Update 9/5/20. It's safe to assume most know me as that guy who reviews dietary supplements (at SupplementClarity.com). But, there is another topic I'm very passionate about rhabdomyolysis (“rhabdo”). For over 10 years I've been educating people about rhabdo. I've also written the first book on Earth on rhabdo too. I call rhabdomyolysis a cancer in the fitness community – and I believe it's on the rise. Here, I'll tell you about a growing trend of rhabdo caused by indoor cycling classes. My goal is not to scare you but save you pain, mental stress, and costly hospital bills caused by this little known side effect of working out too hard. Hopefully, this never happens to you.
My Rhabdo Reviews
I've written extensively about rhabdo and exercise. Here are my other reviews:
- Interview: She got rhabdo from spinning
- Interview: Rhabdo with non-typical symptoms
- Rhabdo and Personal Training
- Can You Have a Mild Case of Rhabdo?
- Is It Rhabdo or Muscle Soreness
- 5 Reasons Rhabdo Is Happening in Fitness Centers
- Do I Have Rhabdo
Also, read my rhabdo book too.
What Is Rhabdo?
Rhabdomyolysis (say “rab-doe-MY-O-lie-sis) translates into “muscle fiber death.” When the muscle fibers die, the contents of those cells leak into the bloodstream. While many things can cause muscle fibers to die, when physical activity is the cause, it's called exercise-induced rhabdomyolysis.
Rhabdo needs to be treated medically because, in severe cases, it can lead to kidney failure and heart attacks. I've been told of people who have died from rhabdo caused by exercise. Fortunately, the overall rate of death (from all causes) appears to be low, about 8% by some
estimates, but that is still too high for me.
The following are things that can occur when someone has rhabdo. Because rhabdo can vary in its severity (ranging from mild to severe), not everyone who has the condition will have all these symptoms and signs.
|Muscle weakness||Muscle swelling||Muscle pain|
|Fatigue||Inability to lift/move limbs||Fever|
|Dark colored urine||Reduced urination||Kidney failure|
|loss of consciousness||Heart attack||Liver problems|
Of these symptoms above, the following are often particularly recognized as indicating rhabdo:
- Muscle pain/weakness/ lack of ability to move arms or legs
- Muscle swelling
- Dark-colored urine
To this list, I'd also add in recent participation in an exercise that you were not used to doing or have not done in a long time. As you will see below, this is one of the key indicators of who is most likely to develop rhabdomyolysis.
What Are Case Reports?
Most of what you will see below comes from case reports. These are reports of a single person who got medical attention for some issues. The doctors overseeing the treatment thought the case was important enough to alert the medical community about it. And so, they summarized what happened and submitted it to a medical publication.
The more case reports submitted on a topic, the greater the possibility that a trend might be occurring. I believe the trend is that indoor cycling classes are causing more rhabdo than in previous years.
Case reports are not the same thing as large-scale clinical trials, but because there is no government or medical agency activity tracking rhabdo in the general public, they are a valuable tool to educate others about this condition.
Rhabdo And Creatine Kinase
Creatine kinase is an enzyme that doctors can use as a measure of muscle damage. The more damage, the higher the levels go. Exercise increases CK levels as does damage like rhabdomyolysis. Another name for this enzyme is creatine phosphokinase (CPK).
In the reports below, I'll mention creatine kinase levels. I'll do this because it's been my experience that people who've been hospitalized get clobbered with information about their CK levels. It's basically all they hear about. It's usually the first thing they tell me when they recount what happened to them. So I'll list the CK levels so people can compare them too.
Normal creatine kinase levels can vary, but some estimates put the normal level between 38-234 u/L. Your doctor can give you a more specific level for you. Generally, creatine kinase levels of at least 5 times normal usually indicate rhabdo, but this is just a rule of thumb.
Is It Just Spinning That Causes Rhabdo?
When I use the word “spinning,” I'm not specifically referring to Spinning (as in Johnny G Spinning) but rather to indoor cycling classes. Even though spinning refers to a specific type of cycling program, the word has also become part of the common language (like Xerox, Kleenex, etc.). It's a general term these days.
Reports such as those cited below often use the word “spinning” in their titles but researchers often don't specifically mention the brand name of the cycling class (Soul Cycle, CycleBar, Mad Dogg Cycling, etc.). As such, I believe they are just using a generic name that most people understand.
I mention this you don't think I'm specifically singling out Spinning. I'm not.
Top Rhabdomyolysis Myths
This video I created outlines the top 5 myths about rhabdo. How many did you think were true?
Watch it on YouTube if you prefer.
Rhabdo From Spin Class: The Evidence
Does spinning cause rhabdo? Yes. it can. Here are several reports of people who developed rhabdo after taking an indoor cycling class.
In 2004, doctors reported on a fit, 34-year-old woman in Scotland who complained of leg swelling and pain 2 days after taking a spinning class. The woman reported that she had worked out 2-3 times per week and that this was the first indoor spinning class she ever did.
After 4 days of medical treatment, her creatine kinase level dropped from 409,000 u/L to 29,000 u/L. Fortunately, her kidney function was good and after 4 weeks, her CK levels were back to normal and she recovered fully. This is often cited as the very first case of spinning-induced rhabdo ever reported in the medical literature.
