For most of us, dragging ourselves out the door to go do a workout is a herculean effort in and of itself. We admire those who seem to never run out of motivation, watch them test their mental and physical limits in awe, only for them to return the next day for more.
It’s hard to imagine that exercise — which we are constantly told we need more of — could be damaging to our health, potentially even fatal. Robert Garay, an avid and dedicated CrossFit athlete, had that same opinion until a particularly grueling CrossFit competition landed him in the hospital.
Robert’s Run-in with Rhabdo
Having participated in CrossFit for a year, 37-year old Robert decided to entire a weekend-long competition at his gym in Miami. The AC was broken, and the workout was demanding, but Robert had trained hard and felt prepared.
He completed the workout and was proud of his efforts. The next day he was sore but figured it was just the delayed-onset muscle soreness (DOMS) that usually follows a hard workout. Over the next couple of days, the stiffness became worse, making it hard to stand up straight after sitting at his desk. When his urine began resembling Coca-Cola, he knew he needed to go to the emergency room immediately.
“During the workout, I was drinking water, and I didn’t feel pain or anything to stop me from continuing.” Robert told Men’s Health.
Robert stayed in the hospital for five days while he recovered from the shocking diagnosis: Rhabdomyolysis. (1)
What is Rhabdomyolysis?
Rhabdomyolysis (also referred to as rhabdo) occurs when damaged skeletal muscle breaks down rapidly and release their various products into the bloodstream. One of the most dangerous of these is the protein myoglobin. The molecules are too large to pass through your kidney’s filtration system, and end up causing kidney failure. If not taken care of from the first symptoms, this can lead to death. (2)
Causes of Rhabdomyolysis
Rhabdomyolysis can occur anytime there are severe amounts of large tissue breakdown, specifically skeletal muscle (which are muscles connected to bones or tendons, and which you can control- unlike cardiac muscles, for example).
- This is just as it sounds – when you push yourself far past your usual, to the point of muscle exhaustion and damage. There is an elevated risk whe exercising while dehydrated. (3)
- Trauma-induced rhabdo is seen in people who have been in a severe car accident or had a limb crushed. It is also seen in victims of electric shock. (4) (5)
- Seen in users of cocaine, amphetamines, antipsychotics, statins, and cholesterol medications. (4) (5)
Risk Factors for Developing Rhabdomyolysis
There are several factors that could increase your chances of developing rhabdo. Knowing what they are is the first step in preventing your own encounter with it. (6)
- Heat and dehydration
- Excessive use of creatine and alcohol
- Tobacco use
- Muscle enzyme deficiency
- Sickle Cell trait (7)
- Flu medications
- Men have higher risk than women
Preventing Rhabdo: Practicing Safe Workouts
Proper Warm-up and Cool-Down
Warm-ups allow for practicing the actions required in a workout at a lower intensity and prepare the body to work hard. The cool-down helps decrease the amount of lactic acid (what causes the burning sensation in muscles while exercising) built up in your muscles from exercise. (6)
Know Your Limits
Pushing yourself in a workout can be beneficial, but pushing yourself too far past your usual can be fatal. You may not realize how difficult an exercise is in the moment, so understanding your current capabilities is crucial. Always check in with yourself — increase intensity slowly, especially when trying something for the first time. Trying to push past your limits to show off or because you feel like you need to impress a trainer, friend, or onlooker is never a good idea. (6)
Stay Cool and Hydrated
Avoid working out in extreme heat, and always wear hats and light, moisture-wicking clothing when exercising in warmer conditions. Be sure to hydrate properly leading up to a workout, take water breaks throughout, and rehydrate afterward with water or an electrolyte drink in particularly sweaty situations. (6)
Rest When You’re Sick
A head-cold is one thing, but the flu is another. When you have been under the weather and been suffering from vomiting and diarrhea, you are likely dehydrated and have an electrolyte imbalance, which elevates your risk of developing rhabdo. Rest and recover before trying to jump back into your workouts right away. (6)
Proper nutrition before, during, and after exercise is crucial to preventing rhabdomyolysis. You need to have a sufficient amount of calories to balance the amount of energy you expend in an exercise bout, as well as proper amounts of vitamins and minerals. Protein is a key macronutrient for prevention, so anyone following a vegetarian or vegan diet must take extra care in making sure they have adequate protein in their diet to support their activity level. (6) The recommended protein intake is 0.8 g for every 1kg that you weigh (so, if you’re 160 lbs, that’s 73kg. You should consume 58 grams of protein).
Exercise is an important aspect of a healthy lifestyle. A carefully considered exercise routine will improve both our physical and mental well-being. When working out, we must all consider not only how we are feeling that day, but the conditions we are exercising in, as well as the demand in relation to our abilities and previous experience with physical activity.
The Bottom Line
Always listen to your body. Whether you’ve just started developing a fitness routine, or you’ve had an active lifestyle for years, it’s important to work out in moderation and ultimately work with your body, not against it. If you notice warning signs like sharp or prolonged pain, nausea or confusion, seek medical care.
Disclaimer: Always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with your exercises, stop and consult your healthcare provider.
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