Spinners & Weekend Warriors, Beware of This Growing Exercise-Related Syndrome (original) (raw)

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Rhabdomyolysis “Rhabdo”: How to Avoid This Serious Weekend Warrior Condition

August 18, 2023

Rhabdomyolysis - Dr. Axe

New to spinning? Diving headfirst into a half-marathon with little training? Sedentary all week long and then jump into all-out exercise on the weekends? Then there’s a 14-letter word that needs to be on your radar: rhabdomyolysis.

Often referred to as “rhabdo,” this serious syndrome can occur by overtraining beyond your body’s current ability. And although considered rare and more often associated with “crush” injuries like car accidents and building collapses, reports exist of kidney-damaging rhabdo after a single spinning class.

Studies featuring case reports of spinners developing exertional rhabdomyolysis, many after taking their first class, highlights the fact that going too hard too fast can lead to serious side effects. This is especially true for a subset of people who are often beginners and/or out of shape.

Reports show that active-duty soldiers, firefighters and others with particularly taxing professions and training protocols face a risk of rhabdomyolysis; research also suggests that CrossFit workouts, running and P90X workouts are other among other reasons people land in the hospital for rhabdomyolysis.

You do not have to push to the point of rhabdo to get incredible fitness results. Given the incredible (and sometimes even surprising) benefits of exercise, including high-intensity interval training HIIT workouts, exercise is highly recommended for all. But it’s important to take some simple precautions to avoid this kidney-damaging ailment.

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Anyone taking up exercise for the first time or training hard outside in the heat should take extra precaution to understand the risk factors, causes and symptoms of rhabdomyolysis.

What Is Rhabdomyolysis?

When it comes to the history of rhabdomyolysis, it surprisingly appears the condition was first described in the Bible’s Book of Numbers in the Old Testament. In this instance, the Jews suffered a “plague” while consuming large amounts of quail during the exodus from Egypt. The belief is that the quails ingested poisonous hemlock, which triggered rhabdomyolysis in the humans feasting on the game bird.

But it wasn’t until doctors published literature on “crush syndrome” that we started to really understand the link between muscle damage and acute kidney damage. This research was the result of understanding how World War II-era bombing in London crushed victims’ muscles and triggered acute kidney impairment. Today, we know rhabdomyolysis is major cause of acute-onset kidney failure.

What is rhabdo in medical terms? It’s a complex condition involving the rapid breakdown of skeletal muscle that causes muscle proteins and other muscle constituents to leak outside of cells and into the bloodstream. This damaged muscle and subsequent leakage includes:

A rise in free ionized calcium inside cells is a classic trait of the syndrome. Researchers say this can be triggered by:

This increase in cell calcium levels sets off a series of cellular side effects, including mitochondrial dysfunction and abnormal reactive oxygen species. Ultimately, this results in muscle cell death.

Diagnosis

Doctors use a combination of clinical symptoms plus tests to look for myoglobin and excess creatine phosphokinase (CK) levels to diagnose the serious syndrome.

Rhabdomyolysis CK levels vary, but generally levels above 5,000 U/l reveal serious muscle injury. For comparison, normal levels fall in the range of 45–260 U/l.

In severe cases, CK levels in rhabdomyolysis labs can rise over 100,000 U/l. Often, these “worst case” exertional rhabdomyolysis cases involve a de-conditioned person excessively training while dehydrated and/or under heat stress. Not being properly acclimated to a particular climate and lack of a proper diet can also contribute.

Is rhabdomyolysis permanent? While overtraining beyond one’s capability is one common cause of exercise-induced rhabdomyolysis, there are actually more than 100 different triggers.

It’s also possible to experience rhabdo with or without acute renal failure. Quick identification and treatment can often eradicate long-term problems, although recovering may take several weeks even in cases of severe muscle damage and muscle weakness without kidney damage.

Symptoms

Rhabdomyolysis can cause a wide range of impacts on your body. On one end of the spectrum, someone may experience no symptoms of illness but have elevated creatine kinase levels.

On the other hand, some people experience life-threatening symptoms linked to extreme elevations in creatine kinase, electrolyte imbalance, acute renal failure and disseminated intravascular coagulation.

The exact symptoms one experiences sometimes depend on the causes of rhabdo. Still, here are some of the hallmark signs of the condition. Note: Not all symptoms are always present in each case of rhabdomyolysis.

Symptoms of rhabdo include:

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Complications

Rhabdomyolysis complications can be broken down into “early” and “late” categories:

Early complications

Late complications

Risk Factors

The condition impacts roughly 26,000 people a year in the U.S., although many experts believe it’s much higher than that, with milder, more asymptomatic cases unreported.

While some people show no symptoms and simply have elevated creatine kinase levels, others experience life-threatening complications like cardiac arrest, arrhythmias, compartment syndrome, disseminated intravascular clotting and acute kidney injury.

The following can increase your risk of suffering from exertional rhabdomyolysis:

Exercise isn’t the only cause of rhabdo. In fact, rhabdomyolysis and statins drugs are linked. Other rhabdomyolysis risk factors include:

Causes

How do you get rhabdomyolysis? In the case of the spinning-rhabdo cases we highlighted earlier, the culprit is overtraining that leads to catastrophic muscle breakdown. This is known as exertional rhabdomyolysis.

A study published in the American Family Physician lists the following as physical causes of rhabdo:

As you can see, there’s not just one cause of rhabdomyolysis, but the most common include:

Some causes of the condition have roots in infectious, inflammatory, metabolic or endocrine sources, including:

Some cases arise from genetic conditions that lead to metabolism issues related to fats, carbohydrates or purine-rich foods.

Treatment

When a rhabdomyolysis diagnosis is suspected, the main focus is to avoid damage to the kidneys or “kidney impairment.” Patients tend to have much better outcomes when the syndrome is identified and properly treated fast.

Rhabdomyolysis treatment involves:

How to Prevent

Okay, so how do you prevent rhabdomyolysis? The list of what to do and what not to do isn’t that long, fortunately. Some advice is of the common sense variety, but to prevent rhabdo, it’s also key to pay close attention to fluid intake and the kind of nutrition you’re taking in.

Precautions

Rhabdomyolysis symptoms warrant an ER visit and should be taken seriously. Even those presenting symptoms without cola-colored “brown pee” could be suffering from rhabdo.

The good news is quick identification and treatment (usually involving higher levels of IV fluids) can often bring the body back into balance without long-term damage.

Rhabdo complications can be very serious and sometimes fatal, though, so proper prevention and identification of the symptoms is important. More common “early” complications involve severe hyperkalemia, which can trigger cardiac arrest. Acute renal failure is considered the most serious “late” complication. It occurs in about 15 percent of rhabdo patients.

Final Thoughts