Do I Have Rhabdomyolysis?
What is Rhabdomyolysis?
“Exertional rhabdomyolysis (ER) is a condition characterised by muscle pain, swelling, and weakness following exertional stress, with or without concomitant heat stress” (O’Connor et al., 2008). Athletes who experience ER often present to the emergency department, the training room, or the physician’s office (in this case), constantly feeling as though it is a severe case of delayed onset of muscle soreness (doms). Essentially, rhabdomyolysis is a breakdown of the muscle tissue, where the tissue components enter the bloodstream.
When the muscle breaks down during rhabdomyolysis, the skeletal muscle is affected. The skeletal muscle, on break down releases Myoglobin (a protein component) and Creatine Kinase (an enzyme) into the bloodstream (Nabili S.T).
Early complications of rhabdomyolysis may include very high potassium levels in the blood. This can lead to an irregular heartbeat or cardiac arrest. One in four patients with rhabdomyolysis report liver problems post-diagnosis, and 15% of cases lead to kidney failure.
Do I have Rhabdomyolysis?
If you’re wondering if you have Rhabdomyolysis, you need to check if you have any signs and symptoms of the condition. These include muscle pain and weakness, specifically difficulty straightening the arms from the elbows, or delayed onset muscle soreness that is more than normal after a workout. Check your urine, One of the hallmark signs of rhabdomyolysis is dark, reddish-brown or tea-coloured urine. This discolouration is due to the presence of myoglobin in the urine.
Affected muscles may become swollen, tender, and painful to the touch. Fatigue and overall weakness can accompany rhabdomyolysis, often making it difficult to perform everyday activities. This is a big sign that something is wrong, as usually, the patient notices a sudden drop in energy levels.
What are the other Signs and Symptoms of Rhabdomyolysis?
Nausea and Vomiting: Some individuals with rhabdomyolysis may experience nausea and vomiting.
Fever: In some cases, rhabdomyolysis can lead to an elevated body temperature or fever.
Confusion or Altered Mental Status: Severe cases of rhabdomyolysis can result in confusion, altered mental status, or even delirium.
Rapid Heart Rate and Breathing: As the body tries to compensate for the metabolic imbalances caused by rhabdomyolysis, the heart rate and breathing rate may increase.
Swelling and Fluid Retention: Fluid and electrolyte imbalances may occur, leading to edema (swelling) and fluid retention.
Kidney Problems: Rhabdomyolysis can lead to acute kidney injury (acute renal failure) as myoglobin accumulates in the kidneys and causes damage.
A Rhabdomyolysis Case Study
This particular case starts with a lady; we’ll call her Liz. Liz is 52 years old and commenced CrossFit training in July 2011. A dedicated CrossFitter, Liz consistently trains at 3-4 sessions a week. On this particular week, Liz completed ‘Angie’ on Monday (100 pull-ups, 100 push-ups, 100 sit-ups, 100 squats for time). On the following day, Liz did some strength work and box jumps.
Liz recounts her week: “I completed the 'Angie' WOD on the Monday, on the Tuesday, I just thought I was a bit sore and tired, nothing unusual at that stage. On Wednesday, I noticed my muscles were starting to ache. When I think back to Wednesday, my arms were quite sore, and I felt restricted in what I could do with them. By the Thursday, the arms were still sore, and there were more aches in the body, particularly the left side. I also felt exhausted, washed out and also nauseous.
I woke with the same symptoms on Friday, so I booked to see Alex, my Physiotherapist. I was close to going straight to the doctor but decided against it, as I thought it was still a case of doms. Alex listened to my story and recount of the week; coupled with my symptoms and slight feelings of nausea, Alex referred me directly to my general practitioner. My GP did not think I had rhabdomyolysis, as she stated that it was scarce and she had not seen this in 30 years of practice as a doctor. She thought my muscles had just gone into spasms from working out so hard. However, she agreed to get urgent blood tests based on Alex’s referral and concerns.
I went away that weekend to Rutherglen. I received a call from the Doctor on a Friday night advising that Alex’s diagnosis was correct and that I needed to go to the hospital immediately. She advised me I had a creatine kinase (CK) reading of 32,000 (typical values are between 90 and 140) and that I needed to get to a hospital so they could get me on a drip to flush out these enzymes. She had been in touch with a Specialist before contacting me to confirm the diagnosis and treatment. She did not know I was away. However, we worked out the closest regional hospital to Wangaratta in regional Victoria. She arranged everything so they were expecting me. I was well looked after by staff in emergency and transferred to Wangaratta Private Hospital the following morning. It took about ten days to get the CKs back down to an average level”.
As you can see, Liz’s story is dramatic and natural. With early detection and diagnosis, there is a high possibility we prevented liver damage, liver failure or cardiac arrest in Liz. I can safely say that Liz is travelling well at the present period. She has slowly integrated into CrossFit training, with a schedule to build her training back up to her previous level over twelve months. Her story reflects the seriousness of the situation, the truth that with the burst of CrossFit into the world comes the reality that we as CrossFit Coaches and Health Professionals have a duty of care, a need to be on the ball, highly educated, non-complacent and we need to be one step ahead of our clients.
As Coaches, Affiliate owners, and Health Professionals working with CrossFitters, we need to improve our communication across the board. Health Professionals must debrief affiliate owners on the clients they treat and communicate this to their coaches. We need everyone on the same page. After all, CrossFit is about longevity, the longevity of our work as Health Professionals, Coaches, and in Business. Most importantly, it’s about the longevity of the Health and Fitness of our clients and us as individuals.
