CrossFit and Rhabdo, Oh My!
There are few words that are more fun to toss into a room full of CrossFitters than “rhabdo.” I mean, “paleo” is fun, “zone” will start a lively debate, and “kipping” is a classic. But really, “rhabdo” is where feathers will start flying.
But, as we approach Memorial Day, when, along with a bajillion other folks, we will be doing “Murph,” I always want to talk about rhabdo with our members. It is real. It’s also really unlikely to happen to you, but if it does, I want you to know what it looks like so that you can get medical attention immediately. Because it can kill you. I don’t mean that metaphorically. It can literally, kill you. So, while it’s unlikely to happen, it’s super important that you recognize it if it does.
All that said, yes, it has happened in our gym. It has happened a few times, and in every single case, it was the last person and reason you’d ever expect. It happened with good programming and good coaching. So let’s dispel a few myths first…
Rhabdo only happens with bad programming. Nope. In fact, in our gym, 100% of the times that it happened, it happened with pretty mellow programming that had been modified. Intense, yes. But “bad,” no. In 7 years, we’ve had less than a handful of cases, and in every case, lots of other people did the same workout.
Rhabdo only happens when you do something crazy. Nope. 100% of the cases of rhabdo in our gym came from ring rows. Why? Well, the reason is pretty simple: you can do a lot of them, and people tend to have a slow-return so as not to crash their rotator cuffs at the bottom. That eccentric work is where rhabdo is most likely to happen.
Rhabdo only happens to people who go gonzo. Nope. I’m laughing, because without giving away the identity of the people who got rhabdo in our gym, “gonzo” is the last word you’d use to describe them. They were each about as average as you can get, in every way. Not new, not weak, not going to the Games.
You can get Rhabdo doing anything, like mowing your lawn. Nope. Rhabdo is caused by muscle tissue breaking down under extreme strain. So, unless you’re mowing your lawn using quilting scissors, cutting one blade at a time over the course of many hours, you’re not gonna get rhabdo from mowing your lawn. (If you do, you sure as hell might get it in your forearms. Also, that’s just stupid.)
Rhabdo is always deadly. Nope. It’s always something to take seriously, but no, it’s not always deadly. It doesn’t even always require hospitalization, and I’d bet dollars to donuts that people have had it and didn’t know. I say that because we had one case that was only caught after the fact with routine bloodwork for something else. An athlete did complain about being insanely sore, was worried they’d hurt themselves, but didn’t have the other symptoms….
SO, WHAT IS RHABDO
Short version: Rhabdo is what happens when muscle tissue breaks down and releases toxins, including myoglobin, into the blood and causes kidney strain. In extreme cases it can cause kidney failure and DEATH. Actual death. So if you even think you might have it, go to the ER immediately. If you’re a member of mine, I will come with you and tell you bad jokes the whole time.
You can read more about rhabdo on it's very own wiki page.
Does CrossFit cause Rhabdo? Well, sure, but other things can too. (No, still not mowing your lawn, really.) It can happen from “crushing” accidents, big things falling on you and crushing your muscle tissue. It can happen from extreme running and cycling type things. It can happen any time you push your muscles past their literal breaking point. But usually through extreme strain and repetitive movements.
Which is why I always issue my Rhabdo warning before we do Murph. Because a 1 mile run, 100 push-ups, 200 pull-ups, 300 squats and another 1 mile run can totally do that to you, if……
RISK FACTORS FOR RHABDO
Look, if we knew 100% what caused it, it would never happen, right? But, there are some things that we’re pretty damned sure play a part:
Dehydration. Most people seem to agree this is a HUGE risk factor. And we’re not talking about drinking during Murph (or whatever) but even the day before. Hydration, for a day or two before, during an intense workout, and a day or two after. Which, if you’re like most CrossFitters, just means ALL THE TIME. Stay hydrated!
Alcohol. One of “our” cases didn’t happen in our gym, it was just one of our athletes who got it at another gym while away for a bachelor party. They were, you guessed it, hungover. Hungover = dehydrated. Pretty much by definition.
Some drugs. There is medical research showing a correlation – WHICH IS NOT CAUSATION – between Rhabdo and some of the most common medications for depression and anxiety.
Pushing too hard. Listen to your body, folks. It’ll talk to you. With repetitive intense movement, things can go wrong. As a coach, what I look for is that “sewing machine” vibration in people’s muscles. Especially ring-rows and push-ups. If you feel like you “just can’t” do another one, then don’t. If you feel that rapid vibration that is like a sewing machine needle in motion, stop.
Having had rhabdo before. Yup. Having it once makes you more likely than others (which doesn’t mean likely,) to get it again. And some people may just be more prone to it for reasons that no one seems to understand.
SIGNS AND SYMPTOMS OF RHABDO
Okay, you think you did everything right, but something still seems wrong. First off, please trust your gut. Even if you’re kind of a hypochondriac, just err on the side of caution. There are some clear signs, and we’ll start with the scaries first.
BROWN PEE. If your pee is even kind of brown, go to the ER immediately, and start drinking water. That is a sign of kidney strain and we don’t mess around with that.
EXTREME MUSCLE PAIN. You’ve been sore, you know what sore is. This is more sore than that. This is the kind of pain that literally limits your range of motion. Like, you really can't straighten your arm all the way, things like that.
MUSCLE SWELLING. If extreme soreness is accompanied by swelling at the site, you have a problem. It might be Compartment Syndrome, which I think of as “rhabdo lite,” or “one rep way from Rhabdo.” But it might be rhabdo. Don’t risk it.
DIZZINESS, VOMITING and the like. This most often happens at the time, so you’re probably already getting medical attention. But sometimes it takes a few hours to sneak up on you. If you’re super sore, had an intense workout and are vomiting and dizzy later, go to the ER immediately.
Are you scared? Sorry. I don’t like to be the scary lady, but Rhabdo is something to take seriously. (You should hear my STD talk. Seriously, condoms, everyone, every time unless you are in a fluid-bonded monogamous relationship!) Why? Because when we are armed with knowledge we can do more, more safely, and we can do it with more gusto. When we understand the risks of something, we’re safer doing it.
When I think about the rhabdo cases I’ve known personally, there were no red flags. It just happened, despite all the best intentions, attention, precautions…. In 7 years of being open, and literally thousands of athletes coming through our doors, we’ve had 2 known cases happen in our gym. Another couple that I think probably were, but were never diagnosed. And one that was our athlete working out elsewhere. IT IS NOT COMMON.
But it does happen. And I think it’s my responsibility as a gym-owner to educate our members, so they can know if it happens to them. And do what they can to prevent it.
DID I MENTION HYDRATION??????
Alright. Murph on. Get that sweat, get those reps. We’ve got this.