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.