and the Crossfit journal all talk about Rhabdo and emphasize caution.
I agree as they should!
Good stuff here man. I’m wondering though if using bodyweight exercises is any safer. I’m starting slowly on convict conditioning now to get back in shape after lifting weights for awhile then stopping altogether from back injuries.
I think a lot of people need to realize that the majority of health and fitness mags and to some extent “training” books are written by and for steroid users.
I just thought i was being a slacker….WRONG! That being said I’ve worked out pretty hard in the past and never gotten rhabdo but reading bout this makes me a lil apprehensive to say the least.
My heart goes out to all the people on here who went through this and also had to deal with our broken medical system as well.
Kenny, theoretically any workout that is intense enough can cause rhabdo. Convict conditioning programs are popular and if you progress slowly you should be ok. I would mention that rhabdo is a problem among convicts. Here is a link to a very good review of rhabdo in prisoners.
I am better now but it ended my time at academy and probably any future police career… Hard pill to swallow
Sandra, I’m so sorry…
This is full of really great information. I’ve been working out since high school. However, when I was 21 a professor of mine made my class do crossfit. I was hospitalized for almost a week. When I was finally admitted 3 days after the incident my CK was 94,500. It took 4 months to get back to my “normal”. It was amazing how for months after I tired out so easily. I couldn’t even open a door! I still tire out faster than I use to, and it’s been 7 months.
AB, I’m amazed that your professor didn’t realize he might cause rhabdo in some of his students. Glad your on the mend. just give it time.
I’m on the 20 th day after having developed Rhabdo and anxious to get back and get my bicep strength back (I’ve gone from being able to do 30 pull-ups to not being able to get to 90 degrees). I haven’t been able to find any articles on recovery training but have noted some people have relapsed after going back to train. I’m a police officer and need to get back to my normal strength as effectively as possible. Any suggestions or articles you can send my way?
DK, I think the best thing is to keep getting your CK levels checked by your doctor to make sure you are ok before you start to ramp up the intensity again. You may be at greater risk of getting rhabdo again so do talk to your dr about this possibility. I would start with a circuit training routine using light weights. Just curious, what did you do to get rhabdo?
Crossfit. A workout called Angie 100 pull-ups, push-ups, sit ups and air squats for time in that order.
Thats a crazy and potentially unhealthy workout for anybody to do.
1. Thanks for the detailed explanation of Rhabdo!
2. This IS very serious, as I gave myself this disorder last week.
3. I don’t know how anyone could miss these symptoms as I thought I was passing a kidney stone or at least had a UTI.
— either would have been odd since I’m a black male.
3. I’ve been an athlete and dancer for years, but recently increased my workout intensity this summer and one day last week took it too far.
4. This really scares me b/c I take pride in making healthy choices in my life and seldom ever even get the common cold, much less something this serious!
5. Thanks again Joe. I apparently need to read some more literature on the subject and I’ll most likely check out your book! ~CK
My husband and I both got rhabdo from p90x at different times. I’m not in the best shape, but he runs marathons. I wish I had read this before starting the program. You are right, P90X should put a specific warning on their discs. Thank you for this post. Wondering if there are any after affects.
Nicole, so sorry to learn about your problems. Hopefully you and your husband are ok now. Rhabdo was the first thing I thought of when I heard about P90X. I think you both should keep in contact with your doctor about what your risks are of getting rhabdo again. I think for your husband who runs marathons, that its not likely but I’m guessing. Best to discuss your feelings with your doctor. I’d also not do P90X again just to be on the safe side.
Joe,
I have been following the comments on this post. I found a video of a presentation a friend of mine Matt Brzycki from Princeton University did at the Smarter Team Training conference hosted by Doug Scott at the Pingry School in NJ, last year(http://www.youtube.com/watch?v=iZays8VxSXk). Obviously the whole presentation was longer but you might want to check it out. You may be able you get the whole video by contacting Rob Taylor at Smarter Team Training, (http://www.smarterteamtraining.com)
Dwayne Wimmer
Owner
Vertex Fitness Personal Training Studio
Dwayne, thanks for that video! Its nice to know I’m not the only person talking about this.
I am 64 yr.old male. My question can walking about 1 1/2 mi. bring about Rhabdomyolysis? Sunday morning while walking dog I started to feel run down and went home. As day progressed both leg calves hurt.
That night I went to ER and was diagnosed with ‘myalgia’ and told to rest and follow up with Dr. Monday I was sore all day and enervated. Tuesday the calves though still tender but not as painful I walked as usual.
I just felt like I had the flu and went back to ER. This Dr. diagnosed Rhabdomyolysis because Ck count was 3845. Gave me 2 bags of IV solution. Wanted me to stay 2/3 days to undergo solution flushes but I returned home because I have no one to care for dog.
Calves no longer hurt but I feel run down and weak. I increased my fluid intake including Gatorade and stopped walking. Also I have had lot of stress in life recently and have had mild seizures (absence type);cannot that also increase Ck levels?
Frank, I’ve heard of just a little exercise causing rhabdo. In one of the studies I referenced in my review, a guy got it who only did 30 sit-ups per day for 5 days in a row! All that said, while I’m not a doctor, I did find a study that noted that seizures can raise CK levels. Here is the link :
http://www.ncbi.nlm.nih.gov/pubmed/6847427
Did you get rhabdo? I’m not sure. Have you walked that distance before without problems? I’d talk to your personal doctor about this and see what he/she thinks.
Either way ,I am glad you – and your dog – are doing ok
Thanx for response and info. I don’t have any muscle pain but going to Dr. today for new test to see if Ck levels returned to normal. Just feeling enervated.
sounds good Frank thanks for letting me know 🙂
Very good article, thankyou. I recently joined a crossfit gym, the trainers explained rhabdo and I have heard it brought up in a few sessions, but I still wasn’t 100% sure what Rhabo is and common it is.
Michelle, Great! Im glad the mentioned this to you!!
My grandson is in the hospital w/rhabdo. His pee was dark brown and he could barely walk, couldn’t bend his knees. Dr. told us that the cpk test they do can’t read over 20,000. Dr. said he is guessing his cpk count was & still is 100,000 -150,000. He is in school to be a firefighter. the work out are extensive for 30mins. He told his instructor he was not able to do work out the night he was admitted to the hospital, but they made him do 5mins. He is on 24hr fluid IV, he has been in the hospital 6 days, CPK is of course still over 20,000.
His liver enzymes are up. His kidney function is good. now they are talking about checking his thyroids, and doing a muscle biopsy. He is only 18. I read some of the other comments and their cpk is well over 20,000. why can’t the hospital he is in do a better job of reading the test unless the correct test had not been ordered.
grandmother, I dont know why the tests done by the hosptial your grandson is in wont measure CPK levels over 20,000. I would ask his doctor this question. Either way, thats a very high level. Im glad his kidneys are doing well. Tell him he needs to keep in contact with his doctor about when he will be able to workout – and do fireman training again. Ask the doctor about his risk of getting rhabdo again.
Joe,
This is a GREAT post!! Another reason our industry needs more professionals like you in it. It is way too easy for someone to become a personal trainer without the right education. I know the people out there who really care, like you, will continue to work to make a difference.
Thanks again for your post.
Dwayne Wimmer
Owner
Vertex fitness Personal Training Studio
Dwayne, thanks I appreciate that. Ive been wanting to write this review of rhabdo for a long time.
Hi Joe,
Very good article and thank you for trying to train the personal trainers out there.
My husband was 37 years old when the doctors diagnosed him with a fatty liver and instructed him to work out. He is an all or nothing kind of person, so he wanted to make sure he was doing it right and hired a personal trainer from our local gym.
The first work out was a 1/2 an hour workout on the upper body. This was tough, but he made it through it and went back for round 2 about 4 days later. This was to be a 1/2 an hour workout on the lower body.
He wasn’t fat by any means, he was always active and muscular, although he NEVER worked out before hiring the personal trainer. And I believe you are right, she was a woman and he would have never admitted that he could do something to her. She had him doing squats while holding 200 lbs worth of weights. Could he do it – yes. SHOULD he do it, NO!
Half way through the workout he started throwing up and she said that they should stop at that point. 2 days later when he could barely get out of bed, he went to the ER because he thought he had blood in his urine. His CPK numbers were 69,000 and he was admitted for a week. That was over a year ago now and he has never recovered. He still can’t do anything physical for more than an hour before he gets completely spent and has to rest.
I just called the gym where this all happened at because I noticed that they are still charging me for his gym membership (that had been on hold for a while after the incident) and was informed that I have to pay for 3 more months of the membership because there isn’t a way to get out of it. It’s ridiculous!
Their personal trainer changed my husbands life for what seems like will be forever and I can’t get out of a 1 year contract with them. I’ve talked to them, cried, yelled, they don’t understand or see the severity of what they did to my husband or take an responsibility in it.
While I agree, yes, he should have said this is too much – he was paying someone who was trained to do this and should have known better than to allow him to squat with 200 lbs when he never worked out prior to this.
