Rhabdomyolysis and Personal Training Facts You Need To Know

It’s ironic that most people have never heard of rhabdomyolysis, even though you’ve probably seen it mentioned on TV every day!  Rhabdomyolysis is a condition that results in the death of your muscle cells from a stress (like exercise) that overwhelms the body’s ability to adapt.  Basically the muscle cells rupture and release their cellular contents into the blood. This can not only be dangerous, it can be deadly!

 

Rhabdomyolysis (Rab-doe-my-o-lie-sis) can occur following a variety of scenarios ranging from but not limited to car crashes, snake bites, anexorea nervosa, weight loss supplements like Hydroxycut and some cholesterol-lowering  drugs and supplements that lower cholesterol like  red yeast rice.  Too much exercise is also known to induce rhabdomyolysis.

 

“If you experience any pain or weakness, see your doctor as this could be a sign of a rare but serious disorder.”  Do these words sound familiar?  They should because you have heard them almost every day.  Every TV commercial for cholesterol lowering drugs gives this warning – which is a reference to rhabdomyolysis.  See, you hear about “rhabdo” every day and just never knew it!

 

Rhabdomyolysis Caused By Exercise

In the past, rhabdomyolysis was, for the most part, relegated to very physical efforts like military training or other very demanding situations (police academy, fireman training, etc.).  In recent years however rhabdo has – unfortunately – also been documented in those who exercise in the gym.  That said, nobody can say for sure  how likely rhabdo is to occur.

Tip. Break the word down: rhabdo-myo-lysis. The letters “myo” means muscle and “lysis” means death. Translation: muscle cell death.

 

Technically called exertional (exercise induced) rhabdomyolysis, this form of the disorder occurs when people increase the intensity of exercise beyond the body’s ability to adapt.  It’s important for people to understand that rhabdomyolysis can happen after only 1 workout.

Tip. Rhabdomyolysis is not the same thing as delayed onset muscle soreness that happened after exercise.

Case reports of rhabdomyolysis in people who exercise do exist.  For example, in one report, a 24 year old male induced rhabdomyolysis in himself after increasing the intensity of his workout. Rhabdomyolysis is also more likely when the exercise is unaccustomed – like for example, jumping right in to an intense exercise class at the gym that you have never done before.

In others, rhabdomyolysis has occurred after a spinning class. See the comments below, for more info on spinning classes and rhabdomyolysis.

 

Low intensity exercise can also cause rhabdomyolysis.  In another case report, rhabdomyolysis was observed in a healthy, 29 year old untrained man who performed 30-40 sit ups a day for one week.

Let me repeat.  He only did 30-40 sit-ups a day for a week! Here is a report on 32 year old man who developed rhabdomyolysis after swimming only twice!

 

Tip. Rhabdomyolysis can happen in both athletes and beginners.  It can happen in just 1 workout.

You can’t look at somebody and tell how much exercise would cause rhabdomyolysis.  Some people can train to be a Navy Seal and never get it.  In others, only 30 sit ups a day for a week might cause it.  Therefore, it appears that some people might be more susceptible to getting rhabdo from exercise than others.

 

Rhabdomyolysis Signs And Symptoms

While doctors can easily diagnose rhabdomyolysis with a blood test, some of the physical signs and symptoms of rhabdo include:

  • Heart attack
  • kidney failure
  • severe muscle pain / swelling/ weakness
  • dark color urine – think dark brown “coke-a-cola” color

These symptoms – especially the first two – highlight the seriousness of rhabdomyolysis.  As the kidneys stop working, there are alterations in electrolytes which can cause heart rhythm abnormalities and heart attacks. The dark color urine is caused by blood in the urine. Basically you start peeing blood.

If you ever hear of anybody whose kidneys stopped working after they exercised, it’s probably rhabdomyolysis that caused it!

 

The pain of rhabdomyolysis happens fast – immediately after exercise, up to 24 hours later.  This pain happens more rapidly than delayed muscle soreness (DOMS) which typically happens 24-72 hours after exercise.  Also, the muscle pain hurts when people are not moving.  Remembering this sign – as well as dark urine color – can help you identify rhabdo.

Some people take pain killers – like aspirin or Advil (Ibuprofen) to alleviate muscle soreness but people need to understand that because these pain killers can affect how the kidneys work, using pain killers may increase the chances of rhabdomyolysis occurring.

 

Personal Trainers and Rhabdomyolysis

Personal trainers have – unfortunately – also been the cause of rhabdomyolysis.   How many personal trainers have caused rhabdo?  This is unknown because rhabdo is not always fatal (thank goodness!) and many people don’t go to the doctor / hospital when it happens – because they don’t recognize its symptoms.

That said, I am personally aware of several cases personal trainer-induced rhabdomyolysis that have arisen within the past few years.  I’ve also met 2 people who accidently caused rhabdo in themselves!  I believe the incidence of personal trainer-induced rhabdomyolysis is under-reported in the medical literature.

If anything is going to cause U.S. personal trainers to one day get a personal trainer license, it will be a personal trainer causing rhabdomyolysis in a high profile individual.

 

I think personal trainers cause rhabdomyolysis in their clients for several reasons including:

1. never having been educated about it

2. thinking that more sets /greater intensity is best for everybody

3. being shy about stopping a training session when the client has had enough

4. failure to recognize the benefits of circuit training

 

An unfortunate fact is that rhabdomyolysis is not discussed in many personal trainer certification textbooks.  In fact, my book, was one of the first personal training books in the US (and maybe THE first!) to educate fitness trainers about this condition.  My book is also the official textbook for the Interactive Fitness Trainers of America.

PE teachers also need to know about rhabdomyolysis because there is some evidence of young children getting rhabdo from gym class.

 

Sometimes you hear people say that dehydration causes rhabdomyolysis but this is not true.  Being dehydrated can make rhabdo worse or increase the chances of it happening but saying you got rhabdo because you were dehydrated is incorrect. The dehydration must be combined with intense or unusual physical activity that overwhelms the body.

 

One aspect of rhabdomyolysis and exercise that does not get the attention it deserves is its relationship to eccentric muscle actions (“negatives“).  These types of muscle contractions occur when the muscle is lengthened as force is applied to it.  An example would be the lowering phase of a dumbbell curl.  Negatives put more stress on the muscle and cause more muscle damage, hence their connection to rhabdo.  Exercises that involve lots of negatives (like plyometrics) have a greater chance of causing rhabdomyolysis.

Eccentric muscle actions (negatives) do result in greater strength and elevations of resting metabolic rate. This is why you hear so many people in the gym saying “Get the negative.” But, performing intense exercises that involve a lot of negatives in someone who is not used to – or increasing the intensity of the workout too fast –  it can be a recipe for disaster.

Personal Trainers: With Great Power…

Personal trainers need to understand that they have a power over others.  Nobody talks about it but it’s there.  The power is that most of their clients will never tell a personal trainer “no.”  In other words, most people will never tell the personal trainer when they think they have had enough.  Most will keep working out as long as the trainer gives them things to do, for as long as the training session lasts!

 

This power is great and as Peter Parker (aka Spider-Man) says “with great power, comes great responsibility.”  If you’re a personal trainer with big, hulking muscles or a boisterous personality, you need to know that you might intimidate your clients – without even trying to – leading, unintentionally, to a greater risk of rhabdo.

 

One case report of personal trainer-induced rhabdo occurred in a doctor.  Doctors are VERY well aware of rhabdomyolysis yet this physician allowed the personal trainer to push him to the point of muscle cell death.

 

Of all personal trainers out there, female personal trainers have the greatest power.  I say this because most men will never tell a woman they can’t do what the woman can do! No man wants to appear weak in the eyes of a woman.  Female personal trainers must be aware of this power when they train male clients. When you think somebody has had had enough. End the training session.

 

Rhabdomyolysis And Statin Drugs

It is well known that in some people, cholesterol lowering drugs (statins) can increase the risk of rhabdomyolysis.  This is why they give that warning in TV commercials for these drugs.  Intense exercise – esp those that contain negatives – can also increase rhabdomyolysis risk.  Therefore, would people who take statin drugs have an greater risk of rhabdo when they exercise intensely?  Yes.  There is some evidence that people taking statins have more rhabdomyolysis than those not taking statins.

I believe personal trainers who do fitness bootcamp classes should consider statin use when they work with people and tailor exercise intensity accordingly to reduce its risk.

 

Rhabdomyolysis And Sickle Cell Anemia

The risk of rhabdomyolysis seems to be increased in people who have sickle cell anemia and those who are carriers of the sickle cell anemia gene (these people don’t have sickle cell anemia. They just have the gene for it).  In 2010 a healthy, 19 year old college football player with sickle cell trait developed rhabdo during training, which contributed to his death. This is but one of several incidences of sickle cell trait contributing to the occurrence of rhabomyolysis.

The presence of sickle cell trait does not mean that exercise-induced rhabdomyolysis will occur and it does not mean that people with this genetic marker can not exercise.  Rather it only means that the risk of rhabo is increased. To reduce the risk, fitness trainers may want to ask about sickle cell trait (and sickle cell anemia) in their health history questionnaires. This will allow the personal trainer to modify the exercise intensity to reduce the risk.

 

Rhabdomyolysis And McArdle Disease

McArdle disorder is a genetic condtion where people do not store glycogen, our bodies reserve storage form of carbohydrates. People who have this condition have an elevated risk of rhabdomyolysis.

 

How To Reduce Rhabdo Risk?

The easiest way to reduce the risk of exercise-induced rhabdomyolysis is to introduce exercise slowly and give the body time to adapt between workout sessions.  Tossing an overweight (or normal weight) novice into a fitness boot camp class and on the first day having her do 250 lunges, crunches and squats is a recipe for rhabdomyolysis.  This is actually a true story told to me by the woman this happened to.  She got rhabdo from this workout.

 

Rhabdo and CrossFit

Crossfit, the popular hard core exercise program, has also resulted  in rhabdomyolysis in some of its participants.  Among CrossFit trainers, the syndrome is often called “Uncle Rhabdo” however I don’t like this term.  I feel calling it “Uncle Rhabdo” undervalues and water-downs this serious disorder.

In the June 2011 CrossFit Journal, they likened the phrase Uncle Rhabdo to Smokey The Bear because Smokey reminds us about forest fires while Uncle Rhabdo reminds us of rhabdomyolysis.  I disagree totally with this analogy.  Referring to a potentially life threatening disorder with a euphemism like Uncle Rhabdo, downplays the significance and, I feel, leads CrossFit trainers to think rhabdo not such a big deal.

 

I feel rhabdomyolysis is one of the most serious disorders facing fitness bootcamp trainers today. It should not be made fun of. Anyone who has found themselves in the hospital knows how serious it is.

 

Crossfit trainers: is rhabdomyolysis covered in the Crossfit certification exam? Please let me know.

Update. On 2/28/12 I was informed by a cross fit personal trainer that there are are 10 pages devoted to rhabdomyolysis in the cross fit manual (the manual is 117 pages in length). I was informed also that there are 2 questions about rhabdo on the cross fit exam. It appears that Cross Fit is taking rhabdo much more seriously and I commend them for this.

 

My #1 question test for ALL personal trainers: “Tell me what rhabdomyolysis is.” If they can’t tell you or only give you a superficial description, walk away.  That is not the person you should entrust your health to.

 

Let me be clear.  I am not beating up on CrossFit.  I am aware of rhabdomyolysis occurring in other lesser known fitness boot-camp facilities as well.  Heck, personal trainers – not doing boot camp workouts – have caused it too.  To their credit – Cross Fit has discussed this disorder openly in their Crossfit journal.

The fact is that ANY extreme workout – P90X, Insanity, plyometrics, football combine camps – or other intense exercise routines can cause rhabdomyolysis.  Here are some tips on how to set up a safe exercise program.

If you are going to take part in CrossFit, P90X, Insantity or any boot camp-type fitness program, I recommend starting with only 1 time per week. Start with 1 time per week for the first week. Then 2x per week the second week and so on. Remember, the body needs time to adapt to intense exercise. I dont feel Cross Fit or other intense programs should be done more than 3 times per week.  In my opinion, anyone who recommends that beginners start intense exercise programs 2-3 or more times per week, does not know what they are talking about.

How Likely is Rhabdo?

I don’t what the odds are of getting rhabdo from exercise – and nobody else does either right now. Unfortunately, the CDC has not released any recent statistics on this condition. Its sometimes estimated that there are 26,000 cases of rhabdo in the US each year but that is an older statistic and it considers ALL the causes – not just exercise.

Some people who down play its significance and try to prove this to you by quoting studies and statistics. With respect, no matter how smart they sound, they suffer from the same lack of information I do. They don’t know any more than I do what the rate is.

 

Hopefully the CDC will eventually put out some better statistics.

 

What To Do If Rhabdo Occurs?

Personal trainers basically only have 2 ways of “seeing” rhabdo.

    1. Somebody has very intense muscle soreness which hurts even when the person is not moving and which happens very fast (immediately after exercise up to 24 hrs later).

    2. The person’s urine looks dark brown colored – like maple syrup or cola-colored.

If you are a personal trainer and these symptoms are brought up in conversation, I recommend you stay calm – and call an ambulance.  I can’t stress more.  This is the safest course of action.

Telling somebody to “go to the hospital” might make things worse – if the person had a heart attack on the way to the hospital.

I know for some, calling an ambulance may seem over the top.  Heck, I’d bet most personal trainers working in gyms today have not even been told about the gym’s emergency procedures!  I’m sorry but being a personal trainer means that you may have to “take the bull by the horns” from time to time.

I look at it this way:  At the end of the day, I want to be able to look myself in the mirror and say I did my best.  I tried to do good.

 

All personal trainers and group fitness instructors need to be aware of rhabdomyolysis and work to reduce its risk.  ANY personal trainer or other individual who doesn’t know what he / she is doing can accidently cause this disorder.  Reducing exercise-induced rhabdomyolysis is best done by considering the health of the person and by slowly increasing exercise intensity and frequency where appropriate, and knowing that no single exercise routine or program is best for everybody. Remember, they call it personal training for a reason.

Here is my Kindle book on Rhabdo which goes beyond what was covered in this review.

What do you think?

Comments

  1. says

    Thanks for this Joe, very enlightening. I’ve never heard of this. Cheers Happy New Year. (Of course I don’t watch much TV at all.)

      • Joe Cannon says

        Don, sorry that happened to you. Please share my review with your friends. I also feel more people should know about rhabdo.

        • Haley Clair says

          Can the “muscle pain/fatigue/weakness” feel like the flu?? I’ve been trying to figure out what is happening to me for 2 days now, knowing pretty well that I don’t have the flu (no fever, chills, headache). But I am experiencing whole-body aches and weakness very similar to what the flu feels like. My urine is not dark though–Its actually lighter than normal because I’ve been super-hydrating lately.

          But I recently started a negative accentuated training routine, and did my second negative workout on Thursday, and pushed myself pretty hard. I started feeling this way about 24 hours later and now, on Saturday, it has not gone away. This is not standard DOMS, so I just want to figure out what is happening to my body.

          • Joe Cannon says

            Haley, I’ve never heard of rhabdo described as flu-like but that doesn’t mean it cant be. I’m honestly not sure. what I would say is if you feel worse, then I’d feel better if you were checked by a doctor. A simple blood test will rule out rhabdo. I wish I had a better answer for you. Please do keep me posted on what happens.

          • sarah harper says

            yes!! flu like symptoms are definitely part of rhabdo. I was just informed about this yesterday. I’m dealing with a mild case myself, treating at home til I get bloodwork back (I elected to go to clinic over ER for time being).

          • Joe Cannon says

            Sarah, thanks for the feedback! I do hope you are doing OK over there. I dont think Ive ever heard of “mild cases” of rhabdo (muscle fiber death). Id recommend the ER over waiting back for blood-work results. Your health is worth more than any copay you might have to pay. Several people here have told of how their CK levels increased from the time they went to the ER. I want you to be safe Sarah. Please keep me posted on how you are doing!

          • Sarah harper says

            Well, I was hoping for mild, but I type this while lying in a hospital bed at the ER with an iv :/

            My levels Monday were 16,380. I don’t know yet what they are today but the Dr has mentioned my liver enzymes are elevated. So, no conclusions yet…. I bet my room charge is an arm & a leg. They always do that when you don’t have a reservation ;)

          • Joe Cannon says

            Sarah, Im just glad you are getting the proper attention. Nobody likes to go to the hospital but I do feel this is the place you needed to be. Your health is most important. Hopefully you will be home soon. Please keep me updated on what happens. At least you have an internet connection there :)

  2. Sal Chavez says

    Hey Joe,
    Great article and very informative…I myself got rhabdomyolysis twice..once when I was 35 and the other when I was 38…I am currently 43…. I was hospitalized both times, but the second time was even more severe, because my right thigh swelled up like a tree trunk and I was hospitalized for over a week. Both were exercise induced and both occurred stemming from the same place in my body..(my right thigh).

    And you are absolutely right about it happening in one exercise workout. Because the first time happened in a cycling class and the second just from doing squats (with no weights) and both times I was out of shape. My question is, Does this mean I will always be prone to getting it? My doctor told me more than likely I will..but my doctor really couldn’t tell me about what exercises I should avoid… So what what exercises do you recommend for me and what exercises should I avoid?…Because you are right about trainers..most of them that I have talked to..have never even heard about Rhabdo…

    So I now I’m afraid of doing any type of exercise in fear of getting Rhabdo again… but my resolution is to lose weight.. I’m 6ft 4inch and 300 lbs..so I definitely need some advice…

    • Joe Cannon says

      Sal, thank you VERY much for sharing your story. Your experiences will DEFINITELY help others. I agree with your doctor that it does seem that you seem to be more prone to rhabdo than most others but that does not mean that you cant exercise. I think the key to avoiding exercise induced rhabdomyolysis is to start slowly and increase the intensity of your workout slowly also. In you, being extra careful would be very prudent. Assuming that you have a clean bill of health from your doc, I suggest you start with just 20 min of cardio 3x per week and do this for a few weeks. Then, if you feel fine go to 4 days per week if your schedule permits. Then slowly increase your cardio to you are doing at least 30 min 4 days per week. I see no reason why you cant eventually do 60 min of cardio 5 or more times a week if you progress slowly.

      I also believe you can lift weights also. I suggest circuit training and using no more than 1 exercise per body part at least for the first several months. Find a weight you can lift for 15 times. when you get to the 15th rep, I still want you to have some gas left for a few more reps. This will prevent you from maxing out. Start with only 3 exercises – one for chest, back and legs. I like chest press, lat pull down or seated row and leg press as these will hit most of your other muscles too.

      Move from exercise to exercise with minimal rest but take rest if needed. After a month, if you would like to add another exercise to the circuit feel free to. Also, you can add a cardio station to this circuit also. The beauty of circuits is that there is an infinite combination of exercise that it can have.

      I suggest that your total exercise session should not last more than 60 minutes -and even then I want you to take at least 3 months to work up to that.

      I also suggest you find a dietitian in your area who can help you with your eating if you think you need it. The website EatRight.org will help you find RDs from in your zip code.

      Again I appreciate you taking the time to write Sal and do feel free to check in if you have other questions and to let me know how you are progressing. I think 2012 is your year Sal!

  3. Christallin says

    Thanks for this supremely informative article Joe. I have always been leery of these extreme kind of programs i.e. bootcamp and Insanity. The reason why is that many people who participate are beginners or people new to fitness or who have been away for a while. The classes do not differentiate by tailoring the class to the fitness levels of it’s participants and people don’t want to be embarrassed that they can’t keep up so they do what is bad for them to look good. Most of the people I talk to to who do Insanity are out of shape and trying to shape up in a hurry. I think this can not only cause injuries but probably has a lot of other downsides due to the person’s fitness level. I also think it leads to people dropping off because they cannot adapt quickly enough and feel overwhelmed.

    And please, don’t get me started on the cycling classes. I love indoor cycling. But I recently went to a class where the instructor insisted leaving the overhead fans off. This was a fully packed class in a relatively small room (compared to participants.) The instructor went on to talk about how people who whine will never achieve their fitness goals. I walked straight out after accidentally walking in on this instructor’s class the next time I was there. But I saw people intimidated by this petite blond who did not have any care for her student’s safety whatsoever.
    Thanks for the signs and symptoms of this disorder. I am filing it in

    my memory bank for future reference. Keep up the great work, I certainly do appreciate it.

    • Joe Cannon says

      Christallan thanks for letting me know about that dumb dumb cycling instructor! I cant believe she did that. There was a fairly recent court case involving one of those so called motivational experts who took people on a weekend retreat into the hot desert and made them meditate inside a tent that was VERY hot. One person died! They were just sitting there, not exercising like the people in that dummys class were! Im sure the temp inside the class did not get above 100 degrees but what does staying cool during exercise have to do with reaching your fitness goals? It never surprises me at what goes on inside some gyms.

  4. Christallin says

    By the way, I also complained to the management of my health club about this instructor. They told me that “that is probably the way she was trained.” Huh? So poor training makes it okay to induce heart attacks? Profit will always out.

    • Joe Cannon says

      Amazing! so the club manager just blew it off and blamed it on the cert and did nothing!This just reinforces what I say that US health clubs are ticking time bombs waiting to go off. Most are not prepared for medical emergencies and do little to correct stupid behavior on the part of their staff.

  5. Kristin w says

    Very gooooood article! I was just diagnosed with rhabdo this week. I am 21 years old, in great shape, did cheerleading and tumbling my entire life..but stopped and got a personal trainer. Two ten minute workouts and I got rhabdo. I was so sore and weak immediately after I couldnt even hold an empty cup in my hand. Nobody could touch me I would just cry out in pain. Got some bloodwork done…my ck level (the muscle breakdown enzyme that this article says is the bloodtest they take ) was scary high. The number range is between 20-200…average is 80… I was at 16, 455

    • Joe Cannon says

      Kristen thanks I’m glad I could help but SO SORRY that you got rhabdo from your personal trainer!!! Can you give me an idea of what the personal trainer did to you in the work out? Did you tell the trainer or gym manager what they did to you? Do you know which organization the personal trainer is certified by? I’m always curious about the certs of personal trainers so that’s why I asked. Its ok if you don’t know (most people don’t ask about that). Did you work out at a gym? if yes what gym were you at? Again, I just like to know these things.

      You will get better, its just going to take time and the good news is that you were smart enough to get to the doctor. Above all else, I am really happy about that!

      Do let me know if I can help more

  6. Kristin w says

    Sorry my phone cut off the rest of my comment. Just goes to show that this disorder can literally happen to anyone. People are hospitalized with numbers like 4000 or less. People with heart attacks dont even get as high as my numbers. They checked it again a couple days later and it was still just as high. My doctors haven’t seen numbers this high before in their own patients. but I’m getting sent to a rheumatologist tomorrow and a neuromuscular specialist. To see if there is another reason my numbers are abnormally high.

  7. Kristin w says

    It was a crossfit workout…go figure! But my cousin is actually the personal trainer and she had never heard of rhabdo. Honestly now that I think about it I don’t think she is certified! Ah. She just offered free personal training for my sister and I, but other people pay for her. She does it out of her home. She is a crossfit goddess, she is good at what she does and competes..but should probably not do personal training without being certified.

    • Joe Cannon says

      Kristen, please do tell your cousin that she can be sued for doing personal training if she is not certified. If she was cross fit certified, they should have taught her about this. Please find out for me and let me know if shes cross fit certified.

      If she is not certified (by anybody), she can’t get personal trainer liability insurance. That means if she is sued (and she can be sued for what she accidental did to you!), shes in a LOT of trouble. I’m sure she looks good but looking good and knowing what to do are very different. Personal trainers as a rule spend too much time in the gym and not enough time in the library learning. Please forward your cousin my rhabdo article so she knows about this. She needs to be aware of this.

  8. Colleen says

    Thanks for this great article. I am a 40 something yr old female runner who is currently in the hosp. Recovering from rhabdomyolysis I got from a spin class last weekend. Intense pain and swelling in my thighs, followed a couple of days later by brown urine. Admitted with CK level of 129,000 – crazy high number. I had never heard of this, nor had any of my running, workout crazy friends. I will be spreading the word. I’m a limitless nervous about resuming workouts and haven’t had that discussion with my dr yet.

    • Joe Cannon says

      Colleen oh I’m so sorry you got Rhabdo! You’re the second person to tell me they got rhabdo from spinning (check one of the comments above). Don’t feel bad I’d bet 99% of people have never heard of it. Please let me know what your doctor said about when you can resume your workout and if he/she gave you any specific instructions about what to do or not do. I think that would really help others who read this in the future.

  9. says

    Wow Joe! Thank-You..and I’ll pass this along to clients and other trainers. I’ve heard of this happening and was aware that dark-colored urine is a very serious situation. My father was diagnosed with bladder cancer after discovering dark urine. He died in 2007.

    I’ve certainly over trained clients at times early in my career. I’ve since moved away from the ‘kill the client’ mentality, even when that is what the client wants. I’ll still challenge the clients weak areas, but in a balanced and safe manner.
    I’m glad you addressed Crossfit.

    Keep up the great writing Joe!

    Chad Sundberg
    Founder – TrainerChad.com
    NSCA-CPT, NASM-CPT & CES
    trainers

    • Joe Cannon says

      Chad, thanks for the kind word and so sorry to hear about your dad. I’ve been there myself unfortunately. Cancer is a terrible disease. I’ve been wanting to provide a reference to people about rhabdo for sometime now. As I discover more case reports of rhado and exercise, I will update this post with that additional information.

  10. backbeat says

    Hi Joe! Fantastic article. I’m one of the guys whose post you replied to last night. Thank you for that. And this article is exactly the kind of info assessment I’m more concerned about with regard to the difference in Certs. The first rule of medicine is (supposed to be) “Do No Harm!”. And as long as my future clients don’t get sucked into the marketing vortex of instant gratification fad systems, my goal of keeping them alive and functioning fully might be realized. Again, thank you very much for the post reply and this article.

    • Joe Cannon says

      Backbeat, thanks for letting me know. I’m glad I could help and Im glad you liked my rhabdo post too. Let me know if I can help more. I subscribe to the “first do no harm” motto also :)

  11. irina says

    Good read. I’ve been doing crossfit workouts for a while with no problem, then took a break for a few months. Then decided to get back into it and hit it a bit too hard at the gym. My initial symptoms were muscle weakness and swelling. I didn’t give it much thought thinking it will go away. I waited two days before going to the hospital, the night before I did not get any sleep because of pain.

    I got mine in the back from doing deadlifts. On the second day I could stand for more then a minute as I couldn’t support my weight, I couldn’t lay because it felt as I was lying on the rocks, I couldn’t bend my torso or lean at all I was so stiff. I had my boyfriend take me to er. By the time we got there the pain was so bad I had trouble talking. morphine didn’t do a thing.

    Got admitted, spent seven days in the hospital. Definitely the worst pain I’ve ever experienced, waiting till last minute probably didn’t help either.

    • irina says

      So my point is it is important to progressively increase intensity and not just jump into it like I did. Learned it the hard way. Ps. Still working out, haven’t had another case of rhabdo since. ;)

    • Joe Cannon says

      Irina, did your cross fit instructors ever -at any time – explain rhabdo to you? Did they mention the symptoms, how to recognize rhabdo or what to do if you got it? So sorry to hear about your pain but I’m very glad you wrote to tell me about what happened to you. Don’t beat yourself up over this. The good news is that you were smart enough to go to the hospital and that is what’s most important to me.

      • irina says

        Nope. Never heard of it from any of the instructors. And ironically the ERdoc was gonna send me home too with pain meds until I voiced my concerned that I might have rhabdo. Good thing I used to work in a hospital and have seen a case of rhabdo before. But you are right, awareness might be raised among trainers. It can happen to anyone from someone who never worked out or a seasoned athlete.

        • Joe Cannon says

          Irina, thanks for letting me know. Please pass my review on to your cross fit trainers so they are aware of it. I’m also glad you had that hospital background too!

  12. Richard Paulin says

    Hi Joe,

    Thanks so much for writing this article. I have learnt more out of this article than I have from a team of doctors.

    I had just started out with a personal trainer two weeks ago and two days after the second session I ended up in hospital with what turned out to be rhabdo. Thankfully I didn’t need dialysis, but had to spend 36 hours on a drip to keep the kidneys going.

    The day that I discovered the cola-coloured urine I was meant to have a personal training session that afternoon. I was going to go and deal with the urine issue the following day. Luckily I decided to present at the Emergency Department of my local hospital instead.

    I also knew something was wrong when I looked in the mirror (as one does) and discovered that I looked “built”, only after the second session. I initially thought “wow, I must have instant-muscle-building genes” but obviously this was the swelling.

    I have been told that the prevalence is 1 out of every million, meaning that there is only about another 22 people in Australia who suffer from this allegedly genetic disease.

    My whole life I had wanted to build muscle and I finally built up the confidence and took the step, hiring a personal trainer and spending quite a sum of money on it. Of course these dreams were just totally shattered as according to the doctor I cannot build muscle without risking renal failure.

    As an indication, blood and urine samples were collected and tested and according to information provided by the doctor myoglobin levels between 1,000 and 15,000 ug/L indicate rhabdo. My levels were 304,000 ug/L.

    The thing is, whilst at the gym I felt that I could have done more in those sessions and I wanted to push further.