Doctors in 2010 reported the case of a 63-year-old woman who developed rhabdo 1 day after riding her stationary bike at home.
This woman was described as a “recreational athlete” but they gave no description of her previous physical activities. They did say she had a “strong” family history of type II diabetes and high blood pressure and began biking at home to help those reduce her risk of those disorders.
Her CK level at hospital admission was 38,000 u/L. After 2 days of reviving IV fluids, she was released. Because cycling at home is becoming popular, health professionals should educate consumers to reduce accidental self-induced rhabdo.
Doctors in Israel reported the case of a 21-year-old woman who got rhabdo after spinning for 45 minutes. This was the very first time she had ever taken a class like this.
After 5 days of suffering from the pain and dark-colored urine, she went to the hospital. Her CK levels at admission to the hospital were 132,000 u/L. This woman was generally healthy, taking no medications, and recently completed her mandatory military service.
She did have a genetic disorder called tomaculous neuropathy (HNPP). It is unknown if HNP played a role in rhabdo development. She was active but had never attended an indoor cycling class before. Within 24 hours of receiving treatment, her urine started to return to its normal color. After 6 days in the hospital, she was released. Her CK levels had decreased to 3781 u/L.
In 2012, a report was published in the Journal of Family Practice that outlined two cases of rhabdo in healthy people:
The first case involved a healthy but sedentary 38-year-old man who took part in his very first indoor cycling class. He reported feeling fine during the class and only felt mild fatigue afterward.
The next day he played 18 holes of golf in a humid, hot environment, after which he admitted to drinking a few beers afterward and not drinking much during golf. These events likely contributed to his development of rhabdo.
He was released after spending 4 days in the hospital.
In the second report, a healthy 26-year-old woman took part in her very first indoor spin class. About 30 minutes into the class, she experienced discomfort and two days later sought medical help due to the increase in thigh pain and the dark color of her urine. Her creatine
kinase level was 86,000 u/L at admission to the hospital. After 4 days in the hospital, she was discharged as her CK levels decreased (CK was 11,000 u/L at discharge. Two weeks later, CK levels were 772 u/L).
In 2014 a 26-year-old woman developed rhabdo after her very first indoor cycling class. From the report, she was healthy and had worked out 3 times a week for the previous 5 months without problems. The spin class lasted 30 minutes and included a 10-minute warm-up period. The woman did report having low fluid intake on the day of the class. While dehydration does not cause rhabdo, it can contribute to it.
The pain in her thighs had persisted for 5 days before she sought medical treatment. After 3 days of treatment with IV fluids, her symptoms began to subside. After a month, all of her blood levels (creatine kinase, etc.) returned to normal values.
In another case from 2014 titled Spinning-induced Rhabdomyolysis and the Risk of Compartment Syndrome and Acute Kidney Injury, doctors report on 2 cases of cycling-induced rhabdomyolysis.
Rhabdo Case 1
This involved a healthy 24-year-old woman who was admitted to the hospital 4 days after taking her very first spinning class. She was experiencing thigh pain in both legs that were tender to the touch and had dark-colored urine. Her legs were painful when she tried to move them.
She reported experiencing thigh soreness and cramps immediately after the class, which progressively worsened. Her thigh muscles were “tight as drums” she told the doctors.
Her heart rate at the hospital was 122 bpm and her blood pressure was 133/99. Both of these values are higher than normal and might be related to the distress and pain she was experiencing. Her creatine kinase level was 161,000 u/L when she was admitted to the hospital (700 times higher than normal!).
Because of her worsening of symptoms, this woman required surgery of her thighs to reduce the pressure that was building up in them (this symptom is called compartment syndrome). The study linked to shows a picture of this. Eventually, her kidneys recovered and she was released.
Rhabdo Case 2
This report relates the story of a 24-year-old man with leg issues present from birth. He went to the hospital 2 days after taking a spinning class for the first time. At hospital admission, he reported worsening thigh pain and dark-colored urine. His creatine kinase level was 14,000 when he was admitted. After 5 days of receiving medical treatment and a reduction of his symptoms, he was released from the hospital.
Other Reports of Rhabdo
Between 2014-2015, researchers in Korea identified 11 cases of indoor cycling-induced rhabdo. All the cases involved women (average age 23) with no risk factors for the disorder. Their most common complaint at the hospital was thigh soreness and dark-colored urine. Most of the people reported dark-colored urine 2-3 days after the exercise class, which was the first time they took part in spinning.
Their average creatine kinase level was over 11,000 u/L and the average length of time spent in the hospital was 7 days. After medical treatment, all women recovered.
In 2015, news organizations in the US reported the case of a University of Tennessee graduate student who developed rhabdo 48 hours after
taking her very first indoor spin class. After the class, she reported being unable to move her legs. Her liver and kidneys were also shutting down. Fortunately, after medical treatment, she recovered.
In a 2016 report titled, Spinning Out of Control: A 19-Year-Old Female with Spinning-Related Exertional Thigh Compartment Syndrome, doctors made the report of a 19-year-old woman who developed rhabdo – complete with swelling in her thighs and dark urine – after participating in a 45-minute spinning class.
This woman told doctors that while she exercised regularly, the intensity of this particular cycling class was more than what she usually did. She also told doctors that this was the first indoor spinning class she ever did. Because of the thigh swelling, surgeons had to slice into her thighs to relieve the pressure that building up.
