Know When to Stop

My son’s bout with rhabdomyolysis shows the dangers of overdoing extreme training.

“I never thought it could happen to me, Dad,” my son Scott wrote to me in an email. “I never thought I could actually work out too much.”

My son is referring to his recent bout with rhabdomyolysis (“rhabdo”), the breakdown of muscle fibers that leads to the release of muscle-fiber contents, including myoglobin, into the bloodstream. Myoglobin (a protein), according to the National Institutes of Health, is harmful to the kidneys and often causes kidney damage. This condition can be a result of overtraining that puts unwanted stress on the kidneys, leading to infection. If not treated early, rhabdo can put you in the hospital on dialysis in order for your kidneys to recover.

Relentless physical activities such as CrossFit may cause serious internal damage if you are not conditioned to a high-intensity/high-impact interval routine. Scott is an avid weightlifter and even wrote his own personal story for this very magazine regarding his foray into the fitness world, so he’s already in shape, yet he still developed this problem. Here’s why.

Nonstop Intensity

While living in Los Angeles working as an actor, Scott wanted to stay fit and not look bulky on camera, so he picked up a copy of my book “Lean & Hard: The Body You’ve Always Wanted in Just 24 Workouts.” In it, I discuss how high-intensity interval training (HIIT) can preserve muscle mass while burning fat. This program is ideal for achieving that shrink-wrapped look that so many fitness-magazine cover models possess.

Entered into a proper cross-training program, my son was exercising for 45 minutes of strenuous, high-intensity activity every day, with only an occasional rest day. Many people in these programs train daily and, in fact, some twice a day (which I don’t completely recommend).

However, Scott went from a weightlifting routine with little cardio to a HIIT program without the proper conditioning. Before starting HIIT, you need to ease yourself into the activity. Start twice a week and slowly build up to what you believe you can safely handle.

By performing a HIIT workout every day, my son was not allowing his body to fully recover. What are the signs? His urine appeared to have blood in it, he was fatigued and he felt an almost constant light-headedness. Believing it to be serious, he went to the emergency room.

Don’t Ignore The Symptoms Of Rhabdo

According to the “2013–14 NCAA Sports Medicine Handbook,” the symptoms of rhabdomyolysis include:

• Muscle pain more severe and sustained than expected.
• Swelling of muscles and adjacent soft tissues.
• Weak muscles, especially in the hip or shoulder girdle.
• Limited active and passive range of motion.
• Brown-colored (like Coca-Cola) urine from myoglobin.

A physician will confirm the diagnosis by documenting an elevated creatine kinase (CK) level based on the gender, race and activity history of the patient.

Blood tests determined that Scott did, in fact, have rhabdo and he would need to seek treatment. Thankfully, his condition was caught at the beginning stages and was treated by lots of rest and plenty of rehydration (as rhabdomyolysis can cause dehydration).

However, had he kept going and not checked into the emergency room, he might be looking at a more serious recovery. Kidney dialysis is not something a 26-year-old should have to face, but unfortunately, studies have shown it’s all too common to contract rhabdo in HIIT programs like CrossFit. I think more trainers need to be aware of rhabdo and should know more about the causes, symptoms and how to avoid it.

Becoming More Common

A recent Huffington Post story chronicled the disturbing outcome of a physical therapist who pushed herself into a rhabdo diagnosis by overdoing a CrossFit program: “While in the emergency department, they tested her creatine kinase level … [which] was more than 45,000, a number that indicated damage to the kidneys.”

According to Arthur Siegel, MD, associate professor of medicine at Harvard Medical School, “Rhabdo is virtually universal in marathon runners who continue to exercise after ‘hitting the wall,’ i.e., when intracellular glycogen stores are depleted. This injury to skeletal muscle triggers a systemic inflammatory response, which initiates the repair process (no pain, no gain), but can also have adverse consequences.”

In August 2010, NFL.com reported that then Washington Redskins defensive lineman Albert Haynesworth “experienced the symptoms of rhabdomyolysis. … Those symptoms included dizziness, nausea, vomiting and muscle swelling. He was treated by team doctors, with rhabdo-myolysis believed to be the likely cause.” Haynesworth’s case was not extreme; he was limited in practice and played the second half of the Redskins’ next preseason game against the Ravens.

But you shouldn’t wait until it gets that bad. Tulane University head athletic trainer Andrew Massey says, “Exertional rhabdomyolysis is a preventable situation. Properly planned, incremental increases in exercise intensity and duration is the key to prevention, especially at the start of a season or after time off.”

Massey says drinking water is an important part of preventing the condition, and athletes, coaches and trainers should make it a priority for all concerned. “Hydration is very important [because] in my experience, dehydration is usually a factor. There will always be isolated incidents of this condition, but multiple presentations from one team at the same time should not happen.”

So what should you take away from all of this? Rhabdomyolysis is a serious condition and it is one that is self-induced. Know your limits, train smart and always hydrate. Take it from my son: It’s scary news to receive that you’ve got rhabdo, but you can prevent it.