    Whilst I understand you do not have the full picture from my individual case, is it possible that the genetic form of rhabdo can be overcome? Is this really the end of the road for my dreams?

    Regards
    Richard Paulin
    Perth, Western Australia

    • Joe Cannon says

      Hi Richard, Thanks for your kind words and Im very sorry to hear about what happened to you! I don’t think your dream has to end. Even though you got rhabdo, you can still make improvements; you will just to go slower at it. Your personal trainer pushed you too hard. if he/she didn’t, this might never have happened to. you. You may have rhabdo “in your genes” but that doesn’t mean you cant exercise. You can. just go slowly. For example, when you are able to, start with 1 set of an exercise and slowly -over the course of months – to increase intensity. Most of us will never be “Arnold” but all of us can improve our fitness and strength.

      For now though I want you to rest and listen to your doctor. Rhabdo may take a few months before you are better so do keep in contact with your doctor. If you know of any physical therapists or athletic trainers, they may be a good resource for you as personal trainers. I also have a friend in Australia who may be able to help you. His name is Bill Sukala and his website is http://www.DrBillofHealth.com Bill is a medical exercise physiologist and he is one of the smartest guys I know. Bill is actually an American who lives in Australia (hes a surfer and says you have great waves over there!) Please do reach out to him and see if he knows of anyone over in your area who can help you safely achieve your goals.

      Don’t lose faith Richard. Rest up and begin anew when you are feeling better. Do, let me know if I can help more.

  13. Richard Paulin says

    Thanks for such a quick response!

    I will get in contact with Bill and keep in contact with my doctor. I have a muscle biopsy in a few weeks time which may reveal some further information.

    My personal trainer was and is such a fantastic guy. I couldn’t have asked for anyone better or more supportive. It’s just one of those things for which I had such high hopes.

    And yes, I would think that we do have the best waves, beaches and landscapes in the world. At least that makes up for the disappointment felt by American tourists who really believe we all ride kangaroos, live in the desert and sound like the Crocodile Hunter! :)

    Regards
    Richard

    • Joe Cannon says

      Richard, keep me posted on what the muscle biopsy says and how your progressing. Just take things slow and I’m sure that eventually you’ll get to where you want to be. Yes Australia is one of the most beautiful countries in the world! I do hope to visit it some day.

  14. Jodie says

    Great article. Several years ago I developed rhabdomyolysis after helping my husband paint our house. I developed severe pain in my legs within hours. I could not sleep because of intense pain. By the next morning, I barely had any movement and was vomiting because of intense pain. I went to a local health clinic and did not get much help. The doctor talked about “a mysterious muscle problem” I could have, but told me it was extremely unlikely since my urine was not dark. He basically said I did too much exercise and had really sore muscles and thought I might have a bladder infection because he noticed white blood cells. He also thought this contributed to my “crabby” mood. I explained that I had been an athlete in high school and college and that this muscle pain was different from any other I had before – it interfered with sleep and hurt when not moving. He told me to take Advil, he would do some tests, and he would be in touch if he found anything.

    The doctor called two days later and told me to go immediately to the ER. My CPK count was over 48,000 (repeated twice for accuracy). Make a note – my urine never turned dark. I only passed white blood cells. I had to spend about 4 – 5 days in the hospital before my counts got below 10,000. I still have to watch exercise and go slowly. I also have to make sure I have plenty of carb intake. This has happened after my initial episode although never to this degree. Luckily I do not have any long term affects from my initial kidney damage.

    Before this episode, I had actually seen this doctor numerous times. I still see him. He had only seen one case prior to me and it was an avid male athlete during mid summer. He did not think this would have been possible. I also did not show some of the typical signs such as dark urine. I’m so glad I insisted that something was wrong. Even though I was called “crabby”, which I most definitely was, I knew something was really wrong.

    • Joe Cannon says

      Jodie, wow thanks for telling me this! Your the first person I’ve heard of who developed rhabdo from painting a house! I’m glad you mentioned that your urine did not turn dark brown. It’s important to know that your urine doesn’t always have to turn dark brown.

  15. Anthony says

    Hey Joe. Thank you for this very informative article. I am currently in the hospital with rhabdomyolysis due to an extreme abdominal workout. I felt a sharp pain in my stomach shortly after my workout but figured it was just soreness from the workout. The next morning, my urine was brown. I came to the hospital and was admitted immediately for rhabdomyolysis. My current CPK level is 70,000 but was 110,000 when I first arrived. It’s VERY important that people are aware of this medical condition. Again, thanks for writing this. 

    • Joe Cannon says

      Anthony, thanks for writing and I do hope you get better fast! I am very glad you went to the hospital too!

  16. Lydia says

    I am an ACSM certified PT and have a degree in Exercise Science. A few weeks ago I was hospitalized for a week with rhabdo. I had NEVER heard of this disorder before this incident. The workout that caused it was a bookcamp type class taught by the owner of my gym. I calculated later that I did over 700 reps of exercises involving triceps (where all my muscle death and swelling occurred).

    I cannot understand why I was never taught about this. I hated to have to go through what I did, but I am so thankful that it was me and not any of my clients! I have been given a brand new perspective on “pushing” clients. I can not stress enough to people that as I was doing this exercise I did NOT feel overwhelmed. That workout was not on my top 50 hardest workouts list. It was simply unfamiliar (I typically do few reps/heavy weight), occurred after a 2 week hiatus from exercise due to strep throat, and while I was on antibiotics and dehydrated.

    • Joe Cannon says

      Lydia, thank you for telling me about what happened to you and please do not beat yourself up. Ive only met a handfull of personal trainers who have heard of rhabdo. I never learned about rhabdo either in college nor was it covered in my NSCA cert. The ACSM is a fine organization but they pretty much are just like most others in the fitness industry in that they only teach the “science” of exercise and not the real life application of the science. Other than myself I dont know too many others who speak about the dangers of exercise induced rhabdomyolysis.

      Please pass along my review to the owner of the gym where you got rhabdo. I’m pretty sure nobody told that person about rhabdomyolysis either.

      I do hope you are feeling better!

  17. Tara says

    Hi Joe

    Thanks for this article. My husband is currently in the hospital getting IV fluids for a CPK level that started off at 67,000. He exercised regularly but just recently started a strength training program to tone muscle. It started off as soreness and he continued to push himself and resulted in swelling if his arm. He went to urgent care after I suggested it and through a series of bloodwork the medical staff felt it was rhabdomyolysis.

    He was admitted to the hospital and is getting constant fluid. He never had the dark color urine. But like you said, this injury can go unnoticed and become fatal if left untreated. Hopefully more people will learn to listen to their bodies and to gradually increase they’re fitness regimen. Great article. Thank you.

    • Joe Cannon says

      Tara, thanks for writing and I am really glad your husband is getting the medical attention he needs! I’m glad he went to the hospital. One of the reasons I wrote my review was my fear is that people with rhabdo might “grin and bear it” putting off going to the hospital and getting the medical treatment they need. I will pray for a speedy recovery for him!

  18. Tara says

    Hi Joe

    Thanks for this article. My husband is currently in the hospital getting IV fluids for a CPK level that started off at 67,000. He exercised regularly but just recently started a strength training program to tone muscle. It started off as soreness and he continued to push himself and resulted in swelling if his arm. He went to urgent care after I suggested it and through a series of bloodwork the medical staff felt it was rhabdomyolysis. He was admitted to the hospital and is getting constant fluid. He never had the dark color urine. But like you said this injury can go unnoticed and become fatal if left untreated. Hopefully more people will learn to listen to their bodies and to gradually increase their fitness regimen. Great article. Thank you.

  19. Tamara Yancosky Moore says

    I appreciated your article and the seriousness in which you respect the severity of Rhabdomyolysis. I have an Inborn Error of Metabolism that causes me to have frequent episodes of disabling and excruciating Rhadomyolysis with CPK’s over 200,000+ at times. It’s not a “hum drum” experience, by any means! I have nightmares and phobic fear of this pain, at times. Thank You for explaining it so well!

    • Joe Cannon says

      Tamara, thank you for saying that. Yes I am sure that the idea that exercise might cause rhabdo would cause nightmares.

  20. Raine says

    I am a huge advocate AGAINST Crossfit! I have done brutal bootcamp workouts, kickboxing in all temperature extremes and I have been around true grit gyms with the Big Boys since I was 16. I spent 2 weeks in Crossfit looking to further push/challenge myself. AND I was appalled at the chaos, there is NOOO way 2 trainers can watch a group of 50 people and be attuned to issues that might arise.

    I didn’t know about rhabdo either, but I did realize the fast tempo they perform dead lifts, clean and jerks, etc with the poundage they are using is dangerous, NOT to even mention the “crescendo glory throw down method” they employ when releasing the weights. IDIOTS any true gym would escort you out for that type of ignorant behavior, couple this by people eating SOOO much freaking vegetables and meat which their bodies are not accustomed to creates a host of gastrointestinal issues.

    One lady was admitted to the hospital she was so full of broccoli she was projectile vomiting. These people are brain washed and on a band wagon of the newest “hot thing” which I am sure in years to come we will have statistical analysis pointing to specific injuries to the body directly attributable to this crazed craze!! Just BECAUSE I can do it, doesn’t mean I should be doing it!! That is all~

  21. says

    WOW thank you for sharing and making people aware of this deadly illness…you see i have a rare muscle disease called CPT2 defiency, my muscles only burns carbohydrates for energy and cannot convert fats and proteins into to energy for my muscles.

    when i burn my carbohydrates i have no reserve for fuel so my body burns muscle causing Rhabdo, this happens to me way to often! I was recently in the hospital for 3 weeks from coughing!!! yes coughing cased my Rhabdo!! when your muscle breaks down it releases CPK into your blood stream, a normal CPK level depends on the amount of muscle a person has, a normal range is anywhere between 100-300, when i have rhabdo my CPK levels rise to as much as 115,000!!! this last time (2 weeks ago i was released) mine was 97,000 and i had kidney failure, luckily i have no permanent damage and dont have to be on dialysis the rest of my life!! I have almost died 2 times from Rhabdo, i have been on complete life support and have been hospitalized so many times i cant count, aprox 4 to 6 times a year!!!

    Another serious disorder that Rhabdo can cause is COMPARTMENT SYNDROME, Again this is a serious disorder not talked about, i got compartment syndrome after a nerve conduction study for carpal tunnel syndrome, because of my muscle disease the test cause muscle swelling and closed the compartment in my left hand off so blood cold not flow through my hand causing compartment syndrome, i almost had my hand amputated from this!

    Compartment syndrome is also something that can happen with athletes or people who exercise to extremes, if your muscles are sore they can swell and cause this in your arms or legs, this requires emergency surgery within 24 hrs to release the compartment or you cold lose your limb!! Again thank you for posting this article and making people aware of this serious illness that can take lives!!! Kim:)

    • Joe Cannon says

      Hi Kim, thanks for sharing and I am SO GLAD you are doing ok! Im also glad you brought up the aspect of compartment syndrome! I will say a prayer for you that you dont get rhabdo again.

  22. Fatu says

    Hi Joe
    I going through your website, I do not think you recommend Supplement which I like in loosing wt process

    • Joe Cannon says

      Fatu, yes as a rule, I am not a fan of weight loss supplements but thats because they all just seem to be the same thing (same ingredients) in differnet bottles. most are either
      stimulants
      laxatives
      fiber
      water pills
      I’m also seeing some that have iodine or things that might stimulate thyroid hormone (Im skeptical if they really work)

    • Fatu says

      Thanks, I just bought your new book on supplement, I want to know everything about them. A friend of mine just recommended few of them to me but I’m still afraid.

      • Joe Cannon says

        Thanks Fatu, I hope you like my book. That’s the book I wish I had! You will also like my website Supplement-Geek.com which is also all about supplements.

  23. Lisa says

    My husband developed rhabdo when he was overseas in the army. From what the VA doctors and other MD’s have told us, there us no cure for rhabdo. Is that correct? Are there any vitamin supplements that he can take to help? We have tried a wide variety of vitamins but they do not seem to have any effect. I heard that seaweed was good. Is that true?

    Some days are better than others for him. I know he gets frusturated because he says that his body hurts all of the time, and lately he seems to be disoriented quite a bit. He is only 35, and we have 2 young children that need their Daddy well.

    • Joe Cannon says

      Hi Lisa, This is a good question. Assuming that rhabdo has been treated, I am under the impression that the pain eventually goes away. Ive known people who accidently caused rahbdo in themselves (from working out too much) and they did not say that the pain always stayed with them. Have you ever consulted somebody outside of the VA about this? Im sure you can find a kidney specialist or internal medicine doc who can give you a better answer than I can. That is what I suggest you do. I would at least think in time, the pain should get better. If you find an answer to this, please do let me know. now you have me thinking…

      I have never heard of any supplement that might reduce the effects of rhabdo. There is some speculation that coenzyme Q10 might reduce the risk in those who take statin drugs (because statins knock out CoQ10 production as they knock out cholesterol production). Co Q10 may be an option but Im not sure how much it might help, if at all. Again, if it works do let me know. I hope some of this helps Lisa.

  24. American Hunk says

    I had been doing at least 50 push ups per day, and 2 weeks ago i joined a gym and worked out with heavy dumb bells and other weights on Saturday and Monday for at least an hr each session.I basically used most of the upper body machines with 10 reps each just to have a good kick start at the gym.2 days before the gym, I had run for 8miles as I usually run to keep fit.I had planned to work on my chest muscles over a 6month period and build some mass.I highly suspect the dumb bell eccentric exercises led to my rhabdo (CK level was 90,000) because my elbow muscles were so PAINFUL.I could not straighten my arm for a day,got tea colored urine and went to the doc a day later.

    The strange thing was that even though I carried my dark urine to show to the nurse before I was allowed to see the doc, the nurse didn’t really think it was a big deal at first as all my vital signs were normal (heart beat, temp etc).I ended up seeing the doc after waiting for 5 hours.

    I am now wondering whether my chest building goal is dead because of rhabdo, and whether I will ever be safe again exerting myself and running at least 8 miles per session.

    Richard Paulin from Australia has stated it so well.You have a goal to build muscle and suddenly from nowhere, rhabdo comes along and shatters hopes. But I do not agree that rhabdo is genetic as he puts it, underlying factors can definitely increase the likelihood of getting it.

    The prevalence rate is also not as low as he put it. As for me I love running, and that now seems to be a risky activity after rhabdo came out of nowhere. I know, people may say , just do stuff slowly, but its not as easy as that, rhabdo can just pop up from nowhere , so the question becomes, is it really worthied?

    • Joe Cannon says

      American Hulk. I’m surprised you had to wait 5 hours to see the doctor! There is likely a genetic component to rhabdo but what we do also can increase the risk. Genetics or not, we all have our breaking point.

      • American Hunk(Kenny) says

        Yes I had to wait that long as I was out of the country and their system is social medicine.
        There is inconclusive evidence that ties rhabdo to genetics, all I know is that some underlying conditions can accelerate its development.

        I am thinking that anyone can over work their muscles to the point of breaking up, we are not made of metal.As for me, I pushed myself beyond my limits.

        Would you care to elaborate on genetics and rhabdo?

        Rhabdo sucks, it leads to paranoia, working out is never the same again.It was the first time I got but wonder if it will come again

        • Joe Cannon says

          I wish I could elaborate on genetics and rhabdo but I can’t. I am assuming that there is some genetic component because different amounts of exercise – sometimes very little – have been noted to cause it. Scroll up and you’ll see my reference to the guy who did 30 sit ups for a week. Thats generally not too much exercise yet it caused it. In most people Id think rhabdo would not occur after dong that. yet in that guy it did.

          No doubt rhabdo is a multi-factorial process. Either way, I agree, rhabdo does stink!

          • American Hunk says

            so the question becomes can anyone get rhabdo after intense exercise that tears the skeletal muscle?
            I agree, some are more susceptible than others, just like anyone can get the common cold, but some get it more often than others

            its funny, when I was 19 I used to do almost the same number of exercise, and now 7 years later, the same exercises brought rhabdo

            What seems to be mostly genetic is compartment syndrome, since some get very high CK levels and never progress to compartment,

          • Joe Cannon says

            American Hulk, good points. This is a tricky syndrome. no doubt about it. yes that is very odd that the same thing caused rhabdo that did not do it when you were younger. I can empathize. Ive been battling tennis elbow for a few months. Same thing didn’t do it when i was younger either.

  25. Scott says

    Hi all,

    I was just released from the hospital from my first (and hopefully last) bout with rhabdo. I’m a very fit 30 year old male and lifelong athlete (water polo,competitive swimming,lots of gym training etc.).6ft 185lb with a body fat percentage of about 14%.

    After having some friends join crossfit I too decided to join at my local gym.My Rhabdo hit after my second workout called “Angie” which consisted of a 400 m run followed by some other warm ups.We then did 5×5 overhead squats and then “Angie” for time.Angie consisted of :

    100 pullups
    100 push ups
    100 sit-ups
    100 body weight squats

    I completed the workout and felt ok.Winded, but ok. This workout took place on a Thursday evening. My biceps were sore but not too bad.I actually went to the gym Saturday for a 2 mile run on the treadmill but I did no weight training.Gradually they got more and more sore over the weekend until finally Sunday came around and I had swelling in my lower biceps and upper forearms and could not straighten my arms out.The pain was far and away worse than any DOMS from normal workout and actually woke me up a few times Saturday night. I hit the computer for answers and came across “rhabdo” in my search results.I did not have any discolored urine because I stay pretty well hydrated but I knew it was likely I had this just by listening to my body.I knew this soreness and swelling was not normal.

    After work Sunday I called my wife and told her I was going to urgent care. I told the Doc there I was concerned about Rhabdo and he tested my blood and urine.He was surprised about the amount of blood in my urine since my urine looked so clear.My bloodwork was funky so he suggested I go to an ER for a more thorough blood test.

    Once in ER the doc informed my wife and I that my CK level was >22,000 which was the highest their test went to and that I was going to be staying and hooked to a continuous IV to flush the Myoglobin from my blood so it did not poison my kidneys. I lucked out with the ER doc because he knew all about Rhabdo and Crossfit as he was a current, longtime military guy and a certified personal trainer as well as being a doctor.

    I was hospitalized and on continuous fluids from that Sunday until Thursday afternoon. The pain and swelling was intense until Wednesday.I got to go home on Thursday still on IV fluids.We got hooked up with home health and my wife would administer the IV at home for me until Monday afternoon. 8 days after being admitted.

    I had to disconnect the IV and drive to my doctors lab each day for more blood work but it was better than being in the hospital.My CK test result timeline was as follows:

    Sunday-Thursday: >22,000
    Friday: 13,700
    Saturday: 6,000
    Monday: 1,600 (got to ditch the IV here)
    Tuesday: 1,088
    Wednesday (today): 600
    My kidney function tested just fine everyday throughout but my liver enzymes were high due to the high CK levels and decreased gradually along with the CK.

    I had a follow up with my PC doc today and she told me I’m pretty much in the clear and it does not appear I did any lasting damage to my kidneys or any other organs.She was also glad I turned to the internet and decided to go to the ER when I did.She said that decision likely saved my kidneys. I have to go for a full metabolic work-up next Monday just to make sure but she said she expects them all to be back to normal by then. I’ve also been instructed to drink plenty of water for the next week or so which I normally do anyways.

    She said it’s unclear if I’m more likely to get this again now that I’ve had it once.I can tell you I will certainly have a mean case of exercise anxiety from now on which stinks because I love staying in shape and am a very active person. She told me not to even consider lifting weights for at least a month but said I was ok to return to normal activities.I will also lay off Cardio for a good 3 weeks while my body repairs and I will never attempt the much hyped “crossfit” again. My biceps are also considerably smaller today that they were prior to Rhabdo.It’s very clear I destroyed the muscle and it’s gone for good.

    The more I read about crossfit and it’s risks the more I feel like an idiot for doing it in the first place. I also wish my gym would have informed me of this potential risk prior to my first crossfit session.Instead they threw me right in. I certainly think a beginner orientation class is necessary for any beginning crossfitter regardless of their current physical condition.

    Long story short.

    I signed up for Crossfit and this is what I got:

    Almost widowed my wife and left my two kids without their dad
    8 day stay in the hospital on an IV
    $4,000 in medical bills (thank God my insurance covers 70%)
    about 15 needles in the arm for bloodwork
    A lifetime anxiety of working out and over exertion
    smaller biceps
    Missed 7 days of work

    Please folks.Educate yourselves prior to any drastic change in your training.I wish I did.I feel very lucky today and wish anyone going through this the best.

    God Bless.

    • Joe Cannon says

      Scott, Thank you for saying all that you did! I am so surprised that your gym did not give you any warning about the possibly of rhabdo occurring. Did the CrossFit trainers mention this? Since I wrote my review Ive discovered that even the guy who invented Cross fit got rhabdo from these types of workouts!

      I understand your “exercise anxiety” (this is an issue not talked about among those who have had rhabdo) but since rhabdo never happened before you started cross fit, I think its unlikely that it will happen again if you go back to your former workout routine. Just give yourself time to heal before jumping back in and then increase slowly just to be safe.

      Im glad you went to the ER and very glad your family still has you.

      • Scott says

        Hey Joe,

        The crossfit trainers did not mention any of this to me. I’m in the process of trying to find out if they normally do. You see, I’m pretty good friends with the director of PT at the gym and I asked him to fill my form out so I could just join and start after I signed. My ego contributed to this as much as the gym’s negligence.

        I’ve requested a meeting with the owner of the gym and the crossfit trainers to tell them my story. In speaking with my friend at the gym who is a level 1 crossfit trainer it appears they have some misconceptions about Rhabdo and who gets it. For example, he assumed I was dehydrated and that’s why I got it.

        He also made a comment that it was strange because I was in better shape than most of the crossfit members there. In my research it is clear that even well hydrated individuals can get Rhabdo and people in pretty good shape are maybe more likely to get it because of our ability to complete these insane workouts. An out of shape persons body will normally not allow them to train to the point of rhabdo.

        • Joe Cannon says

          Scott, I am so surprised that nobody mentioned this to you! I’d ask the PT director if he/she has ever heard of rhabdomyolysis. odds are they have not. As I mentioned in my review most personal trainers in the US (and probably the world) dont know about it. Certification programs just dont discuss it in their textbooks (why I dont know).

          Ive also thought that cross fit trainers were uninformed when it comes to dehydration and rhabdo. Quiz those cross fit trainers too about what they know and dont know about rhabdo. Ask them to tell you the signs and how to recognize it. Id like to know what they say.

          I would not be surprised if this issue about cross fit and rhabdo makes the national news someday.

    • Rebecca says

      Scott,
      I hope you are feeling better! There is NO reason that trainer should have let you do Angie Rx during your first workout… Or even during the first few months of CrossFit. I have been doing CF 7 months, and my trainer still scales things for me. He is very conscious of Rhabdo & over-exertion with, not only new athletes, but seasoned ones, as well. I’m sorry you had a bad experience, and hope you recover quickly!

      • Scott says

        Good news today.My lab work came back from yesterday (1 week off IV) and my CK went from 600 down to 328.She said 328 is still not normal (I’ve read anywhere from 100-400 is normal depending on the individual) but she did use the term “you’re out of the woods”. My kidney function, liver enzymes etc. were all perfect.The doc even said I can go back to drinking a normal amount of water now.One more blood test next week to see what the CK is but it sounds like I’m good to go.

        Very thankful to have recovered from this.I went back to work (desk job) the day after the IV came out and I even walked a mile with my kids on Saturday morning.Felt great.I’m going to wait a good long while to actually workout though.

        Thanks again for the blog and all the info.

        Scott

        • Joe Cannon says

          Scott, that is EXCELLENT news! I am VERY glad to hear you are out of the woods and on the road to recovery!! :)

  26. Rebecca says

    I’m fairly well-educated about Rhabdo (even more so in the last week after having it myself). There seems to be a lot of literature about it on the web, but I can’t seem to find anything about when it’s “ok” to resume physical activity and training. Any thoughts/recommendations?

    • Joe Cannon says

      Rebecca, its a good question you ask. I’d say wait at least until you are no longer in pain and your kidneys are ok. definitely don’t to back to the level you were at when you got rhabdo. Id also wait util your enzyme levels are back to normal. What did your doctor say about when you could go back to working out? Did he/she give you any feedback on this?

      • American Hunk(Kenny) says

        Rebecca,

        Could you please share how you got Rhabdo and what happened?
        I am of the opinion that the best time to go back is after your CK levels are back to normal and maybe after at least 3 months so that your muscles can recover.As you know, they were destroyed and they need to recover fully, even though your pain may have gone away

        • Rebecca says

          I got it after a high-rep workout- over 100 air squats in less than 4 minutes- a workout that I’ve done several times before without even having any soreness. My trainer thinks that the GHD situps I did two days prior were the culprit, but I’m not sure. The extreme pain, soreness, & tenderness began less than 12 hours after the air squats…

      • Rebecca says

        I haven’t actually been to the doctor yet (hard-headed & stupid, I know); I got IV fluids at home. I am waiting for him to call back about ordering lab tests.

        • Joe Cannon says

          Rebecca, keep me posted on what happens. Please DO go to the doctor. Rhabdo is nothing to mess around with.

        • American Hunk says

          Self medication with IV fluids??They need to check your enzymes, a chemical imbalance can even cause catastrophic cardiac arrest.Rhabdo can be lethal within hours.You need to go see a doctor

  27. Laura Higdon says

    Thanks for another great article Joe,

    Yes, we see lots of Rhabdo at the hospital & it is no laughing matter. I think people need to just pick workouts they are able to do, rather than as a “trophy”. I do Insanity, and I take breaks & slow down when I need – I’m too old for this s*** as the phrase goes. However, I also see other people in my group who are clearly not using good form, bragging about throwing up during the workout, all that. I actually took a friend to task for this the other day, scared the crap out of her luckily. Keep spreading the word, exercise is to prolong life not end it!!

    Regards, Laura

    • American Hunk says

      Luara, the excessive exercise can sometimes be as a result of thinking that we still have excess capacity, not necessarily for trophy purposes. Bragging about throwing up seems over the top and odd though.

  28. Derek says

    Great article! I was hospitalized for rhabdo at the beginning of this year. It was exercise induced and it was from crossfit workouts. Luckily my kidney function was normal, but my cpk levels were up to 75000. I now have numbness in my lower back on the left side from nerve damage due to the muscle swelling. I am back to working out now, but advise people to pay attention to the warning signs and this is not a joke.

  29. Alex says

    I got out of the hospital two days ago after a 5 day stay due to Rhabdo. My cpk was 77k, which really scared me and the ER doctors that treated me. Luckily, I caught it in time due to my trainers warnings. The dark colored urine is a dead giveaway. My Rhabdo was caused by a crossfit GHD workout. I had no warning signs…just BAM! The pain, beyond normal soreness, in my abs and the dark urine.

  30. American Hunk says

    Its almost 2 months now since I recovered from Rhabdo, exercise is never the same again as you are always dreading the signs of rhabdo coming up.I have not set foot in the gym, just biking for now.
    After 3 months, I plan to start running again, I am pretty sure the rhabdo was caused by the eccentric exercises on the arms, that’s where the pain came from

  31. Steve says

    Hi Joe, Thank you for writing this interesting article. I also loved reading people’s stories and your response. I suffered a heat stroke three weeks ago today while running a 7 mile race in the heat. I went out (delirious) as my temp rose up over 105 degrees and I didn’t wake up until 90 minutes later packed in ice in the emergency room.

    Well, I got better and went back to life as usual. Two weeks later, I went on a bike trip with my son, 250 miles over four days, without having trained very much. While my son got stronger, I declined.

    I finished the ride but developed intense quad pain the day after which has no persisted four days later. I can barely walk. My urine has not been brown. Do you think this was rhabdomyolysis now with recovery? Interested in your thoughts?????

    • Joe Cannon says

      Steve, while its hard to say for sure, I’m all for assuming it could be rhabdo and saying you should go to the hospital. At the very least go to your doctor and tell him/her your concerns about exercise-induced rhabdomyolysis. Not everybody who gets rhabdo has dark colored urine.

      I would feel better if you got this checked out. please let me know what happens.

    • Joe Cannon says

      Richard, go to your doctor if you have rhabdo. in many cases you ma need dialysis to help your kidneys.

      if you have not gone to your doctor yet I strongly advise you to do it right now!

  32. Joe De Leo says

    Hi all,

    Last November i got the P90x program to get in shape again after 2 years of couching potato..

    I barley finished my first day of my P90x schedule with throwing up and pale face laying on the bed for couple hours..

    The next morning i had the extremest soreness i ever had in my biceps and chest muscles, urine was dark red .. i googled online and i found out it might me muscle injury that caused the dark urine.. and it might me be something called rhabdomyolysis, it was my first time i know about this. i had plenty of water and took appointment with doctor the other day..

    The doctor wasn’t sure what was going on with me, he said it might be normal soreness after any workout and i should go home and rest, i had an loud argument with him and insisted on checking my blood levels of my CPK and Myoglobin.

    The next morning he called me at home and asked me to come to ER immediately since my CPK levels were above 110,000 , Myoglobin and liver enzymes were very high.

    I was hospitalized for 4 days taking IV fluids and drinking bottles of water till my CPK levels reached 10,000 and i was released to home advised to drink plenty of water .

