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. By some older CDC estimates, there are about 25,000 cases of rhabdomyolysis each year in America. Almost 50% of these cases are due to exercise causing it.
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.
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 30-40 sit-ups 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 rhabdomyolysis 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 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!
In a conversation I once had with a reporter researching CrossFit, I was told that many of CrossFit trainers either did not know what rhabdomyolysis was or could only give a superficial description of it. If this is true for the majority of CrossFit trainers, it means that clearly CrossFit is dropping the ball and needs to improve their education of trainers about this syndrome.
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. I’m mentioning CrossFit because their trainers have been known to cause rhabdo accidentally in the past and – to their credit – they have also 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.
What to do if faced with rhabdomyolysis?
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.
What do you think?
{ 78 comments… read them below or add one }
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.)
Thanks KC, glad you liked it!
Great article Joe
Thanks!!
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…
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!
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.
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.
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.
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.
Joe,
Good article as always. Thanks for all your great contributions to the fitness industry,.
Joel, thanks I apprecaite that!
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
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
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.
Kristen, please keep me posted. Im curious what the doctors say. My phone used to do the same to me too
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.
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.
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.
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.
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
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.
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.
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
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.
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.
I am glad to hear you have not had any more rhabdo
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.
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.
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!
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
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.
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
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.
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.
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.
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.
Anthony, thanks for writing and I do hope you get better fast! I am very glad you went to the hospital too!
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.
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!
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.
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!
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.
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!
Tamara, thank you for saying that. Yes I am sure that the idea that exercise might cause rhabdo would cause nightmares.
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~
Rain, very interesting words. I appreciate you sharing!!
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:)
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.
Hi Joe
I going through your website, I do not think you recommend Supplement which I like in loosing wt process
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)
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.
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.
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.
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.
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?
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.
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
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!
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,
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.
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.
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.
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.
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!
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
Scott, that is EXCELLENT news! I am VERY glad to hear you are out of the woods and on the road to recovery!!
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?
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?
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
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…
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.
Rebecca, keep me posted on what happens. Please DO go to the doctor. Rhabdo is nothing to mess around with.
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
Again, I called the dr. to get labs ordered.
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
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.
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.
{ 1 trackback }