Rhabdomyolysis – Know Thyself

Have you heard the hype? I fee like it goes in waves with high intensity exercises programs…They are perfectly safe….they are dangerous…what is the deal?

I know what some of you are saying…Wow, Jerred, back up…what was that…Rhabdo-what? Alright let’s start there.

What is Rhabdomyolysis?

From the smarties at WebMD:

Rhabdomyolysis is a serious syndrome due to a direct or indirect muscle injury. It results from a breakdown of muscle fibers and release of their contents into the bloodstream. This can lead to complications such as kidney (renal) failure. This occurs when the kidneys cannot remove waste and concentrate urine. In rare cases, rhabdomyolysis can even cause death. However, prompt treatment often brings a good outcome. Here’s what you need to know about rhabdomyolysis.

In fitness it really just means you beat the crap out of your muscles…badly. Microtears turn into macrotears and bad things happen.

So what’s the deal with this Rhabdomyolysis?

I have had a lot of friends, who have a distaste for CrossFit, kindly let me know that “CrossFit can cause rhabdomyolysis”. My response is always, “Yea it is incredibly dangerous, you should stay on the couch, where it is safe”.

One thing to note is some of the causes:

  • Use of alcohol or illegal drugs such as cocaine or amphetamines
  • Extreme muscle strain, especially in someone who is an untrained athlete If you found this article after already getting rhabdo and are offended at the term “untrained athlete” (I get a lot of angry emails), notice is says “extreme muscle strain” before “untrained athlete”; ANYONE CAN GET IT so if you have muscles (elite muscles or untrained muscles) and you extremely strain them…rhabdo.  
  • Crush injury such as from an auto accident, fall, or building collapse
  • Long-lasting muscle compression such as that caused by lying unconscious on a hard surface during illness or while under the influence of alcohol or medication
  • Use of medications such as corticosteroids or statins, especially when given in high doses
  • Electrical shock injury, lightning strike, or third-degree burn
  • Very high body temperature (hyperthermia) or heat stroke
  • Seizures
  • Metabolic disorder such as ketoacidosis
  • Disease of the muscles (myopathy) such as congenital muscle enzyme deficiency or Duchenne’s muscular dystrophy
  • Viral infection such as the flu, HIV, or herpes simplex virus
  • Bacterial infection leading to toxins in tissues or the bloodstream (sepsis)

As you can see from that ridiculous list above it takes quite a bit to induce rhabdomyolysis. When is the last time you felt like you were in a car accident after a workout…wait, don’t answer that.

Rhabdomyolysis in exercise alone is caused by a lot of eccentric movement, eccentric movement allows the body to lift around 120% more than concentric movement. If that eccentric movement is coupled with high intensity volume you are now starting to get dangerous (if your body isn’t ready for it). Lastly, heavy high-rep abdominal movements like GHD sit-ups can be a culprit too. For some reason it doesn’t matter how out of shape you are, everyone thinks they have “strong abs”.

Fact of the matter is rhabdomyolysis can happen to anyone. However, high intensity routines make it more prevalent because people are more likely to actually push themselves.

Mainly rhabdomyolysis can just come from lack of education and bad training, either you being a bad trainer for yourself or a bad trainer training you. That is why you need to learn things for yourself.

Three rules to not get rhabdomyolysis:

  1. Drink a lot of water
  2. Don’t do crap (way) beyond your capacity (this is not an excuse to not push yourself).
  3. Work up to stuff…Increase intensity OR volume, NOT intensity AND volume.

Got Rhabdo? 

  • You probably pushed yourself too hard for too long
  • You may have been dehydrated
  • You possibly did a poorly programmed workout
  • You are competing in something maybe you shouldn’t be?

Bottom Line

I work with special operations…I’ve seen rhabdo, but those guys are normally pushing it to the LIMIT and are perhaps a bit dehydrated; they aren’t untrained, but they are doing a lot more than most ever should…and for good reason. If you are competing in the CrossFit Games Open (with no shot at regionals) or just got it from your CrossFit Box doing a poorly programmed WOD…You need to reassess your priorities, your atmosphere, your coach, your hydration, your nutrition, etc. Yes, anyone can get it. But you really shouldn’t. Know thyself!

