Rhabdomyolysis - What? Where? How? Why?

April 3, 2017

 

I realize that I tend to write about injuries (ACL, concussions) often, but after all, they

 

happen to even the most fit individuals. My blog post today has to do with something I have

 

been researching for a while, and it was hard to condense it all into a (rather short) blog post.

 

Pushing ourselves to the max and then laughing at how sore are the next few days is always fun.

 

I personally love the feeling of being sore, as it makes me feel as though I worked hard.

 

However, you should not be getting all the way to 10 on the 1-10 scale of soreness. Why not?

 

When we are sore, many things happen inside of out muscles.

 

 

First, what causes soreness? Some of us were taught in our P.E. class that this bad guy,

 

called “lactic acid”, makes us sore. Not really. Muscle damage makes us sore. Every time we

 

workout, we cause tears in our muscle tissue. These happen for various reasons (more advanced

 

physiology), but their prognosis is the same. Muscles are like rope. Tiny little strings might be

 

sticking out of it, but that does not mean it’s not functional anymore. Muscle fibers tear,

 

inflammation develops, macrophages and monocytes come in for the rescue, and between 24 and

 

72 hours, the affected muscle will develop a mechanical, chemical, or thermal stimulation

 

(Armstrong, 1990; Smith, 1991). This is when we should give the muscle group some rest, in

 

order to let it heal. So why are we not supposed to be at 10 on the muscle soreness scale? If we

 

get to 10, it probably means we broke down a lot of muscle.

 

 

Breakdown of muscle tissue at a rapid rate is referred to as rhabdomyolysis. If we

 

breakdown muscle while exercising, this condition is now referred to as exertional

 

rhabdomyolysis. When we breakdown muscle cells, their content leaks into the blood stream.

 

One of these contents is called myoglobin. If myoglobin starts crystalizing in the kidneys, it can

 

lead to acute kidney failure (Sever et al., 2006). If this occurs, your urine becomes very dark

 

(Keltz et al., 2013). I do not mean apple juice dark. I mean coffee dark. Yes, this happens as a

 

result of exercise. Very excessive and unaccustomed exercise. That’s why we do not have you

 

perform unusual exercise with heavy load. We gradually accustom your muscles (strength and

 

movement-wise) to these new exercises.

 

 

 

 

 

 

Sample of dark-colored urine

 

 

 

 

 

 

 

Other symptoms of this condition include muscle swelling. This is due to the water

 

uptake by the injured muscles, making them look swollen, and very tender to the touch (King et

 

al., 2010). It is hard to miss this extend of swelling. After working out, your muscles are slightly

 

swollen, because of increased blood flood to them. However, shortly after your workout is over,

 

blood leaves the muscles and so does the swelling. In rhabdomyolysis, this swelling can persist

 

as long as seven days.

 

 

Another way to spot rhabdomyolysis (aside from dark urine) is the extreme soreness and

 

aching it brings. I know people who were affected by this in the past, and they were not able to

 

put on their clothes in the morning or wash their hair because of the pain in their arms. It was a

 

struggle for them. They can truly say they got to 10 out of 10 during this condition.

 

 

Lack of skill and conditioning (doing too much too early of something we are not used to

 

doing) is one of the main reasons why people develop rhabdomyolysis. This is why we condition

 

you on a daily basis. There are physical activities (and gyms) out there that lack the proper

 

training (or instruction). On the first day, you will be doing exercises you might be accustomed

 

to, but the amount of repetitions is going to be challenging even for the most conditioned athlete.

 

Worst case scenario, you will be doing something you have never done before without any

 

instructions. Why? Because the person in charge just wants to make you hurt. That is a red flag,

 

that is something you have to stay away from.

 

 

Others red flags include overtraining and lack of proper diet and hydration (Eichner,

 

2011; Stanfa et al., 2017; Urhausen et al., 1987). All of these can lead to the depletion of energy

 

levels and electrolyte imbalances, both of which increase the rate of muscle breakdown. If you

 

lack the calories to exercise, or you exercise too much your muscles will let you know. You will

 

hit the wall, and you will hit it hard. Listen to your body, it knows what is going on.

 

Exertional rhabdomyolysis (dark urine, swelling, 10 on the scale) is not as common as I

 

am making it sound. It requires the perfect storm. It happens, but the chances are low, if your

 

trainer knows what they are doing. I guarantee you that all the coaches at SLHF know what they

 

are doing. Our goal is not to make you hurt. Our goal is to improve YOUR Fitness and YOUR

 

Lifestyle. Our goal is not to injury you.

 

 

If you have any questions about rhabdomyolysis, feel free to reach out to me, I would be

 

more than willing to answer them.

 

 

References:

 

Armstrong, R.B. (1990). Initial events in exercise-induced muscular injury. Medicine and

 

Science in Sports and Exercise, 22 (4): 429-435.

 

Eichner, E.R. (2011). Sickle cell considerations in athletes. Clinics in Sports Medicine, 30 (3):

 

537-549.

 

Keltz, E., Khan, F.Y., & Mann, G. (2013). Rhabdomyolysis: the role of diagnostic and

 

prognostic factors. Muscles, Ligaments, and Tendons Journal, 3 (4): 303-312.

 

King, T.W., Lerman, O.Z., Carter, J.J., & Warren, S.M. (2010). Exertional compartment

 

syndrome of the thigh: a rare diagnosis and literature review. The Journal of Emergency

 

Medicine, 39 (2): e93-e99.

 

Sever, M.S., Vanholder, R., & Lameire, N. (2006). Management of crush-related injuries after

 

disasters. The New England Journal of Medicine, 354 (10): 1052-1063.

 

Smith, L.L. (1991). Acute inflammation: the underlying mechanism in delayed onset muscle

 

soreness? Medicine and Science in Sports and Exercise, 23 (5): 542-551.

 

Stanfa, M.R., Silles, N.N., Cooper, A., Arena, S., Landis-Piwowar, K., Aprik, C., & Hew-Butler,

 

T. (2017). Risk Factors for Collegiate Swimmers Hospitalized with Exertional Rhabdomyolysis.

 

Clinical Journal of Sports Medicine, 27 (1): 37-45.

 

Urhausen, A., Kullmer, T., & Kindermann, W. (1987). A 7-week follow-up study of the

 

behaviour of testosterone and cortisol during the competition period of rowers. European

 

Journal of Applied Physiology and Occupational Physiology, 56 (5): 528:533.

Share on Facebook
Share on Twitter
Please reload

Featured Posts

Starting Line Health and Fitness

February 3, 2017

1/3
Please reload

Recent Posts

October 16, 2017

October 6, 2017

September 29, 2017

September 27, 2017

September 13, 2017

September 8, 2017

September 1, 2017

Please reload

Archive