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Uncle Rhabdo

posted by Missy

Just a reminder that there’s still spots open for the Functional Movement Screen! For more info and instructions on how to sign-up read here. For those of you that weren’t able to make these dates (because you said you have more important things to do with your weekend????) I will be holding additional dates in mid-late December.

Today’s post is not meant to scare you all away from working out and pushing yourself, but it’s still a serious topic that should be addressed. Uncle Rhabdo has been introduced into some older posts, but I wanted to go more into signs that you should look for and what you should do if you or someone else suspects it. It sounds like a cute name, but we’ll see how you feel after this post…

High intensity exercise is still good!

Inspiration for this post came from my experience with 2 athletes a few months ago. I will spare the names, and they ended up being fine, but they came in for a hard workout following a week of being sick and deconditioned. They rocked the workout, of course, but suffered severe muscle pain immediately after, in addition to vomiting, and low back pain. Forrest and I monitored them and made sure they hydrated immediately. They recovered pretty quickly, but still felt like they had been beat up the rest of the day. Could they have had a visit from Uncle Rhabdo? Possibly, but they recovered relatively fast and did not require a trip to the hospital, so no tests were done. I know they had a good wake-up call and realized that their bodies just weren’t ready for that type of workout following their workout hiatus/being sick.

What is Uncle Rhabdo?

This is CrossFit’s term for Rhabdomyolysis. Rhabdo is a disease of the muscle that involves excessive breakdown of the muscle cells, leading to the following cell contents being spilled out into the blood stream:

  • Myoglobin…toxic to the kidneys and steals oxygen from the blood
  • Potassium… toxic to the kidneys and heart in high doses
  • Sodium + calcium….leading to swelling and possible compartment syndrome
  • Creatine Kinase

Uncle Rhabdo isn’t such a cute name anymore huh?

What are the signs and symptoms? (following an intense workout)

  • generalized or specific myalgia (aka muscle pain)
  • muscle tenderness
  • fever
  • nausea
  • vomiting
  • dark urine
  • low back pain (the kidneys can refer pain to the low back)

*Depending on the extent of damage done, most treatment includes immediate hydration through IV. Kidney dialysis may be administered as well, depending on the extent of damage.

 

Muscle tears are a normal part of exercise, to a certain extent. More info from a post a while back by Sean here. However, it’s the excessive tearing of the muscles that causes the above list to be found in the blood in higher levels than the body can tolerate.

Other causes of increased muscle breakdown:

  • Dehydration….increased muscle breakdown from….
  • Increased core body temperature (environment, overweight or un-fit people working at an inappropriate intensity).
  • Severe collisions from a car accident, football games or falls in the elderly.
  • Caffeine also increases core body temperature (so maybe that ginormous coffee, after a night of drinking, right before Saturday’s WOD, is not the best idea)

Obviously the above mentioned happens quite frequently, which means that there must be varying levels of rhabdo because death is a rare occurance. Football teams have had urine tests that show varying degrees of rhabdo following preseason (high intensity workouts following a long rest period, in addition to heat). Then there are those that have died playing football from heatstroke, most likely a resultant of rhabdo. There have also been non-athletes who have done intense workouts (CrossFit and others) that have similar experiences and end up in the hospital for immediate treatment.

Are there long-term effects?

The answer to this is really unclear. I’m continuing to research this but most of what I have read states that long-term effects are unknown. Most of the research so far is looking into the the effects of chronic rhabdo because this is a common thing among high intensity athletes. My thoughts are that repetitive damage to the body like this can’t be good….

Additional risks for getting Rhabdo

  • Rhabdo is most often observed with novel, strenuous, overexertion…..those of you that take months off and then come in to try to find your Fran PR.
  • Use of statins (cholesterol reducing medication; some evidence that they increase the normal levels of creatine kinase following exercise).
  • African Americans have a greater genetic predisposition to muscle breakdown, so hydration is important
  • Diets high in grains (not completely sure why right now…)
  • Electrolyte imbalances (dehydration, but also drinking too much water with not enough minerals/vitamins in it to help your body absorb the water)
  • Hormonal imbalances (sounds like this just throws your body out of whack)
  • Lactic acidosis (increased muscle breakdown)
  • Vitamin E and selenium deficiencies
  • Cocaine
  • Creatine kinase supplementation can put you at more risk for dehydration, so make sure you take it with the recommended amount of water.

