Rhabdomyolysis Revisited

By Dr. Will Wright

In Medical/Injuries, Reference

June 08, 2011

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Dr. Will Wright explains “rhabdo” and what you can do to prevent it.

This review article was written to remind the CrossFit community that rhabdomyolysis is a real and dangerous medical condition which creates a need for introductory workouts that are appropriate and safe for new clients.

In recent months, there have been a few incidents of rhabdomyolysis in our affiliates, some of which could have clearly been avoided with more precaution and concern for our newest affiliate members.

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14 Comments on “Rhabdomyolysis Revisited”

1

wrote …

Good article, how about one on SLAP tears?

2

wrote …

Good article, but it does have to make one wonder, what is 'normal' muscle aches from solid workouts and what is rhabdo? I guess I'm just paranoid now, but It almost makes me feel like I have to quit CrossFit (or any taxing workout) altogether. I have been training for most of my life (now 40yrs old) and have at many times, including now as I type this, after performing some of the most recent wods, felt/feel some serious muscle aches/fatigue. I feel there is going to be some serious aches/pains/fatigue when put thru the ringer of a tough wod. Especially games version wods. Many will be wiped out, as we often read in the blog section, or see in pics and videos of many CF'ers thrashed post-wod. I guess my question is, is it possible to have rhabdo, and not even know it? On that same note, if so, I wonder how many times I've had rhabdo in my 25yrs or so of training? I was going to work out today, like I normally would, in my very achy state, but now I'm not so sure. Maybe I should take a few days off, or quit any serious training. Stick to a few push-ups/pull-ups per day and call it good? We see the likes Mikko, Froning, Khalipa etc. with off the chart work capacity, 3-5 wods/day, but I know even they have to get some severe ache and fatigue at times and still 'work thru' it. Sorry for being long-winded. Just curious if anyone else out there feels the same as me...Discouraged? :)

3

replied to comment from Corey Fehr

I'm no doctor, but from what I recall you can get mild cases of rhabdo from workouts. It's not something to worry about unless your urine color is affected or you feel much worse than usual.

As for your personal recovery, take the time you need, and do it right! Sleep, diet, mobility, etc. Recovery is very important!

4

replied to comment from Latham Fell

Latham, Thanks for the reply! That is what I thought also. I do track my water and as far as the urine color, I do pay attention, but in my climate and the gym I wo at (Texas/and gym has no A/C, probably 100 in there)it's hard enough just to stay hydrated and add in supplements, there are times when urine color isn't as light as it should be! But looking at the pic in this article, it hasn't looked like coke yet either! I certainly didn't want to make it sound like I don't take time off, because I do. But even with that, it's the perfect storm around here for Rhabdo it seems, so the article just made me think more, maybe too much so. But I guess that's the premise of it. To open folks eyes. Thanks again!

5

wrote …

"In recent months, there have been a few incidents of rhabdomyolysis in our affiliates, some of which could have clearly been avoided with more precaution and concern for our newest affiliate member"

Did the author just put the blame squarely on someone's shoulders? Considering the tone of the rest of the article (this is real but don't worry too much, just be aware) stating that those cases could have "clearly been avoided" is pretty direct. Wouldn't want to have to defend myself against that.

6

wrote …

The article says its easier to prevent Rhabdo than to treat it but doesnt really get into much detail about preventing it other than ease new clients in. I've seen rhabdo happen to someone who was an experienced crossfitter. Also, what are the most common exercises Rhabdo occurs. I know GHD's and Jumping pull ups are up there.

7

add to the list:
Kettlebell Swings and Downhill running

8

replied to comment from Nate Peo

Nate have you seen either of these:

"Top Ten ways to avoid giving a client Rhabdo"
http://www.board.crossfit.com/showthread.php?t=38220

"The truth about Rhabdo"
http://journal.crossfit.com/2011/06/rhabdomyolysis-revisited.tpl (both wfs)

I would add drop jumps and split jumps to your list. They are relatively advanced plyometric movements, so unconditioned athletes shouldn't be doing them anyway.

Anyone know how to differentiate between severe DOMS and minor Rhabdo? Might not matter.

Brian

9

wrote …

I wish someone would pen an article on getting back into the gym after Rhabdo. I got it a few weeks back and was in the hospital for 5 days. (61000CK). My plan is to do lots of streching and start at 10% of my normal WODs and increase a little each week over a couple of months. I've got this advise from my coach and from another Crossfit affiliate.

Does anyone have any other suggestions?

10

wrote …

I am just recovering from a mild case of rhabdo. been crossfitting for 3 months and was in what I thought was decent shape before I started. The beginning was brutal just 2 workouts a week. I progressed to 3-4 wods a week. I pushed myself last week and made all workouts rxed and the day after was spilling bloody urine. 2 trips to the ER and lots of fluids. mainly pedialtyte and it is rough as hell.
I advise a word of caution to all that training and pushing yourself is what life is about. but listen to your body and your coaching staff.
Now is recovery time and I plan to keep pushing and becoming a better, faster more powerful me on this journey.

chris

11

wrote …

This is a scary one for Affiliates. I'm wondering if taking BCAA's before and after the workout will help prevent this. When I was in the Army I came down with Rhabdo....was down for a couple days. Those were way different circumstances: lack of sleep, lack of nutrition, high stress, high heat, etc.

I'm also wondering if personality type is a good predictor. My first CrossFit workout was after I returned from deployment. I thought I was in great shape, until 3 Marine CrossFit trainers put me through a WOD. Seven minutes into the workout I puked. I completed the workout, after all it was my mission.....then I got really sick. Urine got really dark yellow and I puked for 30 minutes after the workout to compound it.

Crazy nut that I am. I drank a couple bottles of pedialyte and one of the Marines tapped an I.V. No big deal felt better.

This is not a scenario I'd take an athlete through. Again, thinking there is something to do with that mental switch athletes and operators can turn off. I'm crazy enough to give myself an I.V. if needed, my wife is also a nurse. Again, I don't think like a normal human.

12

replied to comment from Chris Sullivan

I'm wondering about preloading with lots of BCAA's. Also, making sure you are well hydrated before and after (easier said than done). I'm thinking you'll be just fine in a couple week. Its most likely the psychological effect.

According to the principle of progressive overload....you should be stronger now than before.

I've had Rhabdo in the military....but that's way different than the civilian world.

13

wrote …

Just read an article that suggests that supplementing w/CoQ10 could help prevent/minimize the occurence/severity of rhabdo:
http://www.naturalnews.com/035846_CoQ10_health_longevity.html

14

wrote …

I was diagnosed this week with rhabdo. I've been doing crossfit for over a year and fall into that scenario of not being prudent in scaling my wod.

I can't pinpoint the cause of course, but some contributing factors include: return from a two week break with no ramp up; fairly heavy wod that included 100 pull ups and 100 kB swings; possible lack of good hydration.

I did not have evidence of rhabdo in the form of darkened urine, etc and only went to the doctor to be prudent. He wasn't convinced it was necessary to do blood work for this reason but I asked to do so. My CK was 50,000 about two days after noticing other symptoms (pain, lost range of motion and swelling).

I'd say the degree of pain and swelling were far greater than anything I've experienced that could be considered doms or 'normal' soreness.

Thanks for the articles and other comments. I'm new to crossfit journal and it's been a great resource for this issue.

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