Thank you so much for working to train and inform the personal trainers out there of this deadly disease. I thank God that my husband is still alive and miraculously had no kidney or heart damage through the Rhabdo.
Amanda, thank you for writing and I am SO very sorry this happened to your husband. Would you mind telling me the name of the gym and where its located? I like to know these things and think others should know about them too.
It sounds to me like the personal trainer didn’t know what she was doing. I do not believe any QUALIFIED personal trainer would give a beginner do a 30 minute upper body workout (or lower body workout) or have that beginner doing 200 pounds squats to the point of throwing up.
Considering all you and your husband has gone through, If it were me, I’d get a lawyer and sue the gym – and personal trainer. At the least, speak to a lawyer to see if you have a case (I’m no lawyer but I think you do). I know thats not something a lot of people would want to do but considering that its been a year and your husband still is being effected by it, I would sue if it were me.
Hi Joe,
Thought I might share my experiences with you.
I recently joined the gym again after a 6 month hiatus, previously I was doing contact boxing training so had been pretty fit, but had lost most of that fitness. I got some free personal trainer sessions (i was allocated the top trainer the gym had to offer, he was very experienced and very qualified) so was excited about getting back into shape.
On the second session we did upper body exercises for approx 25 min and by the end I was pretty sore. Because of my boxing experience I can push myself pretty hard, so I dismissed this soreness as DOMS and thought nothing of it. The next day I could hardly move my arms, they were extremely sore, with a bit of heat and ice and some stretching they felt better, again it dismissed it as DOMS. The next day nothing had changed, still sore and still stiff. In the afternoon i went to the toilet and noticed my urine was very dark, I knew this was not good but didn’t think it was too serious. I thought I was just dehydrated and drank about 4 litres of water over the next 4 hours, I went to the toilet again and still the same.
It was at this point i thought it might be something more serious, after a few minutes on google I came across this site/thread, and within 5 minutes I was off to the hospital (thankfully down the road.) The nurse in the emergency department looked at me funny when I said I might be suffering from Rhabdomyolosys from a gym session, thankfully the doctor was more concerned. It was at this point (2 days after the training session) that the swelling started in my forearms (I now realize it was the eccentric pull ups that caused the rhabdo). I was hooked up to an IV immediately and bloods were taken, CK levels were 150,000.
I was in hospital for two days, CK levels now down to 40K, thankfully I avoided a compartment syndrome and have not done any damage to my kidneys (or liver.)
What upsets me is the fact that the trainer had no idea what he was causing. Before training started I had a fitness test and came back ‘average.” On the first session we worked on thighs and after 30 mins of hard work I vomited from the exertion. After both of these “flags” going up the trainer still kept pushing me and again because of my previous training I’m not exactly going to let the trainer beat me and give up. Granted I did tick the ‘train me as hard as you can’ box because thats what gets me the best results, but the training was not scaled to my current fitness level.
I would like to thank you for your commitment to educating people about the seriousness of this condition, rest assured I will be meeting with gym management and my trainer next week to discuss my experience, and what they plan on doing about educating their other trainers about Rhabdo.
I am hoping that after a months rest and a slow build up I can reach the same fitness levels without the anxiety of this happening again.
Many thanks,
Dane
Diane, I am SOOOO sorry you had to go through this! I am VERY happy however that you found my site and that it helped you get the medical attention you needed.
For the life of me I dont understand what would possess ANY personal trainer to do 30 minutes of exercise on upper body or lower body – in someone who has not worked out in a long time? And, vomiting??? what was that trainer thinking???
Diane,If I may ask, what gym did this happen at and what state is it in? I’m always curious. Also, do you know who the personal trainer was certified by?
Lack of rhabdomyolysis education to personal trainers is a failure of most in the fitness industry. Its not even taught in colleges either from what I can tell. Why, I just dont know? It’s very frustrating for me. I was not exaggerating when I said that my book – personal fitness training beyond the basics – was the first personal training book in the US to cover this very serious issue.
Please tell me what happens when you go to the gym management about this. I’d like to know how they are going to deal with it.
I hope today you are feeling a wee bit better Diane and I will say a prayer that you continue to improve.
What do I think? Joe, you’ve scared the freakin crap out of me! I purchased your book, “Personal Fitness Training Beyond the Basics” over a year ago and since then enrolled in a program that partners with ACE Fitness… I plan to sit for my ACE exam Oct/Nov as I’ll be done with my “book studies” with the school in December…
With that said, this post, no joke, has scared the crap out of me! I’m one of those that wants and strives to be qualified, not just certified – I want to help people, not hurt them. I chose the school setting vs. learning on my own to gain the much needed hands on experience that I’d miss out on.
I’ll be sharing with my instructor in the morning as we’ve discussed the benefits of “negatives” some months ago, but nothing about dangers such as this. Where can I learn more?
Shanna, your right rhabdo is no joke. While Ive heard of about 17 cases of rhabdo myself over the last few years, it was actually the people who commented on my review of rhabdo that I think is the most telling. Ive always felt that rhabdo was under-reported in the fitness literature. When the people started writing me from their hospital beds, that was the scary thing for me.
I’m not surprised nobody said anything about rhabdo. They didn’t teach me about it in grad school. You have my book on personal training which as far as I could tell, is very first personal training book in the US to describe rhabdo. I discuss rhabdo on page 79 I think. Use the links I put in my review as they are case reports as well as actual reviews of rhabdo I believe.
Negatives are very popular. I see the benefits of negatives discussed in fitness journals but they always leave out their potential to induce rhabdomyolysis. I dont know why.
Id be interested if your teacher knows about it and what he/she thinks so I do hope you let me know 🙂
I’ll definitely let you know. I’m searching through my training materials and the company website to see what I can find about this condition. I think what scares me most about it… is the question, of what ELSE am I not going to know? Even after 13 months of hands on training, 2 months of internship and beyond… years of real world experience… what ELSE?
I realize that I’m at the beginning of my career as a fitness trainer and there are going to be a whole lotta things that I’ll just need to learn as I go in the real world, but still…
Yes Ill be curious to know what happens. I understand how you feel. thats why I wrote my book. Most of the books I have repeat each other and there was a lot of real life stuff that I had to learn on my own. If it makes you feel better, none of us will ever know “everything.” There really is something good about always being a “student” because it means the learning never stops 🙂
Hi Joe! Received my first trade pub today as a certified trainer and one of the articles in it was “Exertional Rhabdomyolysis: When too much Exercise Becomes Dangerous” found in the April issue of IDEA Fitness Journal. I immediately though of this article and our convo. 🙂 Thank you for leading the way.
Shanna, Great! I’ll bet that was the article by Dr. Kravitz. He mentioned it was coming out when I attended his seminar back in February. Really glad to have him speaking about this. It’s such a big issue for the fitness community.
Hi Joe,
Thank you so much for your website, it may have saved my life! I am in the hospital right now with a CK level of over 48,000. My kidney functions appear normal and I have been on IV flush for 13 hours. I can’t urinate though. I am worried the next step is dialysis.
My symptoms were coca cola colored urine and extreme muscle soreness. I went to LA Fitness for my initial training/tour and the trainer worked me very hard. He knew that I had just had surgery 4 weeks ago. Being a former Marine, I don’t know the word can’t and tried to keep up with everything he gave me. I kept telling him that it was too much, but he just kept pushing me for about an hour. He even leaned on he weights to make it more difficult for me.
My wife was supposed to go with me Wednesday but wasn’t feeling well enough. Thank goodness she didn’t go to her appt just after mine or we may have both been in this condition. It is now Saturday, (admitted to hospital on Friday night), and they said they will keep me in the hospital another day.
I came into the hospital with your website on my IPad and a diagnosis of Rhabdomyolysis. The nurses and emergency doctors didn’t believe me and said it was probably a kidney infection. I told them I didn’t have any pain and no fever. Finally they came back with the Rhabdo diagnosis and were astonished. They said no one gets it unless they have “Fallen an can’t get up”.
I hope that this disorder gets more attention and trainers are held accountable!
Thank you again!
Rick
Oh Richard, I am so deeply sorry that this has happened to you! What LA Fitness (location) did this happen at? Just curious. Was the trainer a “certified” persona trainer who took you through the workout? I ask because I believe that the salesman and even personal trainer managers at some gyms do not have to be certified to take people through an initial workout. Do look into this and if this is what happened with you, I believe you may have a legal case against the gym. I know that is the least of your thoughts right now since you’re in the hospital but I wanted to mention it. Find out who that personal trainer is certified by (what organization). If you find out, please let me know.
DO report that stupid personal trainer to LA Fitness Corporate. He needs to be fired for what he did to you!
The doctors and nurses are wrong when they say nobody gets rhabdo unless they “fall and cant get up”. I know of many cases of rhabdo in healthy people who get it -even in 1 workout. The comments on this blog post prove it.
I will say a prayer you recover fast Richard.
