when to return to activity after rhabdomyolysis

How Soon Should You Return To Physical Activity After Rhabdomyolysis?

So you thought you were having a good workout session. Unfortunately it turned out a little bit too intense and you ended up with rhabdomyolysis. Your pee went from yellow to Coca-Cola colored and back to yellow. You’ve been out of the hospital for a bit but now you’re wondering what to do next and how soon you can get back to physical activity.

What To Do After Exertional Rhabdomyolysis

This is part three on our series of exertional rhabdomyolysis – when your workout is a little too intense and you end up damaging your muscles in the process leading to kidney failure. See part one of the series for a full description what causes exertional rhabdomyolysis.

Part two covered on the steps you can take as an athlete to prevent exertional rhabdomyolysis and what kind of rhabdomyolysis treatments there are.

Rhabdomyolysis Recovery

So, now that you’ve experienced rhabdo, you’re probably wondering what you can do. The lucky thing for you is that if you’re wondering what you can do to prevent rhabdo, there’s plenty of information out there for you. Unfortunately, that’s where the information stops – as it’s not too easy to find out what to do AFTER you get rhabdomyolysis. There’s also been no defined medical guidelines on what to do afterwards. This lack of information can lead to frustration as people can have unanswered questions on when they can safely return back to physical activity.

Return To Physical Activity After Rhabdomyolysis

At some point, there’s going to be a period of time where you’re going to want to return to physical activity after being diagnosed with exertional rhabdomyolysis. First, what needs to be done is to consider if you’re a low risk or a high risk for rhabdomyolysis reoccurence.

High Risk For Rhabdomyolysis Reoccurance:

1. When activities have been restricted, it still takes you more than one week to recover from activity.
2. Persistent elevation of blood CK levels(greater than five times the upper limit of the normal range), even when you’ve had strict rest from physical activity for longer than two weeks.
3. Your rhabdo experience was complicated by a kidney injury of any sort.
4. You already have a personal history or a family history of rhabdomyolysis (this could indicate you have a metabolic issue putting you at a higher risk).
5. Personal or family history of recurrent muscle cramps or severe muscle pain that interferes with activities of daily living or sports performance.
6. Personal or family history of malignant hyperthermia or family history of unexplained complications or death following general anesthesia.
7. Personal or family history of sickle cell disease.
8. Muscle injuries after low to moderate physical activity.
9. Personal injury of significant heat stroke.
10. Your original CK blood value was over 100,000.

Last but not least (and I’m adding this in there myself): your rhabdo experience included surgery to correct extreme swelling to fix compartment syndrome.

Low Risk For Recurrent Rhabdomyolysis

Before the advent of modern day exercise (Crossfit, circuit training, P90x, etc.) the majority of rhabdomyolysis cases were primarily in physical training within the military. Obviously, military style physical training in hot/humid environments for hours on end can put a person at risk for rhabdo. Because of that the military developed their own algorithm for a return to physical activity after rhabdomyolysis:

Phase One:
1. Rest For 72 Hours and Encourage Oral Hydration
2. Sleep 8 hours consecutively each night
3. Avoid excessive heat or excessive cold environments
4. Follow up within 72 hours for a repeat blood and urine test – when the CK value is less than five times the upper limit of the lab normal range and the urine has returned to normal, begin phase two. If the labs aren’t normal, follow phase one repeat labs every 72 hours until normal. If the CK remains at least five times higher than the normal and/or the urine test is abnormal for two weeks, see a specialist.

Phase Two:

1. Begin light activity (no strenuous physical activity).
2. Gradually increase the light activity at your own pace for one week; at that time follow up with a primary care physician within one week to assess for a further increase in activity. If There is no return of symptoms, begin phase three. If symptoms return, stay in phase two and follow up with a primary care physician in one week intervals.

Phase Three:

Gradually return to your regular physical activity. Follow up with a primary care physician as needed, espeicially if rhabdomyolysis symptoms return.

Be Smart About Returning To Physical Activity After Rhabdomyolysis

Consult your primary care physician; it should be a given. You need to be assessed to see if it’s safe for you to return to mild activity. Once you have the green light, you can’t automatically return to your level of physical activity before rhabdomyolysis. Chances will be pretty good that you will get it again if that’s the case. I would even suggest working with a fitness consultant to design a fitness program that can gradually increase strength and endurance levels over the course of eight to twelve weeks to help get you back to your baseline level of fitness.

Last of all, don’t be an idiot. Pay attention to nutrition. Hydrate yourself accordingly and give special attention to electrolytes and protein supplementation. Also, avoid drugs, alcohol, and caffeine as these can all precipitate recurrent rhabdomyolysis. If you take statins for cholesterol control, talk with your doctor as taking statins also puts you at an increased risk for developing rhabdomyolysis. In addition to nutrition, pay attention to your environment. Avoid excessive cold or excessively hot environments and most importantly avoid activities that will lead to excessive muscle failure so you don’t end up where you once were.

Have you ever gotten rhabdo before? We would love to hear about your experience and your recovery. Contact us.


Sources:

1. Brennan, F., Campbell, W., Deuster, P., Heled, Y., O’Connor, F. “Return To Physical Activity After Exertional Rhabdomyolysis.” Current Sports Medicine Reports. Nov.-Dec. 2008. Web. 11 August 2014
2. Atias, D., Druyan, A., Heled, Y. “Recurrent Rhabdomyolysis: Coincidence, Syndrome, or Acquired Myopathy?” Competetive Sports Journal. American College of Sports Medicine. 2013. Web. 11 August 2014.
3. Hannah-Shmouni, F., McLeod, K., Sirrs, S. “Recurrent Exercise Induced Rhabdomyolysis.” Canadian Medical Association Journal. 6 March 2012. Web. 11 August 2014.

  • Glenn

    Hi, I am sitting in hospital typing this on my iPad as I recover from rhabdomyolysis after a crossfit session. I found the article above particularly useful and thought to reply with my recent experience.

    I am a 40 yo male, and have always exercised. Soccer, karate, half-marathons, gyms. I have been training in crossfit for 1 year and consider myself fitter and stronger than I have ever been. I adore crossfit and what it has done for me. But like EVERY sport there are particular risks. Rhabdomyolysis is a big one for crossfit.

    The damage occurred on a Friday night WOD, that had a bonus WOD attached to it. The first WOD was strength work, max overhead squats 5 sets of 5 reps. In other words 5-5-5-5-5. This went well for me and I got a new PB. Feeling pumped I chose to do the second WOD, which was 20 full ground touching GHD sit-ups, followed by 2 rope climbs for 3 sets each. It was the 60 GHDs that got me. If you have not seen these, check them out on YouTube, they are an intense movement that involves a huge core stretch, speed and strength. They hit your abs, hips and thighs. This is a large amount of muscle mass, and if you damage this much muscle you are in trouble.

    It’s only after researching this experience that I have found GHDs are notorious for rhabdomyolysis.

    I had not done GHDs for some time so was not in good condition for them to start with. I pulled out the first 20 ok, with a bit of a struggle at the end. I found the stretch hurt quite a lot. The next 20 were hard. I quickly lost speed and strength and really pushed to get through. I should have stopped here. The final 20 were hell, having to pause between each rep, straining to make each one. My muscles were shaking and I had 0 strength left in my mid section and thighs afterward. I could barely climb off the machine. During the last rope climbs I could not lift my legs to get a foot hold and had to climb leg free.

    I got a good time though! The whole class was watching and pride was on the line here!

    Idiot.

    When I got home I could hardly walk. I did not have any electrolytes or protein like I normally would, though I did drink a lot of water. Over the next 2 days my hips, thighs and stomach all seized up, I was walking around bent double and in a lot of pain.

    On the Sunday night 2 days later I went to pee and it was black, Coke looking. I thought this has to be ‘Rhabdo’. I called the doc and was told to go straight to ER. They had trouble believing me when I got in, they had never seen Rhabdo caused by over exercising, only from muscle damage caused by car accidents etc. After my bloods came back with a CK reading of over 89,000 we were all in a bit of shock (it should be 100 – 300).

    They hooked me up with IV sodium chloride solution unregulated for 12 hours then went to 250ml per hour plus oral hydration. They frequently blood test me for kidney function and CK levels. My kidneys are good so far thank God, and my CKs have gone each day from the original 89,000, to 56,000, 48000, 29,000, and just an hour ago 20,000..

    I may just get away with this but it has been frightening, particularly when talking with doctors about dialysis, kidney failure and death.

    My God It was just a workout!

    In retrospect this was caused by several factors, not just the workout.

    – no.1: I DID NOT LISTEN TO MY BODY!

    – It was the end of the week, I had already done 3 WODs in the proceeding days, so I went in tired. I must have been dehydrated with low electrolyte levels after the first WOD on the Friday and this would have caused more strain on my body.

    – I was doing high, fast reps of a difficult movement that I was in no condition for.

    – I was pushing to prove to myself I could get through it and knew the class was watching. In other words I let ego and pride get involved. ALWAYS bad for crossfit. Leave your ego at the door.

    The only smart thing I did was get fast treatment at the first sign of an issue.

    I have learnt so much from this. I will be going back to crossfit after gradually working up to it but I will be far more wary and conscious of my body’s messages. The mind can push us far more than the body can handle.

  • Glenn — that’s a crazy story and I hope you’re starting to feel a little better by now. It always seem to be that moment in our head where we think we shouldn’t be doing something that ends up getting to us. There’s definitely an element of Crossfit that comes into play that puts people at risk for developing rhabdo. Have you any plan for returning to activity?

  • Glenn

    Hi,
    I am at home now and going for a final blood test tomorrow. Looks like my Kidneys are ok.
    Yes, I plan to go back to exercise after a weeks rest from now. I will work up to full training over about 3 – 4 weeks or until I feel comfortable. I might just listen to my body 😉

  • Glad to see you’re doing better. Take it easy. Drink plenty of fluids with protein supplement and potassium/sodium replacement. Listen to your body and let us know if we can help you in any way.

  • Stephanie

    Hi! Thank you for this article. I am recovering from a 3rd bout, but by far the worst, rhabdomyolysis I have had and am terrified to get back working out.

    I have had muscle swelling episodes for 11 years (I’m 30 years old now) and no one can figure out what causes them. I wake up with isolated muscle swelling about once every 2 months and I have constantly elevated CK counts (my baseline is 500-1,000. I have run marathons, which never causes any swelling or rhabdo for me, yet playing tennis for the first time each spring, will undoubtedly make my hands swell. I’ve had every test done under the sun to figure this out, been to the Mayo Clinic twice for extensive tests, and every doctor has deemed me a mystery.

    I am very active, working out 3-5 times a week my whole life. I’ve never done crossfit or heavy weightlifting…I mainly stick to cardio – running and gym classes, yoga and light weights. The Friday after Thanksgiving break I went for a 3 mile run outside. I live in MN and it was very cold, about 10 degrees, so I was very bundled up. I was noticably cold at the beginning, but felt great after a mile. I then went inside my heated house and did some yoga and stretching and a few push-ups (I’m talking 15 modified push-ups). I felt great the rest of the weekend and even went snowshoeing on Saturday for a few miles.

    On Wednesday night (5 days later…MUCH later than other episodes) I started feeling full body stiffness and noticed my arms and legs starting to swell. Then on Thursday, December 4th, I got into my doctor to check my CK (this isn’t my first rodeo), but they were unabel to get results for 2 days. I got home from the doctor and the pain and immobility was so bad I could hardly get out of the car. Then I peed and it had a slight brown tint…I had been warned about “coke colored pee”, but this was DEFINITELY not coke colored, this was light, much like apple jucie. I think that’s important for people to know as it made me think twice, but it was no where near brown as I had been warned about. I made my husband pee so I could compare to make sure I was seeing a different tint! After 2 pees of apple juice, we headed to the ER.

    Sure enough, my CK was 74,000 and I was admitted for the next 6 days. My levels progressively went down and when they got to 12,000 on December 10th, so I was discharged. I have been getting labs drawn every other week to monitor since and I am still at 3,000 over a month after discharge. I am weak, and definitely not myself. Before Christmas I was on my feet a lot and that was enough for my levels to spike up to 7,500. So, I’ve been on quite a rollercoaster. I know I’m not ready to resume exercise – I still have muscle cramping in my legs and am lethargic.

    I’m curious how long this can take to get to regular levels and resume exercise? Also are there any dietary things I can do now to help get my levels down and get me feeling better? Have others been put on prednisone to help treat? I’ve been on prednisone for 7 weeks now and the side effects are terrible. I don’t think it has been helping as my levels are still 3,000 and have fluctuated since being on prednisone. I just wish there was a support group or people I could ask questions to (albeit, I know my situation is rare). I’ve asked my doctor, but there is no clear direction. As an active person, it has been extremely frustrating not being active for 7 weeks now and more than anything, not feeling myself.

    Thanks for the article and for listening 🙂

    Stephanie

  • Wow Stephanie, you are right, that is quite the roller coaster. You’re right about prednisone – the side effects can suck (weight gain, bone loss, difficulty maintaining blood sugars etc..). I’ve heard of people being put on prednisone for rhabdo and it helping but it’s tough trying to figure out what might be causing it in the first place in your situation. What caused it the first time? Are there any other medications that you regularly take (sometimes rhabdo is caused by prescription meds)? Have you ever asked your doctor if it could be related to a congenital muscle enzyme deficiency or something such as Duchenne’s?

  • The_cat

    Hi,

    Thanks for the info on the topic. Actually,there isn’t much of it around the web. I found several academic articles but they’re not free.

    I am recovering for a mild case I would say, after a quite excessive training , this is 50 min of weight liftings after a 2 month hiatus, 45 min spinning session and later on that day swimming training with the squad. I hydrated myself quite poorly that day to be honest.

    Next day I was suffering of major DOMS on both arms: I couldn’t extend them past a 120º angle. Quick search on the web, all I find is some fitness guys that go through the same , saying don’t worry, it’s just DOMS. I felt all the time quite well, and my urine never turned brown.

    The next day, the situation didn’t got better. I still suffered of the arms issue, but kept ignoring it. I even go again to the gym , and do some leg workout. Later that day, in the train home, I do a second search and I come upon some guy’s post with my symptoms talking about some critical health issue called Rhabdo. I freak out in the train, totally scared shit. I go to ER immediately, CK level = 25K. 5 Days later, I am back at home.

    Yes. Internet saved my life, or at least, my kidneys.

    I’ve been told to rest for 2 weeks. I am at week 1 and I wonder wether this is maybe too much rest time. I feel good, my arms I think they’re at 99% of their capacity. I just want to read about cases of people returning back to their daily exercise, but unfortunately, I don’t find many. Not sure if this is due to people just continuing with life and not bothering about telling success stories so much. Hope I return to my daily stuff, sport is my life and I am not willing to give it up because of this.

    Regards,
    The_Cat.

  • The_cat

    Hi Glenn,

    Let us know how do you do now some time has passed.

  • Hey The_Cat –

    It’s hard finding cases about people returning back to their daily exercise. For one, it’s just not well researched and because of that there isn’t really a legit protocol of when to get back to daily exercise. One thing is known though is that regardless, you have to take it slow. Two weeks of rest sounds adequate and regardless intense physical activity is something that needs to be worked up to otherwise you can easily find yourself right back to where you began. Think of it this way – your muscle tissue literally gets damaged so the tissue needs to work up to what it once was. Nutrition and hydration is key and there’s no reason to give up – just a few little tweaks here and there 😉 Because not all rhabdo cases come along with coke colored urine, there’s probably a lot more cases that come up than are reported because some general symptoms can be so similar to DOM’s. Hope you feel better!

