Rhabdomyolysis is only occasionally seen in athletes. Dr. Michael Ray explains why, how the condition is treated and how trainers minimize the risk for their athletes.
Rhabdomyolysis is a medical condition that may arise when muscle tissue breaks down and the contents of muscle cells are released into the bloodstream. One molecule in particular, myoglobin, is toxic to the kidneys and can cause kidney failure and, in the most severe cases, death.
Rhabdo has been seen after high-intensity exercise. It is well known to emergency department physicians who see it in victims of crushing injuries and electrocutions. It can also occur in those with severe bee-sting allergies and massive infections, and occasionally it is seen in athletes, particularly those who have become dehydrated after prolonged exertion in high heat. I work in northern Arizona and see it most commonly in people who have been hiking in the Grand Canyon.
Strategies to reduce the risk of rhabdo include a gradual introduction to intensity. The athletes at highest risk seem to be those with a reasonable baseline level of fitness they have obtained through some non-CrossFit training, or those who are returning to CrossFit after a layoff. These athletes have sufficient muscle mass and conditioning to go hard enough to hurt themselves but do not have the protection that develops with regular exposure to real intensity.
The severely deconditioned don’t seem to have enough muscle mass or the capacity to break down enough muscle to do damage. Established CrossFitters seem to be protected, though the mechanism remains unclear.
There is no way to separate the effectiveness of the training from all risk. A completely safe training program is doomed to produce only couch potatoes. The safety of strength and conditioning programs across the board, including CrossFit, is very good, especially when compared to sports like basketball, football and soccer.