In 2016, Researchers in Korea reported a case of rhabdo in a healthy but unfit 21-year-old college student. Two days before seeking medical treatment, she reported taking a 40-minute supervised indoor cycling class. Her creatine kinase level was 16,000 u/L when she was admitted to the hospital. After 10 days of hospitalization, she was discharged, and her creatine kinase level had decreased to 460 u/L.
Doctors in New York described 3 cases of rhabdo after spin class in their paper: Freebie Rhabdomyolysis: A Public Health Concern. Spin Class-Induced Rhabdomyolysis, researchers report on 3 “unusual cases” of rhabdo following spinning classes.
- In the first case, a 33-year-old woman sought medical treatment 4 days after she took 15 minutes of spinning class. She had weakness and in pain in both thighs and reported vomiting and feeling light-headed immediately after cycling. Her creatine kinase level was 60,000 u/L. The report does not say if this woman was in an actual indoor cycling class or was riding a stationary bike at home.
- The second case involved a 20-year-old male who went to the hospital 3 days after a spinning class. He has weakness in both thighs, thigh swelling and was not able to lift his legs. This person also had a rare, genetic liver disorder called “Gilberts Syndrome.” His creatine kinase level was 14,493 u/l at the time of admission.
- In the 3rd case, a 33-year-old woman was admitted to the hospital 2 days after taking a spinning class. Her symptoms included thigh pain, reduced urination, nausea, and vomiting. She had a history of using nonsteroidal anti-inflammatory medications (NSAIDs). Her creatine kinase levels were over 80,000 u/L and her symptoms were so severe as to require dialysis.
The case of a 35-year-old woman admitted to the hospital with rhabdo, 3 days after taking a low-intensity spinning class was outlined in this 2016 case report titled Rhabdomyolysis After Ankle Strain and Light Cycling. After the class, the woman had severe leg and back pain that grew in intensity.
This woman also reported falling from the bike in the cycling class (due to a handle bar malfunction). After the fall, she contained to ride the bike in class for 45 minutes. She also reported using ibuprofen for the pain she was experiencing. While her injury was not seen as contributing to rhabdo, in theory, the injury and NSAID use may have played a role. We will never know. She had no known rhabdo risk factors before this happened.
This woman showed no leg swelling and no dark-colored urine. Her creatine kinase level was 72,000 u/L at the time she arrived at the emergency room. She stayed in the hospital for 7 days and was discharged.
Are these the only cases of indoor cycling and rhabdo? I'm sure they are not. I'm quite sure many cases go unreported. I'm also sure there are those with “milder forms” of the disorder who never get medical treatment.
What Do These Rhabdo Cases Have In Common?
From the case reports above, there is one glaring aspect that most have in common:
- The people were not used to indoor cycling classes. Many said this was the first class they took.
From this, we can infer that the most likely reason why indoor cycling is causing rhabdo is that people were not used to doing it and/or took part in a class that was more intense than they were used to.
This is the same reason as most other cases of exercise-induced rhabdo I've investigated over the years. It occurs because people increase the intensity of activities they are not used to doing too quickly.
How To Not Get Rhabdo In Spin Class
In-door cycling is a great activity and CAN be performed safely. I asked Holly Hargrave, who owns Athletic Genius in Montclair, NJ to offer some ideas to help people get the most out of their first cycling class.
- If you can take a “beginner cycling class” first, do it. If that's not possible, ride a stationary bike on your own for the first week or so. Start with low intensity for just 5-10 minutes and increase the time slowly. This will help adapt your muscles to indoor-cycling classes.
- Tell the instructor you've never taken an indoor cycling class before. They will set you up properly and pay special attention to you in class.
- Bring water. If you run out of water during the class, go get some more. Water does not prevent rhabdo but it can help prevent
dehydration, which can increase the risk. Proper fluid intake might also reduce kidney damage if rhabdo does occur.
- Don't over-consume fluids. Encourage drinking when thirsty. Too many fluids can cause hyponatremia which might increase rhabdo. This is more proof that fluid intake does not prevent rhabdomyolysis from occurring.
- Exercising in hot classrooms can increase rhabdo, especially in novices.
- Discourage fat burner supplement use. Fat burners (stimulants) have been implicated in rhabdo. See SupplementClarity.com site for honest reviews on weight loss supplements.
- Use the RPE Scale (Borg Scale) instead of the percent maximum heart rate. People of different fitness levels perceive intensity differently. A 70% max heart rate might be harder to maintain in unfit people vs. fit people.
- Don't try to keep up with the cycling class or instructor. When you are in the cycling class, work at your own pace. If you're tired, you're tired. You will adapt. Just give it time.
Rhabdo: Why Does Urine Change Color?
Many people with rhabdomyolysis report that their urine looks dark-colored. It's often described as reddish-brown, like cola or ice tea. This is due to myoglobin (my-O-glow-bin) in the urine. Myoglobin is basically “muscle hemoglobin,” a very necessary compound. But, too much of it in the blood (which occurs when muscle cells die) is toxic to the kidneys. When myoglobin is in the urine, it's called myoglobinuria.
Myoglobin has a reddish color to it, which is why the urine changes color.
Remember not everyone with rhabdomyolysis has dark-colored urine. But when it's present, it's a sign you have it.