    This article might interest you about a personal story from a reader who worked back up to her prior fitness levels after having a case of rhabdo:

    http://yourlivingbody.com/personal-rhabdomyolysis-experience/

  • The_cat
  • Thanks Cat – that was actually one of the research articles I used as cited in the sources. 😉

  • Derek

    Hi,

    After reading this, I have decided to relay my recent story with rhabdomyolysis as a medical professional:

    I am a 30 y/o male that is of good health and a BMI of 25. I consider my fitness level to be low, but I am an active person. I had a glenoid labrum repair 8/2013 and gave myself adequate time for the structures to heal properly. So 18 mos after the surgery I decided to start a workout routine with free weights. I went in and completed a 50 minute work-out, focusing on muscle groups in the upper body. I completed this with some time in the sauna and the steam room. The story should probably end here, but I’m a man.

    Approximately 24 hrs later, I returned to the gym to participate in their ActivTrax program. Thinking this was going to be a mere health assessment, with no physical training involved. My goal was to obtain a reccomended fitness routine and caloric intake for my goals of decreasing fat and increasing muscle mass. Needless to say, when I arrived, I was told we would get a baseline of my physical fitness, which involved machines to evaluate bench press, shoulder press, leg press, and lower back/abdominals (not sure what this machine is called). Abdominal crunches were also in the circuit and only one set, usually around 10 reps, was completed with each exercise station. Afterwards I was a little sore, but still felt well enough to get in my cardio for the day and ran a mile.

    The next morning I was pretty sore and as the hours progressed, I could barely bend my arms or do anything that involved flexing my pecs. It was miserable. Sure enough, by that afternoon, my urine looked like tea. I attempted oral rehydration at home, but the myoglobinuria persisted. I went to the hospital early the next morning for what I thought would be an ED visit for IV rehydration.

    I was subsequently admitted. My CK levels in the ED were 97,000 and the next morning it was recorded at 163,000. Luckily the third day it had come down to 144,00 and on the fourth day we were at 76,000. I was discharged that day. My kidneys were lucky enough to never take a hit, max Cr was recorded at 1.16. I did experience a mild hyponatremia from excessive free water intake the night before seeking medical attention (or further medical attention, if you will).

    I am now 3.5 days post-hospitalization and I only have a slight tightness in my biceps, triceps, and pecs. I will have my CK and BMP evaluated Monday, to assure that I am back at baseline.

    Thank you for this post. I was trying to do a quick search, prior to diving into the literature, about exercise after rhabdomyolysis. This has definitely given me a good starting point.

    Best regards,

    Derek

  • Hey Derek,

    Thanks for your response. Sorry to hear about your bout with rhabdo. Good luck with your recovery. If you have the time I’d love to hear about how you get back to your pre-rhabdo fitness levels. What do you do in the medical profession? If you come across any good literature, let me know. The amount of research out there is so limited from what I could find. One woman who wrote me shared her story: http://yourlivingbody.com/personal-rhabdomyolysis-experience/ and with the help of her MD, she got back to her physical norms and then some.

  • kathy

    I am being treated presently for rhabdo. I find myself frustrated because I workout 4 timed a week. I do crossfit but I don’t do heavy weights and modify a lot because of a back injury. I did 3 – 6 min rounds that had squats, pushups and pull-ups with 2 min rest between. I never did get tea colored urine – there is the take home message! You can get high CPK without kidney failure. My CPK peaked at 35,000. I knew something was wrong when I couldn’t straighten out my arms and they were even more sore at the end of 48 hrs post workout. The moral of the story is don’t wait for your urine to change color, the possibility of your kidneys being damaged increases. Thanks for posting the back to exercise plan. There is not much out there.

  • Kari Ashley

    I also got Rhabdo after 10 minutes of pushups, pullups and squats. I did 5 modified pull ups, 10 modified pushups and 15 squats in reps, got about 4 and a half reps in. It was my first time to try crossfit but I am an active person and do workout. Two days after my workout, my arms were in severe pain, I couldn’t lift them above my shoulders at all, and they started to swell. I had done the workout a Thursday evening and ended up going to the ER on Saturday night, so about 2 full days after my workout, my urine was brown and my CPK levels were at 108,000. I was in the hospital for 6 days, and the entire time the doctors were really worried about my kidneys and worried I would get compartment syndrome because the swelling was extreme and didn’t go down the entire time I was in the hospital. I was off of work for a week after getting out and have been on light duty ever since, still a month later. (I’m a detention officer so it’s probably not a good idea to be on regular duty where I could be at risk of getting into a physical altercation with someone.) I’m very frustrated and tired still. I have to go to a blood doctor and a muscle doctor in the next two weeks to find out if there is any other underlying cause of why I got this and why it got so bad, so fast. I will definitely be asking the doctors when I can start being active again, and when I will maybe get my energy back. Good luck to anyone on here still suffering from Rhabdo, I wouldn’t wish it on my worst enemy!

  • Beth

    I’m recovering from rhabdo now and trying to get back to workout. My rhabdo started after a leg day in my quads. The post leg day twitches never went away and went straight into pain while my glutes and hams went through normal DOMS. My urine was darker but not really dark bit I was feeling really bloated and the soreness lasted 5-7 days. I decreased my next leg day about 10 days later and it occurred again. Then I found rhabdo online and thought it is what I had. I called my doctor but be said I’m getting older and need to workout less. I spoke with 2 other friend doctors that were doubtful that is what I had. The pain only occurred after fast twitch muscle workouts so in between I was teaching spin classes and wouldn’t get the pain. Then my leg day was down to 60 air squats with the same pain as my initial occurrence with my longer, heavy leg day. It was so painful on my quads that when my hubs would give me a gentle love pat it felt like he hit me with a baseball bat. I found a doc that finally listened to me and sent me for testing. When I was tested I was not sore at all and was about 20 days out from being sore and my CK levels were over 3400. After 2 weeks of no workout I was down to 64. Now I am trying to get back into it again but fearful. I know i need to progress slowly but I felt really discouraged the other day in pilates when we were laying on our stomach and my quads were in pain just from the resting pressure on the floor.

  • Things are very vague on what to do after rhabdo and almost differs for each person. What’s your nutrition looking like? That has a huge impact as well. Start off with simple activity – you can’t go from zero back to one hundred. Activity as tolerated is the key.

  • Absolutely right! Some people have some but not all the symptoms.

  • Good luck Kari, keep us posted on how your MD’s take you back through the course of recovery and if they find anything that predisposed you to rhabdo.

  • Beth

    My nutrition is good. I eat clean. I love my chocolate treats but Ionly get one a day and I have to earn them, LOL. After my diagnosis I increased my salt intake (I don’t eat processed food and never use salt with cooking so it was low). I also started drinking Gatorade and increased my carb intake. I think it helped as the last occurrence I had prior to diagnosis was not as severe as the previous occurrence. I am trying to go slow and just walking a few miles a day, spinning a few times a week, pilates a few times and lifting my upper body. I can still feel that my quads are damaged when I am doing some things in pilates and I have to make modifications or bow out of some moves. My quads are still sensitive to the touch at times. I am trying to take it easy yet keep up the activity that hasn’t bothered it, meaning my slow twitch muscle activity. It is hard though as I feel like my body responds better when lifting and doing resistance. It is so hard to know where to start and how to increase. The fear of the damage it can do as well as the fear of the pain also holds me back.

  • Mary Steele Gair

    I had rhabdo 6 weeks ago. I have been doing max-contraction type weight training for 7 years now. I go once a week only, to give sufficient recovery time. 6 weeks ago i had a little tougher workout than usual and knew I “hit the wall”. Two days later I could barely move my arms. The day after that they were actually swollen from the elbow up. I started looking online and found a post by a young woman who had rhabdo and her photo of her arms looked exactly like mine. the next morning I had bloodwork done and my ck level was 17,000 but the creatinine (thankfully) was normal. I drank as much water as I could and three days later my cpk was down to 2300. The following week it was 300. I was not hospitalized. I am 58 years old, a healthy weight, and as I said I’ve been doing these workouts for 7 years. I am, however, taking Vyvanse, an amphetamine prescribed for ADHD. I am surprised all your people writing in are talking about Statins and their relationship to Rhabdo, and I haven’t seen any mention of amphetamines. There is very little info out there about this relationship. I believe a lot of those Iowa football players were on ADHD meds. Certainly recreational use of amphetamine drugs like cocaine is known to put people at risk for Rhabdo but what about daily controlled use of prescription drugs like Vyvanse?

    Anyway, I waited a couple of weeks to return to the gym and when I did was put through a fairly “light” routine. I went the next week as well and maybe the next (I don’t recall) and then I went to visit a friend on her farm and help her in her busy season of goat kiddings. I worked hard in the barn, lifting hay, buckets of water and milking goats which I hadn’t done in almost 30 years. I was very tired but understandably so since we were missing sleep due to births in the barn at 4:00am etc. I did this for 5 days and returned home exhausted. I felt I shouldn’t have been as tired as I was feeling. I sat on the couch and realized my arms were feeling like they felt when I had rhabdo. They were tired just hanging there. I had my bloodwork repeated and everything was normal. That’s the good news. BUT – my arms are still tired. In fact just typing this is fatiguing them. So although I’m not in any rhabdo-danger I am confused about how to proceed.

    I am thinking that although the Rhabdo had cleared up, I still haven’t had time for the muscle repair to take place. The physical work I’ve done since may be making me weaker rather than stronger. It’s a frustrating place to be as you can imagine. I don’t know how long I need to rest. If I were to follow your military guideline, I should be able to go back now, but it doesn’t seem as though I should. Should I just wait until my arms no longer feel tired?

  • The_cat

    Just wanted to update here.

    Today, I came back to the doctor for follow up. My CK level came as 413 U /L . The lab range goes to 303 as max. So, I am outside the “normal” limits . To be honest, the day before I participated in a pretty hard mountain bike competition, so I expected some result like that. My doctor told that he understands that this could be the reason, but he wants to repeat the test after three days of total resting to define my CK baseline. If numbers are still high, I will be investigated by specialists.

    Anyway, I am back to full exercise, except for the weight lift thing.. I am lifting but very carefully and with small weights as of now. No problem with running , swimming and biking.

    Hope that next time my levels are within range and I can forget about this disgusting incident.. Of course, I won’t never forget this and I will train with much more intelligence.

  • That’s awesome. It’s not uncommon for people who are very active to have higher CK levels than people who aren’t. You and your doctor might find this study useful:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465154/

    There is a proposition out there that athletes should have a higher CK upper limit than those who don’t work out at all. Your doctor is spot on trying to figure out your baseline.

  • Freddy

    So I signed up to the gym after not being active for almost a year and just sitting all day in a computer. Went to the gym and killed it. Thing is my urine turned brown and as hard as it is to believe it I ignored it for like two days I think and kept going to the gym and doing hard workouts for about 2 hrs. My arms got swollen too and I couldn’t bend them but I still went. Then my legs got sore also but I still went back but I finally decided to look it up and I deff got Rhabdo, no doubt but I can’t afford a doctor so not going to one. This is my second day without going to the gym and drinking water and stuff but I was wondering when I could get back cause my arms are fine now. I’m 23 yrs old and been active my whole life, I play sports and even used to go to the gym before but then stopped for a while and just got back to it. I read all the comments and I guess I should take a whole week off? maybe two? That’s so much rest and I really want to workout but I’m afraid I’ll make it worse or if i don’t have it, I’m afraid I’ll get it again. By the way I didn’t lift as much weight as I could but I did a lot of reps, when I get back should I increase the weight and do less reps? like was light workout? reduce the reps by half or the wights? I felt like I was doing light workout and I got rhabdo so I’m confused. My urine went back to normal the day before I started resting from the gym. I went to the gym for 5 days straight.

  • For an active person, getting rhabdo is horrible. Rest seems like an eternity. But with rhabdo, plenty of rest is needed. I don’t offer specific advice for the individual, please contact me in regards to individual services if you’re interested in developing a specifically tailored workout plan geared towards rhabdo recovery.

  • Muscle weakness in severe rhabdo can persist for quite some time. A lot of people want to get back to working out right away within a few weeks but in severe rhabdo cases it can take months to workup back to where you used to be. Listen to your body – if your arms feel tired, don’t push them as hard as you want to. Talk with your doctor about your ADHD medication – you’re right, amphetamines can increase the risk of rhabdo. Also, nutrition is key for rhabdo recovery.

  • Kari Ashley

    I don’t think you should ignore going to the doctor, expensive or not. I was told I could have died easily with the CK levels I had, and also could have gotten compartment syndrome, if you don’t know what that is-look it up. I wouldn’t ignore something so serious. But I’m not a doctor nor am I you, I just think if you’re having such issues you should maybe consult with a physician.

  • Well said. Nothing is worth risking having to be on dialysis the rest of your life. Love your kidneys and they’ll love you back.

  • Mike

    My recovery is in day one – was discharged from the hospital last night. I experienced rhabdo symptoms after completing the Crossfit Benchmark WOD “Nicole”. The workout was 20 minutes of 400 m runs and max pullups after completing each run. After 7 runs and 112 pu’s, I felt tired but fine. I had a normal day, but awoke the next morning with much more severe soreness than I had ever had from a bodyweight exercise. I tried to ignore it and played a round of golf in the AM, but felt worse as the day went along. Soreness continued to intensify and my arms and back began to swell. Next day – same thing – hurt quite a bit to extend my arms and the swelling became quite noticeable. I booked an appointment with my PCP, who ignored my inquiries about rhabdo and diagnosed me with tendonitis and prescribed 800 mg ibuprofen. I had gained 12 lbs in 2+ days, so I was very skeptical of the “diagnosis” – something wasn’t right. After 2 ibuprofen didn’t touch the discomfort and my range of motion decreased further in my arms, I went to the ER at 9PM. Diagnosed with rhabdo, CPK levels of 26K, 3 bags of saline administered at the ER. Scheduled for follow up blood work in two days and I will be following here for advice on how to resume activity.
    Two things I took away from this is activities such as max pullups with load in the eccentric part of the movement must be respected and that you must advocate for yourself with your doctor.
    Best wishes to all in their recovery.

  • Phillip Johnson

    Hey. I was wondering your opinion about returning to normal activity. I am in the military and during a 15 mile hike I came down with severe rhabdo, it spread throughout my body and was the worst pain I’ve ever been in in my life along with vomiting and extremely high ck levels and blood creatine levels. It was bad enough that I blacked out for 18 hours that day and I was in the hospital for 7 days with dozens of IVs and shots in my abdomen. I haven’t really done much since then, about 4 months ago, so I was wondering. What can I do now and what are the chances of it coming back?

  • Hi Phillip, sorry to hear about your rhabdo – there is always a risk of it coming back if physical activity resumes too quickly. I’m only able to offer general advice online but I do offer rhabdomyolysis recovery services. Please see: http://yourlivingbody.com/services/ You can always do a free consultation to see if that would be something you’re interested in.

  • What’s in a name anyway???