Hi Joe,
Thanks for your prayers. What do you think the chances are that they will need to do dialysis? Does that lead to further dialysis or just a one time event?
The LA Fitness division was Orlando Florida, Waterford Lakes location. The trainer was Marvin (Washington i believe) who supposedly is a Jamaican Olympic athlete (track). I am not sure if he is certified or not but he was not the salesman who signed us up. The salesman was not authorized to give us the tour/workout of the equipment.
Thank you so much for your website and information.
Best regards,
Rick
Rick, I’m not sure about the dialysis. you may need it for a little bit until your kidneys heal but your doctors will know best about this. It sounds like you got to the hospital very fast and that is great news. Try not to think about it right now. You are exactly where you need to be right now getting the attention you need get better. Not everybody who has dark colored urine needs dialysis but if you need it for a week or two, then thats what we need to do.
Athletes dont necessarily make good personal trainers. Do look into his certifications when you get better. Even if he is certified, in my opinion he is not qualified. I’d still report him to LA Fitness corporate offices.
Right now, just take a deep breath and take comfort that everybody is doing their best to help you right now.
Keep me posted on what happens with you Rick.
Thank you for this. I am 51 year old female and am struggling with weight issues. I have worked out most of my life and suffered 8 years with female issues and am now doing better and am under a doctors care. I have had a personal trainer for over a year and recently joined his cross fit class.
I have had both knees injured last year and this recent class can be very brutal. I am doing better than most of the younger clients with strength and endurance but he has us running at the end of class and people are racing and I feel like I have to push harder. Most say that they are having anxiety issues before class.
I had experienced some of the symptoms a few months ago but rested at home. Which gave me more anxiety. This guy pushes until people have grabbed their chest after the end. My leg muscles take 2 days to un swell over the weekend sometimes I can’t sleep because I am so sore. Many people not only are intimidated but think about not being able to get out of their contracts.
Jenny thank you for writing and for bringing up the aspect of people feeling anxiety before class. What you said never occurred to me. I wonder how many other cross fit people feel anxiety over how hard the class is?
It sounds like the personal trainer has taken the fun out of fitness.
Its obvious the trainer is pushing you and most people in the class way too hard. Jenny, please quit the cross fit class. You are going to need your knees to be there for you 30 years from now, long after that personal trainer has forgotten about you. Do what feels right for you exercise-wise. Fitness should not have to hurt to be effective.
At the least do show my rhabdo review to the trainer so he can learn what he does not know.
Joe,
Let me preface this by saying that I read your entire page and it is the best collection of information on rhabdo that I’ve found in one central place, and I am very familiar with this condition. I have not read each and every comment, so forgive me if this question has already been asked.
I came across this page because I recently started taking a thermogenic supplement that contains 1,3-dimethylpentylamine. Upon researching the ingredients, I found that 1,3-dimethylpentylamine may increase the risk of rhabdo.
This risk is of great concern to me as I was diagnosed with rhabdo back in 2006. The symptoms of this condition were onset within 6 hours of participating in a very extreme exercise that I had never before participated in. I was hospitalized for 5 days and had went from being a solid 200lbs when I was admitted, to a weak 175lbs when I left the hospital.
The doctors at the time described the weight loss as my muscles melting away, and that it was amazing that I lived through this condition. The pain that I was in during the my entire stay was so unbearable that it could not be masked by the strongest of drugs that they could offer. I couldn’t move, I couldn’t shower, I had to use a bed pan…it was horrible! I say all that to say — I never ever want to be in that kind of pain again, and I wouldn’t wish it on my worst enemy.
With all of that said, do you have any knowledge of the ingredient 1,3-dimethylpentylamine and it’s impact on rhabdo? I’m 32 yrs old and am currently in very good shape and am in the gym again 5 days per week. I’m using this this supplement to reduce my bf% and like I said, I am not interested in getting rhabdo again. Any help that you can provide is very much appreciated.
Again, this site is the most informative that I’ve come across, and I’ve searched high and low so that I could educate friends and family. I’ll definitely be forwarding this page on.
Joseph
Hi Joseph, I have heard of 1,3-dimethylpentylamine. It looks like its also called DMAA and geranium oil. its a stimulant. I believe stimulants can cause rhabdo if they are used in high amounts.
The supplement 411 website has a list of supplements that will cause a failed drug test and 1,3-dimethylpentylamine is om that list . here is the list of banned supplements http://www.usada.org/forms.asp?uid=3588
is that doesn’t work go to the “high risk list of the supplement 411 website. you may have to enter your name / email to access it.
My other website is SupplementClarity.com . there i reviewed a weight loss product I thought had DMAA here is the link for more info
https://supplementclarity.com/plexus-slim-review-ingredients-side-effects/
Hope that helps Joe and so sorry you got rhabdo!
Hi all,
Last November i got the P90x program to get in shape again after 2 years of couching potato..
I barley finished my first day of my P90x schedule with throwing up and pale face laying on the bed for couple hours..
The next morning i had the extremest soreness i ever had in my biceps and chest muscles, urine was dark red .. i googled online and i found out it might me muscle injury that caused the dark urine.. and it might me be something called rhabdomyolysis, it was my first time i know about this. i had plenty of water and took appointment with doctor the other day..
The doctor wasn’t sure what was going on with me, he said it might be normal soreness after any workout and i should go home and rest, i had an loud argument with him and insisted on checking my blood levels of my CPK and Myoglobin.
The next morning he called me at home and asked me to come to ER immediately since my CPK levels were above 110,000 , Myoglobin and liver enzymes were very high.
I was hospitalized for 4 days taking IV fluids and drinking bottles of water till my CPK levels reached 10,000 and i was released to home advised to drink plenty of water .
Thanks to God my kidneys survived and were functioning normal during all this.
Now after more than 6 months i’m planning to go back to GYM but i’m really terrified and anxious of the horrible experience i went through.
I’m being lazy and out of shape and i hate it, i get slightly sore after carrying any heavy thing, is that because of lack of training and being on bed/couch most of the day? or its related to some muscle weakness or some other condition ?
Joe, Please tell me how i can go back to gym slowly ?
I’m 5.9 ft, 165 lb , 28 years old.
I’ll make sure i’ll be eating enough carbs and have my whey protein shake before and after my workout
Joe De Leo, your not alone. most people have never heard of rhabdomyolysis (I wish this warning was on P90x). Just a few weeks ago when I was at my doctor for a routine checkup, he told me about someone who came in and had rhabdo. They had to rush him to the ER.
Ok so you have had rhabdo. that might mean you have a greater chance of getting it again but it doesnt mean you have to get it again. When you go back to the gym follow some of these tips
1. start with no more than 30 minutes in the gym
2. work out at a nice light pace when you do cardio.
3. ask yourself how you feel on a scale from 0 -10 (10 being the worst). Id recommend you stay at a 3-4 on the scale – light to moderate exertion level
4. when you lift weight use light weights – such as a weight you can lift about 15 times comfortably.
5. Only do 1 set per exercise
6. Only do one exercise per body part
7. Don’t do a lot of different exercise. Stay to just 3 or 4. example, chest press, leg press and lat pulldown. Thats all.
8. Start with only 1 or 2 times per week. Slowly increase to 3 days per week if you are able.
Just go at your own pace. When 30 minutes is easy and you feel fine afterwards, slowly increase to 35,40,45 minutes. I see no need for you to exercise more than 60 minutes a day.
You dont need to take your protein shake before and after working out. Id say just after is enough and since you are just starting out, id recommend you forget the shake for now and eat normally. Protein can stress your kidneys so go easy on protein powders if you do use a shake.
How do you know if its rhabdo or muscle soreness? Remember muscle soreness will not hurt when you are not moving your muscles. Rhabdo pain hurts even when you are sitting still.
Glad you are ok now Joe!
Thank you Joe,
I beside feeling really anxious to go back to Gym, I’m also feeling down to start in such a slow pace,,
But you know what? i was just remembering all the times after the first week of going to Gym (since i was 15 yrs old) beside soreness i used to see weird/dark urine during the first week of working out … kinda like the one i saw last time.. i used to think its due to muscles soreness and drink a lot of water and then after 1 week everything is back to normal and i keep working out for at least 6 months and my body gets in best shape..
I’m not sure if i can do this anymore after knowing what is actually was happening to me..
Thanks again Joe, God bless!
Joe, just try my advice. put the emphasis on health and give yourself time to adapt. You dont have to do it all in a day. I think you can get through this. just go slowly.
Dear Sir.
Thank you for this great article.
kindly request the treatment for rhabdo.
thank you
Richard, go to your doctor if you have rhabdo. in many cases you ma need dialysis to help your kidneys.
if you have not gone to your doctor yet I strongly advise you to do it right now!
Hi Joe, Thank you for writing this interesting article. I also loved reading people’s stories and your response. I suffered a heat stroke three weeks ago today while running a 7 mile race in the heat. I went out (delirious) as my temp rose up over 105 degrees and I didn’t wake up until 90 minutes later packed in ice in the emergency room.
