But it’s important to know the warning signs, he says, especially if you’re an endurance athlete.
What Is Rhabdomyolysis?
“I typically tell my athletes to think of every muscle cell as a water balloon full of content — a protein called myoglobin, potassium, enzymes like creatine kinase (CK), and other cellular contents that are supposed to stay inside it,” Dr. Desai says.
In rhabdomyolysis, he says, “Many balloons burst all at once, so their contents flood the bloodstream,” overwhelming the kidneys.
Badly damaged muscles can also swell inside their tight casings, he says, and cut off their own blood supply, a complication called compartment syndrome.
What Causes Rhabdomyolysis?
- Overexertion
- Dehydration
- Heat stroke
- Injury
- Inherited muscle conditions
- Certain medications
- Drugs like cocaine and amphetamines
Muscle breakdown also increases potassium in the bloodstream. Potassium helps control the heart’s electrical rhythm. Sudden changes in potassium levels can throw off cardiac rhythm and make severe rhabdo cases life-threatening, Desai says.
What Are the Symptoms of Rhabdo?
Muscle pain and weakness, and dark urine from kidney stress are common symptoms of rhabdomyolysis, says Brintha Vasagar, MD, MPH, a family physician in Milwaukee.
It can be difficult to distinguish rhabdomyolysis from typical post-exercise soreness. An early warning sign could be pain that feels disproportionate to your workout and that gets worse over two to three days, Desai says. Other red flags are swollen, tender, tight muscles, and true weakness (as opposed to pain-related weakness).
But some people can have no symptoms, Dr. Vasagar says.
Depending on the cause of rhabdomyolysis, symptoms can come on quickly. Vasagar says a potassium imbalance can happen immediately, while symptoms related to exertion may take 24 to 48 hours.
In that scenario, Desai says, “You feel fine leaving the gym, wake up sore the next day, and by day two or three you realize something is wrong.”
Who’s Most at Risk of Rhabdomyolysis?
Endurance athletes are at a higher risk of rhabdomyolysis, especially those who go “zero to 60 in their workouts,” Desai says.
People who don’t typically work out and jump into an exercise program that’s too strenuous are also at risk. So are people who exercise hard in the heat while dehydrated.
Other risk factors include alcohol and drug use and injuries, Vasagar says. She adds that men and people who are Black, have sickle cell trait, or a body mass index over 40 may also be at higher risk.
How Is Rhabdo Treated?
Desai says treatment typically focuses on protecting the kidneys, and includes IV fluids, monitoring blood work, and correcting abnormalities as they happen.
Usually, people with exercise-induced rhabdomyolysis spend a few days in the hospital, and myoglobin levels return to normal over a week or two, Desai says. It can take several days for potassium levels to return to normal, Vasagar adds.
Over several weeks, someone can gradually return to training while getting their labs checked and monitoring their symptoms, Desai says.
Should You Worry About Rhabdomyolysis if You’re a Runner?
Rhabdomyolysis is rare in well-trained runners, Desai says, explaining that most have elevated creatine kinase in their blood the day after a race, a sign of normal muscle stress. But this isn’t necessarily an emergency.
Still, it’s important to know the warning signs of rhabdo: pain that worsens over two to three days, weakness, muscle swelling, and dark urine, he notes. To reduce your rhabdo risk, he offers the following tips:
- Increase workout intensity gradually.
- Avoid adding new or unfamiliar high-intensity workouts, especially right before race day.
- Avoid exercising on a hot day if you’re not acclimated to it.
- Stay hydrated.
- Don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen before or during long bouts of exercise, because they can reduce blood flow to the kidneys.
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