Rhabdo and Sodium Bicarbonate
Some websites discuss taking sodium bicarbonate to reduce kidney failure and other symptoms of rhabdo. Don't do that. According to this 2004 paper titled Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? the researchers point out that sodium bicarbonate will not help when creatine kinase levels are above 5000 u/L. You don't know what your CK levels are unless you go to the hospital.
Bottom line: Don't take advice from the internet. If you think you have rhabdo, don't wait. Turn your computer off and go to the hospital now.
Odds Of Getting Rhabdo From Spin Class
It is hard to say how likely someone is to get rhabdo from a spin class. But, given the millions of people who do indoor cycling each day, I think the risk is low. Still, that doesn't mean it can't happen to you.
Researchers, in a 2015 review paper on this issue, titled Spinning: an arising cause of rhabdomyolysis in young female, looked at spinning induced rhabdo in South Korea from 2011-2015. The group included 70 people (average age 48) suspected of having with rhabdo.
These researchers identified 13 cases (18.6%) that were attributed directly to spinning classes.
That doesn't mean people have an 18.6% chance of getting rhabdo from indoor cycling. This review only looked at a small number of people in Korea. One thing that was interesting though was that cycling-inducted rhabdo appeared to be more severe (people had longer hospital stays) than rhabdo occurring from other types of exercise.
These researchers also tracked the number of cases over time. They noted:
- 1 case in 2012
- 2 cases in 2013
- 7 cases in 2014
This provides some evidence that rhabdo from indoor spinning classes appears to be on the increase – at least in Korea during those years.
In a 2016 review, researchers in the US looked at cases from 2010 -2014. During this time, they identified 52 adults (16-55 years of age) who had rhabdomyolysis – 29, which specifically stemmed from exercise.
Of those 29 people, 14 of the cases (48%) were attributed to spinning. Most of the people were healthy spinning was a brand new activity for them. The average creatine kinase level in the hospital was 73,000 u/l (That's a LOT!). These doctors also report an increase in rhabdo following spin classes.
At the end of the day, the best defense we have on reducing the odds of getting rhabdo is education. The more people know about this condition, the less likely it is to happen.
Is It Rhabdo Or DOMS?
Delayed Onset Muscle Soreness (DOMS) refers to the kind of muscle soreness that pretty much everybody gets when they work out too much. Yes DOMS can be severe – and may occur alongside rhabdo – but they are not the same thing.
One way to tell the differences is to remember that the pain from rhabdomyolysis can hurt even when you are not moving. Muscle pain from DOMS does not hurt when you are not moving. If you think you have rhabdo, stop what you're doing and don't move. Are you in pain now? If yes, it's not DOMS. It's something more serious.
Video Review: Rhabdo vs. DOMS
See the Rhabdo vs. DOMS Review for more on this topic
The PAR-Q And Group Exercise Classes
I believe group exercise instructors should pre-screen new attendees with PAR Q document. The letters PARQ stand for Physical Activity Readiness Questionnaire. While the PARQ does not specifically screen for rhabdomyolysis, it can highlight other issues that may require a doctor's permission before exercise.
Pre-screening also allows cycling instructors to get to know new attendees and educate them on issues relating to getting the most out of the class.
You Think You have Rhabdo. What Should You Do?
If you think you have rhabdomyolysis from an indoor cycling class (or other activity), do not sit there and hope it gets better. Even if you are reading these words in the middle of the night, go to the hospital. Have someone take you. Only then will you know for sure if it's rhabdo and get the treatment you need.
I truly hope these words have helped you.
Great article – just this weekend I was away with friends and I went to crossfit and they all went to workout in the hotel Gym which had a spin class. They dragged along a friend who never did anything before in his life.
Afterwards he said he couldn’t walk and I watched him hobble around the whole day – that night while sitting in hotel room I told him just make sure your Urine doesn’t turn brown Bec I researched rhabdo due to me being involved w crossfit – about an hr later he comes over to me Saying his urine just turned dark brown – he ended up in the hospital still there as we speak w CK levels over 100k now it’s about 50k the doctor says he needs at least 4 more days.
He said if it wasn’t for my warning of brown urine he wouldn’t have done anything he just thought he had extreme soreness.
Anyways I used to get pretty sore after crossfit where I hobbled around for couple hrs but never where I couldn’t move or was incapacitated- now I don’t get sore at all I go to crossfit I workout no pain or soreness – I guess now my body is used to it
Hi Ezra, I am SO glad you were there for your friend when he needed you! You are a very good friend! Sorry to hear your friend is still in the hospital. One thing about rhabdo is that your urine does not have to change color. Still, if urine does change color -as your friends did – its a sign of rhabdo.
I will say a prayer tonight that your friend recovers quickly. Keep me posted on how he is doing or if you have any other questions.
Thanks. It was more of me knowing the symptoms and casualty mentioned it Bec of my concern due to crossfit being associated with it – however, in my crossfit box I don’t see anyone being pushed past their limits. My coaches seem to be mindful and scale things appropriately
When I mentioned this to my coach he said he never heard of anyone getting it from spin class
The fact that I don’t get sore anymore is that a sign that my body is now used to things at crossfit? Really the only thing that gets me sore is the full range GHD sit-up but even those it’s very minor not like it used to be
it sounds like you have very smart Crossfit trainers at your box! To Crossfits credit, they are one of the few fitness organizations that teaches people about rhabdo. While Crossfit has been associated with rhabdo, there are also reports of people getting it in non-crossfit related activities, such as working out with personal trainers one-on-one. if you take a look at the comments at my post on rhabdo and personal training, you’ll see many people getting it from non cross-fit activities.