Well, I got better and went back to life as usual. Two weeks later, I went on a bike trip with my son, 250 miles over four days, without having trained very much. While my son got stronger, I declined.
I finished the ride but developed intense quad pain the day after which has no persisted four days later. I can barely walk. My urine has not been brown. Do you think this was rhabdomyolysis now with recovery? Interested in your thoughts?????
Steve, while its hard to say for sure, I’m all for assuming it could be rhabdo and saying you should go to the hospital. At the very least go to your doctor and tell him/her your concerns about exercise-induced rhabdomyolysis. Not everybody who gets rhabdo has dark colored urine.
I would feel better if you got this checked out. please let me know what happens.
Its almost 2 months now since I recovered from Rhabdo, exercise is never the same again as you are always dreading the signs of rhabdo coming up.I have not set foot in the gym, just biking for now.
After 3 months, I plan to start running again, I am pretty sure the rhabdo was caused by the eccentric exercises on the arms, that’s where the pain came from
I got out of the hospital two days ago after a 5 day stay due to Rhabdo. My cpk was 77k, which really scared me and the ER doctors that treated me. Luckily, I caught it in time due to my trainers warnings. The dark colored urine is a dead giveaway. My Rhabdo was caused by a crossfit GHD workout. I had no warning signs…just BAM! The pain, beyond normal soreness, in my abs and the dark urine.
Alex, really glad your trainer filled you in on rhabdo 🙂
Great article! I was hospitalized for rhabdo at the beginning of this year. It was exercise induced and it was from crossfit workouts. Luckily my kidney function was normal, but my cpk levels were up to 75000. I now have numbness in my lower back on the left side from nerve damage due to the muscle swelling. I am back to working out now, but advise people to pay attention to the warning signs and this is not a joke.
Thanks for another great article Joe,
Yes, we see lots of Rhabdo at the hospital & it is no laughing matter. I think people need to just pick workouts they are able to do, rather than as a “trophy”. I do Insanity, and I take breaks & slow down when I need – I’m too old for this s*** as the phrase goes. However, I also see other people in my group who are clearly not using good form, bragging about throwing up during the workout, all that. I actually took a friend to task for this the other day, scared the crap out of her luckily. Keep spreading the word, exercise is to prolong life not end it!!
Regards, Laura
Luara, the excessive exercise can sometimes be as a result of thinking that we still have excess capacity, not necessarily for trophy purposes. Bragging about throwing up seems over the top and odd though.
I’m fairly well-educated about Rhabdo (even more so in the last week after having it myself). There seems to be a lot of literature about it on the web, but I can’t seem to find anything about when it’s “ok” to resume physical activity and training. Any thoughts/recommendations?
Rebecca, its a good question you ask. I’d say wait at least until you are no longer in pain and your kidneys are ok. definitely don’t to back to the level you were at when you got rhabdo. Id also wait util your enzyme levels are back to normal. What did your doctor say about when you could go back to working out? Did he/she give you any feedback on this?
Rebecca,
Could you please share how you got Rhabdo and what happened?
I am of the opinion that the best time to go back is after your CK levels are back to normal and maybe after at least 3 months so that your muscles can recover.As you know, they were destroyed and they need to recover fully, even though your pain may have gone away
I got it after a high-rep workout- over 100 air squats in less than 4 minutes- a workout that I’ve done several times before without even having any soreness. My trainer thinks that the GHD situps I did two days prior were the culprit, but I’m not sure. The extreme pain, soreness, & tenderness began less than 12 hours after the air squats…
I haven’t actually been to the doctor yet (hard-headed & stupid, I know); I got IV fluids at home. I am waiting for him to call back about ordering lab tests.
Rebecca, keep me posted on what happens. Please DO go to the doctor. Rhabdo is nothing to mess around with.
Self medication with IV fluids??They need to check your enzymes, a chemical imbalance can even cause catastrophic cardiac arrest.Rhabdo can be lethal within hours.You need to go see a doctor
Again, I called the dr. to get labs ordered.
Hi all,
I was just released from the hospital from my first (and hopefully last) bout with rhabdo. I’m a very fit 30 year old male and lifelong athlete (water polo,competitive swimming,lots of gym training etc.).6ft 185lb with a body fat percentage of about 14%.
After having some friends join crossfit I too decided to join at my local gym.My Rhabdo hit after my second workout called “Angie” which consisted of a 400 m run followed by some other warm ups.We then did 5×5 overhead squats and then “Angie” for time.Angie consisted of :
100 pullups
100 push ups
100 sit-ups
100 body weight squats
I completed the workout and felt ok.Winded, but ok. This workout took place on a Thursday evening. My biceps were sore but not too bad.I actually went to the gym Saturday for a 2 mile run on the treadmill but I did no weight training.Gradually they got more and more sore over the weekend until finally Sunday came around and I had swelling in my lower biceps and upper forearms and could not straighten my arms out.The pain was far and away worse than any DOMS from normal workout and actually woke me up a few times Saturday night. I hit the computer for answers and came across “rhabdo” in my search results.I did not have any discolored urine because I stay pretty well hydrated but I knew it was likely I had this just by listening to my body.I knew this soreness and swelling was not normal.
After work Sunday I called my wife and told her I was going to urgent care. I told the Doc there I was concerned about Rhabdo and he tested my blood and urine.He was surprised about the amount of blood in my urine since my urine looked so clear.My bloodwork was funky so he suggested I go to an ER for a more thorough blood test.
Once in ER the doc informed my wife and I that my CK level was >22,000 which was the highest their test went to and that I was going to be staying and hooked to a continuous IV to flush the Myoglobin from my blood so it did not poison my kidneys. I lucked out with the ER doc because he knew all about Rhabdo and Crossfit as he was a current, longtime military guy and a certified personal trainer as well as being a doctor.
I was hospitalized and on continuous fluids from that Sunday until Thursday afternoon. The pain and swelling was intense until Wednesday.I got to go home on Thursday still on IV fluids.We got hooked up with home health and my wife would administer the IV at home for me until Monday afternoon. 8 days after being admitted.
I had to disconnect the IV and drive to my doctors lab each day for more blood work but it was better than being in the hospital.My CK test result timeline was as follows:
Sunday-Thursday: >22,000
Friday: 13,700
Saturday: 6,000
Monday: 1,600 (got to ditch the IV here)
Tuesday: 1,088
Wednesday (today): 600
My kidney function tested just fine everyday throughout but my liver enzymes were high due to the high CK levels and decreased gradually along with the CK.
I had a follow up with my PC doc today and she told me I’m pretty much in the clear and it does not appear I did any lasting damage to my kidneys or any other organs.She was also glad I turned to the internet and decided to go to the ER when I did.She said that decision likely saved my kidneys. I have to go for a full metabolic work-up next Monday just to make sure but she said she expects them all to be back to normal by then. I’ve also been instructed to drink plenty of water for the next week or so which I normally do anyways.
She said it’s unclear if I’m more likely to get this again now that I’ve had it once.I can tell you I will certainly have a mean case of exercise anxiety from now on which stinks because I love staying in shape and am a very active person. She told me not to even consider lifting weights for at least a month but said I was ok to return to normal activities.I will also lay off Cardio for a good 3 weeks while my body repairs and I will never attempt the much hyped “crossfit” again. My biceps are also considerably smaller today that they were prior to Rhabdo.It’s very clear I destroyed the muscle and it’s gone for good.
The more I read about crossfit and it’s risks the more I feel like an idiot for doing it in the first place. I also wish my gym would have informed me of this potential risk prior to my first crossfit session.Instead they threw me right in. I certainly think a beginner orientation class is necessary for any beginning crossfitter regardless of their current physical condition.
Long story short.
I signed up for Crossfit and this is what I got:
Almost widowed my wife and left my two kids without their dad
8 day stay in the hospital on an IV
$4,000 in medical bills (thank God my insurance covers 70%)
about 15 needles in the arm for bloodwork
A lifetime anxiety of working out and over exertion
smaller biceps
Missed 7 days of work
Please folks.Educate yourselves prior to any drastic change in your training.I wish I did.I feel very lucky today and wish anyone going through this the best.
God Bless.
Scott, Thank you for saying all that you did! I am so surprised that your gym did not give you any warning about the possibly of rhabdo occurring. Did the CrossFit trainers mention this? Since I wrote my review Ive discovered that even the guy who invented Cross fit got rhabdo from these types of workouts!
I understand your “exercise anxiety” (this is an issue not talked about among those who have had rhabdo) but since rhabdo never happened before you started cross fit, I think its unlikely that it will happen again if you go back to your former workout routine. Just give yourself time to heal before jumping back in and then increase slowly just to be safe.
Im glad you went to the ER and very glad your family still has you.
Hey Joe,
The crossfit trainers did not mention any of this to me. I’m in the process of trying to find out if they normally do. You see, I’m pretty good friends with the director of PT at the gym and I asked him to fill my form out so I could just join and start after I signed. My ego contributed to this as much as the gym’s negligence.