    Thanks to God my kidneys survived and were functioning normal during all this.

    Now after more than 6 months i’m planning to go back to GYM but i’m really terrified and anxious of the horrible experience i went through.

    I’m being lazy and out of shape and i hate it, i get slightly sore after carrying any heavy thing, is that because of lack of training and being on bed/couch most of the day? or its related to some muscle weakness or some other condition ?

    Joe, Please tell me how i can go back to gym slowly ?
    I’m 5.9 ft, 165 lb , 28 years old.

    I’ll make sure i’ll be eating enough carbs and have my whey protein shake before and after my workout

    • Joe Cannon says

      Joe De Leo, your not alone. most people have never heard of rhabdomyolysis (I wish this warning was on P90x). Just a few weeks ago when I was at my doctor for a routine checkup, he told me about someone who came in and had rhabdo. They had to rush him to the ER.

      Ok so you have had rhabdo. that might mean you have a greater chance of getting it again but it doesnt mean you have to get it again. When you go back to the gym follow some of these tips

      1. start with no more than 30 minutes in the gym

      2. work out at a nice light pace when you do cardio.

      3. ask yourself how you feel on a scale from 0 -10 (10 being the worst). Id recommend you stay at a 3-4 on the scale – light to moderate exertion level

      4. when you lift weight use light weights – such as a weight you can lift about 15 times comfortably.

      5. Only do 1 set per exercise

      6. Only do one exercise per body part

      7. Don’t do a lot of different exercise. Stay to just 3 or 4. example, chest press, leg press and lat pulldown. Thats all.

      8. Start with only 1 or 2 times per week. Slowly increase to 3 days per week if you are able.

      Just go at your own pace. When 30 minutes is easy and you feel fine afterwards, slowly increase to 35,40,45 minutes. I see no need for you to exercise more than 60 minutes a day.

      You dont need to take your protein shake before and after working out. Id say just after is enough and since you are just starting out, id recommend you forget the shake for now and eat normally. Protein can stress your kidneys so go easy on protein powders if you do use a shake.

      How do you know if its rhabdo or muscle soreness? Remember muscle soreness will not hurt when you are not moving your muscles. Rhabdo pain hurts even when you are sitting still.

      Glad you are ok now Joe!

      • Joe De Leo says

        Thank you Joe,

        I beside feeling really anxious to go back to Gym, I’m also feeling down to start in such a slow pace,,

        But you know what? i was just remembering all the times after the first week of going to Gym (since i was 15 yrs old) beside soreness i used to see weird/dark urine during the first week of working out … kinda like the one i saw last time.. i used to think its due to muscles soreness and drink a lot of water and then after 1 week everything is back to normal and i keep working out for at least 6 months and my body gets in best shape..

        I’m not sure if i can do this anymore after knowing what is actually was happening to me..

        Thanks again Joe, God bless!

        • Joe Cannon says

          Joe, just try my advice. put the emphasis on health and give yourself time to adapt. You dont have to do it all in a day. I think you can get through this. just go slowly.

  33. Joseph Sawyer says

    Joe,

    Let me preface this by saying that I read your entire page and it is the best collection of information on rhabdo that I’ve found in one central place, and I am very familiar with this condition. I have not read each and every comment, so forgive me if this question has already been asked.

    I came across this page because I recently started taking a thermogenic supplement that contains 1,3-dimethylpentylamine. Upon researching the ingredients, I found that 1,3-dimethylpentylamine may increase the risk of rhabdo.

    This risk is of great concern to me as I was diagnosed with rhabdo back in 2006. The symptoms of this condition were onset within 6 hours of participating in a very extreme exercise that I had never before participated in. I was hospitalized for 5 days and had went from being a solid 200lbs when I was admitted, to a weak 175lbs when I left the hospital.

    The doctors at the time described the weight loss as my muscles melting away, and that it was amazing that I lived through this condition. The pain that I was in during the my entire stay was so unbearable that it could not be masked by the strongest of drugs that they could offer. I couldn’t move, I couldn’t shower, I had to use a bed pan…it was horrible! I say all that to say — I never ever want to be in that kind of pain again, and I wouldn’t wish it on my worst enemy.

    With all of that said, do you have any knowledge of the ingredient 1,3-dimethylpentylamine and it’s impact on rhabdo? I’m 32 yrs old and am currently in very good shape and am in the gym again 5 days per week. I’m using this this supplement to reduce my bf% and like I said, I am not interested in getting rhabdo again. Any help that you can provide is very much appreciated.

    Again, this site is the most informative that I’ve come across, and I’ve searched high and low so that I could educate friends and family. I’ll definitely be forwarding this page on.

    Joseph

  34. Jenny says

    Thank you for this. I am 51 year old female and am struggling with weight issues. I have worked out most of my life and suffered 8 years with female issues and am now doing better and am under a doctors care. I have had a personal trainer for over a year and recently joined his cross fit class.

    I have had both knees injured last year and this recent class can be very brutal. I am doing better than most of the younger clients with strength and endurance but he has us running at the end of class and people are racing and I feel like I have to push harder. Most say that they are having anxiety issues before class.

    I had experienced some of the symptoms a few months ago but rested at home. Which gave me more anxiety. This guy pushes until people have grabbed their chest after the end. My leg muscles take 2 days to un swell over the weekend sometimes I can’t sleep because I am so sore. Many people not only are intimidated but think about not being able to get out of their contracts.

    • Joe Cannon says

      Jenny thank you for writing and for bringing up the aspect of people feeling anxiety before class. What you said never occurred to me. I wonder how many other cross fit people feel anxiety over how hard the class is?
      It sounds like the personal trainer has taken the fun out of fitness.

      Its obvious the trainer is pushing you and most people in the class way too hard. Jenny, please quit the cross fit class. You are going to need your knees to be there for you 30 years from now, long after that personal trainer has forgotten about you. Do what feels right for you exercise-wise. Fitness should not have to hurt to be effective.

      At the least do show my rhabdo review to the trainer so he can learn what he does not know.

  35. Richard Coate says

    Hi Joe,

    Thank you so much for your website, it may have saved my life! I am in the hospital right now with a CK level of over 48,000. My kidney functions appear normal and I have been on IV flush for 13 hours. I can’t urinate though. I am worried the next step is dialysis.

    My symptoms were coca cola colored urine and extreme muscle soreness. I went to LA Fitness for my initial training/tour and the trainer worked me very hard. He knew that I had just had surgery 4 weeks ago. Being a former Marine, I don’t know the word can’t and tried to keep up with everything he gave me. I kept telling him that it was too much, but he just kept pushing me for about an hour. He even leaned on he weights to make it more difficult for me.

    My wife was supposed to go with me Wednesday but wasn’t feeling well enough. Thank goodness she didn’t go to her appt just after mine or we may have both been in this condition. It is now Saturday, (admitted to hospital on Friday night), and they said they will keep me in the hospital another day.

    I came into the hospital with your website on my IPad and a diagnosis of Rhabdomyolysis. The nurses and emergency doctors didn’t believe me and said it was probably a kidney infection. I told them I didn’t have any pain and no fever. Finally they came back with the Rhabdo diagnosis and were astonished. They said no one gets it unless they have “Fallen an can’t get up”.

    I hope that this disorder gets more attention and trainers are held accountable!

    Thank you again!
    Rick

    • Joe Cannon says

      Oh Richard, I am so deeply sorry that this has happened to you! What LA Fitness (location) did this happen at? Just curious. Was the trainer a “certified” persona trainer who took you through the workout? I ask because I believe that the salesman and even personal trainer managers at some gyms do not have to be certified to take people through an initial workout. Do look into this and if this is what happened with you, I believe you may have a legal case against the gym. I know that is the least of your thoughts right now since you’re in the hospital but I wanted to mention it. Find out who that personal trainer is certified by (what organization). If you find out, please let me know.

      DO report that stupid personal trainer to LA Fitness Corporate. He needs to be fired for what he did to you!

      The doctors and nurses are wrong when they say nobody gets rhabdo unless they “fall and cant get up”. I know of many cases of rhabdo in healthy people who get it -even in 1 workout. The comments on this blog post prove it.

      I will say a prayer you recover fast Richard.

      • Richard Coate says

        Hi Joe,

        Thanks for your prayers. What do you think the chances are that they will need to do dialysis? Does that lead to further dialysis or just a one time event?

        The LA Fitness division was Orlando Florida, Waterford Lakes location. The trainer was Marvin (Washington i believe) who supposedly is a Jamaican Olympic athlete (track). I am not sure if he is certified or not but he was not the salesman who signed us up. The salesman was not authorized to give us the tour/workout of the equipment.

        Thank you so much for your website and information.

        Best regards,
        Rick

        • Joe Cannon says

          Rick, I’m not sure about the dialysis. you may need it for a little bit until your kidneys heal but your doctors will know best about this. It sounds like you got to the hospital very fast and that is great news. Try not to think about it right now. You are exactly where you need to be right now getting the attention you need get better. Not everybody who has dark colored urine needs dialysis but if you need it for a week or two, then thats what we need to do.

          Athletes dont necessarily make good personal trainers. Do look into his certifications when you get better. Even if he is certified, in my opinion he is not qualified. I’d still report him to LA Fitness corporate offices.

          Right now, just take a deep breath and take comfort that everybody is doing their best to help you right now.

          Keep me posted on what happens with you Rick.

  36. says

    What do I think? Joe, you’ve scared the freakin crap out of me! I purchased your book, “Personal Fitness Training Beyond the Basics” over a year ago and since then enrolled in a program that partners with ACE Fitness… I plan to sit for my ACE exam Oct/Nov as I’ll be done with my “book studies” with the school in December…

    With that said, this post, no joke, has scared the crap out of me! I’m one of those that wants and strives to be qualified, not just certified – I want to help people, not hurt them. I chose the school setting vs. learning on my own to gain the much needed hands on experience that I’d miss out on.

    I’ll be sharing with my instructor in the morning as we’ve discussed the benefits of “negatives” some months ago, but nothing about dangers such as this. Where can I learn more?

    • Joe Cannon says

      Shanna, your right rhabdo is no joke. While Ive heard of about 17 cases of rhabdo myself over the last few years, it was actually the people who commented on my review of rhabdo that I think is the most telling. Ive always felt that rhabdo was under-reported in the fitness literature. When the people started writing me from their hospital beds, that was the scary thing for me.

      I’m not surprised nobody said anything about rhabdo. They didn’t teach me about it in grad school. You have my book on personal training which as far as I could tell, is very first personal training book in the US to describe rhabdo. I discuss rhabdo on page 79 I think. Use the links I put in my review as they are case reports as well as actual reviews of rhabdo I believe.

      Negatives are very popular. I see the benefits of negatives discussed in fitness journals but they always leave out their potential to induce rhabdomyolysis. I dont know why.

      Id be interested if your teacher knows about it and what he/she thinks so I do hope you let me know :)

      • says

        I’ll definitely let you know. I’m searching through my training materials and the company website to see what I can find about this condition. I think what scares me most about it… is the question, of what ELSE am I not going to know? Even after 13 months of hands on training, 2 months of internship and beyond… years of real world experience… what ELSE?

        I realize that I’m at the beginning of my career as a fitness trainer and there are going to be a whole lotta things that I’ll just need to learn as I go in the real world, but still…

        • Joe Cannon says

          Yes Ill be curious to know what happens. I understand how you feel. thats why I wrote my book. Most of the books I have repeat each other and there was a lot of real life stuff that I had to learn on my own. If it makes you feel better, none of us will ever know “everything.” There really is something good about always being a “student” because it means the learning never stops :)

          • says

            Hi Joe! Received my first trade pub today as a certified trainer and one of the articles in it was “Exertional Rhabdomyolysis: When too much Exercise Becomes Dangerous” found in the April issue of IDEA Fitness Journal. I immediately though of this article and our convo. :) Thank you for leading the way.

          • Joe Cannon says

            Shanna, Great! I’ll bet that was the article by Dr. Kravitz. He mentioned it was coming out when I attended his seminar back in February. Really glad to have him speaking about this. It’s such a big issue for the fitness community.

  37. Dane says

    Hi Joe,

    Thought I might share my experiences with you.

    I recently joined the gym again after a 6 month hiatus, previously I was doing contact boxing training so had been pretty fit, but had lost most of that fitness. I got some free personal trainer sessions (i was allocated the top trainer the gym had to offer, he was very experienced and very qualified) so was excited about getting back into shape.

    On the second session we did upper body exercises for approx 25 min and by the end I was pretty sore. Because of my boxing experience I can push myself pretty hard, so I dismissed this soreness as DOMS and thought nothing of it. The next day I could hardly move my arms, they were extremely sore, with a bit of heat and ice and some stretching they felt better, again it dismissed it as DOMS. The next day nothing had changed, still sore and still stiff. In the afternoon i went to the toilet and noticed my urine was very dark, I knew this was not good but didn’t think it was too serious. I thought I was just dehydrated and drank about 4 litres of water over the next 4 hours, I went to the toilet again and still the same.

    It was at this point i thought it might be something more serious, after a few minutes on google I came across this site/thread, and within 5 minutes I was off to the hospital (thankfully down the road.) The nurse in the emergency department looked at me funny when I said I might be suffering from Rhabdomyolosys from a gym session, thankfully the doctor was more concerned. It was at this point (2 days after the training session) that the swelling started in my forearms (I now realize it was the eccentric pull ups that caused the rhabdo). I was hooked up to an IV immediately and bloods were taken, CK levels were 150,000.

    I was in hospital for two days, CK levels now down to 40K, thankfully I avoided a compartment syndrome and have not done any damage to my kidneys (or liver.)

    What upsets me is the fact that the trainer had no idea what he was causing. Before training started I had a fitness test and came back ‘average.” On the first session we worked on thighs and after 30 mins of hard work I vomited from the exertion. After both of these “flags” going up the trainer still kept pushing me and again because of my previous training I’m not exactly going to let the trainer beat me and give up. Granted I did tick the ‘train me as hard as you can’ box because thats what gets me the best results, but the training was not scaled to my current fitness level.

    I would like to thank you for your commitment to educating people about the seriousness of this condition, rest assured I will be meeting with gym management and my trainer next week to discuss my experience, and what they plan on doing about educating their other trainers about Rhabdo.

    I am hoping that after a months rest and a slow build up I can reach the same fitness levels without the anxiety of this happening again.

    Many thanks,
    Dane

    • Joe Cannon says

      Diane, I am SOOOO sorry you had to go through this! I am VERY happy however that you found my site and that it helped you get the medical attention you needed.

      For the life of me I dont understand what would possess ANY personal trainer to do 30 minutes of exercise on upper body or lower body – in someone who has not worked out in a long time? And, vomiting??? what was that trainer thinking???

      Diane,If I may ask, what gym did this happen at and what state is it in? I’m always curious. Also, do you know who the personal trainer was certified by?

      Lack of rhabdomyolysis education to personal trainers is a failure of most in the fitness industry. Its not even taught in colleges either from what I can tell. Why, I just dont know? It’s very frustrating for me. I was not exaggerating when I said that my book – personal fitness training beyond the basics – was the first personal training book in the US to cover this very serious issue.

      Please tell me what happens when you go to the gym management about this. I’d like to know how they are going to deal with it.

      I hope today you are feeling a wee bit better Diane and I will say a prayer that you continue to improve.

  38. Amanda says

    Hi Joe,

    Very good article and thank you for trying to train the personal trainers out there.

    My husband was 37 years old when the doctors diagnosed him with a fatty liver and instructed him to work out. He is an all or nothing kind of person, so he wanted to make sure he was doing it right and hired a personal trainer from our local gym.

    The first work out was a 1/2 an hour workout on the upper body. This was tough, but he made it through it and went back for round 2 about 4 days later. This was to be a 1/2 an hour workout on the lower body.

    He wasn’t fat by any means, he was always active and muscular, although he NEVER worked out before hiring the personal trainer. And I believe you are right, she was a woman and he would have never admitted that he could do something to her. She had him doing squats while holding 200 lbs worth of weights. Could he do it – yes. SHOULD he do it, NO!

    Half way through the workout he started throwing up and she said that they should stop at that point. 2 days later when he could barely get out of bed, he went to the ER because he thought he had blood in his urine. His CPK numbers were 69,000 and he was admitted for a week. That was over a year ago now and he has never recovered. He still can’t do anything physical for more than an hour before he gets completely spent and has to rest.

    I just called the gym where this all happened at because I noticed that they are still charging me for his gym membership (that had been on hold for a while after the incident) and was informed that I have to pay for 3 more months of the membership because there isn’t a way to get out of it. It’s ridiculous!

    Their personal trainer changed my husbands life for what seems like will be forever and I can’t get out of a 1 year contract with them. I’ve talked to them, cried, yelled, they don’t understand or see the severity of what they did to my husband or take an responsibility in it.

    While I agree, yes, he should have said this is too much – he was paying someone who was trained to do this and should have known better than to allow him to squat with 200 lbs when he never worked out prior to this.

    Thank you so much for working to train and inform the personal trainers out there of this deadly disease. I thank God that my husband is still alive and miraculously had no kidney or heart damage through the Rhabdo.

    • Joe Cannon says

      Amanda, thank you for writing and I am SO very sorry this happened to your husband. Would you mind telling me the name of the gym and where its located? I like to know these things and think others should know about them too.

      It sounds to me like the personal trainer didn’t know what she was doing. I do not believe any QUALIFIED personal trainer would give a beginner do a 30 minute upper body workout (or lower body workout) or have that beginner doing 200 pounds squats to the point of throwing up.

      Considering all you and your husband has gone through, If it were me, I’d get a lawyer and sue the gym – and personal trainer. At the least, speak to a lawyer to see if you have a case (I’m no lawyer but I think you do). I know thats not something a lot of people would want to do but considering that its been a year and your husband still is being effected by it, I would sue if it were me.

  39. says

    Joe,

    This is a GREAT post!! Another reason our industry needs more professionals like you in it. It is way too easy for someone to become a personal trainer without the right education. I know the people out there who really care, like you, will continue to work to make a difference.

    Thanks again for your post.

    Dwayne Wimmer
    Owner
    Vertex fitness Personal Training Studio

  40. grandmother says

    My grandson is in the hospital w/rhabdo. His pee was dark brown and he could barely walk, couldn’t bend his knees. Dr. told us that the cpk test they do can’t read over 20,000. Dr. said he is guessing his cpk count was & still is 100,000 -150,000. He is in school to be a firefighter. the work out are extensive for 30mins. He told his instructor he was not able to do work out the night he was admitted to the hospital, but they made him do 5mins. He is on 24hr fluid IV, he has been in the hospital 6 days, CPK is of course still over 20,000.

    His liver enzymes are up. His kidney function is good. now they are talking about checking his thyroids, and doing a muscle biopsy. He is only 18. I read some of the other comments and their cpk is well over 20,000. why can’t the hospital he is in do a better job of reading the test unless the correct test had not been ordered.

    • Joe Cannon says

      grandmother, I dont know why the tests done by the hosptial your grandson is in wont measure CPK levels over 20,000. I would ask his doctor this question. Either way, thats a very high level. Im glad his kidneys are doing well. Tell him he needs to keep in contact with his doctor about when he will be able to workout – and do fireman training again. Ask the doctor about his risk of getting rhabdo again.

  41. Michelle says

    Very good article, thankyou. I recently joined a crossfit gym, the trainers explained rhabdo and I have heard it brought up in a few sessions, but I still wasn’t 100% sure what Rhabo is and common it is.

  42. Frank NJ says

    I am 64 yr.old male. My question can walking about 1 1/2 mi. bring about Rhabdomyolysis? Sunday morning while walking dog I started to feel run down and went home. As day progressed both leg calves hurt.

    That night I went to ER and was diagnosed with ‘myalgia’ and told to rest and follow up with Dr. Monday I was sore all day and enervated. Tuesday the calves though still tender but not as painful I walked as usual.

    I just felt like I had the flu and went back to ER. This Dr. diagnosed Rhabdomyolysis because Ck count was 3845. Gave me 2 bags of IV solution. Wanted me to stay 2/3 days to undergo solution flushes but I returned home because I have no one to care for dog.

    Calves no longer hurt but I feel run down and weak. I increased my fluid intake including Gatorade and stopped walking. Also I have had lot of stress in life recently and have had mild seizures (absence type);cannot that also increase Ck levels?

    • Joe Cannon says

      Frank, I’ve heard of just a little exercise causing rhabdo. In one of the studies I referenced in my review, a guy got it who only did 30 sit-ups per day for 5 days in a row! All that said, while I’m not a doctor, I did find a study that noted that seizures can raise CK levels. Here is the link :
      http://www.ncbi.nlm.nih.gov/pubmed/6847427

      Did you get rhabdo? I’m not sure. Have you walked that distance before without problems? I’d talk to your personal doctor about this and see what he/she thinks.

      Either way ,I am glad you – and your dog – are doing ok

  43. says

    Joe,

    I have been following the comments on this post. I found a video of a presentation a friend of mine Matt Brzycki from Princeton University did at the Smarter Team Training conference hosted by Doug Scott at the Pingry School in NJ, last year(http://www.youtube.com/watch?v=iZays8VxSXk). Obviously the whole presentation was longer but you might want to check it out. You may be able you get the whole video by contacting Rob Taylor at Smarter Team Training, (http://www.smarterteamtraining.com)

    Dwayne Wimmer
    Owner
    Vertex Fitness Personal Training Studio

  44. nicole says

    My husband and I both got rhabdo from p90x at different times. I’m not in the best shape, but he runs marathons. I wish I had read this before starting the program. You are right, P90X should put a specific warning on their discs. Thank you for this post. Wondering if there are any after affects.

    • uvd-380 says

      Nicole, so sorry to learn about your problems. Hopefully you and your husband are ok now. Rhabdo was the first thing I thought of when I heard about P90X. I think you both should keep in contact with your doctor about what your risks are of getting rhabdo again. I think for your husband who runs marathons, that its not likely but I’m guessing. Best to discuss your feelings with your doctor. I’d also not do P90X again just to be on the safe side.

  45. CK says

    1. Thanks for the detailed explanation of Rhabdo!

    2. This IS very serious, as I gave myself this disorder last week.

    3. I don’t know how anyone could miss these symptoms as I thought I was passing a kidney stone or at least had a UTI.
    — either would have been odd since I’m a black male.

    3. I’ve been an athlete and dancer for years, but recently increased my workout intensity this summer and one day last week took it too far.

    4. This really scares me b/c I take pride in making healthy choices in my life and seldom ever even get the common cold, much less something this serious!

    5. Thanks again Joe. I apparently need to read some more literature on the subject and I’ll most likely check out your book! ~CK

  46. DK says

    I’m on the 20 th day after having developed Rhabdo and anxious to get back and get my bicep strength back (I’ve gone from being able to do 30 pull-ups to not being able to get to 90 degrees). I haven’t been able to find any articles on recovery training but have noted some people have relapsed after going back to train. I’m a police officer and need to get back to my normal strength as effectively as possible. Any suggestions or articles you can send my way?

    • uvd-380 says

      DK, I think the best thing is to keep getting your CK levels checked by your doctor to make sure you are ok before you start to ramp up the intensity again. You may be at greater risk of getting rhabdo again so do talk to your dr about this possibility. I would start with a circuit training routine using light weights. Just curious, what did you do to get rhabdo?

  47. AB says

    This is full of really great information. I’ve been working out since high school. However, when I was 21 a professor of mine made my class do crossfit. I was hospitalized for almost a week. When I was finally admitted 3 days after the incident my CK was 94,500. It took 4 months to get back to my “normal”. It was amazing how for months after I tired out so easily. I couldn’t even open a door! I still tire out faster than I use to, and it’s been 7 months.

    • Joe Cannon says

      AB, I’m amazed that your professor didn’t realize he might cause rhabdo in some of his students. Glad your on the mend. just give it time.

  48. kenny hodges says

    Good stuff here man. I’m wondering though if using bodyweight exercises is any safer. I’m starting slowly on convict conditioning now to get back in shape after lifting weights for awhile then stopping altogether from back injuries.

    I think a lot of people need to realize that the majority of health and fitness mags and to some extent “training” books are written by and for steroid users.

    I just thought i was being a slacker….WRONG! That being said I’ve worked out pretty hard in the past and never gotten rhabdo but reading bout this makes me a lil apprehensive to say the least.

    My heart goes out to all the people on here who went through this and also had to deal with our broken medical system as well.

  49. Chris says

    My friend’s 27 year old daughter participated in an extreme CrossFit session and was admitted to the hospital within 24hrs diagnosed with rhabdomyolysis; her CK at 88,000, normal range is <125; severe upper body swelling and kidney failure.

    Almost lost her.

    She is on complete bed rest for a week. Hard lesson. Not one of the trainers knew what rhabdo was. "Personal Trainers" vs. a good Exercise Physiologist would have prevented that. Dumb asses.

    • Joe Cannon says

      Chris, I’m glad she survived! The lack of information on rhabdo to fitness trainers I say is a complete and utter failure on the part of the fitness industry as a whole. I know some may say I’m being extreme and a bomb thrower by saying that however, if that is the case, then why is rhabdo not mentioned in hardly ANY personal trainer textbook?

      Until the day occurs when the leaders of the industry re-write their textbooks and start educating people about this, I think everybody needs to ask fitness trainers what they know about rhabdo, before they entrust that person with their health.

      • Doug says

        I will say that if those Crossfit trainers didn’t know what Rhabdo is then they aren’t staying current in the Crossfit world. The several gyms that I go to and the Crossfit journal all talk about Rhabdo and emphasize caution.

  50. Sara says

    I am recovering from a slight case of rhabdo currently…my levels 4700. I am have been doing Crossfit for about a year and a half and LOVE it. I am totally addicted and the gym is like a family to me. My trainers all knew of Rhabdo and have talked about it before.

    After a relatively “easier” workout on Sat (deadlift/ pushups) my arms started swelling up. Went to doc and drank tons of water all weekend and the swelling is almost gone now. My point is that not all crossfit gyms push people too hard.

    When I started we started out very slow (my gym has different levels of classes) The trainers have all been educated on Rhabdo in their Crossfit training. I agree more people need to know what Rhabdo is. It can hit you if you are new to working out or if you have been working out for a long time.

  51. Jim Stacey says

    Joe, twice you made the following comment about how rhabdo can cause muscle pain [immediately after exercise up to 24 hrs later]. Forgive me for a little confusion but do you mean ‘immediately after exercise OR up to 24 hours later?’ To me 24 hours later is not immediately, so please straighten me out on this. Thanks.

    • Joe Cannon says

      Jim, the pain can happen immediately after exercise while others may have pain up to 24 hours later. Also the pain hurts even though people are not moving (regular muscle soreness doesn’t hurt when we aren’t moving).

      Rhabdo may also cause a lot of swelling in limbs. it may stop the person from flexing their arms for example. this is a scary sign that needs immediate medical attention (go to the ER!) because in extreme cases, doctors may need to amputate limbs to save the persons life.

  52. Doug says

    I’m currently recovering from Rhabdo. I had done crossfit for a year took two months off to recover a sore shoulder and went back at it. Within two weeks of being back at the crossfit gym I tackled a workout that meant doing 78 pullups and 78 burpees in 20 minutes. For most people that sounds crazy.

    I had already built myself up to that level just two months previous. I was crazy sore the next day but went back for another workout. I felt fine after warming up and did 5 rounds of 3 snatch 135 lbs, 20 situps and 200m sprint. Again I was sore that night. The next morning I was still very sore and now my morning urine looked like cola.

    I knew immediately what I had done to myself. I couldn’t believe I had pushed myself that hard. My CK level when I checked into the ER was 155,000. The next day it was 183,000 then 187,000 and several days later I finally got to go home with level of 18,000. two weeks later I’m weak.

    My kidneys hurt most of the time (depending on how well I hydrate). I still am supposed to wait another two weeks before I do any type of exercise at all.

    Rhabdo is no joke and it has wiped me out. I only hope that being a little bit wiser I’ll be able to go back to crossfit and ease my way back to the fitness level I was at and where I want to be.

    • Joe Cannon says

      Doug, please go slow and give yourself a lot of time before you do cross fit again. I advise you to not do cross fit again. I’ve heard of people who have lost their kidneys from rhabdo. Please be VERY CAREFUL!

      • Doug says

        No worries. I will be very careful. I do not want to spend another week in the hospital or worse lose my kidneys. I really like having them. You could say I’m attached to them.

        It was the negative rep I was unintentionally doing that caused me to get Rhabdo. I will definitely ease into it. My goal written in sand is to get back to where I was by June. I’ll take it slow. The trainers at the gym that I go to are very careful. I got away with getting Rhabdo because I have been going there for quite a while. I do not plan on doing any high rep pull ups or heavy high rep workouts for quite some time. I’ll probably focus on strength and mobility.

  53. Fiona says

    I’m currently recovering from something very close to rhabdo, after a moderate-intensity free weights workout, undertaken after not doing weight training for approximately 18 months.

    It was a really hot day which didn’t help (I live in Australia, summer here). I noticed extreme muscle stiffness and soreness in the days following the workout that didn’t seem to be diminishing as it normally would- I could barely straighten my arms and stretching didn’t help at all.

    I wouldn’t even have found out were it not for a cholesterol test I had about 5 days after the workout which detected CK levels of 12 000 and compromised liver function.

