Pulled muscles, torn ligaments, broken bones, a nasty case of the flu.
Those are the types of ailments that athletes fear. But there’s another condition that few ever talk about and even fewer understand, yet can have far more frightening consequences—and it’s on the rise among athletes and everyday gym goers.
It’s called rhabdomyolysis, or “rhabdo” for short. This potentially life-threatening condition occurs when an athlete pushes herself so hard in training or competition that she causes muscle tissue to burst and leak myoglobin, a sticky blood protein that can clog the kidneys. Rhabdo can hit immediately following a hard workout or game, or develop after days of overtaxing the same muscle groups. Symptoms include muscle soreness, weakness and swelling, particularly in the arms, abdominals and quadriceps, along with vomiting, brown or Coca-Cola–colored urine, confusion, dehydration and, in the most acute cases, kidney failure.
While the condition is relatively rare, rhabdo has recently become more prevalent, thanks to the rise in popularity of more intense training regimens like iron-distance triathlons, CrossFit, military-style conditioning and high-intensity interval training (HIIT). Treatment for rhabdo usually requires hospitalization, and while the syndrome is usually reversible, it can prevent an athlete from training for several months to up to a year, if not permanently.
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Rhabdo has also become more of a concern lately in college sports, where rigorous preseason routines have sent numerous athletes to the hospital in the last few years; some have even died. The condition often affects athletes who don’t prepare properly for preseason and are then forced to push through demanding training. Athletes with a mind-over-matter attitude are especially at risk, since they are often not afraid of working out beyond exhaustion.
Last fall, eight volleyball players from Texas Women’s University were hospitalized with rhabdo immediately after taking their annual fitness tests. Several years earlier, in 2012, six female lacrosse athletes at Ohio State were admitted to the emergency room after developing the condition due to intense training.
Kelly Becker, one of the Ohio State lacrosse players diagnosed with rhabdo, said the muscles in her arms were so painful, weak, swollen and shaky after one day of training that she couldn’t even write or drive her car. She said she knew something was immediately wrong after practice that day but didn’t know what.
“I had never heard of rhabdo,” Becker told the Columbus Dispatch a year after the incident.
While rhabdo is often foreign to pro and college athletes, there is one community inordinately familiar with the condition: CrossFit, the popular fitness sport that involves heavy Olympic weightlifting, gymnastic movements, running, rowing and other demanding exercises. Since the nature of competitive CrossFit is to push athletes to their physical limits, the occurrence of rhabdo is more common than in sports like soccer, basketball or lacrosse.
In fact, the CrossFit community has been the heavily criticized for pushing its participants too far and prescribing a training regimen that, especially for those who aren’t well-trained when starting classes, injury is often hard to avoid.
Many CrossFitters know “Uncle Rhabdo” as a popular meme, featuring a feverish, bleeding cartoon clown who is hooked up to a dialysis machine next to his workout equipment.
Bodybuilders and fitness freaks beware! Rhabdo doesn't only affect Crossfitters! Take the time your body needs to REST & RECOVER and STAY HYDRATED!! A week off from the gym WILL NOT KILL YOU! But RHABDO COULD! We ended up spending the day in the ER with Ryan hooked up to an IV and CK levels TRIPLE normal range. He was directed to stay out of the gym until Wednesday so if you see him in there before that STOP HIM and CALL ME immediately!! #uncleRhabdo #rhabdo #rhabdomyolysis #bodybuilding #crossfit #fitnessfreak #overtraining #extremeovertraining #stayhydrated #publicsafetyannouncement #stayhealthy
But unlike the meme, rhabdo doesn’t always make its presence immediately known or in the form of easy-to-detect dripping blood or fever-ridden fatigue. Instead, it can creep up slowly on an athlete, especially one who does too much of any single exercise, says Dr. Nikolas Harbord, a kidney specialist at Mount Sinai Hospital in New York City.
“You may not know during the exercise. You may only know after,” Harbord told Excelle Sports. “So in intense exercise, you may often feel muscle pain that’s thought to be from lactic acid.”
In other words, it can be difficult for athletes accustomed to fatigue to tell the difference between muscle soreness and exercise-induced rhabdo. In fact, some athletes don’t even know they have rhabdo for days, if not weeks.
“There are people who have mild levels of rhabdo who just take a week away from their exercise and they are really, really sore,” said Harbord of athletes who don’t recognize they have the condition. “They don’t necessarily need to go to the hospital.”
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If you suspect you might have rhabdo, the best way to know for sure is get a test for high levels of creatine kinase enzymes (CPK) in your liver. High CPK is often associated with the presence of myoglobin in the blood.
Another sign you might have rhabdo: if you’re unable to pee or your urine includes even the faintest amount of blood. In either instance, says Harbord, it’s a sign that you should seek immediate medical help as you may need intravenous fluids or, if more severe, dialysis to prevent permanent kidney damage.
For mild cases of rhabdo, though, total rest and hydration can usually lead to a full recovery. But how much rest can be hard to determine.
“Everybody’s body heals differently, but in a few days to weeks, you should get better,” he said.
Unfortunately, though, there are occasions when an athlete’s muscles never heal completely but remain weak, painful and prone to cramping, meaning she won’t be able to fully train again. That makes prevention imperative.
“Spend time on stretching,” Harbord said of warming up the body before exercise. “Any muscle that’s not stretched and is not working at its full length might well be likely to have harm.”
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Staying hydrated, including getting enough electrolytes, is also key to rhabdo prevention. Proper hydration also helps myoglobin filter through the kidneys faster rather than clogging them up if you do happen to develop early stages of rhabdo.
There is also research suggesting that athletes with predominantly either type II fast-twitch muscle fibers (such as sprinters and weightlifters) or type I slow-twitch fibers (like marathon runners and other endurance athletes) are at a higher risk for developing rhabdo if they follow an exercise regimen not best suited to their tissue type. The data concludes that it’s important for coaches and trainers to create conditioning programs that align with athletes’ strengths and limitations.
The NCAA also recommends that coaches and trainers pay particular attention to athletes who have pre-existing medical conditions like sickle-cell trait, which can make one more susceptible to rhabdo.
Even though rhabdo is rare, it is deadly and can affect anyone who likes to work out. Fortunately, its completely preventable—so long as you’re aware.