I’ve requested a meeting with the owner of the gym and the crossfit trainers to tell them my story. In speaking with my friend at the gym who is a level 1 crossfit trainer it appears they have some misconceptions about Rhabdo and who gets it. For example, he assumed I was dehydrated and that’s why I got it.
He also made a comment that it was strange because I was in better shape than most of the crossfit members there. In my research it is clear that even well hydrated individuals can get Rhabdo and people in pretty good shape are maybe more likely to get it because of our ability to complete these insane workouts. An out of shape persons body will normally not allow them to train to the point of rhabdo.
Scott, I am so surprised that nobody mentioned this to you! I’d ask the PT director if he/she has ever heard of rhabdomyolysis. odds are they have not. As I mentioned in my review most personal trainers in the US (and probably the world) dont know about it. Certification programs just dont discuss it in their textbooks (why I dont know).
Ive also thought that cross fit trainers were uninformed when it comes to dehydration and rhabdo. Quiz those cross fit trainers too about what they know and dont know about rhabdo. Ask them to tell you the signs and how to recognize it. Id like to know what they say.
I would not be surprised if this issue about cross fit and rhabdo makes the national news someday.
Scott,
I hope you are feeling better! There is NO reason that trainer should have let you do Angie Rx during your first workout… Or even during the first few months of CrossFit. I have been doing CF 7 months, and my trainer still scales things for me. He is very conscious of Rhabdo & over-exertion with, not only new athletes, but seasoned ones, as well. I’m sorry you had a bad experience, and hope you recover quickly!
Good news today.My lab work came back from yesterday (1 week off IV) and my CK went from 600 down to 328.She said 328 is still not normal (I’ve read anywhere from 100-400 is normal depending on the individual) but she did use the term “you’re out of the woods”. My kidney function, liver enzymes etc. were all perfect.The doc even said I can go back to drinking a normal amount of water now.One more blood test next week to see what the CK is but it sounds like I’m good to go.
Very thankful to have recovered from this.I went back to work (desk job) the day after the IV came out and I even walked a mile with my kids on Saturday morning.Felt great.I’m going to wait a good long while to actually workout though.
Thanks again for the blog and all the info.
Scott
Scott, that is EXCELLENT news! I am VERY glad to hear you are out of the woods and on the road to recovery!! 🙂
I had been doing at least 50 push ups per day, and 2 weeks ago i joined a gym and worked out with heavy dumb bells and other weights on Saturday and Monday for at least an hr each session.I basically used most of the upper body machines with 10 reps each just to have a good kick start at the gym.2 days before the gym, I had run for 8miles as I usually run to keep fit.I had planned to work on my chest muscles over a 6month period and build some mass.I highly suspect the dumb bell eccentric exercises led to my rhabdo (CK level was 90,000) because my elbow muscles were so PAINFUL.I could not straighten my arm for a day,got tea colored urine and went to the doc a day later.
The strange thing was that even though I carried my dark urine to show to the nurse before I was allowed to see the doc, the nurse didn’t really think it was a big deal at first as all my vital signs were normal (heart beat, temp etc).I ended up seeing the doc after waiting for 5 hours.
I am now wondering whether my chest building goal is dead because of rhabdo, and whether I will ever be safe again exerting myself and running at least 8 miles per session.
Richard Paulin from Australia has stated it so well.You have a goal to build muscle and suddenly from nowhere, rhabdo comes along and shatters hopes. But I do not agree that rhabdo is genetic as he puts it, underlying factors can definitely increase the likelihood of getting it.
The prevalence rate is also not as low as he put it. As for me I love running, and that now seems to be a risky activity after rhabdo came out of nowhere. I know, people may say , just do stuff slowly, but its not as easy as that, rhabdo can just pop up from nowhere , so the question becomes, is it really worthied?
American Hulk. I’m surprised you had to wait 5 hours to see the doctor! There is likely a genetic component to rhabdo but what we do also can increase the risk. Genetics or not, we all have our breaking point.
Yes I had to wait that long as I was out of the country and their system is social medicine.
There is inconclusive evidence that ties rhabdo to genetics, all I know is that some underlying conditions can accelerate its development.
I am thinking that anyone can over work their muscles to the point of breaking up, we are not made of metal.As for me, I pushed myself beyond my limits.
Would you care to elaborate on genetics and rhabdo?
Rhabdo sucks, it leads to paranoia, working out is never the same again.It was the first time I got but wonder if it will come again
I wish I could elaborate on genetics and rhabdo but I can’t. I am assuming that there is some genetic component because different amounts of exercise – sometimes very little – have been noted to cause it. Scroll up and you’ll see my reference to the guy who did 30 sit ups for a week. Thats generally not too much exercise yet it caused it. In most people Id think rhabdo would not occur after dong that. yet in that guy it did.
No doubt rhabdo is a multi-factorial process. Either way, I agree, rhabdo does stink!
so the question becomes can anyone get rhabdo after intense exercise that tears the skeletal muscle?
I agree, some are more susceptible than others, just like anyone can get the common cold, but some get it more often than others
its funny, when I was 19 I used to do almost the same number of exercise, and now 7 years later, the same exercises brought rhabdo
What seems to be mostly genetic is compartment syndrome, since some get very high CK levels and never progress to compartment,
American Hulk, good points. This is a tricky syndrome. no doubt about it. yes that is very odd that the same thing caused rhabdo that did not do it when you were younger. I can empathize. Ive been battling tennis elbow for a few months. Same thing didn’t do it when i was younger either.
My husband developed rhabdo when he was overseas in the army. From what the VA doctors and other MD’s have told us, there us no cure for rhabdo. Is that correct? Are there any vitamin supplements that he can take to help? We have tried a wide variety of vitamins but they do not seem to have any effect. I heard that seaweed was good. Is that true?
Some days are better than others for him. I know he gets frusturated because he says that his body hurts all of the time, and lately he seems to be disoriented quite a bit. He is only 35, and we have 2 young children that need their Daddy well.
Hi Lisa, This is a good question. Assuming that rhabdo has been treated, I am under the impression that the pain eventually goes away. Ive known people who accidently caused rahbdo in themselves (from working out too much) and they did not say that the pain always stayed with them. Have you ever consulted somebody outside of the VA about this? Im sure you can find a kidney specialist or internal medicine doc who can give you a better answer than I can. That is what I suggest you do. I would at least think in time, the pain should get better. If you find an answer to this, please do let me know. now you have me thinking…
I have never heard of any supplement that might reduce the effects of rhabdo. There is some speculation that coenzyme Q10 might reduce the risk in those who take statin drugs (because statins knock out CoQ10 production as they knock out cholesterol production). Co Q10 may be an option but Im not sure how much it might help, if at all. Again, if it works do let me know. I hope some of this helps Lisa.
Hi Joe
I going through your website, I do not think you recommend Supplement which I like in loosing wt process
Fatu, yes as a rule, I am not a fan of weight loss supplements but thats because they all just seem to be the same thing (same ingredients) in differnet bottles. most are either
stimulants
laxatives
fiber
water pills
I’m also seeing some that have iodine or things that might stimulate thyroid hormone (Im skeptical if they really work)
Thanks, I just bought your new book on supplement, I want to know everything about them. A friend of mine just recommended few of them to me but I’m still afraid.
Thanks Fatu, I hope you like my book. That’s the book I wish I had! You will also like my website SupplementClarity.com which is also all about supplements.
WOW thank you for sharing and making people aware of this deadly illness…you see i have a rare muscle disease called CPT2 defiency, my muscles only burns carbohydrates for energy and cannot convert fats and proteins into to energy for my muscles.
when i burn my carbohydrates i have no reserve for fuel so my body burns muscle causing Rhabdo, this happens to me way to often! I was recently in the hospital for 3 weeks from coughing!!! yes coughing cased my Rhabdo!! when your muscle breaks down it releases CPK into your blood stream, a normal CPK level depends on the amount of muscle a person has, a normal range is anywhere between 100-300, when i have rhabdo my CPK levels rise to as much as 115,000!!! this last time (2 weeks ago i was released) mine was 97,000 and i had kidney failure, luckily i have no permanent damage and dont have to be on dialysis the rest of my life!! I have almost died 2 times from Rhabdo, i have been on complete life support and have been hospitalized so many times i cant count, aprox 4 to 6 times a year!!!
Another serious disorder that Rhabdo can cause is COMPARTMENT SYNDROME, Again this is a serious disorder not talked about, i got compartment syndrome after a nerve conduction study for carpal tunnel syndrome, because of my muscle disease the test cause muscle swelling and closed the compartment in my left hand off so blood cold not flow through my hand causing compartment syndrome, i almost had my hand amputated from this!
Compartment syndrome is also something that can happen with athletes or people who exercise to extremes, if your muscles are sore they can swell and cause this in your arms or legs, this requires emergency surgery within 24 hrs to release the compartment or you cold lose your limb!! Again thank you for posting this article and making people aware of this serious illness that can take lives!!! Kim:)
Hi Kim, thanks for sharing and I am SO GLAD you are doing ok! Im also glad you brought up the aspect of compartment syndrome! I will say a prayer for you that you dont get rhabdo again.
