Let’s talk about Rhabdo, folks. Rhabdo is CrossFit’s “Dirty Little Secret;” something you hear about happening to someone at another gym. Everyone seems to know a friend of a friend of a friend that “got Rhabdo from CrossFit.” Google “CrossFit and Rhabdo” together and you’ll see about 31,900 results and thousands of blogs about CrossFitters’ experiences with this condition . In fact, CrossFit has an unofficial Rhabdo Mascot, Uncle Rhabdo. Rhabdo jokes are frequent at the gym and on CrossFit shirts, but it won’t be funny if it happens to you.
WHAT IS RHABDOMYOLYSIS ANYWAY?
According to the National Center for Biotechnolgy Information at the U.S. National Library of Medicine, Rhabdomyolysis (“Rhabdo”) is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and can cause kidney damage. Rhabdo may be caused by any condition that damages skeletal muscle, especially injury.
There are several risk factors for contracting Rhabdo and they include the following: Alcoholism, Crush injuries, Drugs: especially cocaine, amphetamines, statins, heroin or PCP, Genetic muscle diseases, Heatstroke, Ischemia or necrosis of the muscles, Low phosphate levels, Seizures, Severe exertion (such as marathon running or calisthenics), Shaking chills, and Trauma. Symptoms of Rhabdo include Abnormal urine color (dar, red or cola colored), Decreased urine production, General weakness, Muscle stiffness or aching, Muscle tenderness, and Weakness of the affected muscles.
Your pee should not look like this:
Symptoms of Rhabdomyolysis are non-specific and may not be present, so clinical testing is the best way to diagnose the condition. The two most important factors are creatine kinase (aka CK, a muscle enzyme) and myoglobin (a muscle protein). Extremely elevated concentrations of CK in the blood confirms the diagnosis; however, it is the presence of myoglobin in the urine that generally alerts the athlete that something is really wrong. (When myoglobin appears in the urine, the unrine color changes to dark brown.)
BUT CROSSFIT MAKES MY MUSCLES SORE?!
In CrossFit we worry about Exertional Rhabdomyolisis, which is the degeneration of skeletal muscle caused by excessive, unaccustomed exercise. This rare, but serious complication of too much exercise can affect people of any race, age or fitness level. It has happened to military recruits, “weekend workout warriors,” marathon runners, and even experienced CrossFitters. This muscle damage that arises from overexertion of the muscles can happen to anyone, but usually occurs in the untrained or when high-heat/high-humidity conditions are present and an individual is severely dehydrated and fatigued.
CrossFitters will experience sore muscles. Often. That’s just part of CrossFitting. Sometimes CrossFitters will even experience some slight swelling and pain in muscles and joints. Again, that’s part of CrossFitting and hard training. These sore muscles and minor swelling/joint pain from overexertion do not indicate Rhabdo, but they could be accompanied by slightly elevated CK levels in the blood. This is normal and recovery is fairly rapid.
Rhabdo is much more than run-of-the-mill muscle soreness that lasts for a couple days. When the soreness and pain are accompanied by extreme swelling of the affected muscles, a physician should be consulted to make sure the condition hasn’t develped into Rhabdo. If the muscle soreness and swelling are accompanied by dark urine, get yourself to the ER. Stat! You do not want to go into renal failure. Recovering from a bout of documented acute exertional Rhabdomyolsis could take weeks or months, depending on the severity of the condtition.
THE GOOD NEWS
The good news is that a) Rhabdo is very rare and b) Rhabdo is completely preventable. One way to help reduce the chance of Rhabdo is to maintain proper hydration before, during and after working out. Another way to avoid Rhabdo is to maintain a regular fitness routine. We want you to work hard, but be smart. If your CrossFit Trainer tells you to back off the weight or the intensity of the workout, listen! If you’re dehydrated, fatigued or just not feeling right that day, make sure you back off the intensity on your own. This is not the time to do two or three workouts in one day. If you’re taking a statin or any other drug – or if you have a serious medical condition – make sure your trainers knows this as well.
CrossFit training is hard, but it isn’t intended to put you in the hospital. Work hard, play harder and train smart!