Rhabdomyolysis and Runners, Warning Signs & Symptoms

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.

Rhabdo

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.

running and rhabdomyolysis

Causes of Rhabdomyosysis

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?

Urine Colors

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)
  • Fatigue
  • Nausea/vomiting
  • Fever

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?

42 thoughts on “Rhabdomyolysis and Runners, Warning Signs & Symptoms

  1. Thought I’d share my rhabo experience last weekend (today is Wednesday). Doing a 50 kilometer (31 mile) hike (overnight camping). The trail was very rough and undulating. Needed to carrying walking poles. Carrying (11 kilos / 24 lbs). I’m a 55-year-old male and I thought I was in reasonable shape. I hit the wall at around midpoint on the second day. There were eight ascents of approximately 150 metres in height. I got to the 5th ascent and my energy just drained away from my legs. Absolutely no appetite. Fortunately, I was with a group and they got me to the end (although I should have bailed earlier when I had the opportunity. Plenty of water, electrolyte and magnesium tablets. I dropped 4 kilos through water loss. Got back home in the evening feeling like a spent battery. Then the muscle cramps in my calves set in (like being stabbed). Straight up to the local hospital for an overnight stay where they put 6 litres through me. Felt better the next day, but the doctor told me to drink at least 3 litres water for the next two days to flush out the kidneys ahead of my trip to the local GP who was very surprised to read what had befallen me.

    • Wow, glad to hear you’re feeling better. Feel free to come back and let us know your progress. I hope that you are taking a good amount of time off to recover properly and take care of your body. Get some rest, you deserve it and congrats on finishing that hike!

  2. Hi. This can happen to anyone, young or old:

    My son wound (12 years old) up in hospital last night following a run in the late afternoon. It was quite a hot and humid evening and I didn’t really notice anything unusual about him until the end of the last run where his pace increased and he seemed to not be running in a straight line (I thought he was messing about) . At the end of our last run interval (9 mins on, 1 min recovery – repeated 3 times) he was staggering, speaking nonsense and slurring, blue round the lips and very pale. We sat for a few minutes and his breathing was still quite fast and his HR was high – he didn’t seem to be stabilising so I decided we needed to get home asap. We managed to walk the 5 – 10 mins back to the car and drove home, I put him straight into the pool and started giving him cold water while my wife called an ambulance. He was still in an altered mental state while I floated him in the water – almost falling asleep and his breathing had slowed down almost too much.

    After paramedics checked him over (this was probably about 30 to 40 mins after the run) his body temp was 36.8c, BP normal, HR still around 140, blood sugar slightly elevated (he’d eaten an electrolyte iceblock) and his mental state had returned to normal. They recommended hospital assessment. The end of a long few hours in the children’s ward and a urine alanysis confirmed to be containing traces of blood the docs let us head home. Their final diagnosis was poor hydration during the day (we figured he’s only drunk about 500mls of fluid), heat and over-exertion led to a the Rhabdo symptoms.

    It was pretty bloody scary and I don’t think either of us realised at the end of the run that something wasn’t right until the symptoms were quite severe. I’ll be watching much more closely from now on – I think we’ll aim to be able for him to have enough breath to hold a conversation instead of pushing so hard. I feel awful that I didn’t spot that something was wrong earlier.

    He’s pretty much back to normal today, but I’ll never forget this episode.

    • That is very scary indeed. I hope that he gets back to running slowly and that he doesn’t go back out too quickly. I don’t know all of the facts and by no means am I a doctor but I’ve heard from many runners who felt as if they didn’t recover properly or fully after a case of rhabdo. Nothing in life is worth risking permanent injury. Fortunately it sounds as if he’s young and has a long career ahead of him so a little rest for now shouldn’t make a difference. And don’t beat yourself up for not realizing the symptoms were severe, I didn’t know how severe mine were until it was blatantly obvious. I’m glad that he’s okay and I hope that he recovers quickly and fully. I think he has a good team behind him as it sounds like you and your wife are on top of it. 🙂

  3. Hi.

    I ran my first 100 miles race 16th september and got rhabdo. The only way I noticed it and went to hospital for two days was because of the coca cocla-coloured urine. I still have “normal” pain in the lower body after the race and swollowed up a bit and still is. I took some new tests today and will see a doctor tomorrow to follow them up. The CK is still 6 times higher than normal. I really hope I don’t get this shit again, but it’s hard to know when to stop run if you don’t feel anything wrong.

    How long time does it take before I can go back to train and run again, do you think? How long time did you have to wait to recover? Have you had some problem after?