Why Rhabdomyolysis is a Mental Disorder

***Note: This is 100% a personal opinion*** (as if that needed to be stated)

I actually do not think that most people are even capable of getting rhabdomyolysis. Why you might ask?

Most human beings are incapable of pushing themselves extremely hard (which it will take to get rhabdomyolysis). Rhabdomyolysis is more prevalent in athletes who had it once, lost it and think they still have it. That is the simplest way I can put it. When your mental capacity does not match you physical capability you are at risk for rhabdomyolysis.

While it is great that you have the mental capacity, because most don’t, if you have been out of the game for awhile…be sure to work back up to things.

My References and Things You Should Read About Rhabdomyolysis:

Rhabdomyolysis Revisited – CrossFit Journal 

Looking at Rhabdomyolysis – Eat, Move, Improve 

CrossFit Induced Rhabdomyolysis – CrossFit Journal 

Rhabdomyolysis – WebMD

photo , photo

  • Misty

    good post Jerred, I think you are right, Rhabdo is something that people should be aware of as a precaution but the actual incidence of Rhabdo is very low, I have yet to ever see it happen. But to err on the side of caution I limit the number of GHD sit ups that new people can do in a day as well as the number of negatives I allow people to do (such as pull up negatives or dips).
    Those GHDs can be nasty things if you get carried away with them and I HAVE made that mistake, luckily I didn’t get Rhabdo, but I made a stupid training decision and did Annie with GHD situps…big mistake…i literally could not stand up straight for 4 days, had to take 7 days off of working out and it was about 2 weeks until I was back to full capacity, my core was so weak I couldn’t even hang from a pull up bar, all I can say is that I was happy my urine did not look like coca cola but i was watching for it.
    be careful and be smart and Rhabdo will never be an issue, and in all honesty id rather risk rhabdo by doing CrossFit than risk diabetes by sitting on the couch…

    • Jerred

      Thanks Misty!

      I think rhabdo was more prevalent at the start of CrossFit. Especially with the initial audience being military and first responders…a lot of people who will push themselves extremely hard. I think the CrossFit culture has wised up, but it is definitely something to keep in check for all the newbies out there.

      That is a crazy experience with the GHDs! Are your abs made of steel now lol?

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  • kingdo goodbomber

    Your argument is a false dichotomy. You act as if it’s CrossFit or the couch when in reality there are an infinite number of MUCH SAFER, easier and less expensive exercise alternatives to choose from.

    • http://endofthreefitness.com/ Jerred

      You’re 100% correct. However, personally, I do not choose the safe and easy alternative to anything.

      • T Sweat

        Another false dichotomy: everything else is a “safe and easy alternative” to CrossFit.

        • http://endofthreefitness.com/ Jerred

          Not so fast ‘T Sweat’. To thwart your false dichotomy statement, I said, to anything, speaking in general terms. Meaning I do not elect to go the easy route, or, I prefer hard work as a human being.

          So, CrossFit or not, I would prefer an exercise program that is not easy and has a certain element of fear/danger like mountain climbing or trail riding.

  • Bruce

    Good article and better title. I have been crossfitting for a year and a half and just got out of the hospital after a 5 day flushing for Rhabdo. My problem was a break down in form because of callous breaks on my left hand during pull ups. I pushed through to complete the 90 but my weight was mostly on my right arm causing the damage. Wouldn’t have happened had I been “strong” enough to call it quits for the day. Gotta wait a couple of weeks but I’ll be back at it just a little wiser.

    • admiral ackbar

      Wouldn’t have been a problem if your crossfit ilk knew how to actually do a pull up. If you did, my guess is you’d be getting about 10% of that… and your hands would be fine.

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  • Elizabeth

    As a doctor, I can tell you that you are absolutely wrong – rhabdomyolysis can happen in ANYBODY, though you are right – exertional rhabdomyolysis is a rarer occurrence. It is NOT more prevalent in “athletes that had it once, lost it, and think they still have it” as you put it. This kind of propaganda is passing dangerous information to the untrained lay person.

    • http://endofthreefitness.com/ Jerred

      Elizabeth, I typically delete comments like this. By comments ‘like this’ I mean when it is obvious someone didn’t read the article, or chose to single out a single sentence out of context. But in your case I will respond….