(This is a bunch of info, so I’m putting the links/references at the bottom if you’re interested)

Evan, ready to battle Uncle Rhabdo with his pvc

Take home message:

  • remember to prepare your body before and after workouts, especially with proper hydration (post on hydration in the near future)
  • listen to your body
  • if you experience any of the above signs/symptoms following a tough workout, just let someone know. Better to be safe than sorry.
  • The goal of this post was to promote awareness on the topic and give you guidance of what to look for, as well as what you should do if you
  • Don’t be afraid of the workouts or freak out if you have low back pain after a workout. Well it’s still not good that you have low back pain….but you know what I mean. Just listen to your coaches and your body.

Important addition from Cody:

Rhabdo is often caused by a sudden, and drastic increase in the VOLUME AND INTENSITY of loading on your muscles, which causes muscle breakdown so severe that your body cannot physically recover. Eccentric motions (pull-up negatives, squats) under heavy loading are especially damaging to muscles, and therefore increase the chances of rhabdo, so these should be avoided in high amounts when first starting, or re-starting, exercise programs.
Thus, listen to your coaches about scaling back a workout when they say to, better to be safe than sorry when coming back to they gym after a hiatus.

References:

1. ACSM position stand on Exercise and Fluid Replacement

2. http://sportsillustrated.cnn.com/2010/writers/david_epstein/08/24/haynesworth.rhabdo/index.html

3. CrossFit Seminars Training Guide

4. http://www.livestrong.com/rhabdomyolysis

______________________________________________________________________________

Workout of the Day 11/18/2011

A. Freestanding Handstand/HSPU Work

Accumulate either 1 minute freestanding or 3 minutes against the wall

HSPU: 5-5-5 (No Bands Allowed, Scale with Negatives, Boxes, or Regular Pushups)

* If you haven’t done your Back Squat 5-5-5 from Monday, do it today instead of Part A

B. For Time:

30 Handstand push-ups (Scale Reps and Difficulty as Needed, No Bands)

40 Pull-Ups

50 Kettlebell Swings (24kg/16kg)

60 Sit-Ups

70 Burpees

Jay Rhodes: 12:14

FUNdamentals

A. Cardio Drills

2 Rounds:

1 min butt kicks

1 min high knees

1 min speed skater

1 min ski jumpers

1 min rest

B. 4 Rounds

300m Row

20 Ball Slams

10 Knees to Elbows

Firebreather WOD

10 Slam Balls (40/30)
10 Box Jumps (30/24)
40M Farmer’s Carry (110/70)

20 Slam Balls
20 Box Jumps
80M Farmer’s Carry

30 Slam Balls
30 Box Jumps
160M Farmer’s Carry

  • http://www.facebook.com/devin.cody.rice Cody Rice

    Hey guys,
    Rhabdo is often caused by a sudden, and drastic increase in the VOLUME AND INTENSITY of loading on your muscles, which causes muscle breakdown so severe that your body cannot physically recover. Eccentric motions (pull-up negatives, squats) under heavy loading are especially damaging to muscles, and therefore increase the chances of rhabdo, so these should be avoided in high amounts when first starting, or re-starting, exercise programs.
    Thus, listen to your coaches about scaling back a workout when they say to, better to be safe than sorry when coming back to they gym after a hiatus.

  • Missy

    Well said Cody

  • http://www.facebook.com/kelly.hover1 Kelly Hover

    “so maybe that ginormous coffee, after a night of drinking, right before Saturday’s WOD, is not the best idea” …. oops.

  • Missy

    Yep Kelly…..we are all guilty of that….I think the muffin helps re-hydrate though??

  • http://www.facebook.com/kelly.hover1 Kelly Hover

    hah! absolutely – the Java Man knows what’s up.

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