    I was diagnosed with Rabdo nearly 3 1/2 weeks ago. One month ago on a Tuesday, I did reverse pyramid muscle failure on incline and flat bench. This was done after not working out for several years (chalk it up to trying to show up the younger guys around me). I had extreme muscle fatigue and couldn’t even pick up my cell phone to my ear to answer a call without having to do some very interesting moves to get my arm raised high enough. I also didn’t hydrate afterwards and I’m overweight to boot. I began peeing iced tea colored urine, googled my symptoms on that Friday, discovered this thing called Rabdo and decided to get checked out by my doctor. Went to the ER actually (I’m a veteran and that’s how they do it at a VA center), had urine drawn, waited 3 hours for them to triple check my CK levels. By the way, they were over 61,000. I was immediately admitted to the hospital, and spent 3 days being treated. Levels were down to under 13,000 when they discharged me and under 6,000 two days later at a follow up in my local clinic. I’ve waited 2 weeks to begin working out, although I’ve been taking some walks and pushing my two babies in a stroller to add some resistance, but certainly not doing anything strenuous. My concern is this. Now that I’ve been away from any exercise for a couple weeks and went back this morning, I noticed that I was not nearly as capable of lifting weights as in the past. I understand that free weights are a different animal than working on a bench machine, but I could barely lift 115lbs in flat bench. In doing my muscle failure, I was pushing 180 over 27 times prior to changing weights and doing the reverse pyramids just 3 short weeks ago.

    So, when a person experiences Rabdo, how does it actually affect the muscle itself? Does it “weaken” and “destroy” the muscle so that you can’t lift what you once did? And does it make one weaker than before because of the damage done to your muscles? I’m being very careful to eat right, have lost 16lbs in the past 3 1/2 weeks through proper diet and hydration (weighed 267 and down to 251, am 5’9 and used to be a heavy gym rat), but I want to know if there is something to my inability to work with heavier weights (I’m talking just plates at 45lbs on each side – 135lbs) as a result of damage done to my muscles from my Rabdo?

    Hope you can shed some insight. I’m open to your suggestions.

  • This should clear up what happens with your muscles: http://yourlivingbody.com/understanding-exertional-rhabdomyolysis-in-atheletes/

    Rhabdo recovery can take up to months and is specific to the client and their needs. Please contact me for a free consultation if you want to discuss rhabdo recovery.

  • Whitney Cunningham

    I was thru hiking the PCT when after a 20 mile section (with the last 5 miles being an elevation gain of 1200ft) I got into camp and almost instantly fell asleep. I woke up a few hours later and leaned out my tent to vomit. I tried to stand up so I could walk over to a near bathroom but couldn’t stand. I was hospitalized for two days after my rhabdo diagnosis and given salt tablets to add to my water. Unfortunately I contracted Cdiff while in the hospital and am now off trail.
    This was almost 3 weeks ago. Last week I went on a couple 4 mile hikes and have been walking everywhere I go. Today, however, I did some squats, wall sits, lunges, sit ups..I thought I was going to die. My muscles felt just like they did on the hospital. It feels as though its going to take forever to fully recover.

  • Hey Witney, that sounds like an awesome trail and if you wouldn’t mind emailing me: yourlivingbody@gmail.com I’d love to hear more about your experience and even possibly post a guest article on my blog with your story. It can take a while to work back up to former strength/endurance levels and it requires a lot of patience and planning.

  • Thomas Dalhover

    I am a competitive bodybuilder and didn’t drink much water after a competition, which included a water depletion process. My calf muscles balled up on me at the gym. I went to the ER and my CK levels were at 13,000. The doctor said I was very lucky to have no had kidney damage. They hydrated me with an IV for two days. I was able to return to the gym after three or four days. Rhabdo is no joke though. They told me to stay off protein supplements for a bit though. Just to make sure my kidneys would stay functioning.

  • The_cat

    Hi Stephanie,

    You should be screened for methabolic myopaties such as Mc Ardle dissease. There’ a genetic test done with a blood sample. Any neurologist should be willing to order it as per your history.

    Being so prone to rhabdo is a clear symptom of those , take a look online.

  • Vance

    I am currently going through rhabdo. I never had dark urine or any signs other than leg cramps. My CK levels reached 29,737 almost 2 weeks after my last workout. I competed in a bodybuilding competition and after my show i was taking a break from the gym. About a week and a half later i started getting super bad leg cramps where i could not walk and went to the doctor on a friday. I got a call sunday saying i needed to go to the er to get another lab done because my ck levels were over 9,000. When i got to the er and they took my blood, thats when it came back with the 29,000. It peaked at that number and started slowly coming down after that. The high ck level was on april 26th. My show was on april 17th and the last time i touched a weight was on april 14th. It is now may 28th and 2 days ago may 26th i had my blood taken and my ck level is finally at 275 which is still high!! I am currently waiting to see my doctor june 2nd for further action. I am in the United States Air Force. Please ask if you have any questions.

  • Daniel

    Hey! I am a

  • nicole

    How long do we wait until we start back up

  • nicole

    My Rhabdomyolysis came about after MURPH on Memorial Day. My arms are still stiff as well as my glutes. I’m so bummed about sitting on my butt to REST

  • nicole

    What do you find to be the best supplements

  • The start up time varies from individual to individual and there are several factors to consider. Unfortunately without knowing more about your situation I can’t tell you over the internet, nor do I generally recommend supplements without knowing more about someone’s history. If you’re interested in knowing more about what can work for you please see: http://yourlivingbody.com/services/

  • I spent 4 nights in the hospital this past Memorial Weekend with Rhabdo. When I arrived my CK levels were 64,000. I have worked out and played sports my whole life. I have been doing Crossfit for 1 year and like Glenn I feel like I am in the best shape I have ever been and I just turned 36 yesterday. Crossfit Games Atlantic Regionals had just finished the weekend before. I rested Friday – Sunday. On Monday I did:

    Regionals Event 1
    Randy
    75 Snatches at 75lbs for time
    followed by
    15-12-9 Thrusters
    5-4-3 15ft Rope Climbs

    On Tuesday I did:

    Regionals Event 3
    50 Over Head Squats at 95lbs
    100 GHD Sit-ups (This is what did it for me)
    150 Double Unders (TIME RAN OUT AT 107 DUBZ) Stopped Here
    50 Sumo Deadlift High Pulls
    100 Box jump Overs

    When I finished the workout I drank water and when I got home I drank the P90X Results and Recovery Formula like I always do and I had dinner shortly thereafter. The next day I felt sore in my core. As the day went on I actually made the mistake of stretching a bit. On Day 2 I was in extreme soreness and again made the mistake of stretching again. By around 5:00pm I pee’d brown and said to my wife there is something wrong I need to go to the ER. I was in the ER within 30 min. They put an IV in me right away, took blood and urine test. My levels were at 64,000 and I was informed that I will be admitted. Next day, Morning #1 my levels dropped to 49,000, morning #2 levels went back up to 51,000, morning #3 dropped to 39,000, morning #4 I was tested twice 20,000 then 18,000 then I was released.

    Last week Monday I followed up with my doctor and did a blood test. Levels came back at 317 and all other tests came back normal. Doc also prescribed an Ultrasound as he felt my Liver was enlarged. Ultrasound test came back negative as well THANK GOD! Tomorrow I will take another blood test and every week for the next 4 weeks. I will find out tomorrow if I can begin to workout slowly. The doc wants to test me weekly while I am working out to check my levels. I really can’t wait to start.

    I will definitely be more cautious and listen to my body. What is strange to me is that I am always aware of my body and whether I should slow down or keep pushing. I may not have been hydrated enough and possibly the workout the day before got me good too. I know for sure that the GHD sit ups did it as I was not sore anywhere else but my core. I was not fatigued or exhausted. I know one thing, I will be hydrating myself more before and after every workout no matter how light or heavy the load.

  • To everyone who has commented so far:

    I originally wrote this article as a series on rhabdo and I never realized the amount of responses that I would end up getting from this. A while ago there was a study done to determine the nature and prevalence of injury during Crossfit and no rhabdo was reported:

    http://yourlivingbody.com/nature-and-prevalance-of-injury-during-crossfit-training/

    Judging by everyone’s responses, rhabdo must be a lot more common in Crossfit than it is actually reported. I’ve done Crossfit myself before, and I understand how we all want to push ourselves in that type of competitive environment. It seems that their trainers are not very well at recognizing/educating when people might need to scale it back. I hope everyone who has commented on here eventually gets back to where they want to be physically.

  • KO

    I’m 23 years old, recovering from a pretty bad case of rhabdo over the last month. My BIGGEST piece of advice to anyone suffering from rhabdo (or even think there’s a chance you might be) is to get your CPK number quanitified immediately!! It took my hospital 3 days to realize that my CPK count was over 144,000.
    I was hospitalized after extreme swelling and pain in arms, from shoulder to wrist. I’m a very active person, work out 4-5 times a week. Trained for half marathons, high school and college athlete, completed the ‘Intensity’ workout program, and love to lift. I was involved in a local ‘group personal training’ class that is very similar to Crossfit. I worked out Monday night, woke up Tuesday with pain, swelling and thought nothing of it – you’re supposed to be sore after a good work out! Wednesday pain was worse, but I went back to the gym, felt good because it was leg day, not much work on my arms. Thursday the pain was unreal. Could barely put on clothes. By the time I was driving home from work my hands were numb and I knew there was a serious problem.
    The generic CPK test only goes up to a reading of ‘over 20,000’. They thought I would easily come down from that reading within a day. They were blaiming my problems (liver, kidney) on the amount of tylenol I took, or ”drugs” that I took and MUST of been lying about. I’ve don’t do drugs. After 3 days of the test not coming back under 20,000, they finally quanitified it. 144,000, unbelievable. They followed up with sonograms, lupus, thyroid and other tests. I spent a week in the hospital on pain killers and an IV line of 250ml per hour. I was released at 3,900 and told to not return to work for 4 days and drink Gatordade and Ginger Ale. At the end of the stay, doctors told me I was only a few hours from extreme complications. If they had known how bad I was when I was admitted, I should have been put directly on dialysis.
    Per the doctors orders, I’m on 3 months of no physical activity. Can’t say I’m begging to go back, I’m very nervous. I can still feel the pain in my arms with things as simple as picking up my baby cousin, box of paper at work, or carrying groceries. I also have an extreme lack of energy lately- this may be from not working out? I’m not sure, but I know it was a side effect for me.
    It’s frustrating because the doctors have never seen it before, so their ”recovery” orders are essentially just a guess. Followed up with massive amounts of blood work. I’ve started working myself back into being physical, with things as basic as going for walks with my dog.
    This article was very helpful, thanks to everyone for sharing.

  • rachel

    ok so this is a good start on getting back to normal. Please realize I got Rhabdo because I’m easily dehydrated with pregnancies. Pregnancies last nine months so it’s not like I could jump back into a routine. I always drank my water. I was the water nazi. In fact the Dr in the hospital told me I was drinking too much and she would she me back for that fact. Therapies helped but Rnhabdomylosis still takes a hit on your brain especially after a 90 pound weight loss. Most cases are due to people always beginn good physical shape. Now I had plenty of muscle build up to shred, but since I carried those 90+ pounds for 15 years, my story is different. I still think that cross fit and spin should be under a better spotlight.

  • Joe

    I experienced Rhabdo in 1991, while going through AIT at Ft. Benning, GA. I didn’t know that at the time, but after what can only be described as extreme abuse I, and several others in my company, all experienced the symptoms. I was given ibuprofen and Ben-Gay, and treated like a slacker. I feel fortunate to have survived, and completed my training. I have been out since ’96, and I am still feeling the effects of it. My muscle tone never recovered back to where it was. Is there anything that will help?

  • Sherri

    Hi – I am a 48 year-old female who just returned home from a five day hospital stay being treated for Rhabdo. Something until last Sunday I had never heard of. I am healthy and relatively fit although my exercise routine only consists of walking a few miles a couple of times a week and the occasional yoga class. On Wednesday, I joined a girlfriend for a spin class – my first one. Schedule for 45 minutes I only made it for 28 – I was sweaty, nauseous and my legs felt like spaghetti – I was sure I would be sore for a few days but had no idea what was coming. Over the next four days the the soreness and burning in my legs my increased and at times was almost unbearable, yet although I was exhausted and in pain I was not completely debilitated. It was the tea colored urine on Sunday night that finally sent me to the emergency room. My blood was tested and my CK levels came back at 59,000 – from a 28 minute spin class! I was immediately hospitalized and put on fluids and over the next four days my levels decreased 40,600, 26,400, 15,900 and 7,300 today. I was finally discharged with the promise to drink copious amounts of water and report for every other day blood testing until my levels are normal. The burning in my glutes has lessened, but I still find myself achy and weak. I am still in disbelief about the damage I unknowingly did to my body and am left wondering just how long it will take for me to feel like myself again ..

  • Hi Sherri, rhabdomyolysis recovery is a complex issue and can take several months to get back to normal and can vary/be specific to each individual. I specialize in assisting people with rhabdomyolysis recovery. Contact me to schedule a free consultation: http://yourlivingbody.com/services/

  • Hi Joe. Rhabdomyolysis is a complex issue and there is a lot of information/history that has to be considered. Contact us to schedule a free consultation: http://yourlivingbody.com/services/

  • Agreed. With the increase in vigorous physical activity classes and boot camp related fitness workouts, rhabdomyolysis is definitely becoming more common. Unfortunately this illness is rarely taught to personal trainers.

  • Dan

    I was diagnosed with rhado in both biceps last month. After doing a bunch of thrusters the part of muscle near my elbow was swollen. I figured it was normal until it didn’t go away after 3 days at which time I went to the hospital. My CK level was 26,000. Since then, I rested for about 4 weeks, drinking tons of water, and then started doing light band exercises. Yesterday was my first day back at the gym and I scaled down the workout. Both arms have the usual soreness and I made sure to avoid any high repetition exercises for now.

  • rachel

    The thing is I go back to my usual workout and get the Rhabdo feeling in my legs again. I hate having these mind games. I’ve had my baby and I just want to get back to where I was pre pregnancy. Frustrating! 🙁

  • Kari Ashley Facinelli

    I don’t think I ever responded…I had numerous blood tests/an EMG and a muscle biopsy, to which all returned normal results. There was nothing that predisposed me to getting this crazy condition. The doctors are completely flabbergasted but have no explanation about it. I have been playing softball again, on regular duty at work and trying to take it easy other than that. I did a muay thai class about a month ago and it made my arms feel kinda strange again so I haven’t gone back in fear of getting it again. It’s frustrating but I believe I’m getting better.

  • Bill

    how long after the swelling went down would you say it took for the CPK numbers to return to normal?
    Also, How did you feel strength wise in your arms? I am a week after the event and doms is gone but my bicep muscles have no power. I am wondering when the strength returns.

  • Bill

    I had a mild bout as well. The symptoms I still have at 1 week are fatigue and muscle weakness. Does the muscle strength return or do I have to start from a lower point?

  • Kari Ashley Facinelli

    My swelling didn’t go down until about 3 days after I was released from the hospital. I was in the hospital for a week, they were swollen the entire time. My original CPK Levels were at 108,000…I was released when they were dropped to 3,500…I feel that my arms are a LOT weaker than they were originally. Still, after 7 months. I think it returns maybe, just very slowly. I went to a muay Thai class a few months ago and they felt like they were flaring up again so I haven’t gone back to the striking class. I’m not sure if my arms will ever be the same, I have read cases that people never go back to normal after. Very frustrating and scary.