    I’m very lucky that my kidneys appear unaffected (hence the lack of cola-urine, fortunately). I hate to think what my CK levels would have been in the days immediately following the workout.

    I kind of feel lost as to what to do now- I want to keep weight training (after my doctor-imposed exercise ban is over- one more week!) but am scared of this happening again!

    • Joe Cannon says

      Fiona, listen to your doctor. you will not lose ANY fitness in week or even 2-3 weeks. When you do start to work out again, you will regain your strength, endurance and cardiovascular fitness faster than you got it the first time. So don’t worry. You need to give your body time to recover from this. I do agree that you were very lucky that you had a cholesterol test after getting rhabdo to identify this. That test may have helped you more than you realize.

      I know for people who like to work out, being told to hold off on working out for a time can be a nightmare however look at this as something you need to do to give your body time to get stronger. If you work out now, in the compromised position you are in now – you’ll make things worse.

      Keep in close contact with your doctor on this. He/she will be able to tell you when its OK to workout again. And when you do start to workout, start slowly (As a general guideline, my personal recommendation: 1 set per exercise, light weights, low intensity. no more than 30 minutes per workout total. No more than 30 minutes for cardio too. Don’t work out more than 1x per week at first).

      Ask your doctor about your risk of getting rhabdo again. its possible it may happen again (I’m not sure) but if you follow my guidelines of going slowly I think the risk of it happening again is low.

      If you ever do experience anything like you did before, see your doctor immediately.

  54. Katherine says

    Hi Joe,
    Great info here! I’m a crossfitter, been at it consistently for about 9 months with a fairly recent (Nov. 7) ovarian laparoscopic surgery where I took about 3 weeks off and came back slowly. I’m also nursing some knee tendinitis so have been focusing on arms for a bit.

    Tonight I subbed (240 reps) for squats, along with pushups and pullups (fewer reps for those) and my abs started feeling sore about an hour later (typically I’d feel sore tomorrow afternoon); however, I’m not feeling pain while just sitting around, and from your info that is a key sign.

    Would you recommend seeing my GP for a blood test tomorrow just in case? Or just increase water intake and monitor urine for awhile? Thanks so much, sorry for all the background info but thought it might be useful. Appreciate your work!
    Katherine

    • Joe Cannon says

      Katherine, I recommend you go to your doctor and get checked out. Tell your doctor what you did and that you suspect rhabdo since the pain came on super fast. Sorry for taking so long to get to you about this. My site’s been getting some updates. I do hope that this has not caused you to not get treated. I do hope you are ok now. Do let me know how you are doing!

      • Katherine says

        Hi Joe!
        Thanks for the reply. I gave it a couple of days and am doing great. I think I just over-worked myself a bit, so have been taking it easy on the abs!

        Thanks again! All of your info was so helpful.
        ~Katherine

  55. Dave Bolton says

    Hi Joe

    I recently did my first work out for 3 months, for 6 days after all my upper body ached and I couldn’t lift my arms above my head, on the 6 day I had had a couple of beers the night before and then on the morning had a lot of coffee and no water and started feeling dizzy, I was sent from work to ER were my CK levels were 20,000 ,

    I am now one week on and arms still ache and I feel a little dizzy, I have to have weekly blood tests until the CK LEVEL comes down, I have had no issues with kidneys but I’m so paranoid and anxious in case it’s some thing worse like a stroke or heart attack waiting to happen,

    also what if I have wrecked my muscles so much that I have started Muscular Dystrophy. I am very paranoid as all of this was a massive shock.

    • Joe Cannon says

      Hi Dave, I dont think you have to worry about getting muscular dystrophy from rhabdomyolysis. The thing to remember is that you have billions of muscle cells. Ok some of those did get killed off from rhabdo but you still have a LOT of muscle fibers left. I think the thing to remember is that you got rhabdo because you pushed yourself too hard and too fast. This doesnt necessarily mean you will get it again especially if you work out more aware the next time.

      So when your doctor says its ok to work out and you are feeling better than you are not, just start out slowly. for example, a few things to think about include:

      Start out with only 1 day per week, no more than 30 minutes per exercise session.

      Don’t do more than 1 set per exercise at first.

      Increase the number of reps you do before you increase the weight you lift.

      Increase reps, then sets performed and finally weight you can lift.

      Know that you don’t have to feel sore to improve with fitness.

      Remember that your body gets stronger when you are resting after working out.

      Do talk to your doctor about your fears. at the very least he/she can help you sleep better at night and can also give you good tips on how to avoid rhabdo in the future.

  56. Kevin says

    Hi I’m sitting in a hospital getting IV pushed through me. I have rhabdo from pushing too hard on a Monday night workout and then getting up and working out at 6am the next day. Wednesday night another arm workout. The thurs morning more of an core workout.

    The Monday workout we did a ton of tricep reps until we couldn’t even lift our arms. Then tues am was a series of seven exercises reports at 40, 30, 20, 15, 10 then 5. Anyways, My arms have been swollen and sore ever since and I had brown urine Thursday at about 11am. Now my ck levels are above 15000. Dr. said to lay off all exercise or muscle work until levels are normal.

    • Joe Cannon says

      Kevin, I am SO sorry this happened to you! I am glad you made it to the hospital and am getting the treatment you need. I will say a pray for you that you have a speedy recovery. Please do tell others what happened to you when you go back to the gym. That way I hope you can help others from getting rhabdo.

  57. Dave Bolton says

    Hi joe

    I’ve had my second test and the CK Level is down to 187 now which is good news, the doc has said she wants me to come back ad do another test in 4weeks time, guess it must be to monitor what’s happened and see why it was initially so high.

    Cheers for your Help and advice

  58. Leah says

    Hi Joe,
    I’ve been reading up on this since a friend from my crossfit gym was just admitted to the hospital after GHD sit-ups, crazy stuff! Now, I might be paranoid but I have been bloated for several months now. Dr’s are unsure at this point what it is- we’ve done numerous blood tests, ultra-sound etc. Could this bloating be some form of rhabdo? Is that possible and do I need to get tested?

    • Joe Cannon says

      Hi Leah, Id think that if you had rhabdo, the doctors would have figured it out by now. Its often easily seen by measuring various enzymes. You can mention rhabdo to them and your taking part in cross fit and see what they think. I’m not sure what could be causing your bloating. Anybody ever mention PCOS? Just a thought out of left field that occurred to me. I wish I had a better idea for you. I would be surprised if you had rhabdo.

      Sorry to hear about your friend. Im curious, did the cross fit trainers know about rhabdo a did they warn people about rhabdo symptoms?

  59. Jared Latimer says

    I recently began working out after more than a year of real, consistent exercise. I worked very hard doing a “cross-fit”-like routine. 20 min per day for 2 days. The next day I had the root beer urine. I also had real muscle pain but I associated that with the intense workout. Obviously the brown urine worried me. I began hydrating very diligently.

    Later that day urine was returning to that old familiar color. The next day (today) it seems to be back to normal. I still have some soreness in my muscles but that too seems to be going away. Should I be concerned, even though the symptoms are dissipating, that I am still suffering from Rhabdo?
    Thanks.

    • Joe Cannon says

      Jared, to be safe I recommend you go to your doctor and tell him/her what you just told me and that you suspect rhabdo. they will run a blood test and see what is going on. They can then give you a better idea of whats going on and when you are able to go back to working out again. Just because your urine is back to its normal color does not mean you are out of the woods and have a green light to go back your intense workouts. I think this is the best and safest course of action.

  60. tracey says

    Hi I’m new to this site for the reason of a strenuous workout. I had just finished my third class of the day and by the next morning I was sore but went to a heavy weight training session as I’m training for a figure contest.

    Within 24hrs I had pain like i have never experienced, swelling and unable to use my arms or shoulders. It’s been a week and they have tested me for a dvt (negative) I returned to the gym today for a leg workout only to recognize that I am extremely fatigued and accompanied with heart palpatations. Urine is normal.

    It has been a 8 days and still cannot use arms normally. Feel like I have been beaten all over my upper body and arms.

    Any ideas??

    • Joe Cannon says

      Tracey, did the doctors test you for rhabdomyolysis? One test they usually run is to look for elevations in creatine kinase (CK). Im not sure what you have but I am going to STRONGLY suggest you not workout until your doctor says its ok AND your symptoms are 100% gone. Thats not what you want to hear but I think this is safest. I dont like the heart palpitations and your swelling makes me think it might be rhabdo.

      I’ve been hearing that some doctors don’t suspect rhabdo in people who workout because they have been conditioned to believe it can only happen in super extreme conditions. If you read the other comments you saw where this happened to some people here.

      I recommend you go to your doctor TODAY and tell them you feel you may have “exercise induced rhabdo.” Print up my review and show it to them if they don’t believe you.

      I hope Im wrong Tracy but I think this is best. I don’t want you to keep working out and making this worse.

      Please let me know what happens.

      • Amir says

        Hi Joe
        I’ve been training with weights and cardio for 5 years now. On the 18th of this month I performed deadlifts at 10 sets of 10 reps. The workload for the first 5 sets was 205lbs, then 135lbs for the 5last sets. Immediately I began to feel extreme tightness and pain in my lower back and hamstrings. My first thought was DOMS. The following morning the pain and swelling increased.

        I Layed in bed all day and night until 2.am the 20th I could no longer take the pain. I called 911 and was rushed to the ER. At 9:20 am my first report showed my CK at 51,000, and urine coloured like cola. My AST was also elevated to 536. I was given 200ml/hour by IV and followed that till my release on the 25th Jan with a ck of 5100. My Creatinine never elevated to abnormal readings. What exactly saved me from Renal Failure?

        To know I had ck levels that high and my kidneys were not taxed blew the docs minds away. My creatinine levels were 91 on the 20th, then 84 by the 25th.

        Joe I am in absolute love with resistance training. I’m afraid I won’t ever want to lift weights after what I went through. I’m 25 years old,male,5 foot 10in, 175lbs. Any questions or thoughts would be greatly appreciated. Im Glad to have found this page. I feel a lot less stressed now.
        Cheers
        Amir

        • Joe Cannon says

          Amir, first I am glad you are ok and also glad you had the sense to call 911! You are on the road to recovery. Several others have said that they were afraid to workout again after they got rhabdo. I liken this almost to a type of post traumatic stress syndrome.

          I suggest you keep in contact with your doc and ask him/her when they think you can workout again. when they say its ok its important to start slowly. As an exercise physiologist I can tell you that 10 sets of any exercise is too much for most people. Remember the injuries you cause now when you are young (Im not talking rhabdo but joint problems etc) will come back to hurt you decades from now and actual hinder your ability to lift weights. Its when you are 60 that I really want you to lift weights! Thats when its going to make a LOT of difference in your life.

          The key is that you will be able to lift again and you dont have to get rhabdo ever again. Just remember that moderation is the key. The day will come when you can even lift heavy again. Just remember that too much of anything isnt a good thing.

          Keep me posted on your progress Amir and Im glad I was able to reduce some of your stress.

  61. Jason says

    On January 29, 2013 I completed a CrossFit workout called Angie (100 pullups, pushups, situps, and squats – in order) as prescribed and felt crummy after; nothing abnormal for a CrossFit workout. My arms began to swell on January 30th and by the morning of February 1st I had dark colored urine.

    I immediately slammed two 24 ounce bottles of water and headed to the Emergency Room. My blood was tested and my CPK levels were 84,400 (703x greater than normal). I was admitted to the hospital with Rhabdo and put on aggressive IV fluids.

    The next morning my levels were 94,400, then 101,400. A day later they dropped to 69,610 only to spike back to 103,100 (caused by stretching my arms). Levels began to fall on February 4th (70,550), then February 5th (33,100), and finally February 6th (12,857).

    I was released on February 6th with CPK levels still 100x greater than normal. While I felt little pain during the entire process, the number of labs, IVs, fluids, and other medical necessities began to weigh on me. A very experienced and highly regarded nurse practitioner told me that in her 25 year career, she’s only seen level above 100,000 twice. Both in men less than 25 years old. Both are dead as a result.

    My general health, fitness, diet, and young age saved my life. My kidneys remained healthy through the treatment. My liver enzymes (ALT/AST) were very high as a result of the Rhabdo, but they fell with the CPK levels.

    In my effort to expand my fitness, I could have lost everything. 6 days in the hospital, $100,000+, at least 6 weeks rest, and potential permanent muscle damage. Was it worth “Rx’ing” that workout? No. Go ahead… say it can’t happen to you.

    Buy in to the CrossFit extremes while ignoring your body like I did. Rhabdo is a hell of a way to learn a lesson in humility. Please, learn from my experience.

    • Joe Cannon says

      Jason, thank you for writing. Did the cross fit trainers ever mention the possibility of rhabdomyolysis to you? Just curious. Whether they did or didn’t is irrelevant. I’m coming to the conclusion that cross fit is dangerous.

      • Jason says

        Thankfully trainers introduced us to Rhabdo during our introductory classes. In fact, I give great credit to the local Madison, AL CrossFit community for their focus on health, fitness, and potential dangers. Where I agree with you, however, is the general CrossFit mentality to push through pain to get a good time or do something “Rx’d”. I mean… GHD bench press? GHD wall ball toss?

        There is simply no need to do these things; they’re not only dangerous but likely not effective in producing better athletic performance. When 90% of CrossFitters cannot complete a workout as prescribed… the programmers need to reevaluate the workout’s intensity.

        Program for the average person and not only the top 10% and save some people their physical abilities. Let those with greater abilities scale up; no one said scaling had to be unidirectional.

  62. jason says

    Joe ? for you. Ive been doing Cf for almost a year now i participated in a workout with 2 movements Power Cleans and Pullups 55 of each.

    No onset pain immediately but 3 days later i couldn’t fully straighten/extend my arm the pain was super intense even resting. like i said Ive been doing it for a while its been 9 days now and they soreness is still there Ive noticed the last couple of week Ive had DOMS!? any ideas or information would be greatly appreciated!

    • Joe Cannon says

      Jason, I think you may have rhabdo but I’m not a doctor so Im going to recommend strongly that you go to your doctor today and if you cant get an appointment, go to the hospital. They can run a blood test and see whats going on. Tell them what you did exercise wise and tell them you suspect rhabdo. Do let me know what happens.

  63. Mimi says

    My brother had his first training session Wednesday night with a personal trainer who pushed him to his limits & he is in hospital now with Rhabdomyolysis! His levels are dangerously high & dr’s have never seen anything like it! They say his progress is good though, still doing tests to see kidney damage etc :( i still can’t believe it!!!! Mimi Australia

    • Joe Cannon says

      Mimi, SO sorry to hear about this! Can you tell me the name of the gym?. Can you find out the organization that the personal trainer is certified by. I like to know these things. Please tell the gym that this happens to your brother. They need to know what one of their employees did – and that personal trainer needs to know too.

      I really hope your brother is ok…

  64. Beth says

    Hi..Not sure if this has been covered but here goes: I had exercise induced rhabdo two years ago. I had always worked-out but was just coming back after a surgery and decided to get a trainer at my gym. I was doing really heavy squats….my husband didn’t even lift that much.

    One night at work (charge nurse in our local ER), I started having “palpitations”. I had been extremely sore in my glutes/hamstrings for a day and was literally walking on tip-toe and could not sit down. After my shift, I checked in…and a cardiac workup was done. My CPKs were over 12000 and my doc originally thought I was having an MI. Anyway I stayed for a few days with IVFs. Oh, and I have had recurring PVC’s ever since. Never had them before!

    My QUESTION is…..I am trying SO hard to get back into running. I still go to the gym and do P90X but I want to run. Hills kill me. I feel like I have absolutely no strength in my glutes/hamstrings.

    What are the long-term effects of rhabo? I thought I had heard that the muscles calcify? Will this have any lasting effect on the strength or elasticity of these muscles? Thank you for any information…..

    • Joe Cannon says

      Beth, wow! sorry you went through that but very glad you were at the hospital and were able to get the help you needed! Ive never heard of muscles calcifying from rhabdo. You did lose some muscle cells but you still have a LOT left that can bounce back.

      you are free of rhabdo now right – no heart palpitations etc?

      My question for your personal trainer is why did he/she having you squatting so heavy if your goal is to get back into running again? If your goal is running, you should lifting mostly lighter weights (say 12-15 repetition maximum) with short rest periods. Lifting very heavy (more than your husband as you say) is training for power! Nothing wrong with power and Id even say runners could do that sometimes as well, but its not the primary way I would work your muscles. Do you know who this personal trainer is certified by? I always like to know these things?

      Did you get rhabdo at a big box gym? Its ok to say the name of the gym.

      I’m wondering if the P90X workout is just kicking your butt so much (no pun intended) that when you do try to run up hills you have no more gas in your gas tank? Why dont you try this. Take 2 weeks off everything. you wont lose any fitness in 2 weeks. Then start running again and see how that goes. if you want to do P90X again, only do it on days that are not just before you go for a run and dont do it on the day after you go for a run either. Its possible that the combo of running and P90X is just overworking your body a little too much. Remember there is a condition called over training syndrome. Check out my review to see if you have any of the symptoms.

      • Beth says

        Thanks for the reply! The gym is just a local gym in Maryland and I’m not sure about the trainer. I will say at the time, I was not running. I just wanted to get back into shape after a surgery. I’ve just last month started a couch to 5 k running program so I’m really not even running all that much. I just know going up even small hills is difficult and I feel that my hamstrings are very weak.
        I might take your suggestion of the two weeks off…thanks!

  65. brett says

    This article may have saved my life. I have rhabd and am currently in er they also found my liver enzymes are extremely high. Glad i read this and came to the er. Thank you

    • Joe Cannon says

      Brett, thanks for letting me know and Im really glad you found me also! What caused you to get Rhabdo? I really hope you are doing better. keep me posted.

      • Brett says

        I used to power lift heavily back in high school. That was 5 years ago now I work at my home office daily and am out of shape. I went with my brother to the gym on this past Monday we did upper body bench incline bench curls etc. I stayed with him but wasn’t putting up his weight I didn’t wanna push to hard. Well apparently I did anyway.

        I was sore but to me it wasn’t different from any time you stop lifting and begin again. This past Tuesday I noticed my urine was dark didn’t think much of it. Yesterday my pee was so dark it was like looking at coke a cola.

        Looked up on Google and found your article rushed to er. I had to stay over night and now have to stay tonight to as they flush the stuff out of me.

        • Joe Cannon says

          Brett, thanks for letting me know. Im glad you got the medical attention you needed. It stinks you are in the hospital but you are in the best place right now to get the help you need.

          Generally when we start to work out -or go back after a long time off – its best to start with circuit training because its safest. Do ask your doctor when its ok for you to start working out again.

          • Brett says

            I wish I would have known about this disease before hand but I much appreciate your advice. And I will ask before I get discharged.

          • Joe Cannon says

            Brett, yes I know. its not something that is talked about much outside of medical school or college. I have faith that you will be ok Brett. Just listen to your doctors. you will be able to work out again. I know you will.

  66. Denise says

    Hi,4 days ago I did 6 minutes exercise with a Kettle Bell.Have not exercised in years,due to my husband’s illness.I must have done about 50 lifts or more. Now my upper arms are swollen and sore and also quite hard.After reading the posts here am worried,should I go to my Doc?

      • Denise says

        Hi Joe,thank you for your reply.Today the swelling has gone down by half,right arm still quite sore.My urine is normal and I feel ok.Believe me living in Ireland I know the doc will dismiss this as just over use,do you think if the swelling has gone down it is ok?Sorry I know you’re not a Doctor

        • Joe Cannon says

          Denise, its a good sign its going down but I would still love it if you went to your doctor. I just want you to be able to sleep at night without worrying if anything is going on inside you besides the swelling. the doctor can measure your CK levels to see whats going on as far as rhabdo. I say go to the doctor or the ER.

  67. Brian says

    Hi Joe- I am recovering from rhabdo. I was in the cardiac ICU for 4 days with a CPK of > 80,000. I have been out of the hospital for close to 4 weeks. My kidney and liver tests have all been normal since 3 days after discharge.

    My question concerns working out. My muscles are still very weak, especially my legs, abs and arms. From what I have read, this is normal. How hard should I be working out? Should I be working out hard to regain my muscle strength, or should I be taking it easy? I normally do 1 hour of cardio on climbing stairs and another hour of traditional weight lifting.

    My family has made me quit Crossfit, so I won’t be doing that anymore. BTW, it was the GHD sit ups that brought the rhabdo on and I was doing CF in a friends garage, as opposed to a CF gym.

    • Joe Cannon says

      Brian, I say take it easy and do not work out again until your doctor says its ok to do so. While eventually – several months from now – I think you may be able to work out harder again – that is not your goal for now and I dont recommend you ever do cross fit again. Talk to your doctor about when you can workout again and ask his/her thoughts on when you can do back and the types of activities they recommend when you do first start back.

      did your friend ever mention rhabdo to you? was this friend a personal trainer?

      • Brian says

        He hadn’t heard of it until I got it. He’s been doing CF for about 3 years and has not had any problems. He is not a PT. I had never heard of rhabdo until I woke up with the tell tale brown urine and did a google search. I belong to a chain health club and asked one of the PT’s about rhabdo this morning and he looked at me like I had 3 heads and asked what rhabdo was.

        As a funny aside, I found out that my internist belongs to a CF club and does it 3x’s/week. He is all for me doing it again, but I’m terrified of getting rhabdo again.

        • Joe Cannon says

          Brian, Im not surprised the personal trainer didn’t know about it. Most don’t. Please show my rhabdo review to that personal trainer. All of them need to know what it is.

          I’m also surprised the doctor said it was ok to do cross fit again. Then again, he is doing cross fit at a club (that might have experienced staff) and not with a buddy who isn’t cross fit trained and knows nothing about exercise science… Still, I disagree with him/her on this. I wouldn’t do it again.

          Brian, I don’t want you to be afraid of working out again. you can and you can even workout hard again. As I said it will take time. There are cases of people who get rhabdo multiple times. this is what leads me to believe there may be some “genetic tipping point “that some have that contributes to rhabdo. It could be for you, that the intensity of cross fit might be that “tipping point.” other hard workout programs, which might be less intense than CF, might be fine for you. Its a hard call either way to make for sure but I will prefer to be conservative on this and say steer clear of it.

          Just listen to your body, and the doctor and when you do workout again, just remember that none of us, is bullet proof. that’s something I need to keep reminding myself of as well.

    • Joe Cannon says

      Sandra, you’re not alone. I’ve heard of others in the police academy who got rhabdo. Unlike most people who do cross fit ect for fun, I can understand intense exercise programs in the police academy, military etc. Still, its a sad thing when it happens and I do hope you are better now.

  68. Jay says

    Hi Joe, I recently got rhabdo and am recovering now. My cause was from doing 8×8 squats, 30sec rest at 60%, following a big weekend out with the lads – the cause behind dehydration. My ck levels hit ~125000 before coming down. I was released from hospital after 4 days when it came down to 15000, and after 7 days it was at 2500. Its now day 10 and I’m wondering whether I can start training (low intensity) again. In general I feel fine now, my legs feel a tad weak but it feels more from not moving much than anything else. Could you let me know your thoughts?

    • Joe Cannon says

      Jay, dont work out until your doctor says its ok. your muscles are still recovering and exercise causes more muscle damage and increases CK levels. Id rather you not overtax your body so soon after this happening. I dont have a time table for you on this. Please talk to your doctor before you do anything.

      • Jay says

        Thanks for your reply Joe. Your website and forum has provided a lot of helpful information on rhabdo. Is one more susceptible to getting rhabdo again once they’ve had it before?

        • Joe Cannon says

          Jay, I think that yes if you got it before, you may be more likely to get it again although I don’t know the odds of re-occurrence. There is at least one case report of someone who got it several times. Im sure all this depends on several factors including how hard one is working out. This is also sometime to run past your doctor to get his/her impute.

  69. Dave S. says

    Joe,

    I’m 51, in average office-worker shape and was holding my new years resolution of eating right, losing weight and getting exercise. I even found a local personal trainer I liked. First two weeks were very light as I got used to the movement. Last week we increased my upper-body and arms workout both Mon and Weds to include more reps of lighter weight and focused on the negative movement. It was NOT excessive by any means.

    By Friday my arms were swollen and my urine was dark. Saturday morning I found your website, saw my Dr. as your recommended and was admitted to the ER with a CK of 55,300. Treatment included a hospital stay and six 1,000ml of IV soulution at full speed. Blood work every four hours ot make sure I was flushing and my kidneys were keeping up. I was released home at a CK score of 27,000 with the promise to hydrate and return every 24 hours for another blood test until I am normal.

    Thanks for the info here. It caused me to go to the hospital. Most importantly I wanted to share that I DID NOT lift very hard or very much. Also, my trainer had never heard of rhabdo before.

    Keep up your good work.

    • Joe Cannon says

      Dave S, glad you are feeling better and sorry you are going through all that. I think that personal trainers need to realize that when working with beginners, that the first 8-12 weeks of strength improvements is mostly neurological – in other words, the muscles get a little stronger, but its mostly because of changes in the way the nervous system “talks” to the muscles that results in most strength gains during this period. As such, there is no need to focus on negatives or anything like that so soon after starting an exercise program.

      I know your personal trainer meant fell and feels terrible about what happened. Please share my post with him so he is more aware of rhabdo.

      • Dave S. says

        Thanks for the reply Joe. My last CK level was 1027. Coming down nicely. My personal trainer was absolutely mortified as you guessed. She has followed up almost daily and I am sure her confidence is shot. I meet with a physical therapist from the hospital who will get me going on a slow return to exercise. Again, great site.

  70. Jim Arbogast says

    Hi Joe,
    I just found out about Rhabdo early today and dove in it and of course your advice column. I’m now 60, have been active all my life with sports, working out, cardio including working out the last year with a 21 yr old future PT who’s 5% BF. Great work outs with the kid and staying up with him.

    Last October I went on my annual extended wknd hunt where I knew I was going to hike. I prepped in the gym to get ready with various leg & squat exercise and of course good doses of the treadmill using the higher incline rates.

    Here’s the scoop. When I got out to the ranch, the 2nd day I elected to hike with my gear and I was gone for 4hrs, obviously far more demanding than what I became accustomed to in the gym.

    I felt great and gained & lost quite a bit of elevation. I decided to hike off trail up a mountain that I hadn’t been before. I pushed myself and once I got to the top I was spent and getting sore, real sore. Now I had to come down on what turned out to be a long grueling decent to the valley and back to camp, hurting with each step.

    I’ve been hurting since, especially in both hamstrings & quads. I don’t ever recall having any discoloration in my urine. I felt I took plenty of water with me.

    A few weeks later I consulted with the trainer at the college where I work , he advised that I look up a top notch Chiropractor, which I did. He thoroughly checked me out, took a few Xrays of my lower spine and explained that I exhausted myself to the point that I was an inch out of line & my hips were thrown forward. He made adjustments over the next seven visits that helped, but I knew there was some other problems and moved on.

    I was referred to a top flight Primary Care Oncologist. He checked me out for an hour, took seven samples of blood for a wide variety of issues which I felt included exposure to Haunta Virus, Valley Fever & even Triconosis. This is now nearly three months after the hike. My legs are still hurting bad, never had any swelling, but difficult to stand up from the pain from a sitting position, which is also effecting the way I walk.

    The only issue he found in the blood panels was a high Inflammation Rate of 49.4 which should be 3.5 and the Sedimentation Index of 20, which should be less than 10. He said that I have some kind of virus.

    He sent me over to an infectious Disease Doctor who looked at that 1st Docs blood work and sent me over to take additional samples for more tests. He couldn’t find anything and further me over to a Neurologist who looked at those samples and had me take a couple of more.

    On my return visit to him, I was put thru a battery of electrical tests on both hands, arms & legs by his tech. He further ran tests on my left arm & leg which involved a needle in the muscles where an audible sound came over a speaker that changed pitch when I moved my limbs.

    He said I checked out fine, but also said that he doesn’t know what I have, but has seen this before and that it may take six or twelve months for it to go away.

    I also was advised that I not work out anymore and when I pressed him, he advised to just use the treadmill, but at a low level. And when I do, such as yesterday of just one mile, my upper legs will give me fits the next day of more pain. Difficulty getting out of bed to stand and of course using the toilet is painful.

    I also have some milder discomfort in my chest & back that has come on during all of this. I hardly workout which is discomforting and when I do, it’s worse. Squating to get down is difficult and painful and I need my arms to get me back up. Lots of strength has been lost.

    Earlier today A friend who is an RD discussed my condition with a Therapist at his hospital who suggested that I may have Rhabdo.

    What’s your spin on what may be ailing me?
    Thanx, jim

    • Joe Cannon says

      Jim, that’s quite an ordeal you went through! I am honestly not sure how long the effects of rhabdo could last but it does sound like that hike was a doosy! Waking downhill is an eccentric action and eccentrics (negatives) put more stress on the muscle, cause more muscle damage and are more associated with rhabdo.

      Did anybody check your CK levels? I’d expect they would go up after exercise but I’d be curious if they are still elevated. Again I don’t know how long CK would stay elevated with rhabdo. Id discuss the possibility of rhabdo with your doctor and see what he/she thinks. At the least they could run some blood tests to see what your CK levels are.

      If you get an answer on this, please do let me know. I’m really curious whats going on myself.

