News
April 23 2018

Rhabdomyolysis: Are you pushing yourself too hard?

By: Mark Paul S. Castillo, MD, Department of Emergency Medicine
 
 

Rhabdomyolysis is the destruction of skeletal muscles, caused by any mechanism that results in injury to myocytes (a type of cell found inside the muscle tissue) and their membranes (or lining). When the muscles break down, it releases myoglobin, an overwhelming amount of which may poison the kidney, causing kidney damage.

Rhabdomyolysis gained attention during World War II, particularly after the bombing in London where victims developed kidney failure and myoglobinuria (myoglobin protein in urine).

It had been initially associated almost exclusively with traumatic conditions or injury, but non-traumatic causes are now five times more frequent. Some non-traumatic causes include abuse of alcohol and illicit drugs, and other medical conditions.

Rhabdomyolysis due to exercise
Recently, rhabdomyolysis is seen in people engaged in strenuous activities or exercises, like spinning, weightlifting, running, and other high-intensity training.

Symptoms are non-specific. It may include muscle pain, swelling, and weakness, fever, fatigue, nausea, and confusion. A brown-red urine may be the symptom that prompts a patient to seek consult.

Worst-case scenarios for rhabdomyolysis is kidney injury or kidney failure (requiring the patient to go on dialysis or necessitate the need for a kidney transplant), and the dreaded hyperkalemia (too much potassium in the blood) leading to electrical abnormalities in the heart and even death.

Although rhabdomyolysis may occur in people who regularly work out if they push themselves too hard during an exercise, it is more prevalent in beginners. 

How to prevent rhabdomyolysis
This condition is preventable. Remember these tips when exercising:
  • It is important to be slow and gradual when beginning a new type of workout routine.
  • Tell the instructor that you are a “newbie”, to assist you in your workout.
  • Hydrate before, during and after exercising.
  • Avoid taking Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) as pain relievers.
  • Do not drink alcoholic beverages when engaged in these exercises because aside from it being a direct cause of rhabdomyolysis, it may also cause dehydration and may lead to further kidney damage.
Most of us would want to push ourselves to the limit to be a healthier individual. However, bear in mind that your body also has limitations. Always do things in moderation. Transforming to a healthier and fitter you is possible without causing yourself injury or harm.    
 
References:
Why intense workouts are leading to a life-threatening condition
By Daniella Emanuel, CNN
Updated 0907 GMT (1707 HKT) July 26, 2017
 
Efstratiadis, G., Voulgaridou, A., Nikiforou, D., Kyventidis, A., Kourkouni, E., & Vergoulas, G. (2007). Rhabdomyolysis updated. Hippokratia, 11(3), 129–137.
 
 
Read more in the second issue of informED (available March 2018 at the Department of Emergency Medicine).