Rhabdomyolysis Symptoms, 5 Causes, Risk Factors + Treatment

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Several years ago, awareness of rhabdomyolysis, also called rhabdo, increased when people started experiencing rhabdomyolysis signs and symptoms during intense exercises like spin classes and HIIT workouts.

Although rhabdomyolysis can be caused by things other than exercise, understanding exertional rhabdomyolysis, rhabdomyolysis symptoms during workouts, and how to treat rhabdo is exceedingly important for athletes who engage in vigorous workouts.

It is also important for beginners alike who are just starting to work out and might take on too much too soon in terms of their workout program.

So, what are the symptoms of rhabdomyolysis? What are the risk factors for rhabdomyolysis? How do you treat rhabdomyolysis, and what does rhabdomyolysis recovery look like?

In this guide, we will discuss what rhabdomyolysis is, its causes, rhabdomyolysis symptoms, and how to treat rhabdo so that as soon as you detect rhabdo signs, you can quickly implement strategies to prevent dangerous sequela of rhabdomyolysis.

We will look at: 

  • What Is Rhabdomyolysis?
  • Rhabdomyolysis Symptoms
  • What Causes Rhabdomyolysis?
  • What Are the Risk Factors for Rhabdomyolysis?
  • Rhabdomyolysis Treatment

Let’s get started!

A person burnt out on the floor with rhabdomyolysis symptoms.

What Is Rhabdomyolysis?

Rhabdomyolysis (pronounced “rab-doe-my-ah-luh-suhs”), often abbreviated to the easier term rhabdo, is a dangerous condition in which your muscles start to break down or disintegrate acutely.

Not only does rhabdo lead to the death of the muscle tissue itself, but it can also be toxic to the body and potentially fatal.

When the muscle tissue starts breaking down when you are experiencing rhabdo, toxic components from the muscle fibers that are disintegrating enter your bloodstream.

Since muscle tissue is biological tissue, you would think that the body could handle muscle tissue breaking down without experiencing toxicity.

However, rhabdomyolysis muscle breakdown causes dangerously high amounts of intramuscular substances such as creatine kinase, myoglobin, urate, phosphate, and potassium to leach out of the muscle and into the bloodstream.

A person at their desk with a headache.

Because the kidneys filter all of the blood and help remove toxins, these toxic muscle components infiltrate the kidneys.

These compounds can damage the kidneys or cause kidney failure if the kidneys are unable to process them quickly enough or the concentration of these muscular components is too high for the processing rate of the kidneys.

According to the Cleveland Clinic, rhabdomyolysis can cause kidney damage, which may be irreparable and ultimately fatal, depending on the extent of the muscle breakdown and how long it takes to seek treatment after the initial rhabdomyolysis symptoms set in.

Rhabdomyolysis complications may not be isolated to irreparable kidney damage but can still be serious.

Other complications of rhabdomyolysis include electrolyte imbalances that can be dangerous for the heart, compartment syndrome in the affected muscles, metabolic acidosis, and disseminated intravascular coagulation.

A person holding their sore shoulder.

Rhabdomyolysis Symptoms

Recognizing rhabdomyolysis symptoms and signs is crucial for preventing the escalation of this potentially life-threatening condition.

One thing to be mindful of is that rhabdomyolysis signs and symptoms can range from mild to severe and early detection is the best strategy for how to treat rhabdomyolysis with the most favorable outcomes.

Therefore, it is important to really pay attention to how your body is feeling, particularly if you have risk factors for rhabdomyolysis in general outside of exercise.

Then, in terms of exertional rhabdo with working out, do not let your ego or workout goals supersede your ability to tune in to how your body is feeling such that you might overlook warning signs of rhabdomyolysis when the beginnings of potential rhabdo symptoms start to take hold.

In other words, if you think you are displaying signs of rhabdo after exercise, rather than hitting the gym when you are still sore or hoping that the potential rhabdo symptoms you are experiencing are just normal post-workout muscle soreness, you should seek medical attention immediately.

A person holding a sore calf.

Symptoms of rhabdomyolysis typically appear 1 to 3 days after the muscle injury occurs, though it can vary depending on what caused the muscle breakdown, the particular muscles involved, and a confluence of other factors that impact the severity and timeline of rhabdomyolysis.

The primary signs and symptoms of rhabdomyolysis include the following:

  • Muscle swelling and inflammation 
  • Muscle pain or significant muscle soreness
  • Muscle tenderness, particularly when touched, squeezed, or contracting the muscle
  • Muscle weakness 
  • Muscle stiffness or difficulty moving
  • Dark-colored urine that may appear brown, orange, red, tan, or tea-colored

In addition to the aforementioned rhabdomyolysis symptoms, there are additional symptoms that may or may not be present and are generally less definitively diagnostic from a clinical standpoint since they can be brought on by a host of other conditions.