  71. says

    My friend is literally in the hospital as we speak getting fluids pumped into to her because of Rhabdo. She did an intense Crossfit workout on her own at a gym, which wasn’t smart. Yesterday while on a bike ride with her she complained of not being able to stretch out her arms, we just thought it was funny. Later that night she was peeing blood. Not so funny.

    Hopefully she will be okay. I think she is getting the fluids in her just in the nick of time.

    How should we know how hard we can push ourselves?

    • Joe Cannon says

      Hi Whitney, This is a hard question to answer because on one side, we are very resilient and on the other hand, some of us have a lower breaking point than others. Here is a few things I suggest:

      1. when in a group setting like cross fit, don’t pay attention to what the others are doing and do NOT worry about disappointing the personal trainer or let that personal trainer push you beyond what you think you can handle. People give up their personal power in fitness situations and thats something I never want to happen.

      2. I like people to use a 0-10 scale when they work out to see how hard they are exercising. This is called the “RPE scale.” basically “zero” is a piece of cake and a “10” rating means an all out effort that you will totally poop out on any second. Most healthy people do not need to be at a 10 in fact, for health and fitness, Id say staying at a level of 5-8 (moderate to pretty hard intensity) is ok for most healthy people (for those with health issues, a rating of 3-5 would be better).

      I’m curious was this cross fit class conducted by cross fit trainers? Did they tell your friend about the possibility of rhabdo?

      Tell your friend not to work out again until her doctor says its ok and I do not recommend she ever do cross fit again. She will be able to work out again in time. again listen to the doctor.

      I really hope your friend is ok and it does sound like she got to the hospital in time. Your a good friend Whitney.

  72. Doru says

    Hi Joe,

    I had exercise induced Rhabdo with CK levels standing at >120.000 (no typo) and just got out of the hospital yesterday after a 10-day hospitalization.

    I feel fine now (no kidney failure or anything, just a bit tired and weak, the CK levels are now at about 200), but I’m concerned about my recovery diet.

    Do you have any recommendations regarding nutrition after an episode of Rhabdo?

    Thanks,
    Doru

    • Joe Cannon says

      Doru, great question. Did your doctor give you any dietary recommendations for after rhabdo? As I understand it, generally people who have rhabdo are often advised to eat a low potassium diet. Potassium is found in fruits and vegetables. If your doctor didnt give you specific recommendations, Id ask him/her about this.

      what did you do that caused rhabdo? just working out yourself or was it a specific exercise program?

  73. says

    Joe,

    Wow. I never dreamed that there would be a physiological negative like this with too much (or too rapidly) exercising.

    It is comparable to my discovering the problems of too much Vitamin B.

    Or my discovering the problems of excess refraction. (www.dyop.org.)

    And it explains much of why the statin drugs I was taking for borderline elevated cholesterol caused so much muscle pain (that led to the inactivity that led to the pneumonia last year). It is also likely that the elevated cholesterol was CAUSED by the excess vitamin B.

    Reading this article, however, justifies the value of Spunk (junk email and webpages that seemingly are a waste of time) in my other reply to you.

    However, I do need to exercise though, to get away from my 60+ hours per week of face-time on my computer working on my vision test.

    As a senior citizen i also have a free gym membership.

    I am going to stop what I am doing now and go work out for an hour at the gym 1 mile away. And I am going to print out this article (without the well deserved rational comments that I am sure are there) and give it to the manager of the fitness center, who I think will find it of interest.

    One more time, THANK YOU.

    -Allan Hytowitz

    • Joe Cannon says

      Allan, I am really happy I was able to help and I hope my rhabdo review helps the staff of your fitness center too :)

  74. Becki says

    Thank you for this article. I am currently sitting in the hospital with Rhabdo. Been here 4 days. I worked out with my trainer on a Wednesday and by Thursday I could not move my arms. Upon reading your article I understand now what may have caused this to happen to me. Lots of “negatives “. It was my first normal workout after weeks of light sessions due to a rib injury. I was using the TRX. Guess I jumped in too fast. Thank you for the information.

    • Joe Cannon says

      Becki, thank you for writing and I am so sorry to learn you are in the hospital! Please give my rhabo review to your personal trainer. He/she needs to read it and understand what happened to you so that it doesn’t happen to anyone else. I will say a prayer tonight that you get better soon.

  75. Jasmaine says

    Hi, I am only 20 years old. I am a student at the University of Mississippi. I work out maybe twice a week. One day after a light jog, I my body started aching Intensely. I went to the emergency room and my ck levels were 10,000. My doctor told me I am at risk of rhabdo when working out because I have the sickle cell trait.

    I was admitted and put on IV. I am well now but, emotionally I feel horrible. My whole body looks different. My legs are no longer defined, my skin is not firm and tight, and I can barely walk to class. I hate that this happened to me. I don’t know when I’ll ever feel normal again.

    • Joe Cannon says

      Jasmaine, yes the sickle cell trait can raise your risk of rhabdo. I know its little solace Jasamine but I do feel your frustration. The good news is that you will get better Jasmine. Im just glad you had the inner strength to go to the emergency room. So many would try to grin and bear it. I am so glad you are different than that!

      Jasmine, I sure you dont look anywhere as bad as you think you do. Even though you have an elevated risk of rhabdo, it doesn’t mean you have to get it and it doesnt mean you cant work out. you can. Just be aware of your body and progress slowly. Rhabdo or not our bodies are amazingly built, designed to last a lifetime and can handle a lot. Your body is no different Jasmaine. We all have to work within our limitations. This risk is one of yours but in the grand scheme of life, its not too bad considering all the other things out there.

      Have patience Jasmaine, workout when the doctor says you can. progress slowly and you will get there. I know you will.

  76. ridgep says

    Hi my name is ridge,I just got out of the hospital about 4 days ago for rhabdo i was taking some metabolism boosters called meltdown vpx and i also did p90x while taking them and i ended up in the hospital, my ck levels peaked at 115,000, today i got my blood checked again and it is now down to 490

    i was wondering when i would be able to start working out again and what kind of workouts would i be able to do. Like would i be able to do the p90x again but just take it easy this time, cuz when i first did it i pushed myself over the limit, i will not be taking the metabolism boosters anymore. thanks.

    • Joe Cannon says

      Ridge, I looked at Meltdown VPX (thanks for the heads up – Ive added it to my list of thigns to review at my other site, Supplement-Geek.com)

      I would not take Meltdown VPX. a quick glance said to me it looks like a powerful stimulant. The combination of extreem exercise (like P90x) and stimulants can raise the risk of Rhabdo

      Did your doctor give you any guidance on when you can work out again? If not, go back and ask. also ask them what types of exercise they recommend for you. Also, I recommend starting slowly and not doing 90x immediately again. I want you to ease back into exercise – start with a walking program. When you do begin P90x again, don’t do the whole workout at first. only do about 15 minutes of it at first and slowly increase the time.

      Please dont take any more metabolism boosters or weight loss supplements that contain stimulants. Trust me. Read my thoughts on weight loss supplements here

      I am so sorry this happened to you – more than you know.

  77. Blaire says

    I just finished my first week of CrossFit, it was recommended that I go 5 days/wk… I am currently in the hospital with Rhabdo and have a myoglobin level of 20,800 (compared to the max of 192). I was never warned of this, nor asked to slow down my training. Clearly, there is a significant flaw in a gym that does not explicitly explain a disorder that they so blatantly use as a mascot.

    • Joe Cannon says

      Blaire, my god, Was this a crossfit certified trainer who said to start with 5 days per week? When you get out of the hospital, go and scream at that person as loud as you can – and report them to the crossfit organization! If this happened at a gym, please tell the gym what happened – the owner, GM or manager. Show them my rhabdo my review. I would not be surprised if the gym owners/managers had no idea about rhabdo!

      I really want to try to be impartial when it comes to cross fit trainers but when I hear stuff like this it just makes me mad! I know Cross Fit has been trying to better educate their trainers about rhabdo but obviously they are not doing enough. Here is the page to contact CrossFit http://www.crossfit.com/cf-info/CF-contact.html

      I feel so bad that this happened to you Blaire. I can only imagine the pain, frustration and fear you are going through right now. Please keep me updated on how you are doing Blaire. I will say a prayer tonight that you get better quickly.

      • Blaire says

        I have made the gym aware, which resulted in a note that Rhabdo is rare but serious, and they are very sorry it happened to me. They recommend that I cut down to 4 days per week, described as 2 on 1 off… I was also given a carb elimination diet as a recommendation, which help excel state my condition.

        It’s clear that they are aware, but never mentioned it. I don’t think saying ‘listen to your body’ is enough… I was told if I wanted to see results, 5 times per week. I guess they see so many people come in and out they lose interest in laboring over personal progress at first…

        I’m so on the fence about what to do, I’m not trying to hurt anyone’s business or a mistake out of proportion, but I don’t think the recommendations were good nor personalized. I already had good muscle tone, so they should have been instantly worried and watchful!

        • Joe Cannon says

          Blaire, this is amazing to me. Even though you are in the hospital with rhabdomyolysis, the gym says to cut cross fit down to” 4 days per week”! They obviously have no idea what they are doing. You’ve already had rhabdo so you are at risk of getting it again. So for them to say to only do 4 days per week is irresponsible in my opinion.

          So the gym also gave you a low carb diet too? Did the gym give you the low carb diet or did the cross fit personal trainer give it to you? Since cross fit workouts rely heavily on carbohydrates as a fuel source, it makes no sense to me that they would also advise you to eat fewer carbs. You need those carbs to workout!

          I appreciate you not wanting to hurt anyone’s business but this is not out of proportion. This was a fitness facility which did not properly educate you on what could happen if you did that class. You trusted them and only after you complained did they issue a note about rhabdo. If this happened to me, I would seek out an attorney. I still cant get over that they told you to “cut back to 4 days per week” even after you got rhabdo!

          Blaire, is this a well known gym franchise or is it a “mom and pop” local gym?

          • says

            Mom and Pop local; I really don’t think they really understand the severity… the female owner has been emailing me and attempting to be helpful, I told her if I were to come back, we would need to talk more about Rhabdo and how to avoid it and diet in a more personalized setting.

            These recommendations and diet suggestions (130 grams of protein, high vegetables, low carb) were given to me in an On Ramp series that lasted three days and featured learning moves. I have suggested to her that she give a small lecture on Rhabdo during this series, and she says she will consider my suggestion.

            I am very upset with the circumstance, but I signed a waiver that limits their responsibility for my injuries when I signed up… The gym seems to maintain an attitude of not showing personal interest until people have proven that they are going to stick around. I am not sure what to do, but I do take some responsibility for pushing myself when I knew I should rest. However, it is hard to avoid an illness you know nothing about.

          • Joe Cannon says

            Blaire, gym waivers are not totally ironclad. While I am not a lawyer and don’t know the waiver you signed, I think the idea of legal action would make the gym owners think twice about what they do in the future. The bottom line is that it would not hurt to speak to someone about this.

            I would be very upset also.

            That’s an interesting website you have :)

          • Blaire says

            Ha, my food blog? Now you see why I need to exercise! Good news, I’m being let go from the hospital with a CK of 10,000 with the promise of no exercise for a week and that I drink water like it’s my job. I’ll keep all your advice in mind in the coming days as I process all of this… I feel super let down, I was really lookin forward to a challenging, motivated group workout environment and, despite the owners, getting to know all the people at the gym. I had already made a few friends… :( boo!

          • Joe Cannon says

            Hey Blaire, that’s really great news. I’m sure you will heal a lot faster when you are home, with your friends and family. Yes I understand how you would feel, making new friends and all. I feel for ya. Just take it slow when you do work out again.

            Yes your food blog looks great – I like food too LOL :)

  78. Sophie says

    Hi,

    I have previously had rhabdo twice, both times quite serverly resulting me to be in intensive care.

    Once was a 15 minute workout with a pt and the other was a pump class, i have been working with doctors for around 2 years and still no diagnosis.

    They tested me for Mcardles disease, but nothing.

    I have recently been doing exercise but my condition doesn’t seem as bad, i am slowly working into it.

    I have had test and apparently when they did the test which was sticking needles into my muscles and seeing the contractions, the could tell that there was something wrong but they still are yet to confirm it.

    Do you know anything else this could possibly be, and what sort of diet i should be on the try and reduce any further episodes?

    • Joe Cannon says

      Hi Sophie, I can imaging how frustrating that can be! Have you ever consulted a dietitian about this? you can search the EatRight.org website and try to locate a dietitian who knows about rhabdo. Id start by looking at RDs who specialize in either sports nutrition or kidney issues. They might be able to give you some dietary recommendations that might reduce your rhabdo risk.

  79. says

    Hi, my name is Michael after two years of almost no exercise I hired a PT to train me and I was pushed FAR too hard. One 20 minute gym session involving me throwing up led to a CK level of 184000. This took about 1 and a half month to decrease.

    I was told to wait 3 months and go slow, I waited 6 months and had one gym session and obviously went too hard as I was back in hospital with a CK level of 50000. Again I was told to wait 3 months ( once it was normal) to begin gyming again, I waited 6 months and did 3 sets of 25LB each arm (curls) which led to a CK level of 16000.

    After reading this blog I feel although I still went far to hard and I am trying for my last time with extreme caution.

    My questions are ( if you can answer with only this vague information) What intensity should I exercise with? Does 3 months 12 months or 18 months make a difference?

    I wish I could sit down and talk to you… Essentially exercise has been a HUGE part of my life for the longest time and I’m terrified it has been stripped away from me.

    Any advice would be wonderful.

    • Joe Cannon says

      Hi Michael, I think its best to work out again when your doctor says its ok. That said when you do work out again, try a simple circuit training program. This is less likely to cause rhabdo than more extreme workouts. when you are trying to figure out how hard you are working out, ask yourself how you feel on a scale of “zero to 10″ where zero means “its really really easy” and a “10” is “really really hard -you are going to poop out any second.” For you, I’d recommend you stick to the lower numbers.

      I can understand the frustration you are feeling right now. I understand the feelings that your fitness has been “ripped away from you” but you can get it back again. it will just take time. Focus on health first and athletic performance / getting ripped etc second.

      If you ever do get a personal trainer again, don’t hire anybody who can’t tell you what rhabdo is.

  80. Jessy says

    Hi Joe,
    My name is Jessy, from Auckland, New Zealand.
    I’m currently in hospital for rhabdo. Ive been here for 5 days now.

    The cause was due to a heavy leg workout that I done with friends. What hit me was the fact I hadn’t trained legs for at least 2 months and then to suddenly hit them with the most intense leg workout I’ve ever done caused the rhabdo.

    A day after the workout I was extremely painful, but I was thinking that this was a good thing, the fact that I was so sore was going to lead to better gains. The following day my urine turned a coca cola colour. I didn’t think much of it, and could of easily brushed it off, thinking it will be alright.

    Shortly after I did a quick google search for “cola colour pee after workout”and got info for the rhabdo. I went to the hospital thinking I’d just get some pain killers. They took a routine blood test. A hour later, Doctors and nurses came out with very serious faces and said that my ck levels were at 147,000, straight they put me on a iv which i have been constantly on for the last 5 days, yesterday I was down to 40,000.

    No sign of kidney damage, which they are all sayin is amazing. Im a bit scared now to step back into the gym and yo really push myself which I previously loved doing.

    • Joe Cannon says

      Jessy, I’m just glad you did a Google search and made the right decision to go to the hospital! I know it stinks now to be in the hospital with rhabdo but the good news is that you say that you don’t seem to have any kidney damage! You will be able to work out again but the thing to do is listen to when your doctor says its ok and dont work out until he/she says its ok to do so. Also when you do go back to the gym, start back really slowly. I suggest you start with low intensity circuit training as its likely to be the least stressful. Moving forward remember the idea of “no pain no gain” is a big myth and that you do not have to be sore after working out to become stronger. Have patience Jessy. Listen to your body and I think eventually you will be ok.

      keep me posted on how you are progressing also.

  81. alexis says

    Hi,

    I am a 32 yr old female cyclist training and competing at an elite level. Last year, after a week long intense training phase, I had a 3 day rest period where I didn’t do any exercise except walking (it was Christmas day/boxing day). It was flipping hot (being Australia). On my 3rd day off the bike, I Suddenly developed the most violent cramping and pain in primarily my L) quads that I could barely manage to walk, drawing me to tears with the pain. I was just walking to catch a plane. The pain lasted about 3 weeks, with fluctuations in pain and I was unable to ride the bike for probably a good 3 weeks to a month.

    I recovered slowly (from what I thought was a serious muscle strain) and have been training ok until a week ago when I did a quick 630km ride over a few days. Exactly the same symptoms. Only when a vet mentioned rhabo did the lights turn on.

    Is this a familiar story? The delayed onset is something I don’t read much about people suffering from.
    I mentioned it to the GP who said to drink more and that its not worth doing bloods. (good old NHS)…Otherwise I am well..
    Whats your thoughts?

    • Joe Cannon says

      Alexis, interesting stuff. Usually rahbdo pain happen 0 to 24 hrs later. Im not sure if it could pop up 72 hours later (I would not rule it out because Im not aware of this). Its possible it was rhabdo but without blood work its really hard to say for sure.

      the good news is you are feeling better now! :)

  82. says

    What a great resource, Joe! Kudos for taking the time to create this AND to respond to all of your commenters.

    With good reason, you are a bit critical of CrossFit gyms here. Because of CrossFit’s affiliate model there are certainly variations in the quality of CF gyms from one to the next. A McDonald’s Big Mac (which I don’t recommend eating) in Los Angeles probably tastes the same as a Big Mac in New York. In contrast, a CF affiliate gym in Santa Barbara might be totally different than a CF gym in Pittsburgh because there is less enforcement of standards from “headquarters.” The quality of a CF gym can depend heavily on who’s running it.

    As an anecdote, and in defense of the good CF gyms out there, the CF gym I worked out at for 1.5 years knew what rhabdo was and educated its athletes about it. That’s why I knew to seek immediate medical attention when I gave myself rhabdo with my own workout outside of the gym. I was at risk because I had taken an extended break from high intensity workouts and tried to jump back in too quickly.

    I wrote my own blog about how I hospitalized myself with rhabdo after a break from CrossFit. My CK count topped out at 165k! I’m very thankful to have not permanently damaged my kidneys.

    There are CF gyms out there who take rhabdo seriously and take action to prevent it. I think your advice about evaluating personal trainers also could also apply to CF gyms – only trust one that can tell you what rhabdo is and how they ensure their athletes don’t get it.

    Thanks Joe!

    • Joe Cannon says

      Marc, thanks for writing and THANKS for writing your own blog on how you got rhabdo! Sorry it happened to you but so glad you turned it into a positive by helping to educate others. This is what I love about us bloggers – everything can be a blog to help others!! I really appreciated the pictures you posted while you were in the hospital too.

  83. sharon says

    I am an experienced ultra runner of over 20 years. Recently I was only 10 hours into an ultra race, running very slowly and became very weak, nauseous, sleepy. I rested a bit and got up feeling even worse, was sick, peed cola colour pee, walked a bit feel weak and then stopped. I drank well and normal colour pee resumed. I returned home (I was in another country), my doctor said I had a virus and would not give me a blood test. Two week later I ran 3 miles, after a mile I felt weak, after 2 my legs felt shaky like jelly, I walked the last mile and felt nauseous.

    A week later my doctor gave me a blood test but normal creatinine levels – could this have been Rhabd please? 9 days previous I had a corticosteroid injection in my hamstring close to the insertion due to teninopathy, could this have caused this please? Thanks

    • Joe Cannon says

      Sharon, its hard to say because exercise alone will increase creatinine levels. The fact that you said you had cola-colored pee makes me think you may have had rhabdo. Run this past your doctor and see what he/she thinks.

  84. Hannah says

    Wow! A great article; thank you! and such a ‘rhabdo’ community here!
    My first exercise induced bout was in 2010; I was doing my personal trainer certification and the instructor told me to do 180 calf raises, no rest, so the competitive athlete in me said sure no problem (i’m an idiot…). Did it, felt like a superstar, then had my military boyfriend carry me to the ER 2 days later.

    Like most of you, CK levels were highly elevated; the highest all the doctors and specialists had ever seen and the words ‘kidney failure’ still haunt me! As a Kinesiology student I was super excited to be the med interns favourite patient, and I went rhabdo crazy with the published journal research, studying it in all my related courses.

    Unfortunately, my first relapse was 4 months after i was out of the hospital. Doing simple bodyweight exercises and very little, being VERY careful, i got rhabdo in my triceps and biceps. The same doctors were working and thought it was very interesting that this happened with little exertion. (I’m talking like 10 pushups here and 10 triceps dips. all assisted..) CK levels were only about 10,000 so i was out of the hospital in a day.

    5 months later, same thing, but in my lower back. I exercised regularly following the doctors very light exercise prescription. At this point the doctors were puzzled. After a week in the hospital (at Christmas time…) they decided that something beyond a simple bout of rhabdo was occurring.

    I kinda went rhabdo crazy, doing lots of research etc. and there really isn’t a lot of published research out there on the topic. (Relatively speaking) I’m still all my xfit friends, ‘friend who actually got rhabdo’. I do have to be careful for i never know if i’m going to get it. I’m very active, always have been, but now can’t be the way i used to.

    Since i’ve been dubbed a ‘medical mystery’ by the dozens of specialists i’ve seen, it’s difficult not knowing what’s triggering it. The doctors say that they should all be isolated bouts, but with me they’re puzzled because it’s not the case. They suspect that something about the first bout, damaged ‘something’ in my metabolism, ‘maybe???’

    Three years later, and I haven’t been in the hospital. But I’m sitting here with throbbing calves that have been resting all day (hence me coming across this article). I’m hoping more people will read articles like this and educate themselves about it.

    For those of you who have gotten it in the past or are recovering, please still be careful! I was told and read in the research that each case is isolated, but this is not the case for me. I’m lucky I have great parents, an amazing spouse, and free healthcare that got me through it all.

    • Joe Cannon says

      Hannah, thanks for writing and wow I am so sorry you went though all of that! The idea that the initial bout of rhabdo damaged your metabolism is a new one on me but its as good of a theory as any to explain why people sometimes get rhabdo more than once.

      I do hope your calves feel better soon.

  85. jeff decker says

    Joe,

    Im a personal trainer, what steps could I take to ensure that I don’t cause a case of rhabdo besides slowly easing de-conditioned clients into workouts. From the article Ive read above, it seems just a few minutes of exercise can cause rhabdo.
    Maybe I could offer 30 and 45 minute session prices to especially deconditioned clients?

    Jeff Decker
    NASM CPT/CES

    • Joe Cannon says

      Hi Jeff, I think the best thing you can do is explain to clients that the first 2-3 months of strength gains is the result mostly of neurological factors and because of that, you will be focusing mostly on form and muscle endurance during that time. If you do that I think your risk of causing rhabdo is pretty low.

      stick to one set programs like circuit training for the first few months. that will cause less DOMS and rhabdo. circuits are also safest for many special population groups (high blood pressure etc)

      I think if you did that then the risk of causing rhabdo in your clients would be quite low.

      • jeff decker says

        Joe,

        Thanks for your quick reply, this seems to be a very serious issue. I have always taken it easy on clients regardless of how intense of a session they wanted, and now I have more concrete evidence on why they should take things easier, i have never been one of the over the top trainers that are so common today. Maybe there should be a rhabdo safety cert?

        Jeff Decker
        NASM CPT/CES

        • Joe Cannon says

          Jeff, sounds like you will never see rhabdo in any of your clients. Id just be happy if the different organizations would start putting info about rhabdo in their certification books. I believe my book was the first personal trainer book in the US to include this information.

  86. says

    I just participated in the Barn Burner 104 as a solo geared rider. I was towards the end of lap 2 out 4 and my right calf cramped/seized up bad enough to kill the race. A few days later my calf my still swollen and painful and since I have a family history of blood clots I went into the ER to get checked out. No clots, but was diagnosed as having rhabdomyolysis.

    The kidney test showed levels at 65 which i assume is mild. They filled me with 2 bags of solution and told me to drink lots of water. Not sure what the future holds in mountain bike racing, but just going to rest up and see what happens…kind of concerned that now I have a disposition to it.

  87. Pat says

    My daughter (age 16) also got rhabdomyolysis from doing calf raises with her personal trainer. She is a high school athlete, not overweight, and had been training for weeks with her trainer. She experienced intense pain and swelling in her legs. Her pediatrician gave her a high dose of NSAIDS ~ not a good idea. I noticed her ankles swelling and took her to the emergency dept. She had a CK of over 22,000 at day 6 after her workout. Her liver enzymes were also off the chart.On the bright side, her kidneys didn’t miss a beat, but she was in the hospital for 3 days receiving lots of IV fluids.

    • Joe Cannon says

      Pat, sorry to hear about your daughter but glad shes ok. Please show my review of rhabdo to her personal trainer. Im sure he/she has never heard of rhabdo. I dont want what happened to your daughter to happen to somebody else.

  88. Mary says

    Joe, i did my first ultra marathon event which was a 12hr race and I was able to do 51.1 miles. After a few hours of starting the event I started to have symptoms which I can only describe as in like a UTI (bladder infection) i.e. the urge to pee frequently, hardly any liquids coming out, very dark color by the end of the day when I could pee, and slight pinkish hue when I would wipe (sorry to be graphic).

    My legs are sore, actually my whole body but not as bad as I expected. I felt very bloated during the race and I feel like I hydrated and fueled properly. I have been drinking lots of water with added electrolytes since the race JUNE 8th and my urine has returned to regular bright yellow not as cloudy but I still have that feeling such as the urge to pee and have to urinate frequently.

    I experienced similar symptoms when doing a one day bike ride called RAIN in IN two years ago (10hrs/160miles) but it went away. What am I doing wrong here? I have recently been diagnosed with narcolepsy without cateplexy due to extreme fatigue and sudden sleep onset. So I take the medication called Provigil (modafnil) as well as 50mg zoloft.

    For the most part I eat a high protein diet. What can you tell me about this… what kind of doctor should I see? Internal medicine? Seems like most people I talk to don’t know or have heard about this.

    • Joe Cannon says

      Mary, any doctor can diagnose rhabdo with a simple blood test. cut back on protein as it works your kidneys hard and your kidneys are being worked over time with rhabdo. But, please dont take my word for this – PLEASE go to your doctor. if they are closed, go to the ER. Please. I would feel much better if you get proper attention to whats going on.

  89. Helly says

    This is why all personal trainers and spin instructors should be appropriately qualified in their repected discipline and have adequate first aid training

  90. Natasha says

    Hi Joe, Thanks for posting all of this information about rhabdo. 12 days ago, I did a CrossFit workout, which included jump pull ups and decline push ups. I was quite surprised to learn that I overworked myself so much with that one workout.

    I couldn’t straighten my arms, and my arms were swollen on Day 4 after the workout. Day 5, I went to the doctor and asked for urine and blood tests. As it turned out, my CK levels were over 20,000, but apparently my urine (and therefore kidneys) were fine.

    On Day 8, I started experiencing some pressure in my chest/sternum, which made it a bit difficult to breathe and I had been feeling dizzy for a couple of days. I went to the ER and they did an ECG, listened to my heart, and tested my blood and urine again. They said my heart sounded and looked fine, my CK levels were down to 7000, and myoglobin was a bit elevated in my urine, but not an alarming level.

    It has now been 12 days since that workout and I still feel a sense of heaviness/tightness in my sternum/chest which makes it a bit difficult to breathe.

    Have you heard of this symptom connected to rhabdo before? Any ideas on why this might be happening?

    • Joe Cannon says

      Hi Natasha, The decline push ups you did do work the chest muscle and so its possible that is what is causing the chest pain you are experiencing. Here is link to an article that mentions chest pain/angina and rhabdo

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175909/

      Did your cross fit trainer ever explain rhabdo? Just curious. They should have.

      Sorry you gt rhabdo Natasha. I’ll say a prayer for you tonight that you get a speedy recovery.

  91. Andrea "Andy" Aguilar says

    Hi there….. Great article! I’m so glad to see that Rhabdo is getting more attention!! I’m 33 not in terrible shape but after I had my daughter allowed myself to let myself go…I have always been a workout person my whole life so 3 years ago when I went to a family friend who personal trains I followed suit thinking I could pick right back up….

    After 80 half burped and a full crossfit type workout my arms were swollen like Popeyes! I went back to her the next day asked her about it and she said you’re just sore keys do some more to make you feel better…. I was in the ER that night.

    It took about an other 24 hrs to diagnose my and I was in the Hospital for a week flushing my system out. My CPK levels were at 6500. I think it’s so important for people to know about this and also that it can come back…my brother just got certified as a crossfit trainer and I was glad to hear that they do cover it however he kept telling me as long as I’m hydrated, we went back and forth but i thought it was at least good that they were now talking about it lol but anyway great article!!

    Thanks,
    Andy

    • Joe Cannon says

      Andrea, thanks for writing and Im glad you were able to find me! Im guessing your brother got the “hydration prevents rhabdo” mantra from CrossFit. I don’t buy it. Thanks for the heads up on this. Glad you are better :)

  92. Debbie says

    Hi, I was hospitalised with rhabdo about 5 weeks ago. I have been training hard for the past 4 years. From childhood until about years 4 ago (I am now 40), I was overweight. When I say overweight, I mean over fat. My body fat levels have always been high. So years ago I decided to stop concentrating on my bodyweight and start decreasing my body fat. This is when I was introduced to weight training. I have always been told the only way you are going to change your body shape and be tight and toned is by pushing your body at each session and keep increasing the weights and intensity.

