Potential risk of pushing through the pain: Rhabdomyolysis

women working out and pushing bench

personal trainer with group of mature womenIn a society where we want instant results, it can be difficult to pull back the reigns a bit on the workout and ease yourself into it. You may hear people say, if you’re sore, you know you did a good job. But at what point can you differentiate between “normal sore” and “dangerous sore” after a workout? This is a situation I faced about two years ago. I am a registered dietitian. I have received education in a number of medical conditions, diseases, disorders, etc. and how to manage/treat them from a nutritional standpoint. But, I do not recall being taught about rhabdomyolysis (commonly referred to as ‘rhabdo’), not even in my sports nutrition class.  And there may be good reason for that, but there is also good reason for it to now be added to the curriculum.

Rhabdo is a condition where a significant amount skeletal muscle has been broken down quickly and the enzyme creatine kinase is released into the bloodstream. Some of the muscle breakdown product, myoglobin, can be toxic for the kidneys. This can lead to kidney failure if not caught early enough and treated. This condition is common in crushing victims and in some drug use. It also has a history of being common in the military where physical exertion is strenuous. We are now seeing a rise in this condition as spinning classes, ultra-marathon running, and classes like cross-fit are gaining popularity. There is nothing at all wrong with any of these sports, however, often-times people go into these classes without properly building their body up to these levels of exertion. The unfortunate fact is, many of the people teaching these classes (not all of course) have not been properly trained in exercise science and/or kinesiology. They push ‘newbies’ just as hard as they do people who have been attending for a while.

I am no novice to working out. I run, ride a bike, lift weights, etc. I have in fact been a fitness trainer in the past. Two years ago I decided to go to a cross-fit class because I had heard so much about it from others and have seen the results they had attained. Now…I may have a bit of a problem with pride and not wanting to appear weak, so when the coach kept telling me to keep going, I tried my darnedest. I pushed myself past fail over, and over, and over again. The next day I woke up and I could not stand up straight the pain was so bad. This lasted for about 2 full days. About 48 hours after the class, I started noticing that my abdomen was very ‘jiggly’, like there was a lot of fluid under my skin. The edema (swelling) kept increasing. I felt a little nauseated. I assumed I had had too much sodium, so knowing my nutrition I ate some bananas and kept myself REALLY hydrated. I never saw dark urine (a tale tell sign of rhabdo) because I was keeping myself so hydrated. On the third or fourth day my then fiancé had suggested I go to the doctor. I am fairly stubborn, so I chose to look up my symptoms instead…headache, nausea, swelling, all following a strenuous workout. The first thing I told him was to take me to the ER because I might be going into kidney failure. KIDNEY FAILURE…. FROM A WORKOUT! After spending three days in the hospital being given continuous IV fluids to help my kidneys filter out the myoglobin, I was able to go home. The swelling had gone down almost completely, but I was told not to work out for 2 weeks, watch my protein intake (which is broken down and filtered through our kidneys), and to drink lots of water.

It took a long time to get my ab muscles back. I do not write this to deter anyone from working out. On the contrary, you SHOULD work out. I write this because I do not feel there is enough public awareness of this potentially life-threatening condition. I have since seen patients who have had rhabdo recently and I now know how to counsel them from a nutritional perspective. They have had coaches pushing them too hard out in the heat or they have fitness trainers (with little to no formal nutrition education) touting protein, protein, protein.

My take-aways for this article would be:

1) Know who your trainer is. Do they really know what they are doing? Do they have an education in exercise science or kinesiology?

2) Always work up to your workout. Never dive in head first into a work out that seems too hard.

3) Really listen to your body. Yes, you should push yourself, but don’t do what I did.

Finally, always give yourself proper nutrition for your activity. If you do not know what that is, seek out the advice from a registered dietitian.

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Susan Wilson, R.D.

Susan Wilson is a registered dietitian with UofL Physicians – Pediatric Gastroenterology. She received her bachelor’s degree in dietetics from the University of Kentucky, and her dietetic practicum rotations through Cedar Crest College in Allentown, Pa. She is currently working on completing her master’s in public health promotion. She has served on the Kentucky Academy of Nutrition and Dietetics board of directors for the past two years. Wilson’s daughter has a nut and peanut allergy. This firsthand knowledge helps her as she works with her patients with food allergies, intolerance or any other condition where a restrictive diet is required. When she has any downtime, she enjoys jogging, working in her garden, and traveling to new places.

All posts by Susan Wilson, R.D.
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