Tips to Prevent Rhabdomyolysis

By Coach Brad McLeod June 13, 2022. Updated Sept 22, 2024.

Rhabdo. That affliction that is the nightmare of athletes who are stricken.  This condition can strike quickly and with little warning. In recent years there has been an uptick in conditioned athletes that are susceptible to this issue.

This disease is relatively rare and tends to be found in endurance athletes. Other high risk groups are firefighters, military, fitness training and older people.

CAUSES

Engaging in intense physical activity beyond the body’s capacity, particularly in untrained individuals, can lead to rhabdomyolysis. Activities such as extreme endurance exercises, marathon running, or excessive weightlifting can strain the muscles and result in muscle breakdown.

This is a serious condition that is life threatening and needs to be diagnosed quickly to keep you from further harm.

Check out these tips to help you prevent Rhabdomyolis (AKA Rhabdo) and stay healthy in the gym or on your next big race.

DRINK WATER

The disease can be prevented by drinking plenty of water. Keeping well hydrated after exercise will help dilute out urine. Plenty of fluid intake helps kidney to clear myoglobin. During exercise, keep water accessible. Drink water when thirsty and never wait for the thirst to increase. If you think you are going to engage in a higher risk endurance event – make sure to drink water the night before.

Warning signs are dark-colored urine, caused by a substance known as myoglobinuria. Be careful not to over-hydrated which can also create problems.

AVOID REPETITIVE MOTION
I have witnessed several cases of rhabdo within various fitness gyms and groups. A common thread is that these athletes all engaged in repetitive motion. In particular the observation was for those athletes that used eccentric motion.

Examples of eccentric motion is described as performing ab situps on a Glute-Ham Developer (GHD machine). Another example is performing pull ups with a weight vest or weighted backpack. Jumping pull-ups are notorious for taking out victims.

All of these motions have an eccentric pull that accelerates muscle tissue tearing. This torn muscle tissue is what enters your blood stream and begins to cause major issues as your body tries to dispose of the waste.

If you work out in a gym that is educated in rhabdo – the coaches will be designing programs that will not put you at risk for this issue. Warning signs are extreme muscle soreness.

Combining eccentric motion for a long period of time with warm temperatures and dehydration and you have a recipe for human disaster.

SLOW DOWN

If you think that you are at risk that may be a cue its time to slow down. It is time to take a rest break in a shady area, cool down and pour water on your head. Massage your fatigued muscles and allow your body to process the torn muscle tissue. If you are in a race – it is ok to stop and allow your body to process waste. You do not want to end up in the local emergency room with a case of this.

DONT EXERCISE TO EXHAUSTION

There has been a trend in the past decade to exercise to exhaustion. That is ok once or twice a week if you are an elite athlete and training for a big event. Exercising to exhaustion every time you workout is not a good recipe in anyone’s book.  Taking care of your body means making sure that you are having proper rest and sleep cycles.  We do believe in high intensity workouts but not exercising to exhaustion during a workout – every single time.

DURING A RACE

If you are in a long distance endurance race that is a different story. Your are a highly conditioned athlete and have trained hard all year long. You are on a 300 mile race in the mountains at altitude. You are trying to push to the next check in station that is miles away. You are on your second day of a five day race. Your goal is to make it to the next station but are becoming more dehydrated under the intense sun. As endurance athletes we are trained to push past the point of exhaustion while training in hot conditions. How do we know when to push forward vs stopping for a rest? If you believe you have the slightest form of rhabdo then make a preventative measure and rest and hydrate. Find the nearest aid station and do not keep going.

STAY FIT

Another great method to prevent rhabdo is to stay fit throughout the year. Be ready for anything at anytime.  Athletes that have been on the couch for an injury or have just been out of a hard training cycle are also susceptible. This athlete goes too hard when they return to the gym on their first workout and that is when the condition hits.

Who are the athletes are most risk?

According to Dr. Leon Chang (CrossFit owner and an MD specializing in anesthesiology), is former athletes who are out of shape. He says, “An ex-military individual or former CrossFitter are perfect examples. These people have pushed hard before and they have the mental toughness to keep going when their bodies say stop. Unfortunately, they are physically de-conditioned and no longer equipped to handle such high intensity. This is a recipe for rhabdo, and for those people, we watch them very carefully, and make sure they don’t push too hard on their first few workouts.”

COMPLICATIONS

Rhabdo is a serious condition that is life threatening. As an athlete or coach you need to be aware and how to treat.

If untreated for a prolonged period it may lead to Electrolyte abnormalities, Hypoalbuminemia, Hyperuricemia, Compartment syndrome, AKI and renal failure, Disseminated intravascular coagulation (DIC, a late complication).

These are all very serious conditions. Make sure you are able to see the warning flags and can take corrective action to keep the athlete safe at all times.

Question from SGPT Athletes

QUESTION: Can you get rhabdo from CrossFit?

ANSWER: Yes; you can get rhabdo from CrossFit, but you can also get it from many other exercise programs. There of many stories floating around the gym about someone who got rhabdo. CrossFit has an unofficial Rhabdo Mascot, Uncle Rhabdo.

In past years you have seen more CrossFit coaches begin to take this matter more seriously and design programs that are less prone to this condition. It is also your responsibility as an educated athlete to know the signs and how to avoid.

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