This is what I have, Kimberly, is CPTII Deficiency (Carnitine Palmitoyltransferase Deficiency Type 2). Interesting to hear of another person who has this, as well. I actually wrote a blog about my experience with it in WordPress. Tamara Yancosky Moore
I am a huge advocate AGAINST Crossfit! I have done brutal bootcamp workouts, kickboxing in all temperature extremes and I have been around true grit gyms with the Big Boys since I was 16. I spent 2 weeks in Crossfit looking to further push/challenge myself. AND I was appalled at the chaos, there is NOOO way 2 trainers can watch a group of 50 people and be attuned to issues that might arise.
I didn’t know about rhabdo either, but I did realize the fast tempo they perform dead lifts, clean and jerks, etc with the poundage they are using is dangerous, NOT to even mention the “crescendo glory throw down method” they employ when releasing the weights. IDIOTS any true gym would escort you out for that type of ignorant behavior, couple this by people eating SOOO much freaking vegetables and meat which their bodies are not accustomed to creates a host of gastrointestinal issues.
One lady was admitted to the hospital she was so full of broccoli she was projectile vomiting. These people are brain washed and on a band wagon of the newest “hot thing” which I am sure in years to come we will have statistical analysis pointing to specific injuries to the body directly attributable to this crazed craze!! Just BECAUSE I can do it, doesn’t mean I should be doing it!! That is all~
Rain, very interesting words. I appreciate you sharing!!
I appreciated your article and the seriousness in which you respect the severity of Rhabdomyolysis. I have an Inborn Error of Metabolism that causes me to have frequent episodes of disabling and excruciating Rhadomyolysis with CPK’s over 200,000+ at times. It’s not a “hum drum” experience, by any means! I have nightmares and phobic fear of this pain, at times. Thank You for explaining it so well!
Tamara, thank you for saying that. Yes I am sure that the idea that exercise might cause rhabdo would cause nightmares.
Hi Joe
Thanks for this article. My husband is currently in the hospital getting IV fluids for a CPK level that started off at 67,000. He exercised regularly but just recently started a strength training program to tone muscle. It started off as soreness and he continued to push himself and resulted in swelling if his arm. He went to urgent care after I suggested it and through a series of bloodwork the medical staff felt it was rhabdomyolysis. He was admitted to the hospital and is getting constant fluid. He never had the dark color urine. But like you said this injury can go unnoticed and become fatal if left untreated. Hopefully more people will learn to listen to their bodies and to gradually increase their fitness regimen. Great article. Thank you.
Hi Joe
Thanks for this article. My husband is currently in the hospital getting IV fluids for a CPK level that started off at 67,000. He exercised regularly but just recently started a strength training program to tone muscle. It started off as soreness and he continued to push himself and resulted in swelling if his arm. He went to urgent care after I suggested it and through a series of bloodwork the medical staff felt it was rhabdomyolysis.
He was admitted to the hospital and is getting constant fluid. He never had the dark color urine. But like you said, this injury can go unnoticed and become fatal if left untreated. Hopefully more people will learn to listen to their bodies and to gradually increase they’re fitness regimen. Great article. Thank you.
Tara, thanks for writing and I am really glad your husband is getting the medical attention he needs! I’m glad he went to the hospital. One of the reasons I wrote my review was my fear is that people with rhabdo might “grin and bear it” putting off going to the hospital and getting the medical treatment they need. I will pray for a speedy recovery for him!
I am an ACSM certified PT and have a degree in Exercise Science. A few weeks ago I was hospitalized for a week with rhabdo. I had NEVER heard of this disorder before this incident. The workout that caused it was a bookcamp type class taught by the owner of my gym. I calculated later that I did over 700 reps of exercises involving triceps (where all my muscle death and swelling occurred).
I cannot understand why I was never taught about this. I hated to have to go through what I did, but I am so thankful that it was me and not any of my clients! I have been given a brand new perspective on “pushing” clients. I can not stress enough to people that as I was doing this exercise I did NOT feel overwhelmed. That workout was not on my top 50 hardest workouts list. It was simply unfamiliar (I typically do few reps/heavy weight), occurred after a 2 week hiatus from exercise due to strep throat, and while I was on antibiotics and dehydrated.
Lydia, thank you for telling me about what happened to you and please do not beat yourself up. Ive only met a handfull of personal trainers who have heard of rhabdo. I never learned about rhabdo either in college nor was it covered in my NSCA cert. The ACSM is a fine organization but they pretty much are just like most others in the fitness industry in that they only teach the “science” of exercise and not the real life application of the science. Other than myself I dont know too many others who speak about the dangers of exercise induced rhabdomyolysis.
Please pass along my review to the owner of the gym where you got rhabdo. I’m pretty sure nobody told that person about rhabdomyolysis either.
I do hope you are feeling better!
Hey Joe. Thank you for this very informative article. I am currently in the hospital with rhabdomyolysis due to an extreme abdominal workout. I felt a sharp pain in my stomach shortly after my workout but figured it was just soreness from the workout. The next morning, my urine was brown. I came to the hospital and was admitted immediately for rhabdomyolysis. My current CPK level is 70,000 but was 110,000 when I first arrived. It’s VERY important that people are aware of this medical condition. Again, thanks for writing this.
Anthony, thanks for writing and I do hope you get better fast! I am very glad you went to the hospital too!
Great article. Several years ago I developed rhabdomyolysis after helping my husband paint our house. I developed severe pain in my legs within hours. I could not sleep because of intense pain. By the next morning, I barely had any movement and was vomiting because of intense pain. I went to a local health clinic and did not get much help. The doctor talked about “a mysterious muscle problem” I could have, but told me it was extremely unlikely since my urine was not dark. He basically said I did too much exercise and had really sore muscles and thought I might have a bladder infection because he noticed white blood cells. He also thought this contributed to my “crabby” mood. I explained that I had been an athlete in high school and college and that this muscle pain was different from any other I had before – it interfered with sleep and hurt when not moving. He told me to take Advil, he would do some tests, and he would be in touch if he found anything.
The doctor called two days later and told me to go immediately to the ER. My CPK count was over 48,000 (repeated twice for accuracy). Make a note – my urine never turned dark. I only passed white blood cells. I had to spend about 4 – 5 days in the hospital before my counts got below 10,000. I still have to watch exercise and go slowly. I also have to make sure I have plenty of carb intake. This has happened after my initial episode although never to this degree. Luckily I do not have any long term affects from my initial kidney damage.
Before this episode, I had actually seen this doctor numerous times. I still see him. He had only seen one case prior to me and it was an avid male athlete during mid summer. He did not think this would have been possible. I also did not show some of the typical signs such as dark urine. I’m so glad I insisted that something was wrong. Even though I was called “crabby”, which I most definitely was, I knew something was really wrong.
Jodie, wow thanks for telling me this! Your the first person I’ve heard of who developed rhabdo from painting a house! I’m glad you mentioned that your urine did not turn dark brown. It’s important to know that your urine doesn’t always have to turn dark brown.
Thanks for such a quick response!
I will get in contact with Bill and keep in contact with my doctor. I have a muscle biopsy in a few weeks time which may reveal some further information.
My personal trainer was and is such a fantastic guy. I couldn’t have asked for anyone better or more supportive. It’s just one of those things for which I had such high hopes.
And yes, I would think that we do have the best waves, beaches and landscapes in the world. At least that makes up for the disappointment felt by American tourists who really believe we all ride kangaroos, live in the desert and sound like the Crocodile Hunter! 🙂
Regards
Richard
Richard, keep me posted on what the muscle biopsy says and how your progressing. Just take things slow and I’m sure that eventually you’ll get to where you want to be. Yes Australia is one of the most beautiful countries in the world! I do hope to visit it some day.
Hi Joe,
Thanks so much for writing this article. I have learnt more out of this article than I have from a team of doctors.
I had just started out with a personal trainer two weeks ago and two days after the second session I ended up in hospital with what turned out to be rhabdo. Thankfully I didn’t need dialysis, but had to spend 36 hours on a drip to keep the kidneys going.
The day that I discovered the cola-coloured urine I was meant to have a personal training session that afternoon. I was going to go and deal with the urine issue the following day. Luckily I decided to present at the Emergency Department of my local hospital instead.
I also knew something was wrong when I looked in the mirror (as one does) and discovered that I looked “built”, only after the second session. I initially thought “wow, I must have instant-muscle-building genes” but obviously this was the swelling.
I have been told that the prevalence is 1 out of every million, meaning that there is only about another 22 people in Australia who suffer from this allegedly genetic disease.
My whole life I had wanted to build muscle and I finally built up the confidence and took the step, hiring a personal trainer and spending quite a sum of money on it. Of course these dreams were just totally shattered as according to the doctor I cannot build muscle without risking renal failure.