Just because you don’t feel sore anymore from exercise does not mean you no longer benefit from it. Its common to confuse lack of muscle soreness with no longer making gains. But this is a myth. Its also a myth that people have to feel sore after a workout in order to make gains too. Another myth that goes hand-in-hand with this is “muscle confusion.” There is no exercise principle called muscle confusion. See my review of DOMS for more on muscle soreness. Take a look at this by tomorrow. I’m in the process of updating it with lots more information.
I got rhabdo too from spinning! You are right it was my very first class! I talked to the gym management about it and they looked at me like I was crazy. Nobody had a clue what rhabdo was.
Ive asked others who have taken classes afterward and not one person told me they were informed about rhabdo. I also talked to various instructors and none of them knew what rhabdo was. So much for management spreading the word
Hi Lee, so sorry you got rhabdo. Most people I talk to say rhabdo occurred after their first spinning class. Main reasons for this include because its a different type of exercise than most are used to and its intense and a class lasts a long time (45-60 min). I’d like to say you are in good company but this is not a group you want to be in. I hope you feel better soon. If you have any questions feel free to ask. I’ve been teaching people about rhabdo for over 10 years.
CK level 50K says
I got rhabdo a few weeks ago. it was my very first spinning class. After I got out of the hospital (I was in the hospital for 4 days) I went to the spinning gym and told them about it. They looked at me like I was crazy. The manager did not know what rhabdo was. Im never going back there again
CK level 50K – Im so sorry to hear you got rhabdo from a spinning class. Ive heard of this before, unfortunately. This often happens after people take their very first spinning class. I’m not surprised the cycling gym did not know about rhabdo. Its because the fitness industry has failed them. Very few fitness organizations teach people about rhabdo. This is true for the biggest names in fitness.
I’m guessing that name was your creating kinase levels in the hospital. I have heard of higher levels but that is pretty high.
Tom Wetz says
Tessa, I have had no luck finding an Attorney that wants to help me. I was taking Amlodipine (a BP med) Google the side effects, there are many. It also has an interaction with Simvastatin (a Statin drug) don’t ever take those. The interaction is that it slows down the Liver and magnifies the Simvastatin, so a 20mg is more like a 40mg.
I was building a big fence, so I was lifting some heavy stuff and digging post holes, basically a full body workout and it got kinda hot in April. I was drinking lots of water and Gatorade. I started feeling bad, but had no idea what was going on. Neither the Doctor or the Pharmacist told me to look for side effects.
I fought it until I collapsed in my living room. I had gained about 30lbs of fluid weight. I never got dark urine, just none at all. I was all swollen, my right arm was useless and I still have trouble eating with a fork. Combing my hair and brushing my teeth became impossible and I am getting really good left handed.
I probably had it from April 25th until May 4th when I collapsed. So, be careful in the heat, take as few prescription drugs as possible and don’t overdo it. I am still not back to work. I am going to try next week and see how it goes. It makes me feel better to have someone who can relate, because I know some very insensitive people who just don’t get it.
Thanks for listening,
You too Joe,
Joe Cannon says
Tom, that is an incredible story! So sorry that happened to you. About the attorneys, over the years, a few of them have reached out to me, looking for an expert to represent their clients who were injuries by personal trainers. While I dont remember any of their names, here is my other review on rhabdo (it has about 500 comments).
I know at one time lawyers were monitoring that post. Try posting something about looking for an attorney there. Maybe someone will reply to you.
Hopefully you were able to do something about being prescribed a drug you shouldn’t have been on? That’s crazy. Also I can’t imagine having rhabdo in my legs and shoulders simultaneously. One area of the body is hard enough to handle.
I went back to the doctor today to get my lab results. CK level is at 418!!
I had to laugh a little because my nurse, whom I guess hadn’t seen my hospital lab results said “wow that’s elevated!” in regards to the 418. I replied “That’s cute….it was 87,000 when it peaked in the hospital!” She was shocked!
All my other lab work came back good, I do have slightly elevated liver enzymes still, but the doctor said they were decreasing back into normal ranges.
I’ve done regular and hot yoga before, and I’m going to start back off with regular yoga, since hydration is key..i told my doctor I don’t understand how I could have been dehydrated when I took the one spin class. Because on the normal day to day I drink A LOT of water.
But the room we did spin in they were not running the A/C during class. So the doctor thinks I could have got dehydrated while in class. Not to mention I live in Houston and it’s already super hot and humid outside.
Joe Cannon says
Tessa, congrats on your CK level coming down!!! Fantastic! Start back to yoga slowly and if you feel tired in class, leave. Lets ease back into exercise slowly.
Tom Wetz says
Tessa, I am suprised that you are doing as well as you are. Yes, going down stairs is much harder. I had a bunch of swelling in my knees and my and shoulders were involved as well. You don’t realize how short toilets are until you are stuck on one! My thoughts on getting it again are if you got it once, it could happen again, or maybe not.