Some of these additional rhabdomyolysis symptoms include the following:

  • Decreased urine output
  • Nausea and/or vomiting
  • Dehydration
  • Confusion
  • Headache
  • Dizziness
  • A feeling of general weakness 
  • Loss of consciousness
A person who feels nausea.

What Causes Rhabdomyolysis?

Although most people associate rhabdomyolysis with exercise, there are additional rhabdomyolysis causes to be aware of.

Here are the primary causes of rhabdomyolysis:

#1: Trauma or Injury

Traumatic injuries or severe injuries are among the most common causes of rhabdomyolysis outside of exercise-induced rhabdo.

Crush injuries, such as those that occur when someone is run over by a vehicle or injured by materials on a construction site, are one of the most common causes of rhabdomyolysis.

Severe burns or electrocution can also cause rhabdo.

In any of these cases, muscle fibers break down rapidly, which exceeds the capacity of the kidneys to process the toxic load coming from the compounds flooding the bloodstream from the disintegrating muscle fibers, leading to the symptoms of rhabdomyolysis.

A person who has fallen during a workout at the gym.

#2: High-Intensity Exercise

High-intensity exercise in and of itself will not necessarily cause rhabdomyolysis in all cases, but exertional rhabdomyolysis, or exercise-induced rhabdomyolysis, is becoming increasingly common.

Rhabdo, after working out, typically occurs when someone pushes themselves too hard and does not take adequate time to recover.

In this way, rhabdo from working out is most common among beginners who jump into a high-intensity exercise class like CrossFit workout or HIIT workout and don’t listen to their body, pushing themselves too hard and causing too much muscle damage in the process.

Rhabdomyolysis can also occur in trained endurance athletes who do an extreme endurance workout without adequate recovery or training for the event.

A runner passed out on the ground in the heat.

#3: Heat Illness or Severe Dehydration 

Cases of heat exhaustion, heat stroke, or severe dehydration can all be potential rhabdomyolysis causes because the kidneys need sufficient blood volume in order to process any toxins in your blood. 

Working out in extremely hot conditions or exercising when dehydrated magnifies the risk of rhabdo because you have the exercise component plus the heat/dehydration risk factors for rhabdomyolysis compounding one another.

#4: Medications and Medical Conditions 

Certain medications and medical conditions can cause muscle breakdown, leading to rhabdomyolysis.

Examples include certain antipsychotic medications, antiviral medications, statins, or genetic conditions like Duchenne’s muscular dystrophy or McArdle disease.

#5: Drug Use

Drug abuse (cocaine, heroin, even large amounts of alcohol) can cause muscle deterioration, and the drugs themselves are toxic to the body, overloading the ability of your body to process toxins.

A person sitting on a plyometric box, tired.

What Are the Risk Factors for Rhabdomyolysis?

Based on the primary causes of rhabdomyolysis, there are several key risk factors for rhabdomyolysis.

Here are the main rhabdomyolysis risk factors:

  • Being an endurance athlete or a competitive athlete who does high-volume, high-intensity workouts without enough rest between sessions.
  • Being new to exercise with an aggressive mindset or the ability to tune out how your body feels and push yourself too much.
  • Working out or pushing your body in hot and humid conditions, either in the case of exercise-induced rhabdomyolysis or with jobs like firefighters or those who do physical labor in hot environments.
  • Being in military boot camp or working in the military, either trying to push yourself to keep up or doing physically taxing jobs in heavy combat gear or hot clothing.
  • Being elderly.
  • Taking certain medications.
  • Having underlying kidney disease.
A person feeling dizzy.

Rhabdomyolysis Treatment

Generally, the steps for how to treat rhabdomyolysis will depend on the severity of your condition. 

Intravenous fluids are generally required to help flush out toxins. 

Most people who are diagnosed with rhabdomyolysis have to stay in the hospital for a few days in order to receive adequate IV hydration.

Dialysis for the kidneys may be necessary when kidney damage has occurred.

Physical therapy can help you strengthen the muscles after they have healed enough to continue your rhabdomyolysis recovery.

Remember, early detection of rhabdo is key to successfully treating rhabdomyolysis and protecting your kidneys. 

Seek immediate medical attention if you are concerned that you are potentially experiencing signs of rhabdo, particularly after working out.

To help determine if it’s too hot to run outside, click here.

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Photo of author
Amber Sayer is a Fitness, Nutrition, and Wellness Writer and Editor, as well as a NASM-Certified Nutrition Coach and UESCA-certified running, endurance nutrition, and triathlon coach. She holds two Masters Degrees—one in Exercise Science and one in Prosthetics and Orthotics. As a Certified Personal Trainer and running coach for 12 years, Amber enjoys staying active and helping others do so as well. In her free time, she likes running, cycling, cooking, and tackling any type of puzzle.

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