Exercise Induce Rhabdomyolysis

In this study researcher identified the dread condition rhabdomyolysis may be much more common after a particularly intense training session than previously believed. But for most people, the only symptom is slightly more soreness than usual. In the past few years, the number of people contacting hospitals with symptoms of rhabdomyolysis after an intense workout has increase dramatically. Otherwise healthy people have been admitted to the hospital with swollen and sore limbs, blood-red urine, and high blood values of an enzyme called creatine kinase.

Rhabdomyolysis occurs when a large amount of muscle tissue is broken down; also the byproducts leak into the blood. Among these byproducts are the proteins creatine kinase and myoglobin. Myoglobin molecules are small; also can easily filter through the kidneys, but when too many of them are released into the bloodstream; also the myoglobin can clog the kidneys and cause acute kidney failure.

Criteria for rhabdomyolysis

Four days later, the students came back to give more blood and urine samples. It was found that all of them had high levels of creatine kinase in their blood, with about half of the participants above the amount used to diagnose rhabdomyolysis. In addition, three of the students were found to have myoglobin in their urine; also thereby meeting all the criteria for rhabdomyolysis.

“The study showed that a significant increase in creatine kinase is fairly common after a hard workout. We can’t say how common it is to have high values of myoglobin as well, however, as our samples were take after myoglobin levels generally have started to decrease. But it seems like it may also be fairly common after a hard workout,” Langlo says.

Despite the increased protein values, none of the study’s participants had any kidney problems. The blood tests actually showed an insignificant increase in the students’ kidney function four days after the workout. “After intense training, people are usually pretty good about drinking lots of water, which may be what’s protecting them. We also encouraged the students to drink enough after the workout,” Langlo explains.

The intense training

Rhabdomyolysis doesn’t only occur after intense training. The most common trigger is actually accidents leading to severe muscular damage. A lot of the literature on the condition focuses on earthquake victims developing rhabdomyolysis. There aren’t specific guidelines for treating exercise induce rhabdomyolysis, so patients who get it are treat the same way as any other occurrence of the disease.

“The main focus is to protect the kidneys with intravenous fluids; with the goal being to keep the myoglobin soluble so that it can be cleared out in the urine, rather than blocking up the kidneys,” Langlo continues. It isn’t actually clear if this is the best course of action for exercise induce rhabdomyolysis. The danger is that patients may be overtreat; also get expose to unnecessary risk of overhydration; so electrolyte imbalances and infections.

“Our study wasn’t design to answer that question; but we know from clinical practice and previous studies that kidney failure is a rare complication of exercise induce rhabdomyolysis. More professionals are starting to treat these patients less intensively, and it’s becoming more common that patients are just recommend to drink lots of water; so as long as their creatine kinase values are decreasing. Adequate hydration is important no matter what trigger the condition; but people who work out a lot are often more aware about staying hydrated,” Langlo says.

Exercise induced rhabdomyolysis

Even though exercise induce rhabdomyolysis rarely leads to serious complications, there’s still plenty of reason to avoid training so hard that you end up with the condition. One of the major consequences is painful, swollen muscles. “Muscular strength and power are reduce for extend periods of time, which is really the opposite of what you’re looking for when you work out. Swelling can lead to tight muscles and decrease circulation. In the worst case, it may be necessary to split the connective tissue membrane around the muscles to protect them,” Langlo says.

The participants in the NTNU study were not allow to exercise for a week before the intense Tabata workout. The results show that the participants with the least experience with strength training were most likely to have strong increases in creatine kinase in their blood. Langlo therefore recommends that people who haven’t work out in a while ease into intense training.

It’s also easier to contract rhabdomyolysis if you have low salt levels, such as after long runs. Lango recommends visiting the doctor if you think you have symptoms of the condition. “There’s a sliding scale between normal muscle soreness and exercise-induced rhabdomyolysis. Intense muscle soreness is common up to a week after a hard workout; but if your muscles swell up or your urine turns red, it’s time to see the doctor,” he said.