  • Hi Bill, a return to strength varies from person to person but can last up to several months at the very least – a full return of strength within one week is very unrealistic of severe rhabdo. Your muscle proteins denature and basically lyse causing a breakdown of muscle tissue that has to be rebuilt over time.

  • Sorry to hear it’s so frustrating Rachel. Keep plugging away and keep us posted. Hopefully you can get back to where you were in the near future.

  • Hi Nicole, I generally don’t recommend supplements without obtaining a detailed health screening/history. If you’re interested in working with me you can vew my services and see which option might be best for you: http://yourlivingbody.com/services.

  • I was hospitalized with rhabdo on 7/10/14 (about a month ago). To preface, I have been crossfitting for 2 years and I have never had any issues with DOMS. I would typically WOD 3-4 times a week. That being said, on a hot and humid day on 7/6/15 I decided to do Karen (150 wall balls at 14#) to see what my time would be (7 min 42 sec). It was tough, but I had done this WOD before, and I felt wrecked after, but nothing abnormal. I did feel slightly nauseous, but I figured that was normal due to the constant “up and down” movement of the squats. One strange thing was that my legs did buckle as I was walking to the parking lot, which is something I hadn’t felt in years. The next morning I woke up super sore, more sore than I had ever been, but the day progressed fine, and I took a rest day because my quads were so tender. Wednesday came along and the soreness had not subsided, but it had not gotten worse, so I decided to WOD and de-load for a little bit of active recovery; I thought it would help break up the acid and reduce the soreness. There were wall balls in the WOD again, but I used a 10 lb ball. The next morning, I woke up with EXTREME soreness in my quads and as the day progressed, the tightness started traveling up to my hips and glutes. I also started to notice some swelling. I knew something was wrong, so I went back to my box and talked to my coach. She noticed the swelling and told me she had something similar happen to her triceps after too many presses. She stretched me out but advised me not to roll-out (thank goodness, because that is apparently the worst thing you can do if you have rhabdo, it breaks up the muscle tissue even more).
    That night I got home and after I took a shower, my legs continued to swell and the pain was getting gradually worse each minute. My urine was clear so I was still unsure if I had rhabdo, but I drank a protein shake, a Gatorade, and plenty of water. By 3 am the pain was unbearable, so I had my boyfriend take me to the ER. My CK levels were at 63,000 Friday morning. My CK levels were going up and down for the first couple days, peaking at 74,000. After 4 days in the hospital, being on a constant IV of sodium bicarbonate, my CK level finally went down to 16,000 and they released me, under the conditions that I drank over a gallon of water per day, I worked a modified schedule, and slept 8+ hours per night. I got my CK checked 2 days later and it was at 2,500; the next week it was down to 160.
    It is frustrating because there is so little information about how to recover and get back to physical activity. I have been doing no physical activity besides walking, and I do push-ups at night (since my quads were the damaged area). This week I have begun yoga and I feel good (I am officially 4 weeks post-hospitalization), but I did notice that my quads are still a bit tender and I have definitely lost strength. I am nervous because when I was doing Karen and the WOD the following Wednesday, I felt fine. So there are no triggers, you just have to be careful. I hope this anxiety goes away soon and I’ll be able to WOD again, but until then, I am reduced to yoga and long walks, and or course my nightly push-ups.
    Thank you for posting this article and thank you everyone for responding, it helps to know that you’re not alone, and this article and the responses have given me more information than my doctors have (they were essentially useless, except for the hourly blood draws and IV bag). Thank you, yourlivingbody. And I hope everyone has a good recovery.

  • Sarah

    Hello. Thank you for this great article. I am a 38 year old female who had Rhabdo in March of 2014. I had been crossfitting for 2-years prior to getting Rhabdo and it was from doing pull-ups. 4-months ago I returned to CrossFit with no issues until this past week. I did a workout that included rowing and weighted lunges, which is nothing new for me as I row at home. Since doing this workout, I have been waking up in the middle of the night with excruciating pain in my arms, where I had damaged the muscles over a year ago. I am unable to bend or move my arms at all when this happens. When I wake up in the morning, there is no pain and I have full range of motion again. Has anyone else experienced this?

  • camuy21

    My Rhabdo, according to,Numerous physicians, was caused by a virus. They found it confounding, but I had all the symptoms and my Ck was in the mid sixties. I had taken a month off of training before this even happened and had not been in a traumatic accident. The ER doc thought I was drunk bc I crashed into some chairs and was splayed out on the ground bc of dehydration. In the hospital for 4 days. This was mid July. I’m a symptomatic, however my “virual” Rhabdo has left me confused as to when in hell I can return to activity. What’s crazy is I also lost 15lbs. That’s a lot of ground beef. I’m a power lifter with no power!
    I

  • camuy21

    In addition. The major muscle group affected was in the femoral muscles and I hadn’t squatted in a month. How curious

  • camuy21

    Rhabdo hit me in the quads. I am still fighting the soreness a full month after. It’s confusing and no one seems to have the answer. I’ve been fine. Then a couple of days ago I(4) I did air squats. I’m accustomed to squatting in the mid 400’s. My legs are trash today. I didn’t go past 50 reps of air squats. Just as confounded as you are

  • TLDRVideo

    I’m not seeing anyone mentioning nutrition here… was anyone else eating a diet that was calorie-restricted, carb-restricted, intermittent fasting, etc.?

    I was doing all 3 and decided to train my legs with some squat jumps for the first time this season. I decided to fast that day, then went back to 1500 calories the next two days (maintenance for me is 3500). Massive DOMS 2 days later from the eccentric contraction. This was nothing new; I’ve had horrible DOMS before. 3 days later I had apple juice colored urine, went to Urgent Care, then ER, then Hospital.

    CK levels don’t appear to be changing after 6 days in the hospital because the lab’s test only goes up to 16,000, which is ridiculous. My liver enzyme ALT is dropping nicely, and it looks like there is a strong correlation between ALT and CK levels: http://rheumatology.oxfordjournals.org/content/45/4/487.long

    Focusing on high-carb, frequent meals for muscle repair, and keeping fat low to hopefully lower liver enzyme levels.

    What was your diet like before rhabdo? I can’t imagine that this comes out of the blue for most of us.

  • john

    Hi. I was recently diagnosed with rhabdo. I am a soccer player and it arised due to the straining of my quad about a week ago. My quad is feeling much better now, but I decided to go to the doctors 2 days ago, did blood work and my CPK levels were high. My doctor told me no exercise for a couple of weeks. I determined (self-diagnosed) that I had a grade 1 strain on my rectus femoris (minimal) due to my range of motion and pain/tenderness on my leg. It wasn’t bad to begin with and is feeling even better now after R.I.C.E. No discoloration with my urine and I drink a lot of water daily but I didn’t really focus on replenishing my electrolytes. Since treatment for non-severe rhabdo is basically fluid/electrolyte replenishment I was wondering how long I should wait for another blood test to check for lower CPK levels and whether I should return to playing with my team as soon as they fall into normal range. I am also wondering if I could be admitted to hospital to be treated with IV, even if not that severe, to speed up my recovery process?? Would the hospital allow that? I am very eager to get back to playing soccer, like hopefully within the next week or so. Any information at all is much appreciated!! Thanks!

  • alma

    I’m [hopefully] at the tail end of my recovery. I took over a year off HIIT after overtraining and experiencing chronically high cortisol and exercise intolerance. Since then I’ve done yoga, walked and done the occasional quickie HIIT home workout. I jumped back into a regimented HIIT program a couple weeks ago doing TRX workouts once a week. Week 2 (last week) I went all out to the point of muscle failure, and by the end of the workout I couldn’t straighten my elbows. My arms were like dead weight and I couldn’t even comfortably wash my face or dress myself. Excruciating pain set in to the point where I couldn’t sleep, but I never experienced the urine changes. By day 3 I was at a loss so I visited my chiropractor to see if he could help me straighten my arms back out. He did, but within 2 hours the swelling set in and my biceps ballooned up. I knew this wasn’t normal, but decided to rest and ice my arms to see if that helped. By the next morning the swelling was getting worse so I went to the ER. Tests confirmed rhabdo, my CK levels were over 20K but the doctor estimated I was already on the mend and at the peak my levels were probably closer to the 40-50K range. Luckily no kidney damage, just got some IV fluids and muscle relaxer and orders to rest and drink close to 100 oz of water a day. Eight days later the swelling has almost totally vanished, yet my arms are still fatigued and a bit sore in the joints.

    Needless to say I’m petrified to ever work out again. This is strike two for HIIT 🙁 I just can’t seem to not push myself too hard with these types of intense, high pressure workouts.

  • Callie Leah G

    I got rhabdo for the first time back in July after a workout with a friend in the park. I had no idea what it was when the symptoms started. I could barely walk and my urine was the color of coffee. My CPK level was 86,000 and I was in the hospital for a week. They took a muscle biopsy and originally they thought I had an auto immune muscle disease like MS but then they changed their minds and said i had a metabolic muscle disease and now it turns out apparently I have nothing and they are very puzzled as to why my CPK level was extremely high considering I do not drink alcohol and no drugs. I am puzzled myself. I just did 10 squats and my legs are starting to feel as they did when the apparent rhabdo started to occur

  • Kari Ashley Facinelli

    That is basically what happened to me as well! Mine was a 10 minute workout, I tried crossfit for the first time and my CPK Levels were at 108,000. In the hospital for a week and I also got a muscle biopsy with absolutely nothing wrong with me. Very frustrating not knowing why this happened but thankful nothing is wrong. Good luck, I think it will take quite some time for your body to feel normal again.

  • Don’t be afraid to use salt with cooking. The majority of salt intake is consumed from processed foods/eating out. Slow and steady wins the race. Hope your recovery has been going well.

  • That’s crazy! What was your workout like in the park? What was your physical activity level like before that workout just out of curiosity?

  • Kari, just out of curiosity, what was the workout?

  • How high were your CPK levels? There’s actually some research out there suggesting that CPK levels should be adjusted higher for (legit) athletes.

  • Very hard to say that it comes out of the blue – a lot of people don’t mention what their diet was like but i can’t necessarily imagine everyone’s diet is spot on. Unfortunately diet and rhabdo hasn’t really been studied too well… Especially with low-carb. I would imagine the basic principle of asking if the needs of the body meets the demands applies here. But just how many squat jumps were you doing and how seasoned were you at squat jumps?

  • Kari Ashley Facinelli

    It is embarrassing to say, because I have been active my whole life, I’m pretty athletic-was a catcher is fast pitch softball for 15 years…
    But I tried crossfit one time and I think it was their on ramp? the workout was reps of 10 modified pull ups on the ropes, 15 pushups (close tricep pushups) and 20 squats… I did about 12 reps I think? After the reps did some rowing on the row machine. I thought it was a good work out and even the next day I just thought I was in a horrible shape and it would be better later, then the NEXT day I couldn’t lift my hands above my head or reach my mouth to eat or even brush my teeth/hair. My arms started swelling and my urine was very dark so I ended up going to the ER And stayed for a week. I honestly think it was the pushups- I’m a small female, I’d like to think I’m strong-for my size but the pushups were a lot of strain on my small arms and they exploded. They’re still not normal and it’s been 9 months.

  • Derek Lee

    I had worked out for about 2 hours in a gym, mostly doing chest workouts, which was longer than my average workout. And heavier weights than usualThat was on a Wednesday afternoon. I had worked an overnight shift that night, got off @ 6am slept for about two hours then went to school. Throughout the day I felt fine but once I went to sleep that night I kept waking up with a lot of soreness in my chest, I didn’t think much of it. I woke up that Friday and could bately reach to my sides, I had decided to work my 12 hour shift that day. Through out my work day I ate healthy and consumed approximately a gallon of water. When I got home that evening I had noticed my chest had swelled up to about three times its normal size, I thought wow I must of really tore some muscles up, it wasn’t until I went pee, I had noticed my urine was coca cola colored. I decided to goto the er. Once admitted an ekg was conducted with normal results, after blood test were conducted I was diagnosed with rabdo. That was on a Friday eveining, my ck levels were over 63k with normal kidney functions and liver enzymes were elevated in the 700ish range. I was given 200ml per hr of iv fluid and hydrated constantly with water. I was released the following Thursday with 4900 ck levels. And a week after that my labs returned to normal range.

  • Glad to see you’re doing better – good luck with your recovery.

  • Kari Ashley Facinelli

    I work at a detention center, I’m a detention officer/deputy. I try to stay fit for my job. I was pretty fit at this time especially because I had just gotten married a few months prior to that and I was working out daily. I do classes, run, walk, play softball (2nd base, shortstop), and ride bikes. I however do not lift many weights and I’m about 125 pounds and 5’2″ so I’m not a muscle strong person but at the time I got hurt, I was very fit. Now that I have gone through this I’m trying to get back into working out and getting fit again but afraid of it happening again because every time I do anything with my arms they feel like they’re going to explode and it scares me so I’m not in great shape right now.

  • There has been a tendency in the last decade for more and more military style boot camp type things as well as the mentality to “go all out” and if you don’t, you’re a pansy. Subsequently, I think it’s leading to a lot more rhabdo cases than there ever used to be.

  • Vickie

    I turned 50 recently and decided to hire a personal trainer. I am mostly a runner but have been doing some machine weights for the last 6 months. I have never done a lot of free weights but my goal was to just get a little stronger and toned so I did not injure myself. My trainer decided we would start with arm day. We did several sets of different exercises and mixed with push ups. If the weight was too much she would encourage me but not push me but my hands were very shaky even just trying to wipe my bangs out of my face. The session was for 30 minutes and she said for me not to lift anything the next 2 days but I could do cardio. I ran 3 miles on the treadmill…2 minutes walking fast and 1 minute sprinting. I did this the next day as well but added a couple of machines that are designed to work on abs but you use your arms to pull your legs up or push your body down. That night my right bicep started hurting. I am right handed and we had noticed during my arm work out that my right arm was actually weaker, so I thought that was why my right bicep was hurting more than my left. I could not stretch either arm out but by the next morning it was obvious my right arm was swelling. I went to work (12 hr shift at a hospital) and it was a tough day. By the end of the shift my right arm was huge compared to my left and people kept commenting on it. I called in sick the next day and went to my family doctor (PA). I am a respiratory therapist and we deal with Rhabdo. I told my doctor that I thought it could be Rhabdo but my urine was not dark. She said she had never seen anything like it before and put me on steriods, NSAIDs and muscle relaxers. She was also concerned I had a blood clot.
    The swelling moved from my bicep to my elbow and forearm. It was not as tight the next day but the swelling was still evident. The pain was some better. I called and left her a message with my concerns. That afternoon, a physician at the hospital I work at said told me he thought it was Rhabdo and explained that I did not have to have dark urine. When I asked him for a blood test. He told me I was overreacting. I called my physician again and asked for a CK test. I was told she left early and no one at the office could help me but they would ask her about it the next morning. The next day (after not hearing from anyone) I sent an email to her office again requesting a CK to rule out Rhabdo. They called around 11 am and said for me to go to the hospital and have labs drawn. Because I work there, I went by and got the results around 3 pm. The physicians office called me at 5 (in a panic) and said I should go to the ED immediately. My CK was over 8000. I began drinking water and gatorade as soon as I even thought it was Rhabdo. I only recieved one bag of IV fluid and was sent home last night with my levels under 6000. I believe if they had tested several days ago, they would have been above 20K. I took off today but am scheduled to work the next 2 days.
    Like most people on this forum, I am scared. I have seen the bad side of Rhabdo (on a ventilator). I am frustrated…that noone would listen and noone seems to know what I am supposed to do now (except drink gallons of water).
    Can I still do cardio? Can I run/walk?
    I used a trainer so I would not end up like this and here I am…..

