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?

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

  1. 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.

  2. 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.

  3. 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. 🙂

  4. 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.

  5. 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.

  6. 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

  7. 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.

Leave a Reply

Your email address will not be published. Required fields are marked *