Rhabdomyolysis
As Summer approaches, two things remain constant: 1.) It will get hot. 2.) More people will go outside. Yes, as the weather gets warmer, it is in our human nature to be more active. Back yards, parks, gyms, and city streets all get a little more packed whenever the weather changes. Aside from New Years, the Spring and Summer months are times where people start physical activities-some new, some old. Lately, there has been a growing trend into “whole-body” dynamic workouts, such as CrossFit, High Intensity Interval Training (HIIT), functional training, spinning, etc. These have all the right components for a great workout. They push you to the next level and help you become a better version of yourself, all while developing camaraderie and giving you a sense of community. However, there are certain things to watch out for when participating in these activities of higher intensity. While our offices are adjacent to training facilities, one of the things that we always particularly look out for is a condition known as rhabdomyolysis. We thought that we’d share a short blog topic on it today to build awareness in our surrounding fitness community.
What is rhabdomyolysis?
Rhabdomyolysis (or simply “rhabdo”, for short), is a condition that involves breakdown of skeletal muscle tissue. Essentially, the cells “burst”, and the contents of the muscles leak into the bloodstream. A National Hospital Discharge Survey reports 26,000 cases in the United States annually1. While it is somewhat rare, it is definitely a potentially serious condition that could lead to kidney failure and death.
There are multiple ways that rhabdo can occur. According to an article in Ochsner Journal acquired in the National Institute of Health archive, rhabdomyolysis is most often caused by direct traumatic injury. The condition can also be the result of drugs, toxins, infections, muscle ischemia, electrolyte and metabolic disorders, genetic disorders, exertion or prolonged bed rest2. The most common way that we usually see this present in our office is usually exertional or exercise-induced rhabdo.
The clinical manifestation and exact pathogenesis of each type of rhabdo is not exactly clear. To spare everyone of the complex physiology of rhabdo, we would like everybody to know that no matter how this particular condition manifests, that they all have one thing in common-direct muscle cell injury and/or failure of energy supply within the muscle cells. This eventually leads to muscle injury and necrosis/breakdown of tissues.
What to look out for
According to Medline Plus and the US National Library of Medicine3, some of the most common symptoms are:
-Dark Urine (aka “cola” colored urine)
-Decreased urine output
-General weakness
-Muscle stiffness/aching
-Muscle tenderness
-Muscle weakness of the affected muscle
Overall, you may feel:
-Fatigue
-Joint pain
-Seizures
Why is it serious?
When your muscle tissue breaks down, certain intracellular muscle components are expelled into the blood, such as Creatine Kinase, Aldolase, Lactate Dehydrogenase, and Myoglobin. The kidneys are important organs that filter the blood and get rid of waste components. As your muscles start to break down, this can cause a drastic influx in the sheer amount of waste products that the kidneys must filter and dispose of. This explains the patients who are experiencing this condition note dark-colored urine. This is due to both the amount, and type of waste products within the urine. This can be particularly taxing to the kidneys, and if left untreated, can cause acute renal failure-or what people know as kidney failure.
I suspect that I have Rhabdo, what do I do?
It is important to understand that while this issue has been presented in our office, it is a potentially serious condition that needs to be addressed under traditional medical care. While we are a form of primary care provider, it is our job as chiropractors to identify the patient that is experiencing these symptoms and then be able to refer them to the proper facility. Once their condition has improved enough that they can be discharged, the patient may elect to seek chiropractic care to help with any additional muscle/joint discomfort, or rehabilitation of the affected tissues.
It is also our job as chiropractors to inform our patients on how to prevent rhabdomyolysis. Here are some tips that can help prevent this condition1.
Drink plenty of water- keeping hydrated helps to maintain cellular health, helps regulate ion concentration, and also helps flush the kidneys which can allow them to function at their best.
Be aware that certain medications such as anti-inflammatories can affect kidney function
Alcohol, in moderation- increased alcohol can cause dehydration. Alcohol is a diuretic which means it will cause you to expel water, rather than retain it.
Note that it is common to experience soreness, sometimes days after a workout. This is a phenomenon known as delayed onset muscle soreness (DOMS). It is important to know that there are other criteria involved with differentiating between the two conditions. If you are worried that you might have rhabdomyolysis, please contact your doctor.
Finally, our best bit of advice is to make sure that you ramp up your workouts responsibly. There are many cases were rhabdomyolysis is a result of “too much too soon”. Obviously, it is your trainer’s job to push you, so that you can improve yourself. But it is your personal responsibility to listen to your body, and to understand that there are risks associated with certain intense workouts. According to Harvard Health, pushing yourself to the “point of exhaustion” should NOT be the idea when beginning a new routine or doing something after not being active for a while1. Know that fitness is a journey, and it is quite alright to not be able to do everything at every workout. If you respect the process, you will get stronger and be able to accomplish more over time-all doing so within a safe manner.
References
Torres, P. A., Helmstetter, J. A., Kaye, A. M., & Kaye, A. D. (2015). Rhabdomyolysis: pathogenesis, diagnosis, and treatment. The Ochsner journal, 15(1), 58–69.