  • Bryson Blake

    I’ve had rhabdo 3 times. The first was during selection for an elite special operations unit. My abdomen and testicles swelled sifnificantly, leading my teammates to joke that I was smuggling grapefruit out of the chow hall. I ended up in the hospital for a week, where I got compartment syndrome in my abdomen which caused significant pain for several years. I got it a second and third time this year without compartment syndrome, but my CK Levels were in the 40K range. I was hospitalized for a week each time when one doctor came in to tell me that rhabdo doesn’t hurt. He proceeded to tell me he worked with military folks in the past, so I should take his word for it. I then set him straight about my experience in elite special forces, and that he didn’t know shit. I’m glad I put him in his place, because there are plenty of medical professionals who think they know, but really don’t. If I were talking to a military doc, I would’ve told him to get the eff out of my room and get me someone who isn’t a total ignoramus. If I see that guy again, I’ll put him through a filthy fifty WOD and see what he thinks about rhabdo then. What a D-bag.

  • Raj G

    First off I would like to say that this is great information, and it is greatly appreciated.

    I would like to share my story because I feel I’m afraid that I won’t be able to play hockey any time soon or ever again due to rhabdo. The thought alone is scaring me because hockey is my therapy, it helps me relieve stress and unwind. I have an ACL surgery coming up in January and it is an 8 month recovery (I’m assuming resting my arms for 8 months will help while I rehab my knee).

    My story all started in the first week of August. I was actively playing ball hockey 2-3 times a week priort to tearing my ACL on June 10th. When I tore my ACL, I did no physical activity until the first week of August, where I asked my friend to train me. We did a very intense workout, that included doing your reps until you couldn’t. (It seems so stupid now that I think of it, but I trusted my friend because he was in really good shape). The next day my arms were really sore and at night I noticed my arms were swollen and I googled this. I found an article that told me to present myself to the hospital right away, which saved my life, I thank God.

    At the hospital my CK was at 56,000. They put me on IV and I stayed at the hospital for 6 days until I was cleared to go home. Along with elevated CK I also had an increase in my ALT of 240 when I was at the hospital. 2 weeks later I did a blood test and my CK levels were normal, my ALT 90 and my kidney functions normal (thank God).

    At the end of October, I decided to go work out, it was October 30th, I did a very light chest workout and my arms felt the same as they did when I had rhabdo but on a lighter level, and after 2 days I was ok but I started to chug tons of water, day and night to keep flushing my kidneys incase I did have it. On the Monday November the 3rd I went for a blood test just incase. I never got a call from my Doctor until last Thursday (November 19th) that I had a CK of 6,000, but my kidney functions were normal. He asked how my arms felt and I said fine, but lately I started noticing the feel like they are lightly burning somtimes, and this is scaring me and I’m thinking I further damaged my muscles and I won’t be abl to play sports again. I will go for a blood test this week to see the CK. I keep drinking litres of water and my urine is clear.

    Do you guys think I will he able to play hockey again? Especially if I decide to rest for 8 months until I rehab my ACL surgery?

  • Raj G

    First off I would like to say that this is great information, and it is greatly appreciated.
    I would like to share my story because I feel I’m afraid that I won’t be able to play hockey any time soon or ever again due to rhabdo. The thought alone is scaring me because hockey is my therapy, it helps me relieve stress and unwind. I have an ACL surgery coming up in January and it is an 8 month recovery (I’m assuming resting my arms for 8 months will help while I rehab my knee).
    My story all started in the first week of August. I was actively playing ball hockey 2-3 times a week priort to tearing my ACL on June 10th. When I tore my ACL, I did no physical activity until the first week of August, where I asked my friend to train me. We did a very intense workout, that included doing your reps until you couldn’t. (It seems so stupid now that I think of it, but I trusted my friend because he was in really good shape). The next day my arms were really sore and at night I noticed my arms were swollen and I googled this. I found an article that told me to present myself to the hospital right away, which saved my life, I thank God.
    At the hospital my CK was at 56,000. They put me on IV and I stayed at the hospital for 6 days until I was cleared to go home. Along with elevated CK I also had an increase in my ALT of 240 when I was at the hospital. 2 weeks later I did a blood test and my CK levels were normal, my ALT 90 and my kidney functions normal (thank God).
    At the end of October, I decided to go work out, it was October 30th, I did a very light chest workout and my arms felt the same as they did when I had rhabdo but on a lighter level, and after 2 days I was ok but I started to chug tons of water, day and night to keep flushing my kidneys incase I did have it. On the Monday November the 3rd I went for a blood test just incase. I never got a call from my Doctor until last Thursday (November 19th) that I had a CK of 6,000, but my kidney functions were normal. He asked how my arms felt and I said fine, but lately I started noticing the feel like they are lightly burning somtimes, and this is scaring me and I’m thinking I further damaged my muscles and I won’t be abl to play sports again. I will go for a blood test this week to see the CK. I keep drinking litres of water and my urine is clear.
    Do you guys think I will he able to play hockey again? Especially if I decide to rest for 8 months until I rehab my ACL surgery?

  • I don’t see any reason why you won’t be able to play hockey again. Slow and steady wins the race. Good luck.

  • Hey Bryson, I can’t believe you’ve had it three times now. Glad your kidneys are holding up. How much recovery time does it take before you’re at 100% again? Thanks for your service.

  • Hey Vickie – not all cases of rhabdo end up with dark urine:

    http://yourlivingbody.com/understanding-exertional-rhabdomyolysis-in-atheletes/

    You’ll still be able to do all you used to do physically but the road to recovery is slow and long. If you go too hard too fast you’ll end up right back where you started (in rhabdo).

    By the way, I’m completely leery of personal trainers and their knowledge on rhabdo and how easy it is to send someone into it. I’d assume most don’t get a decent run down of it and think they’re doing their clients a decent service by pushing them too hard.

  • Dee

    I got rhabdo from doing a Crossfit class about 6 months ago, after taking 6 months off from training. I spent 2 days in the hospital. My CK levels were probably around 80k when I got in. The next day at the hospital, the levels came down to 60K, then they discharged me around 42K. I was told to drink copious amount of water and gaterode. I got tests weekly and it took me about 2-3 weeks to return to normal CK levels (about 130).

    My workout consisted of something like 21, 15, 9, 3 shoulder to overhead and and pushups. And some pullups to start. The next day I couldn’t lift a cup of coffee to my face. 3 days later I went to the ER.

    6 months later I just did my first week of taking it easy crossfit, and my arms are actually feeling nostalgically painful…..drinking a lot of water and seeing how it progresses.

    Stay safe everyone! Trying to look badass isn’t worth it =/

  • Jenny

    I got rhabdo last year in April, and it took me until the beginning of August to feel normal again. Over 4 months !! My CK levels were over 40,000, after “Angie” knocked me down. It was the 100 ring rows that ruined my biceps. four days in the hospital being pumped with over 16 bags of fluid, then got readmitted a day later because I was still dehydrated and my body couldn’t cope. My arms were huge puffy sausages, couldn’t even put a shirt on over them, they were so swollen. 🙁
    Leading up to Angie I had been doing cross fit for 2 years, very active, healthy. I have to say that I was also very stressed out, worn out from running a business and working way too much. and also dehydrated. I decided that I wanted to up my fitness with CF and wanted to go hard – and thats when I got knocked down with rhabdo.
    There are no really good guidelines around about how to get better and the amount of time it will take. I probably pushed myself too much going back to the gym. Cardio and lifting heavy always made me very light headed so I had to try and reign myself in when getting back to the gym. I also quit one of my jobs so I could rest more. I couldn’t ride my mountain bike, go hiking or exert myself in anyway without being totally drained of energy ! If you are recovering from Rhabdo, keep yourself hydrated as possible, go slow, go easy on your body and don’t push it ! It is a major trauma and you have to take time to build yourself back up. Its January now and my biceps are finally getting firm again.

  • azcookiemonster

    I just got out of the hospital about 3 weeks ago. I’m 36 years old, 6’2″ 210lbs. I’ve had high blood pressure since I was 18 (inherited from my family). I went to my PCP to have regular check of blood and everything came back normal except for high cholesterol and triglycerides. Having my 131st child about 60 days ago I want to make sure I’m around forever for my son. So I joined a gym………
    Along with the gym membership came a “free 1 hour lesson from a master trainer.” I made the appointment a week after I started at the gym. And the first week before the “master trainer” went great. I was playing basketball for 20 minutes, then going straight to the treadmil where I walked 1/4 a mile and got up to a mile by the end of the week…. Then came the trainer.. I told him about my blood levels, having asthma, high blood pressure, not working out (with weights or anything) for 20 years, and not wanting to do anything more than just lose some weight and have a healthy heart for my son.. It ALL went in one ear and out the other. Long story short, the trainer worked me too hard, I went home, started peeing blood, went directly to the ER, my kidneys had failed along with renal failure, and my CK LEVELS WERE 167,772. I of course had no idea what that meant, but again long story short, I almost died. And now here I am on a random website telli,g probably nobody who will read this about what happened to me. I STILL haven’t read of anyone who has had higher CK LEVELS than me (nothing to be proud of but it’s scary). And just FYI, like stated before, I went from the training session, STRAIGHT home, and STRAIGHT to the ER. So these CK LEVELS took like an hour to get from 0 to over 167k. Every doctor and nephrologist had told me if I would’ve waited 4 hours I wouldn’t have been alive.. I’m 36. I’m not fat and gross. I still feel like a kid. This is just insane. I came to this website seeking how I should get back into shape. I’m so scared now I have this phobia that I’m going to start peeing blood from doing ANYTHING now and scared to pick up anything or use my muscles! I don’t want to get atrophy so I’m not literally going to stop but nevertheless I have this phobia now. It should also be noted that I am a Respiratory Therapist so I do know quite a bit about the human body.. And again, if I didn’t think I was possibly speaking to a wall (nobody) right now then I would be happy to go into further detail…. I want to sue the trainer too for doing this to me. I sat down with him and I’m not joking I spoke to him for 30 minutes explaining what was wrong with my body and that I ONLY wanted to lose some weight and have a stronger heart and that I wanted a low pace regimen and wanted NOTHING to do with his body type and just wanted to be happy. Told him about my torn rotator cuff, but he’s having my do benchpresses for my first excersise. Just Rediculous. I came SO CLOSE to death and leaving my wife and son here on Earth all because of his negligence. Anyway, I just want to know how to get over this phobia, and get back into shape as quickly and as SAFELY as possible like I WAS doing the first 7 days when I was working out by myself.

  • Kari Ashley Facinelli

    Hi, I’m a detention deputy-120 pound 29 year old female in alright shape, I got rhabdo a year ago from my first time trying crossfit (only time also)
    My cpk levels were well over 108,000 so now you know someone who had higher cpk levels than you. I was hospitalized for a week, off for another week and on light duty for 2 months. I had numerous blood tests and a muscle biopsy, all with healthy results. I think sometimes you can just push yourself too far. . A guy was training me too,but I could have slowed down and not pushed myself to the brink of my arms exploding. I’m barely getting to where I can do pull-ups again. It’s going to take you a long time to recover, but you will, you just have to take it slow. Good luck.

  • azcookiemonster

    My CK was 167,772… But still, it’s nice to at least see someone who had numbers above 100k and at least closer to mine.
    The doctors were coming in to shake my hand and say really unprofessional things (in my eyes) like “Congrats, your the Hughes CK LEVELS I’ve seen in my 24 years of being a physician” and stuff like that. Like parading me around while I was basically on my death bed…. Anyway, I’d still like to meet someone who has had close to or higher CK levels than me just so I know I’m not alone and I can recover..
    Kari, for me I feel mi,d frustrated cause my skin looks fine. I LOOK like a healthy 36 year old guy. I’m not out of shape.. But yet if u were to look under my skin you would see these muscles that (i know you are experiencing too) that are all messed up. Idk, maybe it’s because I’m just a stupid guy or something, but I feel like a wimp not being able to do daily chores that I want to do, barely able to pick my baby up, etc. I’m not “depressed” or anything- just REALLY frustrated and none of my doctors really spoke in any great detail about how long I’m going to feel this way! It was more like “just a little bit at a time, and u will get back to yourself.” “If u decide to start working out again, go really slow. Maybe just walk for 5 minutes on a treadmil then be done. Next week you do 1p minutes and so on.”
    I swear that’s pretty much all that was said. Idk, I’m just bitching. Thanks for replying to me though it was really cool to know I wasn’t just writing to nobody. And it would be nice to have a “rhabdo buddy” to discuss this stuff to if you would like to exchange Facebook names? Mine is “Ty Salminen” it’s a pic of my wife and I and I have a blue shirt on. If not, that’s ok I understand. Like I was saying it’s just nice to k,ow other people are out there dealing with this too :/ And I’m SO SORRY you are dealing with it too right now it’s so awful. Thanks, Ty

  • Sorry to hear your struggles and frustrations with the post-rhabdo recovery. Unfortunately not a lot of physicians address this issue in details because, well, there’s not really any major research done on the topic. Unfortunately the rhabdo recovery is a lonnnng process. Being young and feeling mentally all there it’s natural to want to go and kill it again but you could just end up right back to where you started before. You’re going to literally be starting to work out and it’s going to feel like you’ve never worked out a day in your life. Start slow, build a strong base, and gradually start increasing your strength and endurance. Good luck.

  • Great advice about keeping hydrated! Couldn’t agree more. Aside from taking it slow with recovery, nutrition is one of the most important elements. Good luck!

  • Stephanie Moe

    I am a 36 yr female recovering from my first time having rhabdo. I have been doing Crossfit for 3 years and been eating paleo for three years as well! I tried a spin class for the first time and that was the only change in my workout activity! I have been an athlete my whole life, runner, soccer player, basketball.
    I woke up one morning two days post spin 3 days post my Crossfit workout, horrible chest pain like I’d been hit with a bat! A visit to the ER determined it was rhabdo and I was admitted and give IV fluids and sodium chloride. My levels weren’t as high as some on this forum, mine were 5,000.
    I was discharged and fell into depression while “resting” from physical activity. My mind and body were worlds apart. I stay active and fit and eat very clean, how could this happen to me?!
    I had no symptoms, except the chest pain.
    I returned to Crossfit at about 50% 4 days after being discharged from the hospital. Reason being is the depression! I felt ok after the workout, my chest pain is still present and I avoid any alcohol or caffeine that could possibly make my heart feel funny.
    I found this forum because after rhabdo recovery is very vague. I have increased my water intake and have introduced a few more carbs into my diet.
    I am now drinking 80 oz of water a day and increased my calorie intake.
    I am just listening to my body taking it very slow!