Mine was from an interaction between two drugs, one of them I should have never been prescribed. I have been working out for 40 years and I am now scared to as well. I have been doing Yoga for Athletes. It has been 3 months and 1 week now. I googled famous people who got Rhabdomyolysis and I read about College football players and Lacrosse players and Swimmers, multiple players at once and they kept it hush, hush. Just take it slow and stay hydrated.
The first couple of days at work were rough. My feet would swell up really bad and start throbbing. I lost my balance a couple of times if I tried walking too fast. Being a woman I couldn’t get up off the toliet without grabbing a counter top or something to use my arms to lift me up.
Yesterday I tried to use stairs for the first time. I can go up stairs with out much trouble, but oddly enough going down the stairs is difficult, I feel like the muscles I use to go down the stairs aren’t working properly. How long did it take for you to feel as though you could move around normally? It is truly awful that you had to use a walker. I’m sorry.
A couple of times this week I have gotten really discouraged because I can’t do what I want to do physically. Examples would be run or walk fast, walk my large dogs, sit Indian style (which apparently I did often) because trying to sit down naturally or normally for me now can’t happen.
My right leg is still way worse off than my left leg is. In fact my left leg doesn’t really hurt at all and functions pretty normally. My right leg throbs and hurts when I move it certain ways or try to bend it. I tried researching how long it takes to recover from Rhabdomyolysis, but I couldn’t find a set time frame since I guess everyone and every case is different.
I also wondered if I should take physical therapy to get fully back to normal. And lastly I’m really scared to work out ever again. I enjoy physical activities and I won’t be happy if I can’t partake in them again. I should probably stop reading things I see online. I read that once you’ve had rhabdo you are prone to getting it again. But my doctor said that’s not true.
Whenever I feel down or defeated over this, I take a step back and remember being in the hospital when I was told I was going to have to have surgery for compartment syndrome. Luckily I didn’t have to. So I tend to think of those who have had too and they have to learn to walk all over again.
Also, I had hyperkalemia and was almost going into renal failure. And I survived both of those and so far my kidneys are doing great. So yes it’s a horrible horrible experience..but maybe we are some of the lucky ones whom didn’t have major complications, cause we are still here conversing ???? I did get lab work done on Friday, won’t get the results until Monday. I will report back then!
Joe Cannon says
Hi Tessa, so glad to here you are doing better. this will take time to get past. Let me try to answer some of the questions you brought up
1. when we sit down (on the toilet on a chair) or when we walk down steps, they all involve “eccentric muscle actions.” Basically the muscles are lengthening. This tends to put more stress on the muscles than walking up steps for example. Since you are still weak from rhabo, this makes sense why you;d have trouble in these areas
2. You are correct in that its not possible to know how long to recover from rhabdo. the blood tests may say you are good and you may still have issues. It depends on the severity of the rhabdo someone had. Regardless, it will get better.
3. the genetics of rhabdo. There are reports of people getting it multiple times. This hints that there may be a genetic link. Its a bit controversial and nobody has ever found the “rhabdo gene” so that probably why your doctor said it wasn’t true.
4. You will be able work out again. Don’t be afraid that you can’t. Its just going to take time. Look at this as just a speed bump in life. you will get past this. Every day you are getting better, even if you are not aware of it. There are even people who go back to workout out intensely after rhabdo too. You’re going to be ok. 🙂
Tom Wetz says
Tessa, how are you doing at work? How are your legs handling the activity? It took me a long time (and a walker) to get around. I know that you are going to get bloodwork tomorrow, let us know how it is.I had mine done yesterday. I hope that it is normal again. What a horrible experience.
They actually discharged me today. Which my husband and I were kind of concerned about. They told me to drink a ton of water. And I go back on Monday for bloodwork. My legs are pretty swollen again, they had subsided but the last day and a half in the hosptial they upped my IV fluids and that swelled my legs back up.
I’m sorry you went through this too. It’s very traumatic and painful. It’s nice to talk to someone who has been through it, because I don’t think people understand how serious and painful it is.
Tom Wetz says
Tessa, I feel for you.. I am 3 months out of the Hospital and I am just starting to feel better. It is a horrible experience and I pray for you a speedy recovery. Don’t push it, there is really no timeline for recovery. I had never heard of Rhabdomyolysis and now I hear about it almost daily.
People are getting it needlessly and it shouldn’t be a secret for you to find out the hard way. It is really serious and oh so painful. Hang in there and don’t let them discharge you too early.
I’m currently laying in a hospital bed reading this article because I can not sleep. I am currently being treated for rhabdomyolysis. I took my first spin class on Friday morning and then ended up in the ER on Saturday night. Worse pain I’ve ever been in. My CK levels reached 86,000 and I currently can’t leave the hospital because they are still reading over 40,000. I’ve went through 11 IV bags on my first 24 hours at the ER. I’m now on my 20th IF bag.
I have had over 30 blood draws in the last 5 days. I’ve had leg, kidney and liver ultrasounds. I’m taking a blood thinner, been on and off electrolytes, morphine, and antibiotics. Like many people I waited about 36 hours before I thought hey this could be serious and not just muscle soreness from working out. My urine was brownish colored so I asked my husband to take me to the ER. Here I am.
