What Is Rhabdomyolysis?

Photo of a woman in a spin class

According to U.S. National Library of Medicine, rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle.

Recently there was an article published by the New York Times News Service titled As workouts intensify, a harmful side effect grows more common. The article tells the story of a woman named Christina D’Ambrosio who went to her first spin class on a stationary bike. You know the kind where you pedal like mad to top-40 hits as a spandex clad instructor whoops and hollers at you? You know, for motivation?

Well apparently D’Ambrosio, who was a “regular exerciser” (whatever that means), found the class more challenging than she had anticipated. By the end of the class her legs were “sore and wobbly.” Join the club, sister.

As the day went on, her legs hurt more and more, her urine changed to a cola shade of brown, and she was also nauseated. She went to the hospital, where a doctor told her that she had rhabdomyolysis (or Rhabdo for short).

Now the article went on to explain that Rhabdo is a rare but life-threatening condition often caused by extreme exercise. The article says that “it occurs when overworked muscles begin to die and leak their contents into the bloodstream, straining the kidneys and causing severe pain.” Which is true. Especially in Christina D’Ambrosio’s case. She had clearly overdone it and was paying the price.

Why Does This Matter?

If you follow fitness folks on social media even half as much as I do, you will know that this article has been shared, posted, reposted, printed and reprinted and heralded by all the fitness naysayers as yet another reason for them to remain sedentary. You know those people who have every excuse in the world not to workout and to also try to kill your runner’s high along the way? Yeah, you know the one. The one who quotes the title of the article “As Workouts Intensify, a Harmful Side Effect Grows More Common” and then jumps straight to the part where the doctor that they interviewed says something horrifying like “They are being pushed too hard, and they’re not trained to do this, and so they get really bad muscle trauma.”

“They are being pushed too hard, and they’re not trained to do this, and so they get really bad muscle trauma.”

Anyway, the reason I take such exception to this article is due to their explanation of rhabdo and for focusing so holey on its link to exercise. I mean sure, 26,000 people are affected by it each year in the USA and it can have serious side effects and complications such as muscle pains, weakness, vomiting, confusion, and an irregular heartbeat. The most problematic complication being that some of the muscle breakdown products (protein myoglobin) are actually very harmful to the kidneys and can lead to kidney failure.

That sounds scary, right? 26,000 people exercising themselves into kidney failure! What? Well, if you dive deeper, that is nowhere near the entire story. The article makes it sound like exercising yourself into rhabdo is just a single pedal stroke away. Like all us fit folks should just stop what we are doing before it is too late.

In Reality

The majority of the 26,000 cases are due to muscle compression (resulting from things such as having your leg crushed in a car crash), alcohol abuse, the use of certain medications or illicit drugs, electric shock injury and even heat stroke.

There is a list of causes of rhabdomyolysis as long as my arm in a paper from the State University of New York at Buffalo School of Medicine and Biomedical Sciences featuring things like: Lightning strike, Immobilization, Extensive third-degree burn, Crush injury, Heat-related causes, Heatstroke, Malignant hyperthermia, Neuroleptic malignant syndrome, Ischemic limb injury, Exertional causes, Marathon running, Physical overexertion in untrained athletes, Pathologic muscle exertion, Heat dissipation impairment, and Physical overexertion in persons with sickle cell disease.

A friend of mine who is an Emergency Room nurse (for over a decade) in three of the largest trauma centres in Canada told me that she has only seen a small handful of cases of exercise induced rhabdomyolysis in her career and 2 of those involved the use of illicit drugs, immediately followed by some very poor decisions in the weight room.

The New York Times article highlighted two papers. One called Spinning-induced Rhabdomyolysis and the Risk of Compartment Syndrome and Acute Kidney Injury: Two Cases and a Review of the Literature and the other called Increasing Incidence and Unique Clinical Characteristics of Spinning-Induced Rhabdomyolysis. Choosing these two papers gives the distinct impression that the author is attempting to point the finger in the general direction of Spinning or Spin Classes being a menace to society. But as stated in the title, there were only two cases of spin induced rhabdo in the first paper – both of whom were discharged with “good mobility, sensation, and renal function.” While the other paper reported only 14 cases between December 2010 through November 2014.

Serious Stuff

Now, if you are one of the unfortunate souls out there who has exercised yourself into this state, I certainly didn’t intend to poke fun at you or belittle your experience. Rhabdomyolysis is absolutely no fun and also nothing to laugh at. I am merely bringing us down from the hype and hysteria. Can rhabdomyolysis from over exertion in an exciting and energetic spin class or an enthusiastic throw down at the squat rack? Yes, it can.

Are you so at risk of this happening to you that you need to demand a refund on your Spin Queen unlimited sessions member card?

Are you so at risk of this happening to you that you need to demand a refund on your Spin Queen unlimited sessions member card? Probably not.

If you manage to make it all the way to the end of the New York Times article, you’ll see the conclusion: “I never thought that exercise could be dangerous,” she said. “But it can be when your body is not prepared for really intense levels.” Now that is something I can get behind!

Too Much, Too Soon

When I get asked what the most common cause of injury is that I have seen in all my years of coaching, I always have the same answer: doing too much, too soon. And no, I am not talking about rhabdo although, as we have learned that is one of the ways you could get it but I have never actually seen that. The closest I have gotten to a case of rhabdo is a few suspicious flecks of blood in a friend’s urine after an Ironman Triathlon and a client who had a story about getting it when she was a professional rock climber doing a CrossFit workout.

The “too much, too soon” injuries that I am talking about are shin splints, IT band friction syndrome, patellofemoral pain syndrome, sacroiliac joint pain, Achilles tendonitis, rotator cuff tendonitis and the list of itis-es goes on. These are the real villains. These are the true boogey men hiding in the bleachers waiting for us to let our form falter, our technique slip, our ego get the best of us, or skipped our recovery day in favor of a 100k group ride. These issue are well worthy of our attention and concern. Which is a large reason why I encourage all new athletes that I coach at SkywalkerFitness.ca to begin their training with a few weeks of what is commonly referred to (in the surgical and fitness community anyway) as pre-hab.

What is Pre-Hab?

Pre-hab is a program of training designed to prevent sports injury. Depending on the program, sport or event that is being trained for, it will begin with a movement assessment, a gait analysis, a flexibility test, a strength assessment, and a few other tricks of the trade to identify any weak links in your kinetic chain (sometimes called the kinematic chain). Once those have been identified, a series of strengthening or mobility exercises will be prescribed to shore up the weaknesses before the actual program begins. This is a step that is often forgotten or skipped and is the almost surely the reason why incidence rate for running injuries is between 37 and 56 percent.

We were indeed as a species born to run but we gave up the birthright when we decided to plop ourselves for hours on end in bucket seats, lumbar supported chairs, reclining lazy boys, and pillowy couches.

Yes, we were indeed as a species born to run but we gave up the birthright when we decided to plop ourselves for hours on end in bucket seats, lumbar supported chairs, reclining lazy boys, and pillowy couches while outsourcing our basic survival needs to the local supermarket. You couldn’t do that to our hunter gatherer ancestors and then expect them to chase down dinner either – but more on that another day.

In the end, what I am getting at is that with the right amount of pre-hab and a little restraint,  “too much, too soon” doesn’t have to be a problem. It certainly doesn’t have to result in a trip to the hospital for a dialysis treatment to help your kidneys filter those dastardly waste products from the not so common after all, exercise induced rhabdomyolysis.