Acute Rhabdomyolysis

PeteSuppoti

For all of you who know what this is, I am writing to get some advice regarding management of it in regards to strength training. I have been stricken with this in my past and as you know can cause some serious problems. If you have experienced it and moved on past it, please let me know what you did to avoid a recurrence. Thanks in advance.

ilovedeadlifts

If you've ever dealt with it, your programming sucks and you need to quit doing crossfit.............

"strength training" doesn't do this to you.

PeteSuppoti

I will disagree with you on the point that "strength training" does not cause this condition. The cause of this condition is not limited to a particular type of training. It is simply a condition that can occur in an individual whenever there is muscle tear, given other exogenous factors.

However, I am looking for some useful tips and guides on how to limit the impact it may have to those of us who are somewhat more prone to this condition.

DJRicDoc

I saw the message and though I have no personal experience with this, I've read a bit about it and treated it on a few occasions so I could give my two cents here. As a disclaimer, I wouldn't consider this medical advice, if you're really concerned about exertional rhabdomyolysis then I would recommend following up with your family doc.

To get started with rhabdomyolysis I think we have to get the language right...there is rhabdomyolysis (RM) which is a syndrome we see in the ICU where patients have marked breakdown of skeletal muscle with massive elevations of creatine kinase (CK) and myoglobinuria which leads to the systemic complications of renal failure, DIC, hyperkalemia with associated dysrythmias, etc. THEN, there is what we're talking about here, exertional rhabdomyolysis (ER) which follows a much more benign course.

ER is usually a syndrome associated with overexertion (most commonly, but can be associated with normal exertion if there is an underlying abnormality) with nonspecific features such as muscle soreness, tenderness and tea colored urine with a rise in creatine kinase. All of the initial research was done in the military during BMT and they found that elevated CK and myoglobinuria was extremely common with no clinical sequelae, most were self limited with no long term renal or myopathic injury. The risk factors for ER are usually low baseline fitness and early introduction of repetitive maneuvers (jump squats, squats,pushups). The prognosis for ER is much better than RM from other causes (burn, crush, toxins, etc) and in a few reviews I've read patients admitted to the hospital for ER had no evidence of renal failure, it was a self limited condition that responded to some IV fluids.

So I guess the real question is, will it come back? My opinion is the risk of ER decreases as your fitness level increases. Also, were you getting ER when you were really over doing it or were you doing the same exertion as others? It seems that people who get ER when they are really pushing themselves would not need an exhaustive workup; however, if you get ER (muscle soreness, tenderness, tea colored urine) from normal exertion then you may want to get checked out by your family doc to make sure you dont' have an underlying condition like CPT2 deficiency, McArdkle disease, AMPD deficiency, etc. The risks of reccurent ER with renal failure after one episode of ER are not known, each of us may have our own threshold for developing ER. My recommendation would be to stay well hydrated and get in shape at your own pace...like the strong lifts philosophy of starting small to build core over a several week period.

Hope this helps. I read an article entitled "Exertional Rhabdomyolysis: A Clinical Review With a Focus on Genetic Influences" by the Journal of Clinical Neuromuscular Disease which served as the reference for this reply. It was just published this past March, Volume 13, Number 13 Page 122-136.

PeteSuppoti

I do recall being diagnosed with AR, however I also recall the Dr. telling me it was his first diagnosis as such so it appears it could have been ER instead.

This was in the course of some heavy strength training, quite some time ago. In hindsight it was overdone considering the dormant period that had preceded it, which was several months. This workout resulted in extraordinary swelling in my calf muscles (to the point were I could hardly put my heel to the ground when walking). As a measure of caution, I was hospitalized for the purpose of flushing out my kidneys due to extraordinarily high levels of CK. My doctor told me he was erring on the side of caution due to his lack of exposure to this specific syndrome I suppose. I did not suffer any renal damage/failure.

It took about a week for the swelling to subside, and for my heel to be able to reach the ground when walking.

So, it appears this was the case that it was most likely ER. I appreciate your clarity and advice. Since that day I have made it a point to stay as hydrated as possible, as a result of the threat of kidney damage for my lack of it prior.

Thank you.

DJRicDoc

It definitely sounds like ER, and fortunately you were in tune to your body, went to the hospital and got "flushed out" before your kidneys suffered. I think it's very smart to keep hydrated and given your history to be careful with overexertion. I would be curious to know how many people have suffered the same problem you have. When I look at the data form the military trials, 39% of new recruits were documented to have increased CK but I don't know if this was clinically relevant. Anyway, that's neither here nor there...I would say the risk of a subsequent episode is low, but either way, it sounds like you know what to look for...perhaps the trick is...when you think your done drinking water, have another glass.