    • Hi.
      I wish I could give you the answers but it’s different for everyone. The good news is that Rhabdo very rarely progresses to kidney failure but you definitely want to make sure that you fully recover before you start training hard again. Listen to your body and if you’re in pain or there is swelling maybe you should take some time off until you feel a bit better and then ease back in. I’m not going to tell you that it wont happen again because it might but you can take steps to try and prevent it. Try to avoid NSAIDS and make sure you stay hydrated. And while it could happen again, you might also be one of the lucky ones who never gets again. I hope so. And great job on the 100 miler! How’d you do?

      • Thanks for your answer. I never tak NSAID’s in combination with exercise or races, and I really had a good plan with nutrition, energy and drinking, so I don’t understand how this could happen. The only reason I went to hospital after was the cola coloured urine. I did pretty well, I think. It was a tough race and I got 18 hours ,19 minutes and 26 seconds. 🙂

  4. I got rhabdo a few months ago, i ended up in the ER because of it. My level was 2700 when max it’s supposed to be 400 i believe. I was running quite frequently as well as HIIT. I wasn’t showing any of the warning signs besides the confusion ( why i went to the er). I’ve trained as hard as i was when i found out i had rhabdo many times before in the past so i wonder if i’ve had it before. It freaks me out now not knowing how to really get back into the training if i didn’t really know i had it when i feel comfortable picking back up at the level i was when i found out i had it.

      • I was just diagnosed with rhabdo on Thursday. I was playing softball, as I do every Thursday of summer, and as I started running toward first I was stopped by a severe surge of heat and pain through the front of both of my thighs. The pain was so severe that I made my husband bring me right to the ER. I was unable to use the muscles in my thighs. I could not lift my legs or move my foot around. After 2 bags of iv fluid and pain medication I was sent home. I’m very frustrated by this as I enjoy running as my main workout and am trying hard to lose the last 30 pounds after my 4th child. The weekend prior to my injury we had a softball tournament and played 2 games Saturday and 1 on Sunday. I’d also done a 5k Sunday morning. I was fairly sore that Monday but nothing too unusual as I do typically work out pretty hard between running, yoga sculpt, cross fit and hiit workouts. I’m just worried about the lasting effects of this type of injury. Could you please elaborate on the kind of lasting effects this has had on you and how you prevent this in the future? Also, how have you changed your running or training to prevent this? Thanks in advance.

        • Hi again
          After my brush with rhabo, I came across some solid research promoting the benefit of saunas in alleviating rhabo. Go to website foundmyfitness
          Cheers

        • Hi Jackie,
          I wish I could say that I came back 100 percent but the truth is when I get to a certain level of training now, my body literally will not go any further. It’s very weird because I can run 12 miles on a Saturday and feel great and then the next Saturday I’ll have 13 or14 miles on my schedule but at 8 or 9 my body will start to show signs that it can’t handle it. It may be partially mental, in fact, I’m almost convinced that some of it is but it’s physical as well. I get migraines way more than I used to when I push myself too hard and I become dehydrated much more easily. I think it’s my body’s way of warning me that I’ve had enough. I do take a day or two off every week now and I also drink a cup of soup broth with sodium every day because ever since my experience I’ve had a hard time retaining salt and the broth helps immensely. Make sure that you take the time to heal your body and do as your doctor says and you should be okay. Hope you feel better soon.

  5. A close friend has had 2 episodes of Rhabdo in the last year! The second one required hospitalization for 5 days. I am appalled that no one seems to have a protocol for exercises to follow after Rhabdo! I know it’s rare but of latel I’ve heard of more people getting it . And guidelines weren’t give to her after the first onset I look forward to hearing from you! I am a Occupational Therapist
    Although I haven’t practiced in years I never heard of the disease! An educational campaign and research is a necessity !

    • Wow, 5 days in the hospital is serious! Just this week I spoke with a physician friend of mine and I asked him if he would be willing to do a podcast or a Q and A via Twitter with me for some of my readers and he was very open to the idea so stay tuned I’m going to work out the details and I’ll put that together soon! 🙂

  6. I am 69, and I have been running long distance since I was 14, and I never had any problems until the past twelve months in which I have experienced three episodes that I am still trying to figure out if it was HYPONATREMIA or RHABDOMYOLYSIS. I passed out on three different occasions after a run. I have gone to the emergency room at hospital each time. On the first occasion, my CK levels were very high indicating Rhabdo … However, my urine was not dark colored. The interesting thing is that after each episode, I have memory loss. The memory seems to come back after about 3 – 4 weeks which is annoying because I have always had a near photographic memory. I also experience erectile disfunction which seems to disappear after about two weeks. I am told that I have to quit running completely, and this is proving difficult because I have always used long distance running for positive mind process. I have never drank alcohol at all, no drugs whatsoever, and very healthy diet so it is interesting that an activity such as running which has always been a positive turned into a negative.

