That mean old son-of-a-bitch Uncle Rhabdo is in town. He rarely shows up anymore, and he definitely has overstayed his welcome this time. Uncle Rhabdo is the true epitome of Debbie Downer. Lets talk about the life of Uncle Rhabdo and why you want to avoid him at all costs…
For those of you who may have not totally caught on yet (Lauren B ), I don’t actually have an uncle named Rhabdo. Rhabdo is short for Rhabdomyolysis and it is a breakdown of muscle tissue caused from a variety of different things including crush injuries, electrocution, trauma, seizures, but in my case over-exertion.
I got Rhabdo after completing Memorial Day Murph. For the non-CrossFit addicts out there, that is run 1 mile, complete 100 pull-ups, 200 push-ups, 300 air squats and finish it all off with another 1 mile run. I have done Murph many times before, but this time was the first time I did not partition the bodyweight movements. My overall time was not the fastest I have completed this workout before but an average time for me (46:58). I have been consistently doing CrossFit for over three years and would like to think of myself in pretty good shape as well as educated in the movements, philosophies and ideologies of our sport. So what happened? What went wrong? How did I end up in the Intensive Care Unit almost going into renal failure? First, lets look at what happens when you get Rhabdo.
As your muscle tissues begin to break down, the cells of your muscle fibers begin to release all of their contents into your bloodstream including potassium, Myoglobin, Calcium, Sodium and Creatine Phosphokinase (CPK). So no big deal right? They’re just electrolytes. I thought electrolytes are good for you?
It is actually much worse than that. Think about putting a piece of steak in the microwave for half an hour (46 minutes 58 seconds in my case). To say the least, these molecules can cause incredible damage when outside the structure of your cells.
Before and after of what Rhabdo does to muscles
Now, how does each one of these expelled contents affect you? Potassium, when released into the bloodstream, is toxic to the kidneys and in high doses can cause heart arrhythmias, which could lead to death. Myoglobin is an oxygen-binding protein that is found in muscle tissues. In cases of muscle injury, Myoglobin makes its way to the kidneys, stealing oxygen in the bloodstream on its journey. When it reaches the kidneys, Myoglobin disassociates and a portion called Ferrihemate (toxic to the kidneys) damages the cells of the kidneys and in severe cases can cause acute renal failure leading to death. Calcium and sodium work in a similar fashion causing severe swelling (see pic of my elbows) that can lead to compartment syndrome, which requires immediate surgical intervention. Creatine Phosphokinase (CPK) has no toxic effects to other tissues or organs, but it is a very good indicator for hospital personnel to measure & confirm Rhabdo. CPK levels found in a healthy adult are 20-200 units/Liter. Upon admission to the hospital my CPK level was over 46,000 units/liter!
It is safe to say that we now have a general picture of what Rhabdo is and how it works on the cellular level. Now lets look at signs and symptoms as well as conditions that cause Rhabdomyolysis. The primary focus here is on “exertional Rhabdo,” this is what we need to be most concerned with in our community because it is what we will most likely come across.
Signs & Symptoms of Rhabdo:
- Abnormal urine color (dark, red, or cola colored)
- Decreased urine production
- General weakness
- Muscle stiffness or aching (myalgia)
- Muscle tenderness
- Weakness of the affected muscles
- Joint pain
- Weight gain (unintentional)
Risk Factors of Rhabdo:
- Alcoholism (with muscle tremors)
- Crush injuries
- Drugs, especially cocaine, amphetamines, statins, heroin, or PCP
- De-conditioned Athletes
- Ischemia or necrosis of the muscles
- Severe exertion
So I now know what Rhabdo-myo-whatever is, and I know what I should watch out for, but what happens if I get it? What should I do? Well let me tell you what I did. I waited almost four days after the first onset of symptoms to do anything about it. In
Hey Mr. T-Rex, those pain meds kick in yet?
Here is a list of actions to treat/never get Rhabdo:
- HYDRATE!!! (Dehydration leads to muscle fatigue which will exacerbate Rhabdo)
- Listen to your body (If I didn’t, I could be dead! Seriously)
- Drop the EGO. (If you push it past your capabilities, Uncle Rhabdo will be waiting.)
- Go to the hospital (If you get Rhabdo, you need advanced treatment to save your kidneys. You’ll end up there sooner or later with Rhabdo, so be smart and go early)
- Act prophylactically! (Take steps ahead of time to make sure this doesn’t happen to you.)
- Ice any unusual pain or soreness after every workout (no exceptions here folks, if you come to me with soreness you’ll know what I’ll say from hear on out.)
- Educate yourself [Know what movements are more likely to cause Rhabdo; eccentric movements (loading muscles while also lengthening i.e. pull-ups, squats, GHD sit-ups, etc.)]
- Go through On-Ramp (If you are new to CrossFit, regardless of your background you should start off with an On-Ramp class to avoid Rhabdo)
In-hospital Treatment Guidelines
It is my new priority to make sure each and every one of you never have to go through what I have been through this past week. In no way is it a badge of honor to have had Rhabdomyolysis. It is not cool and it doesn’t make you a more “badass” CrossFitter to be ungodly sore days after a workout. I will not be able to workout for probably over a month and from what I have read, it will most likely take me over a year to get back to where I was before this happened. Kidney damage is said to begin to occur when CPK levels reach greater than 20,000 u/L. I was more than double that. I spent over four days in the hospital. I went through over 25 liters of fluid, and been so drugged up I think I’m going have to go to a few NA meetings now. We do CrossFit to be better athletes, to live a healthier lifestyle and to be apart of an awesome community, NOT to only get better at CrossFit. Do not forget the reason you started doing CrossFit in the first place. No one has a magic cloak of immunity against Rhabdomyolysis. Yes, research shows that some people may be at a greater risk of getting Rhabdo (Someone coming off a extended period away from CrossFit or a newcomer to CrossFit), but just because you may not fit the “typical” Rhabdo mold does not mean its okay to be ignorant. I thought I wasn’t a likely candidate and here I am sitting in a hospital bed writing this to you. Anyone can work his or her muscles past a point of exhaustion and into complete breakdown. Be smart about how you train and educate yourself from others’ mistakes.
Rhabdomyolysis Revisited By Dr. Will Wright
The Truth About Rhabdo By Dr. Michael Ray
CrossFit Induced Rhabdo By Greg Glassman
Killer Workouts By Eugene Allen