By KAREN WALKER
correspondent@centrecountygazette.com
Almost anyone who has embarked upon a new fitness regimen knows the feeling of intense muscle soreness that sometimes follows your first couple of workouts — that painful sensation that makes it difficult to lift your arms high enough to wash your hair in the shower or walk up a flight of stairs without grimacing at each step. Sometimes, even seasoned athletes experience this kind of pain upon returning to the gym after a long vacation or illness, or just upon pushing a workout a little too hard.
Normally, a little muscle soreness is viewed as a positive thing. It is a sign that you are using your muscles in new ways and building up strength. But soreness also indicates a breakdown of muscle tissue — and if that is taken to the extreme, it can result in a relatively rare, but dangerous, condition known as rhabdomyolysis, or “rhabdo” for short.
My husband recently learned about this potentially life-threatening condition the hard way. Ordinarily a regular exerciser, he had taken about a six-week hiatus from the gym this spring due to a busy work schedule. When he finally went back to the gym in June, he tried to make up for that six-week absence in 60 minutes, lifting heavy weights and pushing himself extra hard.
The next day, he complained of a headache and extreme muscle soreness in his arms. These symptoms continued into the following day, along with new symptoms: fever, fatigue and dark, tea-colored urine. In addition, by this time, his arm muscles were so sore and weak, he could barely lift a fork to his mouth.
After ruling out COVID with a home test, we did what they always say not to do: we Googled his symptoms. It’s a good thing we did, because rhabdomyolysis came up in the results. The description was sufficiently scary to convince him to head straight to the emergency room at Mount Nittany Medical Center.
Bloodwork eventually confirmed the rhabdomyolysis diagnosis. Specifically, my husband’s creatinine kinase (CK) levels were high, which is the primary indicator of rhabdomyolysis. While normal CK levels range from 30 to 223 units/liter in adult males my husband’s age, his CK levels peaked at over 12,500 u/l.
My husband was admitted and put on IV fluids for 24 hours. Physicians told him that if he had waited one more day to seek treatment, he would have needed dialysis.
That’s because, according to Mount Nittany Health hospitalist Thomas E. Covaleski, M.D., “Kidneys suffer the most immediate effects from rhabdomyolysis.”
When a muscle is overused or injured, Covaleski explained, “It will release creatinine kinase, myoglobin and other substances from within the muscle cells into the circulatory system. … These substances can then cause injury to the kidney.”
In addition, he said, “As the muscle is injured, it swells, taking fluid from your circulation and reducing the blood flow to the kidney. This creates a dehydration-like reduction in blood flow and oxygen supply.”
If caught early enough, treatment involves nothing more than rehydration through IV fluids. My husband was also ordered to drink a lot of water and electrolytes after being discharged. He continued to have blood tested and monitored twice a week for three more weeks, until his CK levels and other indicators returned to normal. It took another week or two beyond that for him to feel back to 100 percent healthy.
While rhabdomyolysis is not common, it has become increasingly common with the rise in popularity of high intensity interval training workouts such as CrossFit or indoor cycling (“spin”) classes, according to the National Institute for Health.
The condition has also been in the national news recently. Earlier this year, a strength and conditioning coach at the University of Oregon settled a lawsuit filed by one of three football players who were hospitalized with rhabdomyolysis following an intense post-break workout in 2017. Other collegiate sports teams have reported similar outbreaks in recent years, including the Ohio State women’s lacrosse team and the University of South Carolina’s men’s and women’s swim team.
Closer to home, Covaleski said, “At Mount Nittany Health we see cases of rhabdomyolysis throughout the year. Although it can be associated with muscle injury and trauma, it is more typically seen with excessive exercise. We sometimes see an uptrend of rhabdomyolysis in the weeks leading up to spring break as people are trying to quickly get into beach-body shape.”
Increasing exercise intensity gradually and staying well-hydrated can help people avoid developing rhabdomyolysis, Covaleski said. Anyone experiencing excessive muscle pain and swelling along with dark or brownish urine should promptly seek medical attention for blood work, he said, because if rhabdomyolysis goes unchecked, it can eventually affect the heart and nervous system in addition to causing kidney failure and permanent muscle damage.
