Running and Rhabdomyolysis (Rhabdo), What you need to know
I’ve debated whether or not I wanted to write about this, mostly because it’s very personal to me. I was told it’s very rare but in the past few months I have met 4 other runners who experienced the same thing and after talking with others, I realized it isn’t all that rare.
I also wish that I could have found more info on the subject before it happened to me because I could have probably avoided it all together. What it is, is Rhabdomyolysis and I’m not going to go into great detail about what I went through, except to say that I have suffered from exercise-induced rhabdomyolysis. Fortunately, I was able to correct it and learn how to prevent it and I hope by sharing some info about it I can help you avoid it too.
What is Exertional or Exercise-Induced Rhabdomyolysis?
Unlike non-exercise-induced rhabdomyolysis where the progression from rhabdomyolysis to acute renal failure is higher, exercise-induced rhabdomyolysis rarely progresses to acute renal failure, but it can.
Rhabdomyolysis is caused when muscle cells are damaged during exercise. When muscle cells are damaged, the enzyme creatine phosphokinase (CPK) is released into the bloodstream. While normal levels of CPK are around 200 U/L , a diagnosis of rhabdomyolysis is made when those levels rise above 10,000 U/L. While the CPK enzyme itself if not harmful, it is used as a marker to determine myoglobin release. Myoglobin is a protein that can block or crystallize within the kidney tubules. This in turn leads to dark or coca cola colored urine which is a sign that there is a large amount of myoglobin being released into the bloodstream. Rhabdomyolysis can lead to kidney injury and in some severe cases, renal failure.
How do you get rhabdomyolysis?
Although rhabdomyolysis is thought to be a rare condition, in truth a lot of athletes suffer from a mild version of it on occasion. However, when rhabdomyolysis leads to renal failure, there are other factors that are thought to increase the risk, such as dehydration, the use of NSAIDs, recent viral or bacterial illness, sudden increase in exercise or excessive heat. Fortunately renal failure resulting from rhabdomyolysis is rare.
What are the warning signs of Rhabdomyolysis?
The symptoms associated with rhabdomyolysis are muscle pain, weakness and little urine output that is very concentrated and dark. Even if you do not have pain or weakness, if you have dark-colored urine that resembles coca cola or tea and it continues for days or gets worse or if you have lower back pain or become bloated, you need to see a doctor immediately.
What does your urine color say about your hydration?
Be aware of the following warning signs which could indicate Rhabdomyolysis.
- Dark colored urine (looks like tea or coca cola)
- Muscle pain and/or weakness (Sort of like a very severe case of the DOMS Delayed Onset Muscle Soreness)
Runners and other athletes should be aware of these symptoms and if the warning signs are present seek medical attention immediately.
How can you prevent Rhabdomyolysis?
Fortunately, you can prevent rhabdomyolysis the same way it’s treated, by properly hydrating.
You can also prevent Rhabdomyolysis by:
- Avoiding abrupt increases in exercise or training intensity.
- Avoid hard exercise, (or running races) when you are ill or have the flu.
- Hydrate properly – don’t drink too much or too little.
- Avoid all NSAIDs at least 24 hours prior to exercise.
- Listen to your body and if you have warning signs, see a doctor and take some time off.
I also drink a sports drink after a particularly long run and in the summer months when it’s very hot, I weigh myself before and after long runs to determine how much water I may need to replace.
You can find additional information about Exercise-Induced Rhabdomyolysis here.
Have you ever suffered from rhabdomyolysis? And if so, how severe was it?