    Doctors are still trying to figure out what caused my rhadbo but now after seeing this forum, I believe it has been from the exercise I have been doing. My CK levels got to 110k, my kidneys failed, told last week they are now back to normal. My heart has been effected with a chamber being inflamed and my liver has a lesion on it. I am back to the cardiologist in Aug and once kidneys get stronger they will do a CT on my liver. I am still very weak and have been to an exercise physiologist to help me with a program to just help with the muscle weakness.

    I am only doing 5 reps with body weight and this is still a huge challenge for me. What makes me sad is that I am too scared to get back to weight training and it worries me that I cant combat the flab any other way. I don’t want to lose any weight, I just want to know when I can eventually get back to exercise is there any other exercise I can do that will give me a toned body. I want to look strong and healthy not skinny and soft.

    I also want to say a huge thank to everyone on this site & Joe. I will be telling the specialist that I have to go back to in Aug that I believe it has been the exercise that caused my rhabdo.

    • Joe Cannon says

      Debbie, so sorry you went through all of this! I am glad you are on the road to recovery. The idea that people have to push your body at each session and keep increasing weight lifted is wrong. People can make progress without pushing themselves at each workout with more weights.

      I completely undersand your reluctance to workout again. many here have said the same thing. I liken it to a kind of a post traumatic stress syndrome. you did go through a tramua so this makes sense to me. explain your feelings to the exercise physiologist when you see him/her and see if they can offer some advice. you can go back to the gym Debbie. it will just take time. Your exercise physiologist can educate you on the proper way to workout and avoid rhabdo from happening again.

      Please keep me posted on your progress.

  93. Rick says

    I read an article a couple of years back regarding the dangers of rhabdo during crossfit. I am 32 years old, I am corrections officer and a member of the departments SERT team (basically the jails equivalent to a SWAT team), I’ve been an athlete my whole life and work out on average 2-4 days a week.

    I took a few weeks off of crossfit and the gym recently doing work around the house, working overtime, vacation etc…then jumped back into the gym full force. 2 days of crossfit in a row. The second day wasn’t anything too crazy it was the angle workout (100 each of pull-ups, push-ups, sit-ups, and squats for time). I didn’t have any immediate pain, but the next day I couldn’t extend my arms without pain.

    I chalked it up to muscle soreness and went about my work week. However after 4 days of soreness and swelling I started to get concerned. I remembered your article from 2011 and started poking around the Internet for symptoms. I didn’t have any discoloration in my urine, nor did I have pain unless I tried to extend my arms, but the swelling persisted so my convinced me to go to the E.R. for the enzyme test. Normal range is supposed to be between 55-170. Mine was 53,470! 24 hrs later and 6 IV bags later and my levels dropped to 40k.

    I’m still in the hospital waiting to go home, probably gonna be another day or 2, but my doc said I’m lucky I came in before any kidney damage or failure occurred. Hope you continue to educate athletes and regular joes like me of the potential dangers of working out and things to look for that could seem innocuous but can be very harmful.

    Thanks,
    Rick M.

    Rocky Point, NY

    • Joe Cannon says

      Rick, thanks for sharing and glad you go to the hospital when you did! Having watched my share of Saturday night MSNBC prison documentaries, I’m familiar with SERT teams – you guys rock!

      Heal up fast!

  94. Mike says

    Went to the beach last week and ran 30-40 minutes each morning in pretty warm, humid weather. Sweated a lot. Had dark brown urine 3 days in a row. Days 1-2 were a one time occurrence. Day 3, discoloration lasted about 4 hours, getting less and less each time. Exerted lots of effort body surfing in pretty heavy waves day before all this. No pain, no swelling, no other symptoms, just dark brown urine.

    This happened twice previously about 3 and 6 months ago, but to a much lesser degree – doing Insanity workout at that time. Have been on Statins for 10+ years with no previous side effects. Family doctor found no blood or infection in urine. Urologist appointment scheduled for next week. Reluctant to go running again.

    Does this sound like a mild case of rhabdo? Everything back to normal since those 3 days. 54 years old and have always been pretty active.

    • Joe Cannon says

      Mike, hard to say but it could be exercise-induced rhabdo. Do mention to the urlogist your past dark colored urine while you were doing intense exercise. Statins might increase your risk of rhabdo and past rhabdo might raise the risk of getting it again. did they measure your CK levels? that is something I’m sure the doctor will do as soon as you mention rhabdo. Let me me know what happens and good luck.

      • Mike says

        Hello again Joe,

        As much as I hope my dark colored urine after jogging on a very hot, humid beach was a slight case of Rhado, it turned out to be a very small bladder tumor; probably cancerous. I just had it removed six hours ago and doing pretty good considering. Sitting at my kitchen table emailing you. Urologist said on a scale of 1-10 this was less than 1. Easily treatable and caught very early. I think it is important for your readers to realize dark colored urine needs to be looked at by a doctor. Damn glad today that I did.

        • Joe Cannon says

          Mike SO GLAD you got the treatment you needed and are doing well today! Yes, anytime the urine looks dark coloried its always good to get it checked out. We are so complex beings, that alone, its very difficult to know what is going on. I am so happy you are doing well! Thanks for the update :)

  95. Todd says

    Joe,
    I was NOT diagnosed with Rhabdo by my doctor after I suspecting it. My symptoms following a max effort push-ups and hand-stand push-ups wod (Friday night) was severe soreness and pain in my triceps (and lesser degree in chest)in the first 24hrs (Saturday) followed similarly in the deltoids in 48hrs (Sunday), with no relief by 72hrs (Monday). I went to the doctor yesterday (Tuesday) and blood work has revealed elevated levels of the following: ck = 8,481 creatinine = 1.4 BUN =28 Liver enzymes AST = 220 and ALT = 78. Again, I was NOT diagnosed with Rhabdo and was told to repeat blood-work in 2 weeks, hydrate and decrease protein intake.

    Any advice on what to do other than that?

    • Joe Cannon says

      Todd, do your muscles hurt when you are not moving? if yes it could just be a bad case of DOMS. Other than that I say do what your doctor says to do.

  96. Todd says

    Joe,

    My muscles hurt when I am not moving, but it comes and goes, sometimes more with activity or having my arms raised at the keyboard or driving. It was more severe pain in the evening and I didn’t rest well until I took a muscle relaxer last night. Would my ck elevation of 42x normal limit and elevated liver enzymes be more consistent with DOMS or rhabdo?

    • Joe Cannon says

      Todd, Id think rhabdo but exercise can also raise CK levels. it shouldn’t normally alter liver enzymes that I’m aware of. your doctor did not give you a diagnosis at all?

  97. lost_princess says

    Hi Joe,
    Thank you for this article. It is by far the most informative page I have read regarding Rhabdo, and trust me, I have read it all! lol.

    I have been working out in extreme bootcamps and personal trainers for a few years now and have never experienced this nor ever heard of it.

    One day three weeks ago my husband, who has refused to join me in any of my fitness endeavors came home from work and asked me about Crossfit. I was elated that he was interested in joining a program together and we quickly ran over to our nearest one, signed up for 6 months and got started on our beginner classes the very next night.

    After the first class…he complained of being sore. Barely could walk ect. and we giggled over all this because we knew he had just experienced what everyone says after a work out. How were we to know his was different than anyone else’s soreness? More importantly, how will we ever know again?

    After our third beginner class, (these are just the beginner classes mind you) my husband was extremely dizzy, was having tunnel vision, chest pains across his chest and heading down his left arm, was trying to collapse on the sidewalk and was barely responding to me when asking him questions. I called 911.

    Im actually getting anxious again just writing about this. Was so scary.

    Needless to say, he was admitted into the hospital and in ER we were told that he had had a mini heart attack. Day 2 his levels were in the 35k range and they were running all kinds of tests on his heart. Ultimately they said his heart was fine, but that he had Rhabdo due to his new work out program. They said luckily we went in and got a hold of this early on, that there was no kidney damage and he will fully recover within 2 to 3 weeks.

    We are both very scared to continue to work out. Everything I read says its ok to work out again, to just take it easy.. but how do we know what is “taking it easy” and when its ok to push a little bit? Where do we start? And how do we handle having a bit of ptsd after all this?

    Thank you for your time and information!

    • Joe Cannon says

      lost_princess, oh my goodness I am SO SORRY to learn what happened to your husband – and to all the stress that YOU ALSO have been going through.

      Did anyboy at Cross Fit ever tell you about rhabdo? Im shocked that some cross fit trainers do not tell people about this possibility. Do the cross fit trainers know what happened to your husband? Please tell them and PLEASE show them my rhabdo review so they can read it.

      Were you outside the gym when your husband collapsed? did the gym help you in anyway when you called 911? What gym was this? This is for my own information. I like to know how gyms respond to medical emergencies.

      For your husband. I would not do cross fit again – ever! listen to your husbands doctor and what they feel is OK for when your husband can work out again. And when he does workout, I recommend only walking in the beginning. Eventually if he dose ever workout with weights again (and I think he can do this eventually also), circuit strength training is likely safest for him.

      I will say a prayer today for your husband and you. I cant imagine the stress -both physical and psychological – you both have been going through over the last few weeks.

  98. lost_princess says

    Nope, no one has ever mentioned it to us before. I used to do an extreme bootcamp 5 days a week for an hour a day for 2 1/2 years and I even trained and ran for a half marathon, and never had it or heard of it. But now.. it all makes sense. When you hear about people having heart attacks during marathons and everyone says ” so crazy, they were soo healthy” .. .well yeah, but what they didn’t know was their muscles were poisoning their bodies the whole time.

    He started to feel it (chest pain and said his whole rib cage sort of hurt) during our work out.. and stopped for a bit, took a small walk around the gym, then felt better so he continued the rest of the work out. After it was over, i could tell he was exhausted and super hot.. so i poured my water bottle on him and he said he was feeling a little better…

    I told him to switch me seats with me and I drove us home, only 2 miles away. On the way home he said he was feeling a bit better…. but as soon as we got out of the car and made it halfway down the sidewalk to our place it came back, full force. So we weren’t at the gym when it happened.

    Since then though, they have been all over us.. checking in on him, calling us, emailing, setting up meetings and doing everything they can to accommodate our situation with our 6 month contracts.

    They insist that we do not give up on Crossfit and said that we can pay more for personal training as my husband will definitely need to take it slower and be paid more attention to. Which we were considering, however one of my husbands doctor called today after finding out he was hospitalized and told him never ever to do what he was doing again, that it will happen to him again if he does. So we are a bit lost as to what to do next.

    I dont know if you are going to publish this on your site or not so Id rather not give the exact name of the gym we go to, I dont want to cause anyone problems when all we are trying to do is just find answers, yanno?

    I did forward your article to the people in charge and they sent me back a couple pdf’s from their headquarters that they all receive on Rhabdo. They told me that it is very rare but also said that they would take your article and forward it on to their coaches for a reminder and refresher.

    Thank you so much for the well wishes and encouragement, I appreciate all the effort and information you put into this subject and helping people become aware.

    • Joe Cannon says

      lost_princess, I can only imagine how scarey all of that must have been for you both. I’m glad you both are doing better.

      Few thoughts based on what you said:

      I am 100% in agreement with your doctor – your husband should NEVER do cross fit again! I can’t believe the gym wants has said that your husband should keep up with cross fit. Exercise isn’t supposed to put people in the hospital!

      The gym said they receive pdfs on rhabdo – but why then did nobody not tell you about rhabdo before you both started cross fit?

      Who put out the pdf forms on rhabdo – was it cross fit?

      I’m also quite surprised that the gym management said that your husband could PAY for personal training – after a workout sanctioned by the gym put him in the hospital. I would not pay for personal training at that gym. If you do, I believe it is imperative that you pick that personal trainer wisely. I personally would only accept a personal trainer who is certified by either ACSM (American college of sports medicine) or NSCA (national strength and conditioning association). These certifications tend to be harder to obtain than others and so those who have them, tend to know a bit more about exercise (esp those certified by ACSM). I’d also want a personal trainer who has – at least – a BS in exercise science. If you need more info on how to pick a good personal trainer, just ask.

      Before your husband works out again, please get the OK from your husbands doctor first. If the doctor can give guidelines on what to do/ not do, that would be even better.

      I appreciate you not wanting to stir up any problems with gym. I just want you both to be safe. I’ll continue to keep you both in my prayers.

      • ashlyn says

        Never do crossfit again? Okay, EVERYTHING in crossfit can be scaled back. You do not have to do the insanely tough WODs, you can make it fit your athletic level and you don’t have to push yourself as hard. Talk to your crossfit trainers about this and they will make it work. Don’t give up on exercise or crossfit, just be careful to not push yourself too hard.

        • Joe Cannon says

          ashlyn, I know you mean well but wouldn’t you feel it be best for people to be healthy even if they do not do cross fit, insanity or other really high intensity exercise programs since there is a possibility of rhabdo happening again? I think you would. You mentioned that people should talk to their cross fit trainers about rhabdo but since most people have never heard about rhabdo, I dont know how likely this is to happen.

  99. lost_princess says

    Heya Joe..
    Definitely not going to do anything against what the doctor said. I had just read your first reply and noted where you said “For your husband. I would not do cross fit again – ever!” I was a little shocked since one doc (from the hospital) said its ok as long as he takes it really slow. But then after that, we went to eat lunch, and hubby got a call from his regular arthritis doctor and he said the exact same thing you did. “Whatever you did, do not do it again. You will get it again.” That sealed the deal with us. He also told hubby that he should do 3 days of cardio and 2 days of weight lifting. But lol, thats so freaking vague..

    Yeah, I was a little put off too by the fact that after we have already paid $400 bucks for the beginners classes, that we could now pay an additional $150 bucks for 6 personal training sessions. We were considering it because there is one coach there that sort of took us under his wing and we felt comfy with right away, reminding us to breathe and would tell us to rest and catch our breath and would scale down the reps as well. (He wasn’t there that night this happened) Im not sure of his certifications though, however, the more we think about their “deal” ….. the more annoyed that offer makes us.

    And of course, you and the doc’s say no go so we aren’t considering that anymore. Just need to figure out where to start exactly now. A small walk and swimming? Or can we start with personal training at another gym?

    I believe the pdf’s are from Crossfit Corporation sent to its affiliates… but Im not sure. Its from the “Crossfit Journal”. Ill put them here for you, hopefully it will work.

    http://library.crossfit.com/free/pdf/CFJ_Ray_rhabdo1.pdf
    http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf

    • Joe Cannon says

      lost_princess, yes Ive seen those cross fit PDF files before. They are from Cross Fit. While I am glad they are doing something to educate their trainers, I think more can be done.

      now that you told me your husband sees an arthritis doctor, I definitely would not do cross fit because I feel it would probably make his arthritis worse.

      3 days of cardio and 2 days of wt lifting is close to the basic exercise recommendations for health and basic fitness. That’s why he mentioned it.

  100. JayJason says

    An updated from “Jason February 7, 2013 at 8:17 am.”

    After I was released my the hospital I visited my doctor a few times for blood work. Once my CPK came back to normal he released me to exercise and get on with normal life. My arms have atrophied quite a bit.

    I went back to CrossFit and my trainers programmed a specific routine for me to follow. It was basically a three month rehabilitation. I started with very light strength work; no metabolic conditioning. Key was keeping my heart rate in control and building the CNS/neuro-muscular pathways back to where they should be. I stuck with the program and came out well.

    I’m stronger now than ever and focus more on balancing strength and metabolic conditioning. I will not do workouts from the CrossFit main site or any of the high repetition WODs; they promote bad form and drive the risk of injury (rhabdo and more). I was pretty upset about CrossFit for a while, but I realized it is not “CrossFit” that is to blame. It is individual gyms that do not provide adequate oversight.

    CrossFit has done a lot for me (and many others) personally and physically — so I give great credit to great coaches who care for their athletes. Just be careful where you go and always maintain a buyer beware attitude. You can get hurt (rhabdo and other injuries) from any sport, gym, race, or whatever. Don’t jump in too fast; we all have goals and will never reach them injured.

    Stay hydrated and rest smart. Volume does not correlate with growth/progress. Thanks, Joe, for this great website.

  101. Alison says

    Hi Joe! I am so thankful that I stumbled across your website! I am a 26-year-old female in good health and have working out (cardio mostly) consistently for several years. About 2 months ago, I decided to get back into weight lifting and bought some personal training sessions. I had been doing an average of two 60 min training sessions each week plus 30 min to an hour of lifting on my own. I usually did an upper body push workout, an upper body pull workout, and a leg workout each week in addition to 2-3 days of cardio.

    Well, about 3 weeks ago I did an hour long upper body pull workout with my trainer. I did negative chin ups, lat pull downs, bicep curls, rows etc. I think the chin ups did it to me since the next 2 days my biceps and brachioradialis were in extreme pain and I could barely straighten my arms! I thought it was just an extreme case of DOMS but got concerned when the pain didn’t subside and even woke me up at night!

    I had heard about rhabdo before and did some research on it but didn’t have the tell take signs such as dark urine. I tend to be on the overly cautious side though and requested my doctor test my CPK levels for peace of mind. Of course, everyone thought I was crazy and way overreacting. Well, the results came back and my CPK levels were at 16,000!! I was told to go to the ER immediately but unfortunately it had already been 2 days since my labs and I had done an hour heavy weights leg workout and hour long Zumba class between then since I was unaware of my diagnosis.

    I went to the ER and fortunately my levels had decreased to 2800 and my liver enzymes were elevated. They gave me 2 bags of IV fluids and released me but said to get labs checked again in a few days. I slept like a baby and hydrated a lot over the weekend and by Monday my CPK levels were in the 300s.

    I went to the doctor yet again on Thursday and fortunately my CPK levels were normal and my liver enzymes were also normal! I am SO thankful for this and realize health is something we should never take for granted! My doctor put me on complete exercise restriction for 2 weeks (not even light walking on the treadmill!) and wants me to get labs done again in 2 weeks after I do a moderate cardio workout. I feel like this is very conservative but following the doctor’s orders even though I am struggling with exercise withdrawals.

    I’m not sure when I will be allowed to lift weights again but now I have developed an intense fear of getting rhabdo once I start. Exercise is an important part of my life and I just want to be fit and healthy and stay out f the hospital!

    Do you have any recommendations on when it is ok to start lifting again (of course I plan to start out lightly)? Also, why is my doctor concerned about cardio when I am certain the rhabdo was caused by weights? I LOVE taking Zumba classes which can be pretty vigorous at times and don’t want to give this up!

    Thanks so much for your suggestions and for writing such a great and much needed article!!!

    • Joe Cannon says

      Alison, its possinb for both cardio and weights to cause rhabdo (if you look through the comments you will see someone who said he got rhabdo from a spinning class). I have a feeling it was the pullups that caused your rhabdo (eccentric movements are more correlated with rhabdo) but regardless, listen to your doctor. when you are starting to work out again, I recommend a circuit strength training program – light weights/ 1 set per exercise. Don’t do that and zumba or other cardio in the same session at first. the goal is to ease your way into this. when you do take a zumba class again, don’t do the whole class at first. See how you feel after 1/3rd of a class for example. I do think being conservative is the way to go here.

      Being fearful of getting rhabdo again is a common theme I hear from peopel who have experienced this. Its common. I think in time you can resume most of your activities again because you were working out hard before this happened. It will just take some time. Don’t worry, listen to your doctor and have patience. you will be ok.

      please show my review to your personal trainer. I have a feeling he/she is not aware of rhabdo.

      • Alison says

        Thanks so much for the quick reply, Joe! I already informed my personal trainer about getting rhabdo and he was actually familiar with it but never thought I would have gotten it from an hour of upper body weights! He said he is going to talk to the other trainers at my gym and make them aware of rhabdo, which is much needed!

        Do you think rhabdo is a lot more common than people realize since most people don’t go to the doctor unless they have extreme symptoms? After reading other people’s stories, I’m beginning to think that it is! I’m just thankful that I found out I had rhabdo and could take the proper action to recover.

        I agree that starting out slowly is the best way to go, especially with weights! Maybe I shouldn’t do any personal training sessions.

        • Joe Cannon says

          Alison, glad your personal trainer was aware of rhabdo! I would go it alone for a bit and just let yourself be your guide on what you think is appropriate. Sometimes when people have personal trainers, they give up their personal power to the trainer and in doing so might push themselves more than they are able. Because of that I think listening to your doctor and going easy on yourself when you do start back again is probably a good thing. I’m pretty sure you wont push yourself beyond your boundaries when you first start back.

          I do think rhabdo is more prevalent than some realize if the comments here are any indication. I was aware of a quite a few cases myself, told to me by trainers, before I wrote my review.

          keep me posted on your progress and do let me know if you have any other questions :)

  102. James S says

    Hey Joe,

    My name is James and im 24. I just wanted to write and share my story in hopes of seeking advice. I first suffered from rhabdo a year ago, when I first moved to California from Chicago. I had just started back at a gym with a personal trainer (who had no knowledge of rhabdo). I did some basic warmups and weight training sessions along with pull-ups. I admit, I wasn’t as hydrated as I should have been but that has never really caused damaged to me before.

    After the workout, I felt tightness and fatigue but figured it was normal for a post workout esp after not lifting for some time. But I admit prior to this I attended collage at a university where I was active, did a weight lifting class and strength training as well as the fun of drinking and partying each night which I can I still never developed rhabdo.

    Not until after this stated workout, over a year later from college, I realized a after 2 days my soreness was getting worse and Epsom salt baths didn’t help. (I also tried Korean BBQ for the first time that night, tons of extra protein). The workout was Friday, by that Sunday I could not physically move my upper body much at all not even to extend my arms.

    I panicked and my friend rushed me to the ER on Easter Sunday. At first, they thought maybe a tear or over exertion or DOMS. Then a nurse (who happened to be n amateur bodybuilder) informed me that after seeing my urine color, which was coca cola colored, that what I had was fatal and I was gonna be admitted into the hospital.

    They found out my heart was fine but my cpk was at an amazing (100,000+) which scared me after hearing the normal. The doctor thought I was a fighter trying to bulk up my muscles as saying some bodybuilders do it to get bigger arms. and after a week of hydrating my cpk level was still in the thousands but it had dropped significantly. After 2 weeks I felt normal again.

    After a month I tried working out and drinking socially after 2. A year passes, and I’ve done minor cardio like running and walking and then push ups and pull ups at home with a bar, on and off.

    Until one day, after having my mouth wired for 2 months because of a broken jaw and bad dental job extracting a wisdom tooth, I was at home and decided to do some push ups when the next morning, I had felt tightness again. This time going to the urgent care and once again my cpk was up, not as high only raised to 15,000 max and was back down in a week. But I got hit with rhabdo twice and now I’m 3 months in the clear and I’m terrified to even lift heavy objects or run or drink or do anything really as I’m afraid to reawaken the horror.

    My arms doesn’t always feel strong at times and I just feel weaker and sluggish and any weight that was off from the wires came back and it almost feels as if I don’t have any muscle to keep fat burning.

    I don’t know what to do and no doctor can seem to give me any direct answer just to hydrate and don’t overdue it. But there really needs to be more awareness and group meeting for this because it’s scary and physically draining and now I may never be able to become physically active again as most men my age.

    So I don’t work out at all just try to eat right and I’m so paranoid I watch my urine color everyday just to make sure it’s not dark, in which sometimes it’s a darker yellow then I drink water and Gatorade in hopes it’ll clear up. Sad way To live and why me?

    • Joe Cannon says

      James, your fears are similar to what a lot of people who had rhabdo go through so you are not alone. I feel its very common to be afraid to work out after getting rhabdo. Im sure depression is part of this as well. You mentioned about not having muscle to burn fat. This I can tell you, you do not have to worry about. You are burning a LOT of fat right now reading this. So dont worry about this.

      About working out, few general ideas I’d recommend:

      1. I’m going to recommend you do not drink to excess at parties anymore. I’m guessing you are not doing this anymore but just in case, Id say stop it as drinking close to workouts might increase your rhabdo risk. I have no proof of this mind you. I just feel that for you the drinking is an added stress you don’t need. if you do drink, Id wait at least 24-48 hours before you work out. This is just my personal opinion but I want to be conservative about this with you.

      2. Good job on eating healthy! Eat lots of fruits and veggies and healthy sources of proteins. Don’t load up on protein though and I would not use a lot of protein right after working out. Since rhabdo effects the kidneys I dont feel eating a lot of protein after working out (which is common for exercisers because they want to “feed the muscle”) is something you need. Same thing goes for those high protein shakes that are common – dont use them after working out. You might want to meet with a registered dietitian about nutrition for exercise-induced rhabdo. you can find RDs in your area by going to EatRight.org. Id guess RDs who specialize in sports nutrition would be the best to talk to.

      3. Staying hydrated will help you but it wont stop rhabdo from occurring. Just want to mention that because there seems to be this idea in fitness (and among some fitness trainers) that drinking water prevents rhabdo. it doesn’t. Let the color of your pee be your guide. if its clear, you are generally ok.

      3. You didn’t say how many push ups you did when you got rhabdo again. So, with that in mind, Im going to recommend you write down what you do when you work out. This will help you not forget what you did so you dont over do it. It will also give you an idea of what might cause rhabdo if you ever get it again.

      4. When you workout, the goal really is to progress slowly. I feel circuit training is the best mode of strength training for you. this entails one set per exercise. Circuits usually entail 8-12 different exercises but they can be as few as you like.

      5. Aim for a resistance that you can lift comfortably for 15 repetitions per exercise station

      6. Start with just a few exercise stations and focus mostly on the big muscle groups first – legs, chest and back. Dont worry about the little muscles like biceps. little muscles are already being used during the big muscle exercises.

      7. If you ever say to yourself (I want to do 2 sets of this exercise), just remember this general rule:
      First increase the reps you lift
      Then increase the sets you do. And then – and only then –
      Increase the weight you lift

      So, if you are lifting a weight for 15 reps, aim for lifting it for 20 reps, before you progress to 2 sets and then make it a goal of doing 2 sets of 20 reps before progressing to 3 sets. Mind you, I don’t feel you need to do this, but I wanted to give you some basic guidelines on how to progress in a way that might reduce the chances of rhabdo happening again. Also, the goal is not always to be able to do 2 or 3 sets. The goal is to be healthy, and not get rhabdo again.

      8. When you workout start with only 1 day per week for the first month or so. This should give your body time to adjust slowly. Dont workout more than 20-30 min at first. I don’t feel you ever need to work out more than 60 minutes. Work up to this very slowly (add 5 min per week for example) if you decide to increase the length of the workout.

      9. Don’t workout 2 days in a row back to back. give yourself at least 48 hours (or even 72 hrs) between workouts. Never work the same muscle group more than 2x per week (I recommend for the next several months you stay to only 1 time per week)

      10. If you ever decide to get a personal trainer again, quiz them on what they know about rhabdo. If they don’t know anything or only have a vague idea about it -and are not willing to learn about it before they work with you, get another trainer.

      James you can workout and you don’t ever have to get rhabdo again. Just listen to your body and progress slowly, as your doctor said. There really are not any official guidelines on not getting rhabdo which I’m sure adds to your confusion and fears. I do hope some of this helps. If you have any other questions, just ask.

  103. Kathleen says

    I don’t know much about crossfit – I’m a competetive tennis player in South Florida. I’m a 51 year old female in great shape. I work out most days with a long walk and series of many repetitional exercises to train for tennis, play tennis or hit with a pro 3-4 days a week, and often do a mini bike-walk-swim just for pleasure on Sunday – I love being outdoors and am indifferent to high heat, sunshine and humidity. I also do all my own heavy yard work and walk my big dog constantly.

    Well, this jolly sportif lifestyle has done bit me on the tail! After some intense 3 days of training in really hot weather in advance of my season starting 2 Tuesdays ago, I won my first match then started to feel bad. I thought I was just worn out with DOMS and having an andrenaline crash, coming down after competition. My muscles and joints felt increasingly tense, achy and sore and I was incredibly fatigued with strong facial flushing. Everything went downhill for the next many days then.

    I couldn’t move from bed, I had recurrent fever and chills,heavy night sweats, whole body aches. The weird “backwash” of lactic-burn-like feeling through the major muscles after the slightest movement was bizarre! But the lack of certain other symptoms had me mystified. No sore throat, no vomiting, clear eyes, clear urine, no real headache. So what kind of “virus” did I have? If only I had ever seen the “tell” of dark urine – but I never had it. Hot stiff neck feeling swollen, hot eyes. But no rash, no respiratory symptoms, no appetite loss. Some waves of an almost syncope feeling.

    Then it was then long holiday weekend so I never went to the doctor, but luckily my self treatment of loads of salt, carbs, gallons and gallons and gallons of water and total bed rest were exactly spot-on. Also supportive family members so I never moved. I went to the doctor Tuesday, a week after it all started. Everything checked out perfect except slightly elevated liver values and elevated CK.

    Now that I have read so much more, I have a call into him to get rechecked next week, not in 3 months. I am a little worried about Compartment Syndrome as the back of my left leg feels crampy and still bothers me, but nothing was ever swollen anywhere. Now 9 days later I am still on mostly bedrest and still feel kind of crappy but better each day. Minimal activity and no heat. D

    own to one round of otc pain reliever a day usually around 4 or 8 pm when I feel worst.I have no idea when I will resume anything – just won’t know until I really feel normal, and it feels safe to slowly start back.

