Everything You Need to Know About Rhabdomyolysis

For starters, rhabdo doesn’t have teeth and claws. But are you at risk? The answer — plus, how to best avoid it in the first place.

Everything You Need to Know About Rhabdomyolysis (aka Rhabdo) , Injured girl is sitting on the city stairs
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It's the digital era, which means that staying on top of health news usually includes learning about something new that could potentially kill you every single day. (Yay!) One of the latest viral stories, however, has people pointing fingers at something that arguably everyone's come to know as the ultimate way to get healthier: exercise.

But first, in case you don't remember, let's rewind a few years. In July 2017, The New York Times reported on a then-recent study in the American Journal of Medicine about the uptick in cases of rhabdomyolysis (the dreaded "rhabdo" that you've probably heard about) happening as a result of spin class. The story went viral. People everywhere suddenly became deathly afraid of SoulCycle.

Then, most recently, another rhabdo-related story started making the rounds. This time about a 23-year-old woman who nearly lost her leg due to rhabdo, which she got after, yup, taking a spin class. It's important to note, however, that pedaling isn't the only culprit. Case in point? Bodybuilder Dana Linn Bailey developed the condition after an intense CrossFit workout.

Rhabdo shouldn't scare you away from the spin bike forever — or any other form of exercise, for that matter. It's relatively rare, with about 26,000 people developing it each year, according to the Cleveland Clinic. That said, rhabdo is a serious condition that every active person (or person who wants to be active) should understand.

What Is Rhabdomyolysis?

Rhabdo is a potentially life-threatening medical condition that occurs when damaged muscle tissue starts to break down, sending its contents into the bloodstream, according to the Centers for Disease Control and Prevention. As muscles break down, they release the enzyme creatine kinase (CK) and a protein called myoglobin into your bloodstream, which can lead to three serious health complications:

  1. Kidney failure: ICYDK, your kidneys filter your blood and produce urine. Myoglobin floating around in your blood stream can filter into your kidneys, damaging them, says Denise Pate, M.D., a physician at the Medical Offices of Manhattan and a certified spin instructor. This could ultimately lead to kidney failure — the biggest risk associated with rhabdo.
  2. Acute compartment syndrome: Think of your limbs as separate compartments that can be further divided into smaller compartments (your thigh, your lower leg, ankle, etc.). If enough swelling occurs in one section, it can halt anything going in and out (effectively creating a compartment shut off from the rest of your body). This can cause nerves, veins, and arteries in the area to die, says Dr. Pate, which may result in permanent and extensive muscle damage in the area.
  3. Electrolyte abnormalities: When your muscles break down, they can also release potassium and phosphorous into your blood, says Dr. Pate. Potassium control is super important for your heart to function correctly. Too much potassium in your blood could eventually lead to a heart arrhythmia (a heart rhythm problem which can become dangerous if it affects the heart's ability to function, causing dizziness, fatigue, chest pain, shortness of breath, or even cardiac arrest).

What Causes Rhabdomyolysis?

The type of rhabdo that's often talked about (and mentioned above) — exertional rhabdo — is when muscle breakdown is caused by strenuous exercise, says Alexis Colvin, M.D., an orthopedic surgeon specializing in sports medicine at Icahn School of Medicine at Mount Sinai and the chief medical officer for the U.S. Tennis Association. Other causes of rhabdo include trauma, drugs, genetic muscle diseases, or seizures, according to the National Institutes of Health. Occasionally, nutritional supplements (namely weight-loss aids like Hydroxycut) have caused rhabdo, too. (These new e-stim "workouts" are under fire for causing rhabdo as well.)

The main risk you have to worry about, though, is going too hard, too fast with a new type of exercise. Dehydration can also play a part in increasing your risk. "I think it has a lot to do with how conditioned the person is," says Dr. Pate. "Frequently, in rhabdo cases, you're seeing people who are exercising hardcore for the first time, initially starting exercise, or starting a new type of exercise." (See these warning signs that you're pushing yourself too hard in the gym.)

It's worth noting that even experienced athletes are at risk: Paralympic snowboarder Amy Purdy was diagnosed with rhabdo in October 2016. "Usually, it's from eccentric exercise — where you're contracting and lengthening the muscle at the same time, like in plyometrics," says Dr. Colvin. "You usually don't hear about marathon runners getting rhabdo." (Perfect example: One woman got rhabdo from a grueling pull-up workout.)