  • RobinV

    My fiance got rhabdo after doing Crossfit 2 days-he’s 45. He started because I’ve been doing it for the last 8 months and liked the results I’ve been seeing. He is a former Marine, and other than hiking, hasn’t done a lot of physical activity for a good 20 years. We work opposite shifts so I don’t typically see him during the week. So after the first session he said he was very sore – I didn’t think a lot about it and said “ya I was too, it will pass sort of – or you will get used to it”. He had a couple injuries years ago so I told him to make sure he mentioned them, and they could modify things for him. So then he goes to the second class…and he said he was really sore but went to work. At about 9 he texted me to tell me his elbows were swollen but not in the joints where he would have expected, it was on the front. So I had him send me a picture – and they were very swollen. So then I asked him what his pee looked like, he said he didn’t know he’d check next time he went. So hours later he went and I was asleep so when he came home around 2am I asked him what it looked like and he said it was brown. I told him he needed to go to the doctor and he said ya after I sleep a bit. So I let him sleep until I got my daughter off to school on the bus. I woke him up and told him we were going to the Dr and he fought me about it, but eventually knew he wasn’t going to win the battle.

    When they did tests, they said his liver function test looked odd, but the CK levels were really high so they were going to admit him (they were 107k). They had him on two IV’s at a time for the first day then lowered it to one. His level peaked to 300k before they started going back down. They were under 6k when he left the hospital.

    His Dr told him he couldn’t go back to Crossfit for 6 months which is really bumming him out. He’s just going back to work this week after being out for 2 weeks and on light duty at work for the next month.

  • Jane Crotty

    I am 30, female and about 58kg, BP 118/60, HR48 bpm. Im a part time personal trainer and have been a crossfitter for 3 1/2 years. I was discharged from hospital yesterday with a CK reading of 72,000. I was initially admitted with a reading of 97,000. On day 2 60,000, on day 3 70,000 and on day 4 72,000 which is when they discharged me. Im from the UK so the NHS is massively understaffed and beds are very short so I know I wasn’t their priority. Now Im home I feel weak and swallon and really confused about the upper limit. The hospital said anything up to 50,000 was normal but I haven’t found any articles to support this. I have had 6 bags of fluid and im continuing to drink about 750ml per hour and a half. Feeling ok but a bit scared. Im going to follow your post recovery advice and closely monitor how I feel. Also its good to read everyone’s stories makes me happy that I will be able to return to activity at some point.

  • Hang in there!

  • Roland

    I’m a 6’4 tall, 37 year old male, 94kg programmer. Have mildly high blood pressure 137/82, 69bpm resting heart rate. Early January this year, I gave myself rhabdo after the first day of going to the gym (after nearly zero exercise for most of my life) to do a 5am, 50 minute spin class. I didn’t know I had rhabdo until 3 days later when I noticed brown urine. In between that time, I also did a weights workout, steps, and an 8km walk in the hot sun. Seeing the brown urine, I thought something was wrong. I Googles it like a good hypochondriac. Go to the ER they say! Caught an Uber cab to the ER, told the driver if I go into renal failure, just drop me at the side of the road and call me an ambulance. Got to the ER, told them I thought I had rhabdo because I googled it. Waited about 5 hours to see someone… but I made myself drink about 3 litres of water in that time. They put me on IV immediately and took blood samples. Doc moved me into an overnight ward and visited me to tell me my CK was a lot higher than they expected, at 133,000. I was told I had the second highest CK they had ever seen.. apparently only eclipsed by a massive Russian security guard during the G20. One of the docs also had some mild rhabdo in his arm once.. he showed me some pics on his phone of his arm and the rhabdo tshirt he got. Lot of joking about how it was a badge of honour and a new years resolution. They kept me in for about 10 hours total and let me go because my CK levels went from 133k to 100k in that time. It took about 10 days to go to a CK of 220.

    About 3 1/2 weeks later I started going to the gym again, but with a PT this time, and slowly for the first week. Have been doing HIIT and weights without any problems, apart from a slightly high CK reading of 698, 2 days after an intense workout (which is apparently normal after reading some of the latest studies). Doc ordered me to go on a 2 week break from the gym.. lectured me on how bad he thought high intensity exercise was and told me there’s a possibility I might have muscular dystrophy. I said to him “that’s rare isn’t it?”, and he said his sister died from it recently. That’s a sad thing, but there’s no need to say it to someone who is unlikely to have it, given I don’t have any family history of a rare (1 in 12,000 for adult onset) genetic disease like that or any pain which would normally manifest itself. Anyway, I ignored the docs advice about waiting for 2 weeks before getting the CK tested again because I thought he was a bit crazy… and I was right! My CK came down to 120, 10 days after a moderately intense workout.

    RHABDO INJURIES:

    1. Pain in my lower back. This happened during the spin class because I was bending over when I was cycling. The pain remained bad for about a month, causing some pretty bad sciatica. I went to see a physio after 3 weeks and did a bit of remedial massage on it, and the pain disappeared not long after that! I also did a lot of piriformis muscle stretches and used the foam roller to roll the piriformis too.

    2. Left quad pain. I continue to get some mild burning pain (sometimes) when I start a workout, or even just doing something basic like squatting on the floor. Seems to be okay after getting warmed up.

    3. Knee injury. The VMO is still fairly swollen just above the knee (no pain at all with that muscle). The physio said he thinks it is muscle definition.. I think it’s probably scar tissue or something. I have a bit of weakness from time to time in both the left and right knees after a workout or even walking. It’s pretty random.

    4. Hip area muscle weakness. My physio has given me some exercises to strengthen the muscles in my hips (the clam I think the exercise is called?). I couldn’t do lunges well for a while.. not much stability in leg (shaking left to right). Can do it much better now.. though it’s still weak.

    5. My self respect.

    PRO TIPS FOR RHABDO AVOIDANCE:

    1. DRINK TONS OF WATER before, during and after working out. I was not drinking hardly anywhere near what I should have been.

    2. DO NOT DO ANY INTENSE EXERCISE IF YOU HAVE OR RECENTLY HAD THE FLU! I was still feeling crappy and worn down from the flu when all this happened. A few studies have linked the flu and intense exercise to a greatly increased chance that you’ll get rhabdo.

    3. Eat properly before exercising, particularly if you are new to it and your glycogen stores aren’t up for intense exercise. I also found that I needed to drink gatorade during workouts for a while at the start because I was getting low blood sugar. All fine now.. don’t need so much gatorade but I always make sure I eat a big meal at least 2 hours before training. YOU NEED FOOD, ESPECIALLY IF YOU ARE NEW TO EXERCISE.

    4. DON’T DO A SPIN CLASS IF YOUR BODY ISN’T USED TO INTENSE EXERCISE.

    PRO TIPS FOR RHABDO RECOVERY:

    1. It might be a good idea to see a doctor that specialises in sports injuries/medicine. Every single GP I have seen has very little knowledge on the subject. From what I’ve read, this whole area in medicine isn’t studied enough.

    2. It might be a good idea to see a physio. The exercises my physio gave me helped me get back to normal a lot faster.

    3. Drink tons of water. Eat well. Seek lots of advice to form your own opinion. Get tested often. Don’t push it beyond what you’re capable of, particularly with repetitive movements.

    If you’re reading this.. get better soon. I know how you feel (probably scared and put out).. but I got back to normal pretty quickly.. I’m much fitter than before all of this and I have a real respect for health and fitness now. Best of luck!

  • hope

    I have had Rhabo 4 weeks ago. I returned from a 4 month holiday and i had not been training much while I was away. I went back into the gym and started off my first week with 3 really intense PT sessions, the last 2 being 12 hours apart and both using upper body. My arms were extremely sore the first day after then the next day I couldn’t straighten them at the elbows. the next morning I woke up and they were so swollen this is when I knew something other than DOMS was going on. My urine was on the darker side and i read about it online. I took myself to A+E and the hospital and the doctor was quite surprised, my bloods showed CK levels of 50,000 and i was admitted for 4 days while they flushed my kidneys. Luckily my renal function was ok. I was watched for Compartment sindrome but happened to be ok without surgery. They let me leave hospital when my CK levels dropped to 18500 and i followed up with blood tests a few days later they had since dropped to 5200 then again 2 weeks later they are back down to 50. I rested for a week after and then started light exercise. (just walking) Last week (4 weeks on ) I returned to the gym but staying away from weights still, just cardio for now. I had some chest pains and went back to the doctor my blood pressure has been quite high since the Rhabdo and they are not sure why. its been 150/107 which is high for a fairly fit 30 year old female. I have been instructed to go and have an ultrasound on my kidney arteries to make sure that is all ok after the Rhabdo.

  • tinavel

    Wow, I got out of the hospital after 6 days and still am in so much pain it’s awful. But my first doctor also told me that there wasn’t a pain pill made that would help with this. Next doctor was great and gave me gabapentin and Norco. Still Have major swelling in legs and feet. I gained 30 pounds in 3 to 4 days.

  • David

    1 week ago to the day, I went to the ER because I noticed my urine turn tea/cola colored and instantly knew I probably had Rhabdo. The lady at the ER counter acted like a b**ch and tried to tell me I didn’t have Rhabdo because it was so rare… I pushed on and eventually got to see a Dr and they took my blood and urine sample. After 45 minutes + of being told its being checked still, I was immediately hooked up to an IV and informed I was staying for the night due to my CK level of 140,103. I was held from Thursday afternoon to Sunday evening. Friday morning my CK dropped to 98k, Sat morn 91k, Sunday Morn 61k, and Sunday at 2pm 51k. Released at 7pm Sunday due to levels trending down. I have a followup tomorrow with my primary. Feeling great, just get tired easily and stretching can feel weird slightly painful so I stop before too long…

    I’m a 30 year old male who used to work out 6 days a week and do P90X about 6 years ago. However, I wanted to get back into it after being married for 2 years. I had extreme muscle pain and joint (right shoulder) the first night I worked out (Monday) doing chest/back stuff, enough to wake me from dead sleep at 2am and 4am. I took extra strength Tylenol and went on with my Tuesday doing legs, took some more Tylenol and took a break Wednesday to just stretched a lot. I couldn’t raise arms above head or straighten them all the way, legs hurt to sit down or lower to toilet… but that was expected as I’ve felt similar pains years previous when working out hard. Now I’m being told to only do 10 push-ups or pull-ups and call it quits until i get back into shape… How is anyone supposed to get “back into shape” doing only 10 pushes/pulls a day…..?

  • Roland

    Sounds similar to what I experienced. Slow and steady wins the race.. drink a lot of water, after several weeks continue to exercise the fatigued muscles (but very slowly/low pace/light weights), eat properly every time before exercise. I also have protein shakes after a workout (was still getting slight DOMS for a while, and the shakes helped). It’s now 4 months after I had my 133,000 CK rhabdo, and I’m no longer fatigued in my quads, plus I look fit in that short amount of time. My doctor said to me “listen to your body”.. I think that’s a big thing.. don’t overdo anything, but don’t do nothing.

  • Scott

    I had high ALT and ALS (liver enzyme) levels as well. ALT peaked at 798 and AST 2550 (normal range for both around below 40). This was a bit concerning for the doctors as their research doesn’t indicate that Rhabdo usually effects liver enzymes to be spiked. We ruled out all other possibilities of liver damage/disease (i.e. Hep A,B,C, etc). It’s been 2 weeks and they’re finally starting to go down. Good thing to note here is that high liver enzymes CAN occur in Rhabdo and this information isn’t necessarily provided on the internet. P.S. I had CK levels peaked at 137,000. Liver enzymes take longer to stabilize (no alcohol for at least 2 months) and I’m still advised to wait another 2 weeks before doing even the easiest of exercises (i.e. push-ups, sit-ups, etc.).

  • gseattle

    This is a remarkable set of reports, tons of people with rhabdomyolysis. I doubt you all took statin anti-cholesterol drugs.

    This can’t be natural. It’s not nature, to work out and suddenly have the body decide to start dissolving muscles and flushing them out through the kidneys. There has to be something screwy in the works. Would sure like to know if there is a common thread. Aspertame, decaffeinated coffee, white bread, tap water (fluoride), too much cnn, whatever. No prescription drugs and none of those for me at least, nicotine, yes.

    Rhabdo for me is an odd one, accidentally ingested some Monensin, a farm animal treatment against Toxoplasma. Of five historical reports for the amount (tiny, ~180 mg), I was the only survivor. CK was over 100k multiple days, lost 40 lbs in three days or so, obviously almost died. Legs affected mostly, like twigs now, calf muscles (what’s left) feel as if they have been–or will be–cramping, both false.

  • Leslie Biddle

    I have gotten rhabdomyolysis 3 times so far. My first experience was after my breast cancer surgery. My cpk level was 121,000 then and a year later was 111,000. I was hospitalized a week with my last bout being a few weeks ago. According to the docs I am missing a protein that makes it easier for me to get it . Even though my cpk level was only 6581 this last time, the pain and fatigue has been awful. I am wanting to start working out again to lose about 130 pounds but do NOT want to bring this on again….any suggestions???

  • Sonny Carr

    Hi this is a great article and thread. I suffered with Rhabdo at 28 (now 30) am from the UK and found the information provided at the time very limited. Mine occurred after a circuit in the gym. My chest and arms became incredibly swollen and sore to the point 3 days after I couldn’t move my upper torso without pain. After a bit of ‘googling’ I came across Rhabdo and took myself to the hospital who told me and I quote ‘your too small for Rhabdo it happens to bodybuilders’. Anyway, urine samples confirmed and I was stuck in the ICU as my CK levels were off the chart and was told they could only read up to 100k, hooked up to a drip to manage the alkaline levels (I think they said) and monitored for 5 days. Fortunately following the urine discoloration I started to drink a lot of fluids and came away from hospital without any kidney damage. It took about 4-6 weeks after getting home for my strength to rebuild but have always been worried about getting back into the gym as I used to.

  • kellifili

    I take Adderall (prescribed) and fully believe it played a factor in my rhabdo (as does my doc) a year ago. While I did over exert myself with back to back challenging workouts, I was super hydrated and my nutrition was on point. I had been in pretty good shape and felt okay during the workouts as well. Since my urine was clear, I had to push my doc to test for rhabdo. CK level ended up being 36,363 and that was 3 days after the workout. Thankfully, my kidney/liver tests all came back ok. A year later I am still struggling to get back into the shape I was. I’ve been going to CF now for 3 weeks and I’m not sure I feel any improvement in my muscles and what they can handle. It is crazy how quickly they fatigue. Thankfully, my coaches are awesome and help to scale the WOD appropriately for me. Still, super frustrating to not feel 100% after a year.