    • Joe Cannon says

      Kathleen, sorry that happened to you! I think you are doing the right thing esp keeping on contact with your doctor. I hope you start to feel better soon.

  104. e money millionaire says

    I’ve really enjoyed this article and these responses. I have been doing additional research on Rhabdo lately in light of an article making the rounds “CrossFit’s Dirty Little Secret” which is a horrid slash at CrossFit via the risk of Rhabdo. Not a secret at all…Glassman addressed it in 2005 (um, EIGHT years ago) and a follow up was done that I think was written very well in 2011. The offending author has been in academia too long… But I digress…

    Full disclosure – affiliate owner and long time CrossFit athlete here.

    Here is the other side of the story:

    I understand the risks, causes, symptoms and treatment for Rhabdo. The minute I became aware of this condition (several years before opening my own affiliate) it scared the shit out of me and I did my homework.

    Much to my surprise, I found case after case after case of Rhabdo occurring in non-crossfit contexts. Lots of stuff in college athletes; a high school kid punished with squats; police, fire and rescue stories; and, most surprisingly of all, prison initiation exercise routines.

    What I didn’t find was an out pour of folks lamenting their experience contracting rhabdo after a CrossFit workout. The first commenter in this blog counts as my first. Given the exponential growth of CrossFit, you would think reports detailing the hordes of afflicted would be easy to find. So far…not really. I think the risk and prevalence is overblown. This perception (and I will admit, I could be easily swayed with the right data) does not mitigate my responsibility in discussing this topic with my members.

    Thus far we have probably entertained 200 individuals at our gym since opening, none of which have gotten rhabdo. What does this mean? Little, except that there are affiliates out there taking care of their athletes. We provide a full 1.5 minute rundown of rhabdo. “1.5 MINUTES!?” You say…”that is BARELY enough to scratch the surface!” yes, we talk at the person’s blank face for a whole minute about what it is, how you get it and what to look for.

    The impact…nothing. We live in a society where there is danger, warning and caution everywhere. We are completely insulated to this message. I must have initialed my name next to DEATH a dozen times when I went scuba diving and sky diving. For that matter, we discuss how our building is known to contain asbestos…FUCKING ASBESTOS…and no one seems to care (granted, we did all the correct things to get it cleaned up upon detection). There is a REAL, non-zero, risk of rhabdo when performing crossfit. When I snowboard, I see, without fail, some poor sap getting hauled down the mountain in a stretcher. There is also a non-zero risk of breaking your neck once you get off that chair lift – and people merrily participate by the 1000’s without a care in the world. If it’s not a snake with dripping fangs rattling menacingly, I’ve found that people are horrendously insulated to what real risks lie ahead as compared to the action they take.

    Now hopefully, having been exposed to our lecture, someone experiencing the telltale signs will rush themselves to the hospital. However, when I explain the signs, I say with some levity, “as if those symptoms weren’t enough to get you to go to the hospital anyway, right?!”

    But, every single case and study I’ve come across is how people ACTIVELY DON’T go to the hospital once outside the care of their coach, trainer or whoever last saw them in working order. The thing that gets them to the hospital is appearing to be on the brink of death.

    Fortunately for sufferers of Rhabdo, “4 days later” is considered early treatment (what do you get for a rattler bite…4 hours?). Now, the trainers clearly bear a large portion of this blame because they themselves are not educated on the topic and/or failed to disclose the risks and signs that might ordinarily initiate that trip to the Doc.

    Please, please, please do not take this frustration as that oriented at any of the contributors here. My complete astonishment comes at this breakdown of communication. If one of my clients came back 2 weeks later and said, “yea, I had really, REALLY stiff muscles and had dark pee and really felt awful, but now I’m back!” I would say, “…uh, why the hell didn’t you tell me?”

    To me it is unconscionable that someone would pay me for expertise and I end up hurting them. Likewise, I would do everything I could to help their recovery…which would include free personal training…lol (what a scammer at your CF gym lost_princess, im sorry…) to make up lost ground.

    By the way, lost_princess, I would also recommend your husband not do crossfit…at least in the immediate future. It literally sounds too intense for him. He needs 1 on 1 exercise supervision closely monitored by a doctor (good luck finding a trainer who can pull that off…) because all that heart and arthritis stuff…uh uh, don’t want to touch that with a 10 foot pole. Your CrossFit instructors are crazy.

    When I hear of the FIRST workout that people are doing, it blows my mind out the back of my head with shotgun force. Murph!? Helen?! I’m sorry, are you attempting to kill your friends? The first workout that most of our members complete is via our free trial – and it’s the same every time:

    6 minute amrap
    10 burpee box jumps
    16 walking lunges
    10 situps

    The eccentric load is minimal (seeing that 90% of the time is spent doing burpee box jumps) the pattern is short and the opportunity for rest (once again, right after each burpee box jump) is built right in. Not to mention its only 6 minutes. The result? This workout still CRUSHES people. If you are new to exercise, the burpees get you. If you are a fit hulking badass…the burpees get you. It is win, win, win, win, win, win, win….win. The tendency for CrossFitters to try and “impress” neophytes with some monster, brutal workout is a rookie mistake itself.

    Ok, so at this point this uncontrolled stream of consciousness has really gotten out of hand. Great article! Perhaps we can dialogue in regards to some of the content ejaculated here.

    • Joe Cannon says

      e money, thanks for writing. Im aware of the “cross fit dirty little secret’ article as well as others recently, as they have resulted in MANY extra visits to my website from people looking for more info on rhabdo.

      Like you, I am aware of several cases of rhabdo resulting from high intensity workouts that were not associated with cross fit. I think cross fit was named in recent articles because it is the most well known high intensity workout out there. I did link to case reports of other incidences, not associated with cross fit.

      I also would like to know the actual injury rates or rhabdo associated with cross fit, but I’m not sure if those statistics are known. This I think is partly because most people might just “grin and bear it” and never go to the hospital, and as such never know they had rhabdo. In a nutshell, they got lucky (as far as kidney damage etc. that might have resulted from rhabdo). That said, I have met personal trainers who caused rhabdo after prescribing too much exercise to clients (cross fit and non cross fit related) and I have been told of one death following a cross fit workout.

      I’ve also been personalty contacted by lawyers who represent people who developed rhabdo following exercise prescribed by personal trainers.

      I think that the rate of rhabdo attributed to fitness trainers can be greatly reduced by :

      1. better education by the fitness industry (I believe I wrote the first book in the US that discussed rhabdo and personal training) I’ve even met people with college degrees – in exercise – who have not been taught about rhabdo.

      2. Better screening of those who take part in high intensity exercise classes. I applaud you for telling your people about rhabdo but as far as I can tell, this does not seem to happen universally from what people have told me. I’ve also been told that trainers who conduct cross fit classes do no pre screening of members before those members do cross fit workouts. I’m sure cross fit must have policies on this but it appears to be lacking at some locations. I believe in addition to a talk about rhabdo, that the use of the “PAR-Q” or other health history screening form would greatly cut back on people who are better served by a lower intensity of exercise.

      I know the recent articles on cross fit/rhabdo have resulted in a lot of anger from those who do cross fit and have never had a problem. I’ve been discussing rhabdo in classes I teach for several years – and as far as I knew, I was one of the few who talked about it. My hope is that the recent articles – as painful as they are to personal trainers (cross fit and not) result in a more widespread understanding of rhabdo, not only among trainers – but people in general. That, I feel will ultimately reduce the incidence of this condition.

      • E$ says

        Yes, we employ a Par-Q and a general physical activity questionnaire. We have been fortunate to not have to address any serious issues from those interested in CrossFit (mostly just wear and tear joint stuff). You would be right! Not ONE gym I have walked into has asked me to perform movements, asked about my health or otherwise done due diligence in making sure I don’t collapse mid workout. Perhaps because I always disclose I am an affiliate owner, but that doesn’t necessarily imply anything. The libertarian nature of CrossFit, Inc. lends itself to sort of loose, at your own risk, type controls. This itself is a whole other discussion…lol.

        I have toured to many different CrossFit gyms and most set you up with a text wall, which I am happy to sign, but it doesn’t lend itself to the understanding that CrossFit does pose risks and Rhabdo is real – especially for the newbie. I went to two CrossFit gyms in south korea (whole different can of worms, of course) and there wasn’t any waiver/information/pre-screening AT ALL.

        Actually, whenever we do our rhabdo spiel, I am floored by the amount of people who don’t just have inadequate knowledge of rhabdo, but have NEVER heard of it AND have significant CrossFit experience. There is a serious deficiency in communication and/or education somewhere.

        I agree with your recommendations for reduction. In having this discussion, I am quickly realizing that this is not a problem central to CrossFit (and that is not for want of mitigating the perception of the blame placed on CrossFit). The industry as a whole has progressed towards “intensity” (in its various interpretations) – probably because that is where you can achieve quick and serious results. There is Insanity, P90x, SickFit and all of those weekend warrior type challenge runs that, if the information I have seen is in fact true, pose a threat due to the average “challenger” being grossly unprepared for the often highly demanding challenge ahead.

        A quick aside: I did a “Zombie Run” where I saw people PUKING after about .5 miles. Needless to say, there is a gross disconnect between perception of abilities, real risks and information.

        I am glad you are making this information present and taking an interest in this topic! I suspect that once the industry at large catches on, it will become an ever present, but well managed, risk.

        Greatly appreciate the conversation – it’s rare to have a level headed one via the interwebs!

        • Joe Cannon says

          E$, thanks again for your insights. I am sure people reading this have been well educated about what they should expect to have done when they do a cross fit work out.

  105. Lb says

    So glad I found this article. I am a 40 something year old woman currently recovering from exercise induced rhabdo. If I had not advocated for myself and asked my physician to test for it, I would have fluffed it off as DOMS. My CPK was 24,000 after doing strenuous arm routines which included pull ups, I am finding this to be a common factor.

    I had swelling in one arm so much that I resembled Popeye. Thankfully my kidneys were not affected. I have not spoken to the folks at my gym yet, but I am petrified of restarting exercise. Thanks for the great info!

    • Joe Cannon says

      LB glad you got checked out for rhabdo! Im also hearing others mentioning how pull ups were related to inducing rhabdo, probaly because they are difficult, and they have a pretty intense negative (eccentric muscle action/ the lowering part of the pull up).

      listen to what your doctor says about when you can work out again. A lot of people here have told me how they were afraid to work out again after getting rhabdo. you are not alone.

  106. Brian says

    Hi Joe,

    Found this article after reading about your smoothie. Anyways I have never heard of rhabdo before. I have exercised my whole life and am currently in the military (25). Well my wife and I have started doing the insanity program about a week ago because we want to tone up, but she was never one to exercise growing up just ate healthy so she has very little experience in that area.

    I was wondering, since we jumped straight into a program like insanity (very tough) and she is struggling through it like I am, I was wondering what the risks were. We take it slow doing what we can and taking more breaks in the middle of the exercises compared to the people on the DVD.

    If it has already been over a week since we started and she seems to be fine besides some normal muscle soreness, would she still be at risk for a disease like this even though we have done every cd at least once last week (month 1 phase)? Is this something I need to be watching out for while she does insanity with me even though she has been fine all last week?

    Or is she more or less safe because she has been working at this high intensity for over a week already and has been fine? Sorry for the long post, but after seeing this article it freaked me out for her safety I don’t want her to get hospitalized trying to keep the pace I am keeping.

    Thank you for this great article and getting me a bit more educated on fitness.

    • Joe Cannon says

      Brian, I think that moving at your own pace – rather than trying to keep up with Shawn T on the DVD – is the best way to avoid getting rhabdo. While rhabdo usually does occur quickly, I did recently read a report about a “delayed” rhabdo that appeard to occur 5 days after working out intensely. Here’s the link http://www.cmaj.ca/content/183/16/E1222.full

      that said, I think most cases of rhabdo Ive heard of happen quickly after exercise and if you are doing what you say you both are doing, I think the odds of getting rhabdo are small. Just listen to your body and dont push yourselves too much. Rhabdo seems to occur when people push behind their breaking point- not just their physical breaking point but mental breaking point as well. if you know your limits and dont exceed by much your physical limits too much (a little is usually ok for healthy people) I think you might not have to worry about rhabdo.

      Injuries – joint injuries etc – stemming from high intensity exercise programs are another story so again, pace yourself and remember that the body gets stronger when it has had rest.

  107. Jaenene Geiger says

    Joe,

    Great information and really the only detailed information on Rhabdo I can find. I got Rhabdo back in July. I was doing Zumba -3 times a week, working out with a trainer once a week and training for the 2 day 39 mile Avonwalk on weekends. I had done the walk last year with no problems. I had been on Lipitor for 7 years with no issues.

    On this particular weekend, I walked 12 miles on a Saturday and it was pretty hot (around 90 degrees) but thought I was pretty hydrated with water and Gatorade. That afternoon I was tired and had a little shortness of breath but I have asthma so didn’t think much of it. The next day I was supposed to walk 6 miles for my training. By the 4th mile I was exhausted and was experiencing the shortness of breath again so I cut walk short at 5 miles.

    Over the next few hours I experienced more muscle pains and the breathing issues. Finally by the evening my husband said I looked really pale so we ended up in ER. At first they thought it could be a heart attack. Fortunately my heart and kidneys were fine. They said that my CPK levels were 10 times normal and suspected Rhabdo and was lucky that I had come in. They said the condition exacerbated by Asthma. They gave me IV fluids, prednisone and sent me home.

    ER told me not to do any exercise until I saw my regular doctor a few days later. I did this. My regular doctor told me to take the next 3 months off of exercise, took me off Lipitor, and ran my CPK levels again a week later which were now normal.

    After a few weeks I still felt like crap so I decided to get a 2nd opinion and saw a Rheumotologist (since I wasn’t sure where to go). She ran a whole bunch more tests and said that in addition to the Rhabdo (which levels were still normal) I also have Fibromyalgia which can present some similar symptoms.

    She pretty much agreed with my doctor but told me to slowly work into exercise since my blood levels were normal and by the time I saw her it had been over 6 weeks. I started off slowly with just walking my dog 2-3 miles and that seemed fine but then one day I went back to the gym and did treadmill for only 30 minutes and started having that weird pain in my back and shortness of breath again. This lasted a few days so I saw doctor. She ran more tests but all levels were normal.

    We have talked about a muscle biopsy and some other tests but will decide on these when I go back next week.
    I feel like this doctor just like my other one really doesn’t understand Rhabdo. I know my blood tests show normal levels but not sure why when I exercise I still have those symptoms. Do you or any of your readers here know of any doctor that specializes in Rhabdo cases. I am in Southern California.

    I feel like I am going crazy since before this I was so active and now am afraid to just do basic walking and exercise. It has been almost 3 months so I feel like I should be able to resume a normal life again. Any feedback or guidance you can provide is much appreciated.

    Jaenene

    • Joe Cannon says

      Jaenene, you are not crazy but from what you said it sounded almost like the “perfect storm” for rhabdo to me. I do agree you should go back to exercise slowly (2-3 mile dog walk is more than Id recommend though. Id start with just 1 mile).

      I don’t know of any doctors who specialize in rhabdo but an I’d guess someone who specializes in internal medicine or sports medicine would be good to connect with. Sports medicine doctors are very aware of rhabdo and internal med doctors are pretty much well rounded in a bunch of stuff.

      Interesting the diagnosis of fibromyalgia. I thought they diagnosed this if you were in widespread pain for 3 months and the pain was localized to 11 of 18 known “tender points” – and after everything else has been ruled out. I’ll assume that applies to you.

      Im glad you were able to find me. If I can help anymore, just ask.

      • Jaenene says

        Thanks Joe…appreciate the feedback and the help. I know you are not a doctor and every case is different but in your experience how long do people that have had Rhabdo (and that have normal levels again like me) take before they can regain “normal activities”? Or have you seen that they don’t resume normal activities again?

        You are correct about the Fibro…the doctor has been monitoring me for 2 months now but I’ve had symptoms consistent with the illness for around a year but because other doctors were treating the individual symptoms it was not until I saw the specialist that she put the puzzle pieces together. She said the Rhabdo could have exacerbated or brought the Fibro to the forefront. I do know a sports medicine doctor so think I will go that route.

        Thanks again

        • Joe Cannon says

          Jaenene, You will be able to work out again but I cant not give you a time frame. If you have fibromyalgia that might add an extra something into the equation but it wont prevent you from working out. My best advice is to resume your activities slowly and get feedback from your doctors who Im sure have run a bunch of tests and can advise you on best. Do keep me posted on how you are doing also!

  108. Adam Smith says

    Thanks for this article Joe! It’s good information.

    What recommendations do you have for folks who aren’t sure if they had rhabdo? I’m guessing there are a number of us that have experienced severe DOMS and are now wondering if we could have had a mild case of rhabdo.

    For example, if a person has muscle soreness and swelling, but does not have cola colored pee, is it safe to say they did not have rhabdo?

    To take it a step further. If someone had a slight case of Rhabdo (I don’t even know if that’s possible) and didn’t get it treated and is just now reading this article, are there things that they can look for? Is the lack of definition in their affected muscles permanent? Is there an increased risk of swelling after working out? Can a person return to pre-rhabdo fitness? Can they get stronger or is there lasting damage?

    I seems to me that, if it’s possible to have a mild case of rhabdo, maybe there is something we could be looking for, other than dark urine.

    Bless you for answering all these comments!

    -Adam

    • Joe Cannon says

      Hi Adam, I think its possible to mistake a really bad case of DOMS for rhabdo. The thing that I look for is that DOMS does not hurt when you are not moving. Rhabdo pain does hurt when you are not moving. That said, I think the best way to know if you have rhabdo or not is to get checked by your doctor. dark colored urine does not always show up. If I remember correctly, it only occurs in about 30-50% of cases of rhabdo.

      The things that I’d look for would be
      1. quick onset of pain -usually zero to 24 hours after the activity
      2. the pain hurts -a lot – even when you are not moving
      3. swelling of the muscle.

      That’s not always foolproof though which is why I recommend seeing your doctor.

      exercise induced rhabdo usually occurs when the intensity of exercise is increased too quickly for the body to adapt to. That said I do believe you can return to “pre rhabdo fitness levels” eventually. It depends on the severity of the condition.

      The news in the US is starting to pick up on rhabdo mostly because articles in the the NY Post and Huffington Post. Because of that and because most people have never heard of rhabdo, it’s likely that people will start seeing a LOT of stuff about it on TV etc.

      while I am glad about the awareness the condition getting, its possible that the blitz of media attention might scare some people in to wondering if they have it or not. This is why I recommend for those who think they might have rhabdo to see their doctor. They can best advise people and help them get the help they need.

  109. Francesca Smith says

    Hi Joe,

    Thanks for sharing this article. I am currently recovering from my first case of Rhabdo. I cannot tell you how many people told me (and tried to force this statement on me) that I worked too hard, and that is why this happened to me. But now, I can direct them to your article so they can see for themselves that Rhabdo can occur after one workout, and it can happen to any one with ranging abilities.

    Thank you for helping me to be more confident in the information I give to people who are hell bent on believing that I brought this on myself.

    Francesca.

    • Joe Cannon says

      Francesca, I’m glad I was able to help and so sorry you got rhabdo. My prayers to you for a speedy recovery. Let me know if I can be of any other help.

  110. Damon says

    Joe,
    In your opinion, if you hydrate, eat, take or don’t take certain supplements/medications appropriate for the exercise you do, regardless of intensity can you avoid Rhabd?

    • Joe Cannon says

      Hi Damon, unfortunately no. While having enough fluid can reduce the damages of rhabdo, water will not stop muscle fiber death. Likewise for supplements. I’m not aware of any supplement that will reduce the risk of rhabdo. No herb, amino acid, vitamin, mineral etc. will do it. I hope that helps.

  111. Liz says

    Thank you! Really great article here that I’ve shared on all of my facebook pages. The hardest part as a group ex instructor is getting students to modify their movements and go at their own pace…when they don’t seem to WANT TO! I stress modifying movements and slowing pace, over and over, ad nauseam. It doesn’t always work. Students need to understand the risks as well. Thanks again for writing this so clearly.

    • Joe Cannon says

      Liz, THANK YOU for sharing my review on your facebook pages. It is my hope that everybody who works our or who is a personal trainer understands what rhabdo is and what it can do.

      Thank you for writing and I am glad I could help in some small way.

  112. Dawn says

    Thank you for this article! I was recently diagnosed with Rhabdo on Friday, 1/5/14 after doing an AMRAP at my CrossFit Gym consisting of 42-30-18 Ring Rows 21-15-9 Barbell Back Squats. Ring Rows are when you hold onto two rings, lean back while keeping body straight, then pulling your body up towards the rings, essentially pulling up some of your body weight with only your arms, then back down to starting position.

    Previous to this I had some nerve issues in my left arm, which caused weakness in my biceps and tingling in my fingers, so I took it easy with upper body work for a month, not lifting anything overhead. Then I did the ring rows workout as a substitution for pull-ups (without my regular coach there) because I thought I felt okay. Turns out I was wrong!

    My arms were stiff the next day, but I thought that was just typical soreness. My arms got progressively more sore, I couldn’t straight them out, and got even worse on Sunday when my biceps started to swell up. I knew I had Rhabdo by just looking at my arms.

    When I was admitted to the ER my CPK count was at 8000. Day 1 I was at 11,000, Day 2 at 13,000, Day 3 at 16,000, then back down to 12,000, and when I was released from the hospital on Day 5, I was at 7000. My urine throughout my hospital stay was clear and my kidneys were fine. The day after I was released I took another CPK test and was at 3,000. 2 weeks after I was admitted I am now in the normal levels at 129.

    I love what CrossFit did for me physically. It made me more lean, muscular, and I became a lot toner and stronger. BUT with that said, I have SERIOUS anxiety about going back, and even lifting heavy with my upper body. I don’t even know where to begin working out when I start back up again in a week or two. Any suggestions on workout I can do as far as time/reps goes that will help me build my strength back up in my arms? Thanks!

    • Joe Cannon says

      Dawn, I’m glad I was able to help. Question, did your cross fit trainers inform you about rhabdo before you started? I just like to know these things and in doing so, hope to help other cross fit trainers who may be reading this. Have you told your cross fit trainers what happened? If not, please do so. They need to be aware that this happened so they can better reduce the chances of it happening in others.

      Did your doctor say it was ok to work out again? if not, get his/her approval first before you do anything. I know many people are afraid to workout after they get rhabdo, but you can workout again. We will have to take it slowly.

      I would not go back to cross fit right now.

      If you do get your doctors OK, here are some general ideas that you can use as a guide for when you do start to workout again.

      1. I would start back with just light cardio (like walking on the treadmill or easy eliptical work) for a few weeks to see how you feel. Id say start wiht 15-20 minutes of cardio 1 or 2 x for the first week. Increase the time you exercise before you increase the # of days you workout. That will be safe est and give your body more time to recover from workouts.

      2. when you do start lifting weights again (give it a few weeks to see how the cardio only effects you) I recommend a circuit training program that uses light weights – something you can lift comfortably for about 15-20 times.

      3. I dont want you to push to failure on any set.

      4. Start with only 1 set and I would only begin with 3 different exercises -legs, chest and back. For example you could do 1 set of leg press for 15 reps, followed by 1 set of chest press for 15 reps and then 1 set of a seated row (or lat pull down) for 15 reps. If you do only those 3 exercises, you also hit most of the muscles in your body so its efficient and yet also means you dont have to spend a lot of time in the gym either.

      4. Do that for a few weeks and monitor how you are feeling -muscle sorceress, swelling, change in urine color etc. I dont want you to spend more than 30-45 min in the gym for a while -again to give your body time to workout. Again, I would only spend about 15-20 min in the gym at first, only doing light cardio.

      This is of course after you get your doctors ok.
      I know a lot of cross fit is about the speed you do the reps. I dont care about how fast you do the reps. in fact I want you to lift nominally – like 1 second up and 2 seconds down.

      Dont be go back to wokring out harder out of a fear that you will be “losing all your gains” because they can be obtained again. You will not be going back to square one anyway so take comfort in that. Having patience with your workout is important at this stage of the game.

      Rhabdo happens when we push ourselves too hard, too fast. Giving yourself ample rest between exercise sessions will help this to not happen again. If you ever do cross fit again (I wouldn’t if it happened to me), the trainers need to modify the intensity of what you do to help reduce this from happening again. Do read through the comments also as others have asked similar questions.

      If you have any other questions, just ask and I will try to help.

      • Dawn says

        Hi Joe! I actually heard about Rhabdo from my CrossFit coach a few months ago because he posted an article about it for us to read. I never in a million years would have thought I would get it. I was the first person my Coach has ever seen with Rhabdo. He actually came by my hospital room a couple days to see me.

        I asked my doctor when I can workout again and he gave me the OK as long as I start SLOW. Since Rhabdo occurred in my arms, do you think jogging, squats, lunges will be ok? Light reps of course. I don’t want to go to failure.

        I’m definitely a little bit traumatized when it comes to returning to CrossFit again. IF (and that’s a big “if”) I do return to CF, it won’t be for a LONG time. I do miss it, but I keep thinking about Rhabdo and I’m emotionally, mentally, and definitely physically not ready to return. It may take me a while to get over this whole experience.

        Thanks for your input!

        • Joe Cannon says

          Dawn, good I’m glad they informed you about rhabdo – and kudos to your cross fit trainer for coming to the hospital to check up on you!

          You are not alone and feeling traumatized after getting rhabdo. Many people do and while the news media is finally starting to talk about this more (I think because they have never heard of it before, as I was told by a reporter who interviewed me on TV about it a while ago) none of them yet are talking about the toll it takes on people who are afraid to work out again afterward.

          I would agree that SLOW is the thing to focus on right now. At this point I wouldn’t do squats etc. Just follow the outline I gave you for a few weeks and lets see how you do with it. I know eventually you will be able to do squats etc. but right now, since its only been a few weeks, I just would rather you get comfortable with working out. I’d rather you take it slow now and be able to sleep at night without the worry of “oh did I do it again?” thoughts that I think might pop up as you begin to get back into working out.

          Do keep me posted on how you are progressing too Dawn :)

  113. liz says

    Thanks for in informative article, but you state that the Rhabdo can also be casued with even low impact exercise. You also give some suggestions on PT preventing Rhabdo. Would it be safe to say that it is impossible for PT to prevent Rhabso sometimes?

    • Joe Cannon says

      Liz, I think its impossible for a personal trainer look at someone and exactly gauge their risk of getting rhabdo. That said being knowledgeable about the state of the clients current health and health issues and applying the proper use of progressive overload principle should reduce its risk significantly. I think most personal trainers will never cause rhabdo in their clients. Personal trainers who prescribe high intensity type workouts have a higher risk of causing it accidentally but even in those, if they are conservative in their application of the exercise they prescribe, and include enough rest and education for their clients, they dont have to cross that line.

  114. Dave Carpenter says

    Hi Joe I have recently upped my running distance from 6km to 10km , the last 3 runs I have done have all been 10k ( Thurs, Sun,tues) on the last run I finished the run 4mins quicker than previous runs , it was 3degrees outside . After wards I was so shiverey and cold and felt like I was coming down with the flu , I have leg ache for 24hrs now and was wondering if that is something to do with rhabo?

    Cheers

    • Joe Cannon says

      Dave, its hard to say based on what you said but I recommend you go to your doctor today and get checked out. Its possible its rhabdo or something else. Your doctor can tell if its rhabdo or not. Go today and let me know what happens.

  115. Britt says

    I got Rhabdo the second week of December 2013. I had been doing CrossFit for 10 months prior to this incident and am in great shape. I had gone home on vacation for a week and a half to visit family. also no properly hydrated like I normally am and definitely not eating clean like I normally do.

    I decided to try out a girlfriends box with her where they were doing one of the CrossFit girl workouts called “Nicole” which consists of a 20 min AMRAP of your max rep pull ups (as many pull ups as you can do until you drop to the ground) and a 400meter run every time you drop. I had done this workout before and did 73 reps and was perfectly fine. This time I did 101 reps.

    I clearly did not ease into the workout as I thought i would be fine since I had been doing crossfit for a while and had already done this workout. I was okay the next day but that night and the following couple of days I was so sore I couldn’t straighten my arms out they were somewhat stuck at 90 degrees and i couldn’t lift my hands over my head it was so painful. I thought i was just extremely sore since it had been a while since my last physical activity.

    A week and a half goes by and were flying back home. That night as we get home and I take my jacket off I notice my arms are swollen and continuing to get bigger. I knew then it was time to take a trip to the ER. All the nurses and even the doctor rolled their eyes at me as I told them I thought I had Rhabdo. I am very small 5’2″ and about 108lbs they are thought I was crazy.

    One blood test later and the doctor comes back to apologize because I did in fact have Rhabdo. It was at the ending stage and I was starting to recover but my Levels were still around 8000 so they admitted me and I was pumped with fluids for 12 hours where they did another blood test and my levels dropped to 2000 so I was allowed to go home. 2 weeks later I had a follow up blood test and all my levels were back to normal.

    i was scared to go back to CrossFit for sure but I had a sit down with the owners and coaches and they helped me back into a slow routine with minimal weights. and if they ever saw me trying to do anything more they would yell at me.