I feel extremely lucky to not have waited longer, because when I got to the ER they were accessing me for compartment syndrome and talking surgery to cut open my thighs.
This whole experience has been an emotional and exhausting journey and I can’t wait to go home. My main thoughts now are I feel like the cycling studio should have had information for first time riders. The only help I got was clipping into my bike. There was no information available for first time riders on their website or before class.
There were also no beginner classes offered. Not blaming them. But I don’t want anyone else to have to go through this.
Joe Cannon says
Hi Tessa, I am so very sorry to hear you are in the hospital with rhabdo! It sounds like you have been through hell and back in the last few days! others have told me the pain is the worst they have ever had also (one woman told me rhabdo hurt worse than giving birth to 3 kids!). The good news is you are exactly where you need to be – the hospital. I am so glad you had your husband take you.
When you got rhabdo, was it at a big box gym spinning class or a private studio? you can give the name if you like. My hope is when you finaly do get home (Im sure it cant come too soon for you!). that you tell them what happened to you. While I do think rhabdo from spinning is rare, even 1 case is too many for me. Print out my review and show it too them – or even just the last part on how to not get rhabdo. They need to know what happened so they can adjust what they do so this doesn’t happen again.
Do let me know how you are doing Tessa and if you have any other questions, just ask. I will say a prayer for you tonight that you get out of the hospital soon.
Hi again. Still in the hospital. The ups and downs are what’s killing me now. I was told you should be able to go home tomorrow and then your can’t go home today or tomorrow. My swelling in my legs had gone down significantly. But my CK levels are still at greater than 40,000.
So they upped my fluids and now my leg is swelling up again. Come on CK levels! The pain is not as intense as it was when I first got here. But now I’m just uncomfortable and my leg skin on my right leg feels constricted and it’s not easy to move my leg again.
I’m exhausted mainly due to the roller coaster up and downs and constantly being worried about the swelling and CK levels. Plus, as you can tell from my late night posts I can’t sleep well here.
The studio I went to is a private studio and they have a few locations in Houston and Austin.
The reason I’m sharing my experience is because I don’t want this to happen to anyone else. Before I got Rhabdomyolysis I never even knew it existed. I feel as though studios need to be more informative towards their students to make sure everyone is as safe as possible. I even mentioned I was a first timer and asked if the class was ok for beginners and was told yes. Not putting all the blame on the studio, but I do feel the risks need to be discussed.
I don’t think Rhabdo from cycling is rare. In fact the urgent care place I went to first before being admitted to the hospital said they had 3 other women with rhabo since January from cycling! Then I was researching news articles on it and there were tons! I shared my story on facebook today because I have a lot of friends that do CrossFit and people need to be aware.
Thank you for writing this. I even mentioned your review to my doctor this morning.
Joe Cannon says
Good morning Tessa, sorry to hear you are still in the hospital but from what you say it does sound like you are on the road to recovery. I know it stinks to still be there but Id rather have you there, where they can monitor you, then send you home prematurely before you are 100% out of the woods. I am hopeful that you will soon be home.
For over 10 years, I’ve been yelling to everybody who would listen about rhabdomyolysis. I mention it in every personal trainer class I teach, wrote a book about rhabdo and I was recently quoted in this article in the New York Times https://www.nytimes.com/2017/07/17/well/move/as-workouts-intensify-a-harmful-side-effect-grows-more-common.html
Still, what you say is true -most people still dont know what rhabodmyolysis is – and that goes for fitness trainers too. It is a failure of the fitness industry to not educate about it. I do think that is slowly changing but not fast enough for my tastes. Ive even met recent college grads (masters degree) who were not told about it.
About crossfit, while I do think they try to help their trainers understand what rhabdo is, Ive been told by crossfitters that some trainers downplay it (calling it a “badge of honor” and stuff like that). Obviously more work needs to be done.
I want to thank you for posting pictures of your ordeal on your facebook page. Im so glad you are talking about this and alerting others about rhabdo. May I use the picture of your thigh for the classes I teach? I really try to drive home to people that rhabod is no joke and they – as fitness trainers -do not want to be causes it in others.
Do keep me posted on how you are doing in the hospital and when you get out too. As you can tell, I’m pretty good about replying to comments here. Hopefully you are getting some rest to make up for losing sleep again last night.
I got discharged today. I am at home now. Me and my husband were wondering if it was too soon. My legs are swollen again because they upped my IV Fluids for the last day and half. The doctor told me to drink a ton of water and come back to the hospital of my urine gets darker.
I also go back Monday for follow up lab work. I was released even though my CK levels are still greater then 40,000. Which I was concerned about. But the doctor told me that otherwise I was a completely healthy 32 year old. So he felt it was okay to send me home.
Whenever I started feeling the soreness of my rhabdo I reached out to a friend of mine who is a personal trainer and she just thought it was DOMS. I messaged her from the hospital and told her I was diagnosed with Rhabdomyolysis and she had never heard of it….!!! Not okay. Every fitness instructor or personal trainer NEEDS to know what Rhabdomyolysis is!
Please feel free to share my photo with your classes. The more people that know about this, the better!
I’m glad to be home, but I know I have a long road of recovery ahead of me.