  • Nat Alie

    I am one month post-rhabdo. I am craving to get back to my workouts, but have major fear of re-occurrence. I never want that feeling again. My rhabdo was onset by a CF wod that included 100 pushups for time. I started with long walks for the first two weeks, then tried a step class which I only did 1/2 of and did not push myself as I usually do; I had tingling in my arms and numbness in my hands. Did nothing for a week. Yesterday I did a yoga class, and had the same feeling in my arms. I am not sure if it is psychosomatic or real. My fam doc is useless as he knows nothing about rhabdo. I am considering doing weekly blood tests for a few weeks to see if my CK levels rise again after a workout, this will help me assess whether it is psychological or physical. Oh yeah, #RHABDOCANSUCKIT
    Cheers,
    Nat

  • Brennan Browne

    The orthopedic surgeon I consulted with while hospitalized with exertional rhabdomyolysis advised that the elevated levels of ALT and ALS did not stem from the liver, but rather were present in the bloodstream because they are also components of the skeletal muscle that was breaking down. My ER doc was originally alarmed at the levels, thinking my liver might be out of whack, but this was not supported by the specialist. Here’s a study that states something similar: http://www.ncbi.nlm.nih.gov/pubmed/20407858

    “The incidence of an abnormal AST in the setting of rhabdomyolysis was 93.1%. […] An abnormal ALT was much less common and found in 75.0%. […] AST concentrations decrease in parallel to CPK, suggesting skeletal muscle may be a significant source of AST elevation in these patients.”

  • Rachel Perdue

    Spin class is what gave me the RHabdo to begin with. I was in the best shape of my adult life before that class.

  • B Darnell

    Thank you so much for your articles on rhabdo! It’s been the best resource I’ve read so far and actually had an insulin pump rep refer me to it.
    I myself am a type 1 diabetic and have had elevated CPK levels over 12 years ago during a DKA episode which led to an er visit and 5 day ICU stay. However, this time around was completely different.
    I had recently gotten back into doing weights at the gym. Prior to this my exercise routine consisted of walk/running with our two 60+ lb pit mix dogs outdoors. For reference, I am 5’8″ 161 lbs around 22% bf.
    The week of my rhabdo episode went like this:
    Monday my hubby and I did a hard leg workout and my legs were super wobbly and weak afterwards, but it didn’t seem overly sore or painful. Tuesday I took the day off from the gym, but took the dogs for an hour long walk outside then went to get a pedicure. I didn’t sleep much Tuesdsy night and my husband and I flew to Texas around 7 am for a “work” convention. As soon as we arrived I hit the ground running- unpacking, going to grocery store to stock up on bottled water and food, etc. We were outside quite a bit, but I drank close to a gallon of water and several servings of rehydrate (powdered electrolyte replacement). My calves had been sore all day long but I just attributed this to the leg workout. However around 5 pm Wednesdag my left calf muscle locked up so I ate 2 bananas and drank more rehydrate followed by another bottle of water, then we headed to 6 flags for a leadership event as a part of the conference. I continued to drink plenty of water, but my calf stayed super tight for the rest of the night. (I should note that by the end of the night my Fitbit said I walked 23,000 steps and a normal day for me is between 9-10,000 steps)
    My urine never got darker than pale yellow, but I continued to feel dehydrated or at the very minimum that my electrolytes were off. Thursday morning I woke up, showered, and decided to go to a walk in clinic to try and get some IV fluids but they sent me to ER. At the ER, they drew blood and gave me 2 bags of fluid to begin with. When labs came back an hour later, my CPK levels were st 17,000 and for the first time that week my blood sugar was elevated. (Typically 36-48 hours after a weight workout I always struggle with low blood sugars and all day Wednesday and part of Thursday morning I struggled to keep my bg levels above 80, lowest metered reading was 24 so I cut my Basal rate down to 50% of normal rates) In the ER Thursday it went up to 274 though. The ER dr was concerned bc of my medical history (diabetes, hashimotos hypothyroidism) and threatened to admit me of my CPK levels didn’t drop significantly. After a 3rd bag of fluids my levels dropped to 14,000 and the dr reluctantly released me but told me not to leave my hotel room that night and take it extremely easy the rest of the week. My discharge paperwork showed a diagnosis of rhabdo and elevated bg levels (which I treated myself with my pump). I stayed in and drank over 2 gallons of water Thursday, but Friday I kinda overdid it walking up and down stairs at AT&T stadium causing me to miss the events Saturday morning. However, we had to fly home Saturday night. After getting home I have tried to rest and stay in bed and in the AC as much as possible for the past week and a half. However now I am going STIR CRAZY!
    Last night (12 days after initial ER visit) I went to the park with some friends and wasn’t super active, but the heat just took everything out of me and has caused my back and leg muscles to cramp up and feel very similar to the day I chose to go in to the ER. My blood sugar levels have been very well controlled with very few high or low swings, I have had plenty of rest, but I do notice I am having trouble feeling completely hydrated even with drinking 80-90 ounces of water in addition to drinking 20-30 ounces of coconut water mixed with rehydrate and NO caffeine whatsoever since my ER visit.
    Is this normal? Should I be concerned?
    I did visit my endocrinologist last Wednesday (so 6 days after ER visit) and my a1c is good, my kidney function is good, but my potassium and sodium levels were low (which I am now taking an oral otc potassium supplement for in addition to calcium and magnesium to help treat) My endo was initially concerned thinking that I could potentially have been running ketones, but I don’t think they tested for that in the ER. (Although they did do a urine test, just not sure what they tested for)
    My question is, what gives?!? How long am I going to deal with the muscle weakness and should I be concerned that I still feel dehydrated even though I’m drinking more than 1/2 my body weight in water every day. My endo just told me to take it easy for about 2 weeks, lay off the heavy workouts, and check for ketones. (Every test has been negative and bg levels have been controlled)

  • Hey Nat – frequent blood tests when returning to activity after a bout of rhabdo can be useful. There is some research out there that shows a slight rise in CK levels CAN be normal for those who are active in high levels. Because of that I’ve seen one MD argue that the “normal” should be adjusted for those who work out heavily.

  • CFMItch

    So I have no idea what the F**k is going on with my body. October last year I was admitted to hospital for high blood pressure, turns out I have kidney disease/ failure but they are functioning around 50%. Then this year I have had rhabdo x3 times. First time was only a few days, no pain, no dark urine, no other signs other than swelling of the arms. The 2nd and 3rd time I was in the hospital for a week. Again, only swelling, nothing else. My CK level the 2nd time was over 70k, 3rd time was 54k. Doc said he has no idea how it hasn’t destroyed my kidneys, normal levels should be 204 roughly. All the times it happened, I was doing routine weight lifting, nothing strenuous, no supplements as they would destroy my kidneys even more, just a high protein diet. Initially they thought it was a reaction I was having to some meds I was on (cholesterol – precautionary for the kidneys). But when it happened the 3rd time, I was off the meds for 4months. So the docs now have no idea what is causing this. I’m to go and get a muscle biopsy done to see if there is something within the muscles.

    Should be known that prior to this shit all starting back in October 15, I was in top shape, could sprint flat out for 5mins, heavy weights and work outs, run obstacle courses in my sleep type thing. Now? I jog for 2mins and I’m going to die, lift weights longer than 30mins and I’m going to die. Docs again don’t know why I’m always out of breath now.

    Sounds like I’m 55yrs and older right? Nope. 27. I work in policing for last 2yrs, and Cdn army before that with a tour for 10yrs and counting. All my army buds say it’s probably something I picked up from Afghan or something and I wouldn’t doubt it.

    Pisses me off that no one can seem to pin point the cause of what’s causing all these problems. I want to get back into the shape and then some where I was before, I want to apply to specialty units, future deployments, etc. But I can’t with my current condition, plus doc told me the other day no working out other than cardio until they figure the muscle thing. Can’t do cardio because I end up out of breath and with my body type, cardio isn’t what I need to focus on, it’s weights and muscle gain. I have a lean high metabolism body type. Shit pisses you off….

  • creakygeeky

    Hey there, hope you recover from rhabdo and your phobia!!
    I’m a 21-year old, 5’2″, 52.2 kgs girl and I got rhabdo last month from spinning, was hospitalized for 6 days. I can start exercising now, just not too intense yet. my CK was 164,000+ and then rose about 4 days after to around 190,000. My joints and ankles still feel a bit flimsy (going for a check-up on that soon, hope it goes back to normal) but my muscle pain is gone for now.

  • Bob Willis

    I’m glad communities like this exist. I have been dealing with what was a severe case of Rhambdoiolysis for over two months. I have been a lifelong competitive athlete but for a number of reasons got away from regular training for the last year. Well, me being me I spent about a week breaking myself back in and then kicked it up to 2 a days six days a week. Stupid… A few weeks go by and while I really didnt experience any significant muscle soreness, I was noticeably fatigued for several days leading up to the onset of Rhabdo. Of course I shrugged it off ignoring that and any other possible warning signs my body was giving me and told myself like the old days to “quit being a pussy”. After a particularly high exertion day which included my normal workouts plus getting sunburned and sweating large amounts in the hot sun, I went to bed. I was awoken the next morning by my wife, went to stand up off the bed, and quickly collapsed in on myself onto the ground, immediately realizing I couldn’t feel my legs. I was rushed to the ER where I learned I had renal failure from Rhabdo and my heart was likely only hours away from stopping due to high potassium levels that had been released in my bloodstream. Fast forward to a few days later in the hospital and my renal activity had normalized, but I still could barely move my legs…let alone walk. I was then transfered to a Physical Rehabilitation center where I spent 7 weeks with a PT team and advanced, very slowly, from a wheelchair to walking on two canes. I was just released last week and while I have a long way to go, fortunately the long term prognosis is good. Its just insane to think that your body has the mechanisms to destroy a lifetime worth of leg muscles and nerve endings in an otherwise healthy 37 year old. Its equally insane to me that after 25 years of high level athletics and health/fitness research, I had never even heard of Rhabdo. While I certainly had a rough case of it and many people get pretty significant symptoms, are able to recognize that somethings wrong/seek treatment, and are ok after a few days of pushing fluids in a hospital setting, it can get much worse; My buddy who’s a doc told me of a few cases of marathon runners who got full body Rhabdo and compartment syndrome – which unfortunately often requires a fasciotomy. Ugly stuff. I guess the moral of the story is LISTEN TO YOUR BODY. Of equal importance is to get a full workup with your PCP before and during the period that you take on a new fitness regimen..particularly if you’ve gotten away from training for a period. Good Luck to everyone and remember that you and your loved ones’ health is the most important thing in the world.

  • Solid advice. With the advent of fitness boot camps, Crossfit, and military style training camps the tendency to push ones body past the athletic capability of what it’s used to has become more common. Couple that with all these organizations that give out fitness certifications online and the trainers really have no idea what goes on inside the body.

  • Luke

    I don’t have a story nearly close to the ones listed, but I’m concerned I may be experiencing a relapse and I can’t afford the downtime, but don’t want to be stupid. Initially I contracted rhabdo after crushing my quad while doing heavy shrugs. The bar became entangled in my shirt and when I attempted to free it I lost my grip and the bar came down on my quad. It was bruised and painful for a few days, but I just took a week off of legs and continued do train. Week later I had no pain at all and I decided to do a mild leg day with only extensions, curls, etc. No squatting, no presses, Nada. Next day I could barely stand on the leg and I had a football shaped section in my outer right quad that felt like a rock. I attempted to massage it out thinking it was a knot. Big mistake as the pain almost sent me to the floor. Figured take a couple days off and it’ll heal. Ice and rest for a couple days and I just continued to feel run down, sore, and simply miserable. Knew at that point something was up went into the Urgent care center where they did some blood work and came back with the rhabdo diagnosis. I was not hospitalized as at its peak my CK level was only 3700, so they kept me for about 8hrs ran some IV fluids through me and rechecked my bloods. Reduced from 3700 to 1075 in just a few hours so they sent me home with an order to rest, hydrate, and follow up with my primary doctor. Four days later my levels were down to 440 and doc cleared me to get back to work, but take the rest of the week off from the gym and rest. She told me I could start back Monday taking it easy, listen to my body, and slowly work my way back up. That was about a month ago. I’ve been back full training for a couple weeks and all of the sudden today I feel like its hitting me again. I’ve made it a point to stay hydrated and I eat on a very strict plan as I’m in prep for a bodybuilding show in December. I’m debating if I’m just getting sick or if I need to get back in to get checked out.

  • karl

    hi just thought id write somethng im a 40 year old male who returned to weight lifting after a 8 month relapse of heroin and crack i have used heroin in one way or another since i was 14 years old but fortunatley i wentto prison enough times to still keep my body healthy as i allway got into the gym this time i never went to prison and managed to get clean out instead i hate the fact that im an addict and i hate the fact that i had such a crap childhood i wont bore u with the deatils justto say that my life is not been great. the point that im making is that i went to the gym after coming back from the relapse and trained heavy and straight into the sauna af6erwards not hydrated properly at all and got rahbdo after 3 days in hospital and a good rest period im going back to the gym but will train properly this time gradually too. the rahbdo experience was just awful my pee was like coke and i felt like shit it was areally scary time but one of the stupidist things i done was try to get through it on my own just drinking lots but i went tio the doctors and that was it everything went crazy, im back now and am going to the gym this afternoon.

  • Raj G

    Hey, it’s been a year since I
    Posted, I just wanted to than everyone for responding.

    I got m ACL surgery and have been doing rehab and I expect to play hockey in December!

    I took almost a year off from working out and started again last week. I went to do a chest workout (bench press and free weight) and my arms started to feel the same as they did when I had rhabdo but on a lighter scale ( the benchpress I just did the bar and free weights I did 15 pounds chest press). I’m paranoid it’s rhabdo again, I would hope having a year off would have recovered my arms. I’m going for blood work this week as well as an EMG to determine if everything is good, I pray to God it is. I’m sick of this I just wan to workout and not be paranoid anymore!!!