As an indication, blood and urine samples were collected and tested and according to information provided by the doctor myoglobin levels between 1,000 and 15,000 ug/L indicate rhabdo. My levels were 304,000 ug/L.
The thing is, whilst at the gym I felt that I could have done more in those sessions and I wanted to push further.
Whilst I understand you do not have the full picture from my individual case, is it possible that the genetic form of rhabdo can be overcome? Is this really the end of the road for my dreams?
Regards
Richard Paulin
Perth, Western Australia
Hi Richard, Thanks for your kind words and Im very sorry to hear about what happened to you! I don’t think your dream has to end. Even though you got rhabdo, you can still make improvements; you will just to go slower at it. Your personal trainer pushed you too hard. if he/she didn’t, this might never have happened to. you. You may have rhabdo “in your genes” but that doesn’t mean you cant exercise. You can. just go slowly. For example, when you are able to, start with 1 set of an exercise and slowly -over the course of months – to increase intensity. Most of us will never be “Arnold” but all of us can improve our fitness and strength.
For now though I want you to rest and listen to your doctor. Rhabdo may take a few months before you are better so do keep in contact with your doctor. If you know of any physical therapists or athletic trainers, they may be a good resource for you as personal trainers. I also have a friend in Australia who may be able to help you. His name is Bill Sukala and his website is http://www.DrBillofHealth.com Bill is a medical exercise physiologist and he is one of the smartest guys I know. Bill is actually an American who lives in Australia (hes a surfer and says you have great waves over there!) Please do reach out to him and see if he knows of anyone over in your area who can help you safely achieve your goals.
Don’t lose faith Richard. Rest up and begin anew when you are feeling better. Do, let me know if I can help more.
Good read. I’ve been doing crossfit workouts for a while with no problem, then took a break for a few months. Then decided to get back into it and hit it a bit too hard at the gym. My initial symptoms were muscle weakness and swelling. I didn’t give it much thought thinking it will go away. I waited two days before going to the hospital, the night before I did not get any sleep because of pain.
I got mine in the back from doing deadlifts. On the second day I could stand for more then a minute as I couldn’t support my weight, I couldn’t lay because it felt as I was lying on the rocks, I couldn’t bend my torso or lean at all I was so stiff. I had my boyfriend take me to er. By the time we got there the pain was so bad I had trouble talking. morphine didn’t do a thing.
Got admitted, spent seven days in the hospital. Definitely the worst pain I’ve ever experienced, waiting till last minute probably didn’t help either.
So my point is it is important to progressively increase intensity and not just jump into it like I did. Learned it the hard way. Ps. Still working out, haven’t had another case of rhabdo since. 😉
I am glad to hear you have not had any more rhabdo 🙂
Irina, did your cross fit instructors ever -at any time – explain rhabdo to you? Did they mention the symptoms, how to recognize rhabdo or what to do if you got it? So sorry to hear about your pain but I’m very glad you wrote to tell me about what happened to you. Don’t beat yourself up over this. The good news is that you were smart enough to go to the hospital and that is what’s most important to me.
Nope. Never heard of it from any of the instructors. And ironically the ERdoc was gonna send me home too with pain meds until I voiced my concerned that I might have rhabdo. Good thing I used to work in a hospital and have seen a case of rhabdo before. But you are right, awareness might be raised among trainers. It can happen to anyone from someone who never worked out or a seasoned athlete.
Irina, thanks for letting me know. Please pass my review on to your cross fit trainers so they are aware of it. I’m also glad you had that hospital background too!
Hi Joe! Fantastic article. I’m one of the guys whose post you replied to last night. Thank you for that. And this article is exactly the kind of info assessment I’m more concerned about with regard to the difference in Certs. The first rule of medicine is (supposed to be) “Do No Harm!”. And as long as my future clients don’t get sucked into the marketing vortex of instant gratification fad systems, my goal of keeping them alive and functioning fully might be realized. Again, thank you very much for the post reply and this article.
Backbeat, thanks for letting me know. I’m glad I could help and Im glad you liked my rhabdo post too. Let me know if I can help more. I subscribe to the “first do no harm” motto also 🙂
Wow Joe! Thank-You..and I’ll pass this along to clients and other trainers. I’ve heard of this happening and was aware that dark-colored urine is a very serious situation. My father was diagnosed with bladder cancer after discovering dark urine. He died in 2007.
I’ve certainly over trained clients at times early in my career. I’ve since moved away from the ‘kill the client’ mentality, even when that is what the client wants. I’ll still challenge the clients weak areas, but in a balanced and safe manner.
I’m glad you addressed Crossfit.
Keep up the great writing Joe!
Chad Sundberg
Founder – TrainerChad.com
NSCA-CPT, NASM-CPT & CES
trainers
Chad, thanks for the kind word and so sorry to hear about your dad. I’ve been there myself unfortunately. Cancer is a terrible disease. I’ve been wanting to provide a reference to people about rhabdo for sometime now. As I discover more case reports of rhado and exercise, I will update this post with that additional information.
Thanks for this great article. I am a 40 something yr old female runner who is currently in the hosp. Recovering from rhabdomyolysis I got from a spin class last weekend. Intense pain and swelling in my thighs, followed a couple of days later by brown urine. Admitted with CK level of 129,000 – crazy high number. I had never heard of this, nor had any of my running, workout crazy friends. I will be spreading the word. I’m a limitless nervous about resuming workouts and haven’t had that discussion with my dr yet.
Colleen oh I’m so sorry you got Rhabdo! You’re the second person to tell me they got rhabdo from spinning (check one of the comments above). Don’t feel bad I’d bet 99% of people have never heard of it. Please let me know what your doctor said about when you can resume your workout and if he/she gave you any specific instructions about what to do or not do. I think that would really help others who read this in the future.
It was a crossfit workout…go figure! But my cousin is actually the personal trainer and she had never heard of rhabdo. Honestly now that I think about it I don’t think she is certified! Ah. She just offered free personal training for my sister and I, but other people pay for her. She does it out of her home. She is a crossfit goddess, she is good at what she does and competes..but should probably not do personal training without being certified.
Kristen, please do tell your cousin that she can be sued for doing personal training if she is not certified. If she was cross fit certified, they should have taught her about this. Please find out for me and let me know if shes cross fit certified.
If she is not certified (by anybody), she can’t get personal trainer liability insurance. That means if she is sued (and she can be sued for what she accidental did to you!), shes in a LOT of trouble. I’m sure she looks good but looking good and knowing what to do are very different. Personal trainers as a rule spend too much time in the gym and not enough time in the library learning. Please forward your cousin my rhabdo article so she knows about this. She needs to be aware of this.
Sorry my phone cut off the rest of my comment. Just goes to show that this disorder can literally happen to anyone. People are hospitalized with numbers like 4000 or less. People with heart attacks dont even get as high as my numbers. They checked it again a couple days later and it was still just as high. My doctors haven’t seen numbers this high before in their own patients. but I’m getting sent to a rheumatologist tomorrow and a neuromuscular specialist. To see if there is another reason my numbers are abnormally high.
Kristen, please keep me posted. Im curious what the doctors say. My phone used to do the same to me too 😉
Very gooooood article! I was just diagnosed with rhabdo this week. I am 21 years old, in great shape, did cheerleading and tumbling my entire life..but stopped and got a personal trainer. Two ten minute workouts and I got rhabdo. I was so sore and weak immediately after I couldnt even hold an empty cup in my hand. Nobody could touch me I would just cry out in pain. Got some bloodwork done…my ck level (the muscle breakdown enzyme that this article says is the bloodtest they take ) was scary high. The number range is between 20-200…average is 80… I was at 16, 455
Kristen thanks I’m glad I could help but SO SORRY that you got rhabdo from your personal trainer!!! Can you give me an idea of what the personal trainer did to you in the work out? Did you tell the trainer or gym manager what they did to you? Do you know which organization the personal trainer is certified by? I’m always curious about the certs of personal trainers so that’s why I asked. Its ok if you don’t know (most people don’t ask about that). Did you work out at a gym? if yes what gym were you at? Again, I just like to know these things.
You will get better, its just going to take time and the good news is that you were smart enough to get to the doctor. Above all else, I am really happy about that!
Do let me know if I can help more
Joe,
Good article as always. Thanks for all your great contributions to the fitness industry,.
Joel, thanks I apprecaite that!
Joe is there some way to contact you by email?
Larry, yes there is a contact page on my site. you can email me from there.
By the way, I also complained to the management of my health club about this instructor. They told me that “that is probably the way she was trained.” Huh? So poor training makes it okay to induce heart attacks? Profit will always out.
Amazing! so the club manager just blew it off and blamed it on the cert and did nothing!This just reinforces what I say that US health clubs are ticking time bombs waiting to go off. Most are not prepared for medical emergencies and do little to correct stupid behavior on the part of their staff.