Joe Cannon says
Hi Tessa, I’m glad you are back home now. I’m sure they would not have released if you if they thought there was a significant chance of you getting worse, just follow what your doctor says. Hopefully you dont have too many stairs to climb at your house; I cant imaging what that would be like with leg swelling and muscle weakness Im sure you also have.
yes most personal trainers I run into (a few thousand each year) in classes have never heard of rhabdo. Here is my book about rhabdo. Pass it on to your friend the personal trainer. It will teach her everything she needs to know about it including how to not accidentally cause.
Thanks for permission to use your picture too. I’d also like to add your picture to this review and link it back to your facebook page (if that’s ok) so people can see first hand how bad this can be.
Do let me know what happens on Monday when you go back for your blood work.
Luckily no stairs at my house. I couldn’t even imagine trying to use stairs right now!
You are more than welcome to link my Facebook page if you’d like. I made my rhabdo post public so it could reach more people.
I will give you an update on my labs Monday. I want to see a normal CK level!
Today, the swelling in my legs has gone done a lot and I can walk around some. And I’m finally getting really good sleep in my own bed.
Again, thanks for writing this review and a book on Rhabdomyolysis. I read Tom’s story and was totally unaware someone could get rhabdo from taking certain prescriptions, that’s just awful.
Joe Cannon says
Hi Tessa, I’m really glad your swelling is going down. Thank goodness you are able to sleep better too. I’m sure you have been totally exhausted from this ordeal. I will say a prayer your lab results on Monday are good. Based on what you are saying, I do think you will have good news 🙂
Yes medications (and even some supplements) have been shown to cause rhabdo. Rhabdo is that “rare but serious side effect” you may have heard mentioned in cholesterol drug commercials (commercials now mention dark colored urine too)
Went to the doctor this morning…. from my Friday morning hospital blood draw my CK levels are 26,000!!
They didn’t draw blood today, they are going to on Friday. I still have a little swelling in my feet when I stand up for long periods of time..
I’m going back to work tomorrow (I’m a receptionist) so I should be okay.
Thanks for your support!
Joe Cannon says
Hi Tessa, fantastic! It sure sounds like you are on the road to recovery! Keep me posted on how things are going and much luck at your first day back to work tomorrow 🙂
Tom Wetz says
I had Rhabdomyolysis after taking a 30 day prescription for Simvastatin. I knew that something was wrong with me, but I just thought that I felt bad, so try harder. I started feeling bad on April 25th and I couldn’t remember my alarm code to my house on April 28th and I collapsed on May 4th as I was dialing 911.
I was in Methodist West Hospital for 8 days and I was delusional and hallucinating. I am still struggling with my right arm and both knees. My C/K level was 26,000, but I think that it might have been higher. My BUN was 88, complete Renal failure. The ER Doctor knew exactly what was wrong and had me hooked up to IV fluids before I was admitted.
This is an awful thing to have happen to you. Be informed and avoid getting this at all cost.
Joe Cannon says
Tom, Thanks for sharing that. I am so sorry to hear what you went though. I am very glad that you got the treatment you needed.
I participated in a 60 day challenge at the gym where I go. Spin class was around the 4th week. I have been in so much pain ever since. I immediately went to Urgent Care, the Emergency Room and recently a Primary Care Doctor. They have taking blood, urine, ekg’s, however no ex-rays of my ankles or feet nor have they associated the pain I’m in with the cycle experience.
I know this is where it all began. I will now see a foot doctor, a Podiatrist. I will request x-rays for my ankles and foot, in regards to what they see.
The gym has been suggesting foam rolling and though I have been doing that as well as tennis ball rolling for my feet it doesn’t seem to be relieving me from the pain.
Joe Cannon says
Hi Patricia, have you mentioned to them that you thought this pain may be rhabdo-related? What do they say if you did this? Im so sorry that you hear you are going through this pain.
Please let me know how you are doing. I hope whatever this is resolves itself soon.
Marlene Jenkins says
As always Joe – looking for trends in the industry – this is one that everyone needs to be aware of! Not such a great trend but an great fact. Thanks –
Joe Cannon says
Hi Marlene, you are very welcome and I agree, not a great trend. Hopefully this will help spread the word and reduce it from happening.
Helene Masiko says
Thanks so much, Joe. My daughter, who is an avid spin enthusiast, recently became a Spin Instructor. I passed this information on to her. She greatly appreciated it, and will more carefully screen and observe her students.
As always, it was a pleasure to be in your class for my CECs.
Joe Cannon says
Thanks Helene, so glad your daughter got to read it! Good seeing you in class!
Kristopher Kory says
Awesome article Joe! Instructors need to be aware that they are not there to destroy their students but to give them a healthy workout. So many people seem to think they must feel like they got hit but a truck or they didn’t get a good workout. Beginners especially need to start out slow. I always recommend that they only do 20-25 of cycling the first time out because it can just be too much too fast. Thanks for keeping everybody current!
Joe Cannon says
Hey Kris, thanks for the feedback! I agree, we do seem to live in an age of “go hard always or go home.” Hopefully, this gave some people something to think about.
Excellent information as always. I wlll share it with my workout buddies as they are avid cyclists. I don’t spin. My trainer has warned them of overdoing this activity. He also states that their quads are over developing as a result and that they need to counter with squats for development of the hamstrings.
Joe Cannon says
Thanks Carolyn, I’m happy you got some good info out of this and yes, feel free to share with your cycling buddies 🙂