  • Brehanna

    Hi, I’m 27 years old and I’ve been physically fit alli my life and about a week ago it was my first time back at the gym in about five months or so. I was in a hurry because I had to work right after (I’m a massage therapist). It was only about a 15-minute workout and I was doing back and biceps. For biceps I was doing Drop sets starting at 15 lbs then 10 lbs then 5 lbs. didn’t think it was that hard of a workout but maybe because I wasn’t taking any breaks and was in a hurry is why it happened. I also went straight to work after doing massages for many hours which obviously uses my arms. That day I noticed my arms couldn’t fully straighten and I thought “Wow that must have been a better workout than I thought.” Of course I was trying to stretch my arms and keep the range of motion in my arms. The next day (Thursday) I even went to the gym again and did chest and triceps. that night I noticed my left arm swelled a little and thought that was kind of odd. I didn’t go to the gym on Friday and noticed my arms were very sore and the swelling was increasing. then on Saturday I started Googling things because I knew somrthing wasnt right. I found Rhabdomyolysis and it freaked me out so I told my boyfriend we should go to the hospital just to make sure. when I read about rhabdomyolysis I just started chugging tons of water as well so my pee was actually quite clear when I went to the hospital. the doctor pretty much laughed at me when I went thinking I was wasting his time. His mind chsnged quickly after he took my blood and found that my CK levels were greater than 23 000. At this Hospital they’ve never seen CK levels so high. Anyways I spent the night there with IV fluids and prednisone 50 mg then 40 mg the next day and one more dose of 40 mg. so I just spent the one night there and in the morning my CK levels dropped to 13 000 so they released me and said to keep hydrated and rested. I’m following up with my doctor with bloodwork and urine samples. about a year ago I was diagnosed with reactive arthritis so the internalist thinks that maybe that autoimmune disorder might have something to do with it. I guess I’ll know more with my blood work results and the ongoing testing they will be doing. But I was wondering if anyone has heard of this happening or is it more common in people that have an autoimmune disorder already? I also have people booked in for massage next week. I would like to get back to work but am slightly afraid. I do not to end up in the hospital again. My arms feel good today but still can’t fully straighten them. Work out was 1 week and 2 days ago. Hospitalization will be a week tomorrow.
    Thanks!
    – Bre

  • Brittany

    Hi everyone – first I want to thank you for this article and everyone who’s shared their experiences here it was very helpful and its nice to hear other stories as I feel very much at a loss right now. I also promise I’ll try and keep this short. I am a 30 year old female; played division 1 soccer in college, professionally for a few years after and have been an avid crossfitter since my soccer “retirement” almost 3-4 years ago. Until about a month ago I crossfitted 5 days a week, played soccer (at least) once a week, ran personal soccer training sessions on the side as well and did various road races, half marathons, etc. needless to say I have always been constantly active/ can’t sit still! About a month ago I had a cold which I felt like I could NOT shake, I was only able to get to the gym 3xs that week as I felt SO run down. Then the same totally rundown/exhausted feeling the following week plus I missed my weekly soccer games (something I NEVER do!) my body just felt exhausted and like I could not recover from a workout. I was staying sore for days and everything felt labored. Finally after feeling like this for THREE weeks, along with noticing that my stomach was very distended and swollen past what it would be from just missing a handful of days at the gym I took my stubborn ass to the doctor. They called me the next morning and said my CPK level was over 38,000 and I needed to get to the ER, where they kept me there for four FULL days and three nights and I finally was released once my levels were around 1,700. I’m quite frustrated because I cannot pinpoint a single workout or any real “extreme” swelling like most others have other than my stomach sticking out and having gained like +10lbs so it seems like my rhabdo was a longer slow build up which doesn’t seem common. Every doctor basically told me “oh you have rhabdo from working out to much!” when in reality I had been working out WAY less than normal. Anyway, I understand it will take a while to get back to where I was and to get my activity level back where it was and even though its killing me I am planning on taking a full 3 weeks off. However, I had a few questions for my fellow rhabdo’ers if anyone wouldn’t mind helping me shed some light on all this. My quads and abdomen are still quite swollen a week and a half out of the hospital, is this common did anyone else experience this? I also feel so stiff from just sitting around has anyone been advised one way or another against stretching? Thanks so much!

  • Chris

    Just reading this 3 weeks after having rhabdomolysis as I’m trying to decide when I should return to work. After looking at some of these posts I’m amazed how different my treatment had been here in England. After a brief period of no physical activity due to a hospital procedure I took a spin class, I realised I had over exerted myself but though I’d just be aching for a few days. I went to work the next day, (I’m a nurse at the local hospital) 8 hours on my feet and I was really struggling, despite this I was back in work the following day managing on ibuprofen and co-codamol to get me through the shift. That night I was in severe pain, I knew this wasn’t normal and decided to google my symptoms, my urine had become very dark by this time and I realised what I had. After seeing a doctor he sent me to the Accident and Emegency Department for urgent bloods. I’m not sure what my initial CK level was but I was admitted to a ward on IVs overnight. I had severe pain in both thighs, couldn’t lift my legs or bend my knees.My CK levels had started to come down the next day, they were 118,000 on discharge and I had extensive swelling to both thighs. I returned for bloods 2 days later, my levels were then 136,000, on subsequent return visits it started to come down and was 5,000 after 6 days from my initial admission. I was discharged completely at this point from needing to return, no advice and no aftercare!! My own doctor is now monitoring my CK levels and I’m still unsure if I should return to work? My mobility is now much improved but still very weak, I can now bend my knees which was something I found impossible a week ago. I’m desperate to build up my muscle strength again but concerned about overdoing it and causing further injury. My doctor won’t refer me to physio as my levels are still elevated so I suppose it’s just a waiting game!!

  • Hey how was your treatment over in England? Curious Thanks!

  • Chris

    Hi, well they were very quick to treat me, Ivs commenced as soon as my blood results came back but I was discharged after less than 24 hours and my ck level was 118, 000. Just advised to drink lots of fluids but no advice to rest etc. Retuned every other day for bloods to be checked for 5 days, ck peaked at 136,000 then when it was 5,000 I was completely discharged from their care with no advice what to do. I couldn’t bend my knees or drive and walking was a very slow process. I saw my own Dr who is now monitoring my bloods, ck is currently 500 and my legs are still weak but improving, thankfully my kidney function hasn’t been affected but liver function was slightly. Still had no advice on how much I should be doing and will be returning to work in a few days. I’m a nurse and my 12 hour nightshift will probably take it’s toll. I’ve suffered nausea and have bouts of extreme tiredness but this hasn’t been adressed by any doctors, it’s just a case of, get on with it!!

  • Thanks for the feedback Chris. Sound similar to that over here in the United States – it’s very easy to diagnose rhabdo but not very much on what to do afterwards. It’s very tough for active people on the direction of where to go and what to do. Many physicians are unfamiliar with this.

  • Kari Ashley Facinelli

    It has been over two years since I was diagnosed with Rhabdo, I had been playing it easy for what seems like forever, I’m paranoid to get hurt again…I have recently started to workout daily, by working out I mean I’m running/walking miles and I take a class on Tuesdays. The class is called Rip, consisting of lifting light weights, a little cardio, stretching..it’s a very good class that I used to take all the time. It was my first time back yesterday and it really kicked my butt. It’s embarrassing not being able to even lift 5 pounds multiple times, I have a hard time doing push-ups, they’re probably the biggest challenge for me.
    It’s disheartening trying to get back in it and feeling so weak. I took it very easy in the class, not wanting to over do it again and I’m feeling pretty good today just tired but normal work out feeling.
    Has anyone gone back to normal after Rhabdo? Because to me, it feels like I’ll never go back to normal and it sucks.

  • Hey Kari, I think you commented on here a while ago. Hang in there with your rhabdo recovery. It does take time. You can always work on individual exercises outside of a class to help with strength training. Glad you’re feeling good after the class.

  • Sharlene

    After reading more than 20 stories, I’m fairly confident mine is a bit different. I’m a 37 year old female who has worked a 50+ hour a week job as a reastaurant manager (on my feet 10-12 hours a day) for the past 8 years. I am otherwise not very active and never workout except for the occasional swim in the summer.
    I joined some of my employees for a game of kickball on a Wednesday followed by beers and trivia at the bar. Two days later, I was still very sore but we walked around the zoo for hours. By the time Monday rolled around, I still couldn’t walk normal, was joking about getting old and how I can’t play kickball again. But on Tuesday (6 days after playing kickball) I felt sick, nauseous. Still had trouble walking. Major burning in my quads and hip flexor. Got home, made a wrong move and was reduced to tears from the burning pain. Went to ER and was admitted. Blood drawn and they knew immediately it was Rhabdo. Thing is, my levels were barely 2,000. But let me tell you the pain was horrible! Stayed in hospital from Tuesday night until Thursday morning. I am now 3 weeks out from diagnosis and still having burning pain and weakness when I try to do too much. Im drinking electrolytes, taking a daily multivitamin and trying to listen to my body. I’m supposed to go back to work on my feet Monday but am scared I won’t be able to make it through a 10-12 hour shift on my feet when I am still in pain after a quick grocery store trip.
    I am guessing my slow recovery is due to not having been in shape in the first place.
    A bit more background: I’ve been dealing with muscle/leg aches after work for years along with swelling in my feet and hands after a long shift. I am 5’8″ and about 155 lbs so I am not overweight, just out of shape.
    Any feedback from anyone who has been out of shape when being diagnosed with exertion Rhabdo would be great. My Dr seems to have never dealt with it before and it’s a struggle to get the time off work approved.

  • Pedro Mangueira Brito

    Came out of hospital last night from Rhabdo. I’m 28yo, in a healthy shape, never really went to the gym seriously. I exercise sporadically, light stuff, running (normally about 20min) not very committed etc.

    Last Tuesday I went to the gym with a friend who does a lot more than I do and started the workout. I hadn’t done anything for a while, but wanted to get back to it, so i went for it. It wasn’t anything crazy, at least it didn’t feel like I was overdoing anything, did like 3 series of 10 or 15 reps of: Australian push ups, sit ups, hanging sit ups, lightish weights etc. Nothing much, really. It was tough, but I just thought I was a bit rusted. I did noticed my arms were rock hard and pumped, but I thought was just the normal thing. Went home and woke up in the middle of the night in a lot of pain, all my muscles were sore, but again, thought it was normal exercise pain. Went to work everything seemed fine. I noticed my urine was a bit off, like it wasn’t as dark as people describe at all, was kind of a light caramel colour, didn’t give it too much thought, I had eaten a paella that day and assumed​it was because of the saffron.

    Next day(Friday), went to work as normal ( I’m a waiter, btw, carrying heavy plates all day) my pee was slightly lighter than before but my arms were really sore and got even more swollen, I couldn’t even stretch them straight. That kind of flagged up something and after my shift I started looking up online what I could do to reduce muscle pain/swelling after a workout. Ended up coming across an article about Rhabdo, never heard of it before, but when I read the description and the dark urine thing, everything clicked and I decided to call the NHS helpline. They told me to go to the nearest A&E to have it checked. When I got there, they took a URINE sample, which was a totally NORMAL COLOUR by then and I felt like an idiot for wasting my time. After they ran the test, the nurse told me they needed to run some blood tests as the urine analysis had indicated a lot of blood.

    After the results came back, I was admitted to the hospital. 94.000 CK. Extremely high! This was literally 4 days after my gym adventure and NORMAL URINE COLOR. So, you can still have Rhabdo even if your urine seems normal.

    Spent almost 3 days in hospital on IV fluids. On the second day my CK levels had dropped down to 54.000 and the tests indicated my kidneys were fine.

    The swelling in my arms wasn’t going down and the doctors were concerned I could develop compartiment syndrome. Not fun. They told me I had to rest my arms and keep them raised to help with the swelling. It did help a bit and I got discharged​ Monday night.

    It scares me a bit that they’ve discharged me even though my CK levels were still on the 50k mark(public hospital, you know, they want to get rid of you asap), but I’ve been drinking loads of water, which is kinda the same as the IV fluids treatment, hoping I’ll be fine.

    It’s now early hours of Wednesday, a week after that gym session and I still can’t stretch my arms. They’re ​almost the normal size now, but I keep​ worrying about it, coz they still feel very stiff. In fact, the other muscles I’ve used that day are also still sore and I just noticed some swelling on my abs. I’ll keep an eye on it, hopefully it’ll all get better soon.

    I’m going back to the hospital on Thursday to check my CK levels. Will update you guys then. Wish me luck.

    Xx

  • Beth A. Breeze

    Thank you for posting this article. I was just released 2 weeks ago after arm swelling lead me to the doctor and a CK level of nearly 40,000 put me in the hospital. Everything is fine now (yay) but I haven’t seen any kind of guidance for return to activity – this is a very helpful article. I am very fit and wasn’t doing anything crazy (a variation on pull-ups, but nothing harder than anything else I have done in the past, and certainly not the most strenuous workout I’ve ever done.)

    Unlike many of the testimonials below, I was in NO pain. I had what felt like a little post-workout muscle pain but nothing that I hadn’t felt before in normal recovery after a workout. What was different was the swelling.

    I’ve been given the OK to return to light fitness activity but I’m still nervous about recurrence since my initial injury wasn’t painful at all.

  • Beth A. Breeze

    Bre – It’s funny about your arms not straightening out – that’s *exactly* what happened to me, too! I thought it was funny at the time. And then the swelling started the next day. I hope you’re feeling better now.

  • Courtney Ellis

    Hey everyone thanks for the article/comments.. im guessing this post is still active since the last comment was 9 days ago. My story is pretty similar to alot of you. Im a university football player in my 3rd year. Im 22years old, 6’0″ 235 pounds and generally healthy. I’ve had rhabdo 3 times. One each year since since i started university all occuring sometime after the football season has ended (november, january and most recently february/march) with CK levels over 100,000 for my first time and below 50k/10k the last 2 times. The latest time was the most mild because i caught it early. Every year since the first time i have been diligent in hydrating and slowly and gradually upping the intensity of my workouts but some how it seems to creep up on me and for no reason whatsoever and it ONLY HAPPENS IN MY BICEPS. Really fed up and looking for answers because im approaching an important leg of my athletic career. (P.s. i barely drink and i do not do drugs or steroids. since its the first thing on every docs mind when they see me.) One thing ive noticed lately is that my muscular endurance has been shot and i cant last very long in workouts right now. could be because im still recovering and maybe my CK levels are still somewhat elevated(getting that re-checked this week). The real reason for me posting here is to see if anyone has any updates on information regarding rhabdo, how to avoid it, what causes it and how best to recover from it. theres only so much water i can drink and the doctors here know just as much as what i can find on the internet about it. I just started seeing a specialist so maybe he can help.. or just take chunks of my muscles and poke at them like he said he would if he cant figure out why this keeps happening. I like my muscles so: IF ANYONE KNOWS OF ANY RECENT ARTICLES OR STUDIES I THINK WE’D ALL APPRECIATE IT SO MUCH IF YOU WOULD POST IT HERE. Really just wanna get over this once and for all and get back to getting gainz lol. thanks everyone and goodluck with all your recoveries/prevention

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  • M R S R

    Thank you for sharing your stories.
    I was hospitalized with rhabdo for 9 days in 2015. At that time I was running consistently and strength training for about a year; and spinning for about a month. One week prior to diagnosis I’ve been feeling more fatigued ; soreness to my quads, left shoulder and right sided abdominal pain. I didn’t pay much attention to it.
    11/05/15 at 630am I did a 45min cycling class. By lunch time that day, I felt increased abdominal/muscle pain around the curve of my right ribs and it hurts when I take a deep breath. My abdomen was tender to touch and pain was spreading. My boss (an MD) ordered labs and I was sent home. The following day at work I had increased pain. Also shortness of breath and decreased urine output. Labs showed CPK 2200. Low calcium. PO4 1.1. I was advised to go ER right away due to risk of kidney failure and heart attack. I had trigger point injections (total of 9 sticks) two days prior to hospital discharged. This procedure tremendously helped with my pain during my recovery.

    I’ve tried and still trying to get back to my routine after a year and a half but sadly I still can’t get close to how i was. I start to experience abdominal pain 20-30 mins into a spin class or walking. Strength training is difficult and causes pain it also spikes my cpk. My left shoulder/deltoid is consistently painful; lifting 5lbs is a total joke me. I really know where to go from here other than keep trying and find what will work for me. No suggestions from 5 doctors except to listen to my body and ER precautions.

  • Hey Courtney, unfortunately there isn’t really much new research that I’m aware of. In terms of treatment from a medical standpoint, research has only really looked into rhabdo in the emergent stages so that it prevents life threatening complications. Little has been done to look at how to recover. You can find tips on recovering and preventing future rhabdo through my series on rhabdo.

  • Hey, thanks for your post. Patience is key here. It’s a slow painful process. Nutrition plays a big part on preventing rhabdo:
    http://yourlivingbody.com/preventing-treating-rhabdomyolysis-athletes/

    Unfortunately it’s going to take time to workup to your past level of fitness.

  • I wanted to thank everyone for contributing their personal stories with rhabdo. I never thought this post would get the attention that it has. I want to encourage other people reading this to share their stories. Your story could help someone else who is struggling. I want to encourage those who have gotten back to their physical activity level before rhabdo to email me so I can hear your story on how you did it.

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