Thanks for this supremely informative article Joe. I have always been leery of these extreme kind of programs i.e. bootcamp and Insanity. The reason why is that many people who participate are beginners or people new to fitness or who have been away for a while. The classes do not differentiate by tailoring the class to the fitness levels of it’s participants and people don’t want to be embarrassed that they can’t keep up so they do what is bad for them to look good. Most of the people I talk to to who do Insanity are out of shape and trying to shape up in a hurry. I think this can not only cause injuries but probably has a lot of other downsides due to the person’s fitness level. I also think it leads to people dropping off because they cannot adapt quickly enough and feel overwhelmed.
And please, don’t get me started on the cycling classes. I love indoor cycling. But I recently went to a class where the instructor insisted leaving the overhead fans off. This was a fully packed class in a relatively small room (compared to participants.) The instructor went on to talk about how people who whine will never achieve their fitness goals. I walked straight out after accidentally walking in on this instructor’s class the next time I was there. But I saw people intimidated by this petite blond who did not have any care for her student’s safety whatsoever.
Thanks for the signs and symptoms of this disorder. I am filing it in
my memory bank for future reference. Keep up the great work, I certainly do appreciate it.
Christallan thanks for letting me know about that dumb dumb cycling instructor! I cant believe she did that. There was a fairly recent court case involving one of those so called motivational experts who took people on a weekend retreat into the hot desert and made them meditate inside a tent that was VERY hot. One person died! They were just sitting there, not exercising like the people in that dummys class were! Im sure the temp inside the class did not get above 100 degrees but what does staying cool during exercise have to do with reaching your fitness goals? It never surprises me at what goes on inside some gyms.
Hey Joe,
Great article and very informative…I myself got rhabdomyolysis twice..once when I was 35 and the other when I was 38…I am currently 43…. I was hospitalized both times, but the second time was even more severe, because my right thigh swelled up like a tree trunk and I was hospitalized for over a week. Both were exercise induced and both occurred stemming from the same place in my body..(my right thigh).
And you are absolutely right about it happening in one exercise workout. Because the first time happened in a cycling class and the second just from doing squats (with no weights) and both times I was out of shape. My question is, Does this mean I will always be prone to getting it? My doctor told me more than likely I will..but my doctor really couldn’t tell me about what exercises I should avoid… So what what exercises do you recommend for me and what exercises should I avoid?…Because you are right about trainers..most of them that I have talked to..have never even heard about Rhabdo…
So I now I’m afraid of doing any type of exercise in fear of getting Rhabdo again… but my resolution is to lose weight.. I’m 6ft 4inch and 300 lbs..so I definitely need some advice…
Sal, thank you VERY much for sharing your story. Your experiences will DEFINITELY help others. I agree with your doctor that it does seem that you seem to be more prone to rhabdo than most others but that does not mean that you cant exercise. I think the key to avoiding exercise induced rhabdomyolysis is to start slowly and increase the intensity of your workout slowly also. In you, being extra careful would be very prudent. Assuming that you have a clean bill of health from your doc, I suggest you start with just 20 min of cardio 3x per week and do this for a few weeks. Then, if you feel fine go to 4 days per week if your schedule permits. Then slowly increase your cardio to you are doing at least 30 min 4 days per week. I see no reason why you cant eventually do 60 min of cardio 5 or more times a week if you progress slowly.
I also believe you can lift weights also. I suggest circuit training and using no more than 1 exercise per body part at least for the first several months. Find a weight you can lift for 15 times. when you get to the 15th rep, I still want you to have some gas left for a few more reps. This will prevent you from maxing out. Start with only 3 exercises – one for chest, back and legs. I like chest press, lat pull down or seated row and leg press as these will hit most of your other muscles too.
Move from exercise to exercise with minimal rest but take rest if needed. After a month, if you would like to add another exercise to the circuit feel free to. Also, you can add a cardio station to this circuit also. The beauty of circuits is that there is an infinite combination of exercise that it can have.
I suggest that your total exercise session should not last more than 60 minutes -and even then I want you to take at least 3 months to work up to that.
I also suggest you find a dietitian in your area who can help you with your eating if you think you need it. The website EatRight.org will help you find RDs from in your zip code.
Again I appreciate you taking the time to write Sal and do feel free to check in if you have other questions and to let me know how you are progressing. I think 2012 is your year Sal!
THIS is what we have been looking for, a description of how to ease into it after Rhabdo.
Thank you Joe!
Lost Princes, Im glad to help. keep me posted and if you have any other questions, just let me know.
I need help understanding this. Worked out daily one day off weights and work daily which is a physical job. I did hurt my back at work which wasn’t healing then 3 months later after seeing doctor through work I went to see my doc and CK levels high. Finally coming down to normal she says Rhabdo, but she made it sound like I can’t ever lift. Confused?!
Hi Terri, since you have a physical job and workout daily, that might be related to your elevated CK levels. You can lift again again. many people who have had rhabdo, do go b ack to exercise. you will just have to take it slowly especially since you have a physically demanding job. I would prefer you have your back healed up before you lift heavy again. If its possible to get physical therapy for your back, I think that would be wise.
If your read through the comments here I do go over some of my personal guidelines on how to exercise again after rhabdo. Here is my rhabdo book which covers exercise too.
I hope some of this helps. Do keep us updated on how you are progressing and/or if you have any further questions
Great article Joe
Thanks!!
Thanks for this Joe, very enlightening. I’ve never heard of this. Cheers Happy New Year. (Of course I don’t watch much TV at all.)
Thanks KC, glad you liked it!
Thank you I got rhabdo last year from working out way to hard, people need to know about this
Don, sorry that happened to you. Please share my review with your friends. I also feel more people should know about rhabdo.
Can the “muscle pain/fatigue/weakness” feel like the flu?? I’ve been trying to figure out what is happening to me for 2 days now, knowing pretty well that I don’t have the flu (no fever, chills, headache). But I am experiencing whole-body aches and weakness very similar to what the flu feels like. My urine is not dark though–Its actually lighter than normal because I’ve been super-hydrating lately.
But I recently started a negative accentuated training routine, and did my second negative workout on Thursday, and pushed myself pretty hard. I started feeling this way about 24 hours later and now, on Saturday, it has not gone away. This is not standard DOMS, so I just want to figure out what is happening to my body.
Haley, I’ve never heard of rhabdo described as flu-like but that doesn’t mean it cant be. I’m honestly not sure. what I would say is if you feel worse, then I’d feel better if you were checked by a doctor. A simple blood test will rule out rhabdo. I wish I had a better answer for you. Please do keep me posted on what happens.
yes!! flu like symptoms are definitely part of rhabdo. I was just informed about this yesterday. I’m dealing with a mild case myself, treating at home til I get bloodwork back (I elected to go to clinic over ER for time being).
Sarah, thanks for the feedback! I do hope you are doing OK over there. I dont think Ive ever heard of “mild cases” of rhabdo (muscle fiber death). Id recommend the ER over waiting back for blood-work results. Your health is worth more than any copay you might have to pay. Several people here have told of how their CK levels increased from the time they went to the ER. I want you to be safe Sarah. Please keep me posted on how you are doing!
Well, I was hoping for mild, but I type this while lying in a hospital bed at the ER with an iv :/
My levels Monday were 16,380. I don’t know yet what they are today but the Dr has mentioned my liver enzymes are elevated. So, no conclusions yet…. I bet my room charge is an arm & a leg. They always do that when you don’t have a reservation 😉
Sarah, Im just glad you are getting the proper attention. Nobody likes to go to the hospital but I do feel this is the place you needed to be. Your health is most important. Hopefully you will be home soon. Please keep me updated on what happens. At least you have an internet connection there 🙂
How long do results last my husband has this and seems swollen and tired
Hi Ester, has your husband been to see his doctor? I think that is the best thing for him.
I started a fb page about rhabdo.. It’s a community page… Please feel free to stop by and share your story.. It’s been most 1 1/2 years since I’ve had it and my legs continue to have pain and swelling.. It’s awful.
Hi Michelle, so sorry you are still dealing with rhabdo pain after so long. I will checked you out on facebook.
I developed the same issue and the urine was scary brown. I believe intense exercise in gym coupled with hot water bath caused it. Please add more information related to how to prevent it for getting it second time.
Your article was a great help at that time, thanks.
Hi Nitish, sorry to hear you developed rhabdo. There is at least one case report of rhabdo being caused by a sauna https://www.ncbi.nlm.nih.gov/pubmed/15786826 This person also had the sickle cell anemia trait, which has been linked to rhabdo. whether or not that is relevant in you I cannot say.
I would suppose its possible that both the exercise and hot water bath/sauna might have created a perfect storm where rhabdo is more likely. In the absense of the sickle cell trait though, Im more likely to suspect exercise than the hot water bath.
If you look through the comments you will see a lot of advice I give on how not to get rhabdo again. My rhabdo book also has a lot of advice on this too.
Dwayne, Thanks for the opportunity to do the audio interview! It was a lot of fun! Everybody, we do cover rhabdo in this interview.