    • So sorry to hear that you are having problems. I would take the advice of your doctors and if they say stop running then your probably should until you figure out what is causing your episodes. Maybe you could try walking until it is sorted out? I know it seems daunting but recently I had to resort to walking for several months due to severe migraines and actually it wasn’t too bad. Hang in there! It’ll get better.

  7. Hi! What about returning to running post rhabdo. I got it (only he swelling/elevated CK) in my arms. After 8 days of rest all swelling was gone. If running didn’t cause it, and I’m used to running long distances, how soon is too soon to start back training for ultras?.. I can’t seem to find anything…

    • Hi Brandi, my case was similar to yours only it wasn’t my arms that swelled and I was running again in about 3 weeks. It’s different for everyone but I’m curious, did you have any injuries before you got it? That seems to be somewhat of a pattern. I’m working with an expert on the subject and hopefully I’ll have a guest post soon because I’ve gotten a tone of questions and there isn’t a lot of information out there. Hope you feel better soon!

      • Hi! Thanks so much for the reply! I didn’t have any injuries before doing the workout that caused it..”murph” I’m active in the gym on and off and yoga but always running, mostly ultras. I was lucky in that my kidneys were functioning at a 98% when I first got tested but my CK was uppers of 68k. That was day 3 post workout. Day 10 post workout they dropped to 1700 and all swelling was gone by day 8. I ran for the first time 3 easy miles ok crushed gravel and today (12 day post workout), easy like 20 miles with 2600 feet of gain. I just feel fatigued. I’m going to run low milage for another week. Before rhabdo I had no issues at all. It’s very scary and even more so that gyms do not educate people on what could happen. I’m thankful I started hydrating right after the workout but having never had medical issues this was a big wake up call. Anyway would love to hear feed back and what you and the specialist figure out. It’s hard to find anything on the come back recovery process but I guess it’s different for everyone.

  8. I am glad to hear that you are ok. I had exertional Rhabdomyolysis a year ago, when I was training too hard to run a Ragnar Relay. Have you started training again? If so, do you find that you have odd side effects from the Rhabdo? It has been a year and I am still suffering from it but there is little information regarding the recovery process and any long-term effects. Just curious.

    • Hi Sarah, Fortunately I am much better but I had to be really careful when I started running again and slowly build up the miles. As far as odd side effects, I’m not sure if it’s because of the rhabdo but I do tend to get injured more frequently now and my blood calcium levels tend to run high, also I cannot push myself nearly as hard as I used to especially in the summer because I tend to get back aches and nausea and occasionally dark urine. I do know that if you’ve ever had rhabdo, you have a higher chance of getting it again, more so than someone who has never had it. Hope you are feeling back to 100% soon but if it makes you feel any better, it does take some time, hang in there you’ll get there. 🙂

  9. I read a bit about this from anti-CrossFit articles, and it was enough to keep me away from Cross Fit. I guess I associated it more with lifting than with cardio. Scary. I hope you never feel that way again.

    • Thank you. It definitely is scary but fortunately it can be avoided and lucky for me I learned how to keep it from happening again.

  10. Wow thank you for posting this information! I’ve never heard of it before! I wonder if those “exertion” headaches were a sign for me to take it easy?? I’ve definitely learned to listen to my body.
    Great post! I’ll spread the word and link this in my post later. 🙂

    • Thanks Fawn. I think most people who do cross fit are aware of it because it’s a little more common in that sport but I hope that more runners will become aware of it because it happens to some of us as well.

  11. Thanks for sharing the information. The urine color chart is one of those very simple but helpful things each athlete should have around. If the “eyes are the window to the soul” “urine is the window to your health”. I don’t think that’s going to catch on. HAHA!

    • Yeah, probably not. I actually though of titling the post, ‘Urine the clear’ but I second guessed myself. That was probably good right? LOL

  12. Even with all of my marathon and ultra training, I’ve never suffered from rhabdomyolysis, and hadn’t even heard of it until I saw a news report on it recently. It sounds quite scary. Glad you were able to recover from it!

    • It was scary especially since I couldn’t find anything about it when in first happened but fortunately it is very rare and it happened to me because I have a predisposing factor. Luckily, I am able to keep it from happening again by taking a few extra measures.

    • It is pretty severe. Fortunately I found out about it early enough to correct the situation and learned how to prevent it from happening again.

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