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.





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):




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.

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