That's why exercises built around intense bursts — such as spinning and CrossFit — have been under fire for rhabdo in these recent examples.

Symptoms of Rhabdomyolysis

In addition to swelling, fever, and nausea, there are three key symptoms to look out for and all require immediate medical attention.

  1. Muscle pain: Yeah, that post-leg day ache can be a b*tch. But if you're experiencing much more pain than usual, along with swelling or joint pain, it might be time to take this more seriously than your usual DOMS (delayed-onset muscle soreness).
  2. Muscle weakness: Ditto with muscle weakness. There's a difference between having lazy-feeling arms after a day of boxing and barely being able to move your limbs — the latter of which is more along the lines of rhabdomylyolysis from working out. Keep track of what's normal for your body so you know what's out of the ordinary (and, in turn, know when to go to the hospital for rhabdomyolysis...which, spoiler alert, is stat if you're worried about having it.)
  3. Dark-colored urine: While dark yellow urine can sometimes be an indicator that you're dehydrated, in this case, it means something more serious. When myoglobin (a dark-colored molecule) overwhelms your kidneys, it gets released into your urine, changing the color, says Dr. Pate. If your urine is tea-, cola-, or red-colored, or if you're peeing much less than usual, see your doctor, stat.

How to Treat Rhabdomyolysis

First, what happens if rhabdomyolysis is left untreated? It may go away on its own — in fact, many people are unaware that they have it and don't seek care. However, there's a much greater risk of developing complications if you don't get treated. The only way to be 100-percent sure whether or not you have rhabdo is to get checked out at an ER (and keep in mind that it's better safe than sorry). A doctor can diagnose you with a physical exam and by testing your blood and urine levels of creatine, CK, myoglobin, and potassium.

"If you suspect symptoms of rhabdo I would never recommend waiting it out to see if it will clear up on its own," says Dr. Pate. "Since hydration is the main form of treatment, you cannot compare the difference between hydrating by drinking versus IV fluids in a hospital setting."

On that note, you're probably wondering how to treat rhabdomyolysis. So here's the deal: If you wind up in the ER with rhabdo, you can expect to undergo intense rehydration. If ingesting fluids via mouth isn't enough, your doc will likely go about it intravenously. In other words, you'll receive a mixture of fluids and electrolytes through an IV to flush the toxins (think: CK and myoglobin) from your system, according to the Cleveland Clinic. In severe cases, you may need dialysis (a machine that will filter your blood and do the kidney's job for you), says Dr. Pate.

And though it might not need saying, you can't go straight back to the gym. Every case is different, but you could end up staying in the hospital for anywhere from 24 hours to a few days. Once you're released, doctors will likely recommend that you take at least one to two weeks off from exercise as part of your rhabdomyolysis recovery plan, says Dr. Pate.

So, what does rhabdomyolysis recovery look like, exactly? Again, every situation is different. But most people have lingering muscle weakness for a few weeks post-injury, and in up to 50 percent of rhabdo cases, people experience acute kidney injury, according to the Cleveland Clinic. Depending on the severity and level of kidney function, this might warrant extended dialysis treatment.

How to Prevent Rhabdo

Unfortunately, you can't completely eliminate your risk for rhabdo because experts still don't know all of the risk factors, according to the CDC. That said, if you're wondering how to avoid rhabdomyolysis, remember to "Listen to your body," says Dr. Pate.

A group fitness atmosphere or one-on-one trainer may have you pushing past your comfort zone — in a bad way. If you haven't exercised in a while or you're starting something new, ease your way into it, says Dr. Pate. (Watch for nine signs that you're overtraining.) And when you do head to a workout, hydrate before, after, and during the class, she recommends. (FYI, if you're feeling thirsty, that means you're already dehydrated.) Also: Because hot and humid environments may increase your risk of developing rhabdomyolysis from working out, don't go from zero to hot yoga. Steer clear of drugs and alcohol before a tough workout (should be a given) and be wary of supplements. Last but certainly not least, you should stay home when you're sick. While this too should be obvious (especially with COVID-19), know that many illnesses, such as the flu, and cold medications may increase your risk for rhabdo, according to the CDC.

And remember: Exercise is supposed to make your body feel better. Torturous, tough workouts are fun and satisfying in their own way — but in the end, you should exercise for your health, not your ego.

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