      1.) You state “As a doctor, I can tell you that you are absolutely wrong – rhabdomyolysis can happen in ANYBODY” Let me pick a quote from my article to help you, “Fact of the matter is rhabdomyolysis can happen to anyone. However, high intensity routines make it more prevalent because people are more likely to actually push themselves.”

      See I think it can happen to anyone as well.

      2.) You state, “It is NOT more prevalent in ‘athletes that had it once, lost it, and think they still have it’ as you put it. Before that statement I put this little disclaimer “***Note: This is 100% a personal opinion***” I want people to know that is MY OPINION, not a factual statement yet my opinion.

      3.) You state, “This kind of propaganda is passing dangerous information to the untrained lay person.” No, you are wrong. This is not propaganda. I give pretty sound advice, Three rules to not get rhabdomyolysis:

      Drink a lot of water

      Don’t do crap (way) beyond your capacity (this is not an excuse to not push yourself).

      Work up to stuff…Increase intensity OR volume, NOT intensity AND volume.

      Furthermore, as someone has has trained 100’s, I never once have had an athlete suffer from rhabdo.

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  • BarryG

    Just another cult confusing “if a little bit is healthy, a lot must be great”. My father did ping pong his whole life, he’s 96 and still driving, living independently. Not many “athletes” in his retirement village. Turns out this is in the literature, intense workouts at least past 50 shorten one’s life http://tinyurl.com/k227hnt . We’re animals that were built for short bursts of activity and moderate energy output. Unless you are young and in an extreme profession such as the military, intense workouts are just bad. I run slow, do a few reps and am never wiped out for a day by workouts. Going for my father’s method.

    • Claude

      So you’re making your health decisions based on a health article published in a financial newspaper that mentions studies that aren’t cited? Who funded those studies? What were the other results of the studies that the author has chosen not to publish? Im not saying you’re right or wrong, but I’d be more open to other sources of info if I were you.

      Your dad’s results are fantastic and given what I know of genetics, if it worked for him, maybe it IS best for you. My family also had several members who nearly made it to the century mark and most of them worked very hard, all their lives.

  • BC

    If the answers to fitness existed in medical school, then our country would not be quite so out of shape. Maybe the doc can get people into shape by charging them $200 to come in, sit in her lobby for an hour, then watch her scribble on a piece of paper for two minutes. It could be called the Pharma workout.

  • Dr Hank

    As a physician who has been doing Crossfit for greater than 2 years and who is currently hospitalized for rhabdomyolysis, I feel as if I am exceptionally qualified to comment on your blog. The line “why rhabdomyolysis is a mental disorder” is not just uneducated but dangerous. You are entitled to your opinion; however, if you preach to the public, your comments should be based on knowledge and science, not baseless opinion. I contracted rhabdomyolysis from doing 14.5. I am in very good shape and know my limits but obviously pushed too hard. However, I didn’t push myself any harder than my competitors, but they are not hospitalized. Please leave the medicine to the doctors and don’t preach about things about which you have no clue.

    • http://endofthreefitness.com/ Jerred

      Ah, Dr. Hank why you gotta be like that?

      You have just proven my point of, “mental capacity does not match your physical capability”. See your other competitors had a physical ability that matched their mental capacity; perhaps you were trying to keep up with someone fitter than you.

      Also, my OPINION is stated from experience as a coach and not baseless. And you, as a physician, did not support any of what you said with knowledge and science like you preached I should do. Example:

      I am in very good shape – by what standard? I’m sure you are, but give me some background.

      and know my limits – Perhaps you do; but maybe you don’t – where you dehydrated, what was the temp, should you have done 14.5? etc.

      However, I didn’t push myself any harder than my competitors – this is 100% subjective opinion, you can’t be in their brain.

      Come on doc, if you want to leave a negative comment here – you’ll have to prove that you went through all that schooling.

      Oh, and I will leave the medicine to the doctors, you leave preventative health to the trainers and coaches.

      Good luck on your recovery!

      • Georgia

        Hi Jerred, this article has some good points but I agree with Dr Hank a little on this one. I too got rhabdo from 14.5. I too have been cross fitting for almost two years and this workout was quite within my limits. My score was good and I felt ok during the workout. Next thing I know I’m in hospital for a week. I think its important for ALL athletes to be aware of this very dangerous condition and putting at risk people into a group such as “untrained athletes” can be a damaging assumption.

