It seems that the word "rhabdomyolysis" is popping up more and more in the media lately.
Whether it's pro football players or every day folk doing overly-rigorous boot camp style training, this once seldom heard of condition has almost become common place on internet home pages and on TV.
But what is rhabdomyolysis? What causes it? How do they test for it? What are the symptoms? How do they treat it? And how dangerous is it?
What is it (and how the heck do you pronounce it)? It's is pronounced "r-hab-doe-my-oh-lie-sis". "Myolysis" literally means the disintegration (or degeneration) of muscle tissue, while "rhabdo" means "rod-shaped" and alludes to the fact that there are striations or striping in normal human skeletal muscle.
Rhabdomyolysis is a condition where muscle tissue breaks down and releases myoglobin (an oxygen-carrying pigment found in normal muscle) into the bloodstream. Once in the bloodstream the myoglobin is filtered out through the kidneys. This filtration process can cause kidney damage or even kidney failure.
What causes it? "Rhabdo" can be caused by significant trauma to muscle tissue, particularly when the muscles are crushed (as in disasters like building collapses, earthquakes and accidents), it can also be the result of infections and drug use. Most common in the media of late is the "exercise-induced" variety.
In the case of "exercise-induced rhabdo", excessive eccentric exercise against high-resistance has been implecated as a major contributing factor in developing the condition.
"Eccentric exercise" is the lengthening against resistance phase of an exercise, such as lowering your body down during a chin-up or the portion of a squat where you are moving down towards the floor.
While eccentric is very useful in helping to develop strength gains, but is also associated with increased microtrauma to muscles and delayed onset muscle soreness (DOMS).
Unfortunately, many of the new "go big or go home" type programs encourage inappropriately high volumes of these types of exercise -- often with additional weight added. But the fact is that any extremely repetitive and/or exhaustive exercise (for example running a marathon) could potentially result in rhabdo.
Testing for rhabdo. Apparently there is still no strict medical definition for rhabdo, but all of the following are typically seen in rhabdo cases:
1) Evidence of muscle destruction from some known cause in the patient's recent medical history (in this case excessive exercise)
2) Raised levels of CPK (creatine phosphokinase) in the blood - should be at least 5x above normal values to point to a diagnosis of rhabdo. In rhabdo sometimes CPK levels are 100 times (or more) above normal. CPK is an enzyme found in muscle (heart muscle, skeletal muscle) and also in the brain. Elevated levels in the blood stream usually indicate some type of stress or injury. High CPK levels are also seen in some who's recently had a heart attack.
3) Increase of myoglobin in the blood.
4) Presence of myoglobin in the urine. (the urine of someone with rhabdo is often described as "cola or tea colored")
Symptoms of Exercise-Induced Rhabdo. Besides dark-colored urine (gotta believe you'd notice that one), extreme muscle soreness and weakness following very intense physical activity.
Treatments for Rhabdo. These include aggressive hydration with IV fluids to help the kidneys eliminate myoglobin without further complications. Diuretics to help flush myoglobin through the kidneys. In more severe cases dialysis or even kidney transplants might be necessary. Early and aggressive treatment is key in a good outcome.
Severity of the Condition. If untreated rhabdo can result in kidney failure in 30-40% of cases. Without proper treatment rhabdo can be fatal or lead to long-term kidney problems. Still others continue to be plagued with long-term fatigue and/or muscle pain. Fortunately with early (and thorough care) most people will return to normal within a few weeks to a month.
To avoid rhabdo be careful not to ever radically increase your workout duration or intensity. Workouts that leave you very sore for more than two days are likely too aggressive, progressed too quickly and should be dialed back. With exercise, as with most good things in life, it is possible to have too much of a good thing. Listen to the wisdom of your body and if it seems like you are working too hard, doing too much -- you probably are.
Geralyn Coopersmith, MA, CSCS is an exercise physiologist, certified personal trainer and the creator of The Best Me Ever, a comprehensive weight loss and wellness system just for women
