Medical City Healthcare - August 02, 2017

A recent wave of articles based on a 2017 report published in the American Journal of Medicine (AJM) has exercisers — especially those who take indoor cycling classes — concerned that over-exercising will lead to muscle meltdown. Clinically, the condition known as rhabdomyolysis, or "rhabdo," occurs when muscle tissue begins to die, leaking a protein called myoglobin into the bloodstream. Small amounts of myoglobin can be filtered out by the kidneys, but the protein breaks down into substances that can damage kidney cells and too much will shut them down.

Exercise-induced rhabdo among weekend warriors is rare. In the past, it's been more often associated with soldiers, firefighters, college athletes such as the eight Texas Women's University volleyball players who were hospitalized with rhabdomyolysis in 2016 and others whose professions or training can be especially physically demanding. The AJM report is based on three spinners out of a study group of 46 who got rhabdo from indoor cycling; 42 of them became injured during their first class.

Causes of rhabdomyolysis.

Rhabdo can be caused by a variety of issues that lead to muscle death or damage, including:

  • Trauma, burns or crush injuries
  • Severe dehydration
  • Severe exertion, as from Spinning®, SoulCycle®, P90X®, CrossFit® and marathon running
  • Drug use, including cocaine, amphetamines, statins (cholesterol medications), heroin or PCP
  • Extremes in body temperature
  • Low phosphate levels
  • Seizures or muscle tremors
  • Lengthy surgical procedures
  • Genetic muscle diseases

None of the articles suggest that you should stop doing high-intensity exercise, as it can provide a variety of health benefits. But you should learn to recognize the symptoms of rhabdo, because the earlier treatment is started, the better.

Symptoms of rhabdomyolysis.

Here are symptoms of rhabdo to look for:

  • Uncommon pain, stiffness, swelling, tenderness or weakness in muscle groups overexerted
  • Dark red or brown urine
  • Decreased urine output
  • Nausea or vomiting

These symptoms can also be present:

  • General weakness, fatigue or joint pain
  • Unintentional, rapid weight gain, which can signal a dangerous buildup of fluids

Treatment for rhabdomyolysis.

If you think you or an exercise buddy might have rhabdo, call 911 or head straight to the nearest ER. Time is critical in preventing kidney failure.

Treatment for rhabdo can include:

  • Mild cases involve giving patients fluids to rehydrate and flush out toxins
  • More severe cases may involve
    • Dialysis in the case of kidney shut-down
    • Drainage to relieve pressure on swollen limbs (compartment syndrome)

How to prevent rhabdomyolysis.

As the AJM report noted, exercise-induced rhabdo almost always affects people — even fit ones — trying an aggressive new activity for the first time and overdoing it. Here's how to make sure it doesn't happen to you.

  • Slowly work up to a new, high-intensity exercise that you've never done before or that targets muscle groups you're not used to working
    • This means, in a tough workout class, knowing when to slow down or stop even if the instructor is urging you on
  • Tell the instructor that you're new to this type of exercise
  • Stay well-hydrated before, during and after
  • Avoid taking nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen and naproxen sodium) after an intense workout, as they can be damaging to kidneys and worsen a case of rhabdomyolysis

If your latest exercise routine has you spinning out of control, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you or call our free 24-hour Ask a Nurse hotline.

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Revised 8/8/2018

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