        Whilst you mention that indeed it can happen to anyone, I know of at least 10 people who got rhabdo from 14.5 and they were all trained athletes, so there is no at risk feature with any of these people. Maybe instead of being so defensive about your opinion you could open you mind and take in another perspective, especially first hand perspectives of people who have got rhabdo.

        Dr Hank – I would love to chat about your experience, can I contact you via email?

        • http://endofthreefitness.com/ Jerred

          Hey now, I am only defensive when someone calls me “uneducated” and that my opinions are “baseless” as Dr. Hank said.

          I appreciate the other perspectives, but here are the facts: CrossFit Games Open workout 14.5 is A LOT of volume with two full body movements, and no time cap. If I could chart everyone’s CrossFit Games Open performance I would bet that 14.5 was probably the longest workout, with the most volume and work capacity…ONLY for those that got rhabdo. Rich Froning finished 14.5 in less time than 14.1, few can say that, but for those taking 20 to 30 minutes to complete 14.5…you probably shouldn’t have done it in the first place.

          Signing up for the open doesn’t make you a “trained athlete”, no more than buying a gun makes you a marksman. So, I see your point, but I think ultimately we and a few other commenters disagree on what a “trained athlete” is.

          • Georgia

            I again beg to differ. One of the girls I have spoken to her got rhabdo from 14.5 made it to the regionals in the masters category. Another woman completed 14.5 in 18mins 39 seconds. I completed it in 20 mins 13 seconds.

            The average time to complete the workout was just under 21 minutes. There were over 52,000 woman competing in the open and this lady who i mentioned above came 20,462 in the world in that workout. Are you telling me 31,000 other athletes in the world shouldn’t have completed that workout? Are you telling me that anyone that got over the average time shouldn’t have done it? This is the open, this is the only part of the games where “all athletes from beginner to advanced” can compete on the same stage. As Dave Castro self proclaimed, the open is for everyone. I think it is totally ignorant to think that anyone who completed the workout in over 20 mins shouldn’t have done it.

            I am not trying to disprove anything, I am trying to open your mind so that you see that anyone, no matter how fit they are can get rhabdo. Top military personnel get rhabdo. Stop trying to spread that only untrained athletes can get it, anyone can. That particular workout was a recipe for rhabdo and the number of people who got it from that one workout is no coincidence. In my opinion rhabdo is a programming issue, where certain movements coupled together for a long duration directly contribute to it.

            Maybe instead of getting backed into a corner and getting so defensive, listen to what people are saying and take it on board and try empathise with them. I was in hospital for over a week, in the most intense pain of my life, I think I am qualified to have an opinion. I still advocate CrossFit, I also will, it has enriched my life and improved it ten-fold, but people need to be more aware of this real risk that rhabdo can occur.

            Thats it from me, I don’t want to engage in an argument, I just wish people would be more balanced in their opinions.

    • Melissa Stolasz

      Hey there Dr Hank. I too did 14.5 I went big. HUGE. On the way home I had a hard time holding on to the steering wheel of my car. Arms HURT!! All. Week. Long. Like could not lift them to put my hair into a pony tail. I did 14.5 on Monday. By Saturday I was getting normal arm function back. Took Wed and Fri off from CF because I was wrecked. And I never miss but there was no point in going if I couldn’t even undo my own bra at the end of the day. Went back to CF yest. and the WOD was….. burpees and thrusters. REALLY?? 4 rounds into it I walked out. Just felt that was not what my body needed. Now my arms are all weird and puffy and they are swelling up. And they feel weirdly numb and tight. My pee is light yellow but I am worried about the swelling and wondering what’s up. Can you get Rhabdo this many days after the fact? I did NOT go hard yest… there was no way I could, but I did sand-bag my way through 4 rounds…. do I need to go to the dr tomorrow and get levels tested? If so what do I say and what do I ask about? Thanks for your help!

      • Omg

        Go to the doctor now!

        • Georgia

          Omgosh Melissa, I got rhabdo from 14.5 and this sounds like my symptoms. Go to the ER now and get a blood test, this will tell them your CK levels and get put on fluids straight away if they are elevated.

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