    It is now March and I “thought” I was in the clear as I had gotten back to my previous weights and was doing everything I had done before. Then I did a crossfit open workout friday that consisted of Overhead Squats and Pull ups and i think I may have over done it just a tad.

    Since it was using the same muscle groups I had Rhabdo in before I should have taken it a tad easier. I was still pretty sore come Tuesday so my doctor had me go for another blood test just to see and yeeep my CK levels are elevated again but are only around 1999…..still she told me to rest and now I am feeling defeated.

    I am frustrated and I know I shouldn’t be but this is my lifestyle and I absolutely love it. I know I need to continue to take it easy because this is super serious but its hard when this is everything you love.

    • Joe Cannon says

      Britt, really sorry that happened to you! I understand this is a lifestyle for you. At the heart of the cross fit name is “cross training” which basically refers to doing different things on different days to reduce injury. So, if we only do cross fit we takes the “cross” out of cross training.

      That said, can I suggest that when you do go back to working out, that you bag cross fit for the next several months and just do some less intense circuit training. I know it’s stressful not to do what you want to do – and love to do too – but it may be the best advice for now.

  116. Old Lady Runner says

    Well, Now, I’m confused and slightly concerned.
    I’m training for my fifth 1/2-marathon. I’m not an elite runner (shooting for 1 or 2 1/2-marathons a year) turned 50 years old and have about 10-extra pounds which I expect will disappear as my training continues.

    I increased my run yesterday from 8-miles the week before to 10 miles yesterday. My last 8-mile run the week prior was pretty easy and I wanted to run a particular route yesterday regardless of the distance.

    Well, today, I’m feeling wiped out fatigued. I’m not feeling too much pain or stiffness except for my hamstring which has felt some pain since last week’s zumba class (slight hamstring pull). It’s a slight pain and doesn’t affect my running (just painful when sitting for any length of time). I’m scheduled for a massage tomorrow by my sports massage therapist.

    My concern is because of my extreme fatigue today, and my confusion is – how can I train for a 1/2-marathon which means my distance will continue to increase? I’m running 4-1/2 miles 3 times during the week and try to throw in Zumba at least once, then do the one long run on the weekend.

    I think I’m increasing the distance slowly enough – I have 4 weeks to go and am at 10 miles now….. and want to hit 11-miles this weekend. But, boy am I fatigued today… I DON’T like how I feel. I can’t remember what color my urine was, but I had very pitch black very watery bowel movements last night. And, now am worried I may have done something wrong… Ugh.

    • Old Lady Runner says

      Actually, my hamstring hurts all the time, but really bothers me when sitting. I just don’t feel pain when running, just when using the hamstring in the intense mode – raising my foot (hamstring pull) or putting pressure on my heal (like launching)…. it just seems hamstring pain is kind of normal for my type of training….

      • Joe Cannon says

        Old Lady, its hard to tell if you have rhabdo or not based on what you said. It could be that you are over training and just having a bad day coupled with an injury to your hamstring. It could be that you are just over training.

        Does the pain hurt when you are not moving? if so thats not good.

        Dark color urine doesnt show up all the time in cases of rhabdo but the pain usualy happens fast – zero to 24 hours after the workout.

        How are you feeling today? Did the massage help?

        BTW, you are not “old.” We are basically the same age and if I’m not old, neither are you :)

        • Old Lady Runner says

          Thanks, Joe.
          Actually, since my original post, things went downhill pretty quickly. I Continued to run – increased my distance 10-12 miles and ran a 10K for “fun”. The pain continued to increase. Over those couple of weeks I had massage therapy hoping to loosen things up, we worked the hamstring tightness out until we got all the way to the bone, where I realized there was something more severe going on.

          I had X-ray to rule out hairline fracture so I could keep running (thru the pain) then an MRI. Results were high-hamstring tendonopathy at the ischial tuberosity with associated bone marrow and soft tissue edema. Not fun.

          Needless to say, I’m not running (well, I did run one 10K since I couldn’t run the 1/2-marathon). But, that was three weeks ago (before my diagnosis) and haven’t run since.

          I’m on anti-inflammatory and ice regemine and start physical therapy soon. I’m not a happy camper. But, I think I’m on the road to recovery. The pain is subsiding – still hurts when I sit (and driving), but I can walk better now. Thanks for your time and support.

          • Joe Cannon says

            Old Lady, thanks for the update and sorry about your diagnosis but I am glad that you got an answer to your problem. I can understand and relate to how you are feeling. One thing that keeps me motivated is that we do eventually bounce back. I also tell myself that even though I may prefer some types of exercises, there is no “best” activity and that rotating (walking, running, biking, elliptical etc) is actually healthy and can help keep us doing what we really like doing for a longer time period.

            I hope that is some solace for you and I do pray for your continued improvement. It sounds like you are already getting better…

  117. Lisa says

    Really appreciate this site and all these stories! This has been the best source of info I have found so far in my online research about Rhabdo. My 17 year old daughter was just hospitalized last month with Rhabdo. I was shocked that a perfectly healthy teen could get something like this. We are now on a journey to find out why? I’ll tell her story here in the hope that it can help someone or help us get some answers.

    On February 25th she began her lacrosse tryout/practices at school. Prior to this time she had been running 2 to 3 miles a day about 5 to 6 days per week for the few months prior to get and stay in shape. She also had just added in the T-25 workout tapes a few days per week for the week prior and regularly did her abs exercises and other mat work and arm exercises. So basically, she is was very good physical condition before starting lacrosse season.

    During the first three days of lacrosse practices there was a lot of running, sprinting and drills. On the evening of February 27th after the third day of practice she had a hard time getting up the stairs to her room and later was laying in bed crying from the pain her leg muscles were in. Knowing how physically tough she is I knew this wasn’t normal.

    I asked her if she had seen blood in her urine. (Several years ago my older son had experienced blood in his urine one time after a particularly grueling football practice so I knew it was possible for this to happen after extreme workouts.) She had never looked before so sure enough she checked on the next trip to the bathroom and she had the dark/bloody urine.

    I made her a doctor appointment the next morning when she still had the dark urine and they checked all her levels and the CK level came back at over 20,000 – the highest level this small lab was able to read. Her pediatrician advised a trip to the local Children’s ER to get her an IV to hydrate. So off we went and they then ended up admitting her with CK levels then over 75,000!

    She spent three nights there with two of them in ICU in case of kidney failure! Thankfully her kidneys were fine and all recent tests have shown no kidney damage that we know of.

    The doctors suspect that her CK levels could have been as high as 100,000 when the first lab to test could only read up to 20,000. It seemed crazy how long it took the CK levels to come down. After three days in the hospital they had come down to 13,000 and they let us leave under the condition that she keep pounding the fluids and get her CK levels checked daily and periodically until they dropped to normal. By March 11th they had finally come back down around normal.

    Because her levels got so high, her pediatrician and all the hospital docs suspect that there could be a genetic reason that this happened to her. I mean can this really be a normal thing for a 17 year old in peak physical condition? The only thing we thought could have played a role in this was that she had probably not been eating enough carbs for all the physical activity she was doing. She had been cutting back on those thinking it would help her get the shape and muscle definition she had been working for.

    We have since been referred to a children’s geneticist and we are waiting for results from expensive genetic testing. They suspect that she has a CPT II deficiency. This would cause her body to not burn fat properly and go right to burning muscle.

    In all the cases I have read here on this site….didn’t see any that mentioned this as a possible cause? What do you think? If she has this then we will need to work with a nutritionist to learn how she needs to fuel her body going forward.

    She is having a hard time getting back to physical activity. She has started with 10 – 15 minute jogs but once when she ramped it up and went for a 3 mile jog (30 minutes) it wiped her out and she didn’t have the energy to workout for a couple of days. It’s been frustrating for her and hard coming to terms with the likelihood that her lacrosse season is over for this year!

    • Joe Cannon says

      Lisa, I am SO sorry this happened to your daughter! I do think there is a genetic link involved with rhabdo in some people. In my review I linked to a case study of someone who had rhabdo many times. So, I do feel that once someone gets rhabdo that they may be more likely to get it again. Since you said your son may have had something similar in the past, it’s possible that something genetic could have contributed to your daughters rhabdo.

      That said, I wonder if this might be due to the increase in exercise intensity too quickly. It sounds like she went from running a few times a week, to doing the T25 workout a few times a week and then pretty intense lacrosse workouts in a short time period. Either way, its hard to say at this point until the genetic testing results come in, so please do let me know what that says.

      I know your daughter is frustrated and wants to get back to what she was doing before but tell your daughter that she needs to give her self time before ramping up the intensity of exercise. It is too soon in my view to go back to what she was doing. As I write this, its only been a month since your daughter developed rhabdo. I believe that’s too soon to go back to running again, let alone trying to increase the intensity of her runs. I would not do lacrosse again this season.

      Did the doctors give you any guidance on when she can start working out again? if not consult your family doctor.

      Even though she is 17, I would advise her to take 3-6 months of low intensity exercise, such as what I advised others here, before increasing the intensity of her workouts. Some may say I’m being overly conservative -and I am – but that’s what I feel is best for her.

      As an aside, do tell your daughter that it sounds like she was not eating enough carbs when she was doing all that exercise. Tell her she needs carbs when she exercises. Carbs are her primary fuel source during exercise. I’m not sure if the lack of carbs contributed to her rhabdo but either way, when she goes back to working out, those carbs will help her workout better.

      I would also report what happened to the school so the coaches know about rhabdo. I have a feeling some coaches may still not be familiar with it.

      I hope some of this helps Lisa. Do keep me posted on how your daughter is doing.

      • Lisa says

        Wanted to follow up and let you know that we did in fact learn that my daughter has CPT II deficiency. (we also had my other two kids tested and they don’t have it thank goodness.) We have had multiple follow ups to the geneticist and the nutritionist who are now monitoring her case. It has been an education process for her to learn and accept that she needs to pay close attention to what she eats and when before working out and after.

        She seems to notice if she gets the rhabdo kind of fatigue and it is usually always in her legs which is where she had it the first time. We had her blood tested a month ago and she did have minor elevated levels of CK (312) so I am always worried that she is on the edge of getting Rhabdo again.

        It has been a challenge for her since she is concerned about body image and surrounded by all this high protein, low carb diet information which is not good for her particular case. I feel like I hound her about needing to take in more carbs! She still works out probably six days per week but the real test will be when lacrosse season begins in February to see if she will be able to handle the intensity of the tryout week.

        I will probably ask her doctors to test her blood frequently those first days and weeks. It’s her senior year and she is hopeful she will be able to play through the entire season this year since she had to sit out most all of last year’s season.

        • Joe Cannon says

          Lisa, thanks for the follow up. Do her lacrosse coaches and team doctor know she has a CPT II deficiency? if not, Id call them and let them know. Fatigue is something many with rhabdo have said. I wonder if that is due to the rhabdo itself or related to the CPT II deficiency? I can imagine how stressful this must be for your daughter especially at her young age. Try to make her realize that there will be life after lacrosse and high school. Let me know what happens when Lacrosse season starts.

  118. Barry says

    Joe

    Great article, I am from the UK and I think we are a bit behind in acknowledging Rhabdo as I have been searching for information as I believe I am suffering from it now.

    I did P90X for the first time on Saturday and Sunday, Saturday was chest and back which mostly involves pushups and chin-ups. Sunday was plyometrics.
    Monday I could hardly move and the muscles at the very top of my thighs are very sore as are the lower part of my biceps just above the elbow joint, I just put this pain down to overdoing it and didn’t think any more of it.

    Tuesday morning I was even worse to the point where the pain was making me feel sick, I went to the toilet for a pee and it was dark brown almost black. Straight away I thought I must be very dehydrated so I drank a litre of water. As the day progressed I continued to drink lots of water but my pee was still brown it had got lighter but was still very brown,

    I knew by this point that it was not dehydration that was causing the problem so I turned to Google. After 15min of researching “Brown urine after exercise” I was pretty sure I had Rhabdo so off I went to the hospital. I was seen to by a doctor who took a urine sample and it tested positive for haemoglobin or myoglobin (he told me that the test can’t differentiate between the two).

    I asked him if it was Rhabdomyolosis and he said it was more likely that I had burst some blood vessels in my feet and this was ending up in my urine, when I pushed him further he took to the computer and checked Rhabdo symptoms against mine and agreed that it could also Rhabdo. He then said I would need to rest from exercise for the next 2 weeks and booked me in for a blood and urine test in 2 week’s time and sent me on my way.

    Now it is Wednesday and I am feeling very weak and still sore although not as bad as yesterday but the weak feeling has defiantly got worse. My urine was a lighter brown this morning and through the course of today it is almost clear now but it still has a brown tint to it.

    The bit that still concerns me is the fact that I am to only take a blood test in 2 weeks to see if I am better, everything I have read says that treatment and diagnosis should be immediate and you should be returning to normal after a week? As my pee is slowly returning to normal does this mean that I am recovering and don’t need any treatment?

    Any advice would be great, I would go back to the doctors but as soon as you mention “I read on the internet” they quickly dismiss pretty much anything you say after that.

    Sorry for the essay.

    Barry

    • Joe Cannon says

      Barry, you are not alone because over here in the US some people report that doctors dismiss rhabdo also. My advice is to go back to the hospital again. I’d rather be safe than sorry.

      keep me posted on what happens and Im sorry this happened to you. Please consider posting my review on your social media pages, just in case you are right and people in the UK are not aware of what rhabo is.

      • Barry says

        Hi Joe

        It turns out that I did have Rhabdo, it took some persistence but I eventually got a blood test taken on the Friday evening (6 days post exercise), My CPK was 34634.

        I was kept in for 5 days and on the day of my release it had gone down to 1340.

        It is now about a month later and over the last few weeks and everything has pretty much returned to normal my CPK is now 172 and my doctor has said that I can start exercising again, he has booked me in for another blood test at the end of next week to see if there is any increase due to starting again.

        I assume there would be a small increase anyway that would happen to anybody who is training?

        Thanks for this article, without it I doubt very much that I would have persisted in getting a blood test and hence received no treatment.

        Thanks

        Barry

        • Joe Cannon says

          Barry, thanks SO much for letting me know how you are doing! I am so very glad you got to the doctor to be checked out. I also think its very wise to get another blood test the week you start working out as well. Yes I do think the exercise will increase your CPK levels a little but it should not be anywhere near 34634 it was when you had rhabdo.

          when you start back, just do a light workout – some low intensity cardio and if you lift weights, a circuit training program using light weights. Try not to feel tired when you leave the gym.

          let me know what the next blood test says too.

  119. Louise says

    Hi Joe,

    Thanks for the great article.

    I agree with Barry, the condition seems less well-known here in the UK than in the US. I hope you managed to get treatment Barry, as it certainly did sound like rhabdo.

    I was in hospital last week with rhabdo following a PT session with a new PT.

    My CK when I went in was 66000 and gradually decreased while I was on IV fluids. Today it is 214 and my Creatinine is normal.

    I had been weight-training quite intensively since February but this new PT had me do an exercise new to me – the chin-up or pull-up. I cannot even do one pull-up so he had me jumping in to them and then lowering myself slowly for the eccentric contraction.

    My arms swelled up and I couldn’t straighten my elbows the next day. Two days later my urine turned brown. I went straight to hospital but I had to fight all the way to convince the doctors and nurses what was wrong with me. One nurse in the emergency department laughed and said “You don’t look like a rhabdo patient to me” and left me waiting 3.5 hours and another nurse had never heard of the condition.

    I am now thinking about how to start exercising again when that time comes and your advice is very useful.

    I have shared my story on social media to try and raise awareness as I am so glad I was able to find what it was on the internet and fight for the right treatment. It probably saved my life!

    • Joe Cannon says

      Louise, I am so happy you are doing well today and that you got the medical attention you needed! I hope you told the new personal trainer about what happened. Please share my review with that personal trainer. he/she needs to read it to avoid accidentally causing rhabdo in others.

    • Joe Cannon says

      Larry, Only you can answer that question. I do know personal trainers have been sued from causing rhabdo. Some of their lawyers have contacted me because of this this. You got rhabdo after a demo session with a trainer?

        • Joe Cannon says

          Larry, oh, I’m really sorry that occurred! You are not alone. If you read the comments here, you’ll see people report that their personal trainers caused rhabdo accidentally also.

          Can you share with me -and others -what happened and how you learned your client had rhabdo? what kind of workout caused this? You are anonymous here so no worries.

          • Joe Cannon says

            Larry, I’d rather discuss it here so that others might learn from what happened. you dont have to name names etc and as I said you can remain totally anonymous.

  120. Robert says

    Joe,

    Thank you very much for your article. I am from Austria and I was doing an internship abroad in L.A. I was working out with my roommate (who was in a very good shape) after I didn’t do any work out for many weeks and I pushed it over my limits (combined with dehydration).

    The night after the two workout sessions on Saturday and Sunday, I couldn’t even lift my blanket or turn myself around in bed. I stayed in bed all Monday with high temperature and slept (I didn’t know that there was something like rhabdo). On Tuesday I went to the bathroom and recognized my dark urine. My roommate took me to urgent care, but they told me that I need an ER.

    In the hospital, they did a blood test and my CK-value was 70,000. In the following days I got high fevers and which did not respond well to medication combined with a pneumonia.

    A big “issue” was my mental situation, as this happened thousands of miles from home and I didn’t know what exactly happened to me, as the doctors said that my kidneys and liver are in danger.

    It took me around 6 days to get my CK-value under 10,000 (that was the value where the doctors said that my kidneys are not in danger anymore) and some more days for the fevers to vanish.

    It was an extremely hard and life-changing situation for me (I would have never thought that this could happen to me, as I am a young and healthy person). People should be more aware of this threat.

    • Joe Cannon says

      Robert, I am VERY glad you are ok! I can only imagine what that must have been like for you going though all of this so far away from home and family. I’m just really thankful that you are well today.

  121. Loyd Poplin says

    I got “rhabdo” from taking a statin drug for only 6 months. It’s been nearly 3 1/2 months since I stopped the drug and I’m still experiencing severe muscle pain in my legs, hips, groin area and lower back. My urine was never dark brown and my physician did both blood and urine tests when I was at my worst and the metabolite and enzyme levels were within normal range. I also had knee replacement surgery during this period which magnified the trauma to my body, but I am getting better each day and hopefully will fully recover.

    I am 69 yrs. old and have lifted weights since my early 20s. Rhabdo is very serious and if you are put on a statin to lower cholesterol, you need to be vigilant of any muscle pain and/or continued soreness especially if you do weight training.

  122. KS says

    I suffered from this after jumping into an intense group personal training session. This was a professional training center and after 2 days of working out I was taken to the ER. Even after repeatedly telling my Personal Trainer that something was wrong and that I didn’t feel right, I was yelled at and seemingly forced to continue.

    I eventually stopped the workout and walked out of the PT session. My kidneys began to shut down, my blood pressure dropped below a point of being able to be read. If it was not for the quick thinking of my personal doctor, who is very educated in these matters, I most likely would have died.

    It has been almost 3 years since this has happened and I am finding myself terrified to step back into form of personal training. I absolutely need it.

    I need to be healthy. But I am so fearful of trusting another personal trainer. I am terrified of them not understanding me when I say I can’t do it anymore or that I need to stop. Do you have any suggestions?

    • Joe Cannon says

      KS, I am SO sorry to hear about what happened to you and VERY disappointed at the stupid personal trainer who yelled at you and didn’t take you seriously when you said you didn’t feel right. Did you go back and tell this the training center what happened to you? What did they have to say about this?

      As for starting back, know that its common to feel the way you do after getting rhabdo. Reading through the comments here and you’ll see several others have shared your feelings.

      My thoughts on starting back first get your doctor OK and when you have that,basically just go slow. start with light activity and only do 1 workout for first week. don’t workout more than 20-30 min at first – in fact I think 20 min is best. you should not feel like you worked out afterwords. If you feel tired/exhausted then don’t work out until you feel ok again.

      start with only light cardio at first. After your first workout I think its a good idea to see your doctor afterward and let them run tests to see if that first workout did anything indicative of rhabdo again. that can also give you some psychological benefits too and may ease some of your fears.

      when you do lift weighs again, I feel using light weights and only 1 set per exercise is good to start with.

      I do not recommend you go back to that personal trainer center. If you ever get a trainer again, your first question to them is to ask them what they can tell you about rhabdo.

  123. Joe says

    Hi Everyone, I’ve written a Kindle book on rhabdo that I’m making available for free starting tomorrow 10/2/14 to 10/6/14.

    It’s called Rhabdo: The Scary Side Effect of Exercise You’ve Never Heard Of

    I’m telling all of you about it first because all of you who have commented here were my inspiration.

    I believe this is the first Kindle book on rhabdo ever!

    If you don’t have a Kindle reader, no worries, you can download the FREE Kindle for PC app here:

    http://www.amazon.com/gp/help/customer/display.html?nodeId=201245960

    If you have a Mac, here is the FREE kindle for mac app:
    http://www.amazon.com/gp/kindle/mac/download

    The book is about 55 pages long and goes beyond what I discussed in this blog post. I even covered how to exercise again AFTER getting rhabdo which is something many of you have asked about. There is a Q/A chapter too.

    I hope you find this book helpful. Honestly, it would not have been written if it were not for all of you who have commented here in the past.

    I also hope you all like the dedication too.

    • Lisa says

      I did go to the doctor and was diagnosed (after X-Ray and MRI) with having High Hamstring Tendonopathy. Very painful. With treatment for inflammation and physical therapy (and time/rest) I’ve healed!!! WooHoo! Back to running! So glad it wasn’t rhabdomyolsis pain! Thanks for the info on this site, though.

  124. says

    Hey Joe,
    My situation is lengthy and would appreciate an email to discuss more in depth. In fact this may be up your alley as when we get to the bottom of this my wife (FNP) is going to do a case study on me.

    In short: I am a 40 year old male who has been doing CrossFit for 6 years. I am a Phoenix Firefighter. I was at my fittest ever last year and my volume, work load and intensity was next to none. This year has become a nightmare for me. I was sick over the holidays with vomiting and diarrhea (December 2013). I also was only drinking coffee and no soda as I normally had.

    I then got Rhabdo January 02, 2014. This was due to pullups and was admitted with CK = 15487 four days later. I decided to quit caffeine and try to drink water going forward. I also decreased the amount of Brazilian Jujitsu training I was doing and limited CrossFit to 3 days a week now.

    Then in April I had another minor case of Rhabdo in my arms from Pullups. I let this resolve on its own and never got my levels checked. 3 weeks later I tested my blood work and my levels were high normal for everything. Then the beginning of May I developed Rhabdo again in the arms from a Push Press (I was lowering the weight slowly – eccentric) CrossFit workout. My CK levels this time were 16137 four days later.

    I felt worse this time and mentally was killing me. My workload was less than the first time but my symptoms and labs were worse. I slowly got through this and felt it was due to tapering off drinking water. My water intake had depleted over the last month and I had not drank soda or coffee for 5 months. My initial thought is I was dehydrated and causing Rhabdo to occur. I then was going to internist and PCP and they were feeding me the same thing. They had even told me to go back to drinking soda as that had probably hydrated me in the past (and I am not a water drinker).

    So I did go back to soda, coffee as well as try to drink water. I did not want to go through this again and ended up quitting BJJ. I decided to do CrossFit only 2 days a week and to really notch it down. I would drink water during the workout and even lessen the weight, workload and intensity. I started this 5 or 6 weeks after my 3rd bout with Rhabdo.

    Then came Sept. 23, 2014. I did 21-18-15-12-9-6-3 of 100′ lunges, Pullups and Situps. Nothing crazy and I was very hydrated. 84 reps of each Pullups and Situps with lunges. This would be a easy high-high intensity workout for me a year ago. My time was 7 minutes slower than the last time I did it. I finished in 18:42 while last year did it in 11:52. Rhabdo hit again! The next day my arms were locked and extreme pain.

    I went from 205 pounds to 240 pounds in a few days. My CK = 69212 four days later (9/27). My ALT = 284, AST = 906. I felt like I was dying. My levels were checked again 2 days later (9/29) and CK = 69053, ALT = 368, AST = 789. The doctors believe I peaked at CK = 110,000 (due to 1.5 day half life). The next day my labs were CK = 55098, Myoglobin, syrum = 1251, Myoglobin urine = 3884. This was 1 week later. I was fluid overloaded and feeling bad.

    I went to a Rheumatologist and all labs came back negative! I went to see a Nephralogist and my kidneys are still functioning well! I continued to get my labs drawn every other day until my levels came back to normal. Also had a Chest Xray which was negative. I finally feel somewhat normal physically although I am weaker as this year has been very limited to physical activity. I HAVE AN APPOINTMENT NEXT MONTH WITH A NEURO MUSCULAR DOCTOR THAT TOOK MY CASE IMMEDIATELY. i HAVE A ELECTROMYOGRAPHY SCHEDULED.

    I ended up getting a cough during this episode at the beginning. I would have to constantly clear my throat and it was sore. It feels like I have a golf ball in my throat and will not go away. I have since been to an ENT to scope my throat (I chewed for 20 years) and had an Ultra Sound to Lymph Nodes and Thyroid. This came back negative and ENT said I have an inflamed posterior trachea due to possible stress or GERD. No medicine has helped and won’t go away. I am seeing another ENT this Wednesday.

    Test Test Tests! My wife thinks I have a CPT II deficiency. But everything I look up on the internet (including throat symptoms) mention other serious possibilities. It is stressing me out bad. This is horrible! I would really appreciate any insight and knowledge you may have.Why all of a sudden am I going through this? I think this is an unusual case. I will keep everybody posted and would greatly appreciate contact with you.

    This is a general description to keep it short. Much more info can be shared.

    Thanks for reading,
    Paul
    Fitness Website:
    http://www.fitnessestrella.com

    • Joe Cannon says

      Paul, wow! Really sorry to hear you have been – and are still going through all of that! The stuff about not being hydrated is something I brought up in my book about rhabdo. Dehydration can make rhabdo worse but it doesn’t stop muscle fiber death.

      Based on the other stuff you were saying, I wonder if you are also dealing with over training syndrome. Have you ever kept tabs of your resting heart rate? getting sick can be a sign of this syndrome.

      My advice is to not do cross fit now until your cough gets better and you are feeling more like yourself again. That may not be what you wanted to hear but it cant hurt to try.

      • says

        Yes my resting heart rate has always been in the 50’s. I do believe I did overtrain the last 6 years but the last year I have not. I have eliminated my workload and continue to get Rhabdo. It seems to be mainly with pullups and affect my arms and lats only so far.

        • Joe Cannon says

          Paul, pull ups are very difficult and Ive met others who’ve gotten rhabdo from pull ups. As for the CPT II deficiency, doctors can check for that. unless you’ve been diagnosed with it, Id think this is more about exercise than enzyme deficiency. Have you checked your RHR recently? is it still in the 50s?

  125. Amy says

    Hi Joe, you seem the most informed about this condition than anyone we have been going to. When my daughter was 17 in 2011 she had an eating disorder and her dr did a bunch of blood work and a cpk was one of them. it was 4400 and her liver functions were elevated also. she worked out everyday but really just running and spinning. she was seen by a rheumatologist, all tests came back negative. her levels went down to 700 with less exercising and more water. They ruled out her heart and liver being the problem also.

    then in 2012 she had an episode severe pain in her lower right back that radiates to the front and had to go to the er. they pumped iv fluids in her and brought her numbers down to 700 again and discovered she had kidney stones and again last year she had the same pain no stones this time. just elevated cpk so they did another iv.

    she is 20 now and at college she started lifting weights because she cant lose any more weight she is 5 7 120 pounds. took her to a new dr and again her cpks are now 4700 and her kidney tests came back high. she still has issues with food she says she doesn’t but she has little to no carbs and eats protein bars. and lots of coffee.

    she is going for another ultrasound on her liver and going to see a neurologist. she is miserable if she cant exercise and she goes without food to make up for not burning calories. Any insight you have i would be very thankful.

    • Joe Cannon says

      Amy, as you know, I think we are dealing with more than just rhabdo here. I don’t think your daughter is overweight based on being 5’7″ 120 lbs. I think she needs to realize that being healthy is not about not eating carbs and exercising a lot. She’s got some issues with food and I think in addition to the doctors shes seeing, I think meeting regularly with a registered dietitian who specializes in eating disorders is something to consider. You can find RDs in your area by going to their website – http://www.EatRight.org here is the link http://www.eatright.org/programs/rdnfinder/ this link takes you to the “Find an RD” page of their site. just put your zip code in and they will show up (the page has a disclaimer. just click “I agree” I hate that they do that because it scares people off. That’s life in the 21st century…)

      I think also a sports medicine doctor may be warranted as well. They are usually very well versed in not only rhabdo but also eating disorders.

      I think if she hears messages about what shes doing wrong coming from people who are in authority, she might start to see the light.

      I hope this helps Amy and also hope you keep me posted on how your daughter is doing. I will say a prayer for her tonight.

  126. Joe Cannon says

    Dwayne, Thanks for the opportunity to do the audio interview! It was a lot of fun! Everybody, we do cover rhabdo in this interview.

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  1. […] Muscle sorness doestn hurt when the muscle is not being moved. This is very different from rhabdomyolysis pain which does hurt. Rhabdo is VERY serious so do read that post when you are finished […]

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