Understanding Rhabdomyolysis (Rhabdo) – A Real Risk of Spinning Classes

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

No pain, no gain. It is an old expression that we all find ourselves believing from time to time, and there is certainly some truth to this timeless adage. If you want to achieve your goals and reach new heights, sometimes you do indeed need to push yourself beyond your comfort zone — but not too hard! The risks of spinning classes and other intense workout routines like HIIT and bouldering are all too real.

Pushing yourself too hard can lead to a painful (and increasingly common) condition called rhabdo. It is a real threat to inexperienced and overzealous fitness fans, but it is entirely preventable in many cases.

Here is your complete guide to rhabdo, along with an expert overview of the risks of spinning classes and other workout routines. 

Why Rhabdomyolysis Is Making Headlines

You may have heard of rhabdo, or rhabdomyolysis as it is formally known. You may have even known a new spinning class devotee who has been affected by this increasingly common condition. But, what is rhabdo? Most important of all, how can you prevent rhabdo and other workout-related problems? Before you take on your next intense sweat session, you are going to want to read this guide.

When you start a new workout routine, you can’t give up as soon as you start to feel sweaty and tired. As many new fitness fanatics have discovered, however, the risks of spinning classes and other intense sweat sessions like running can cause serious damage such as foot pains. Namely, you can end up with the painful condition of rhabdo that is often caused directly by pushing yourself too hard during workouts.

You might be interested in our article where we discuss how to determine the severity of your injury.

What Is Rhabdo?

Rhabdomyolysis, also known as rhabdo, is a condition that causes your muscle tissue to break down quickly. The myoglobin in your body along with other muscle cell components is released into the bloodstream. When this myoglobin is introduced into your bloodstream, you are at risk of a serious or potentially fatal condition of rhabdo.

When muscle tissue deteriorates during overly intense workouts, myoglobin is released into your bloodstream. Myoglobin is a protein that is present in muscle cells and perfectly harmless when your body is functioning properly. When myoglobin is flowing in your bloodstream, it is then filtered by your kidneys and eliminated in your urine. This process in and of itself is not damaging to your body, but when myoglobin is released in large quantities as it is during rhabdo, you have a serious health concern. This is a very basic overview of what is going on when you have rhabdo.

Is Rhabdo Common?

Rhabdomyolysis is a serious medical condition commonly associated with spinning classes. While it is a rare condition, it has become more widespread and better known since the jump in popularity of spinning classes. Likewise, as Pelotons became the must-have workout item and people started to use old fashion stationary bikes at home during the pandemic, doctors around the globe have seen a spike in the cases of rhabdo reported around the world.

While we often associate rhabdo with spinning, the increase in rhabdo cases started with the increased interest in working out in general. Despite this increase in the number of cases, rhabdo is not considered to be a common condition. And, while people often think of it as one of the risks of spinning classes, it isn’t tied to any exact sport or movement but is instead a result of overtraining.

Who Is at Risk for Developing Rhabdo?

Though rhabdomyolysis is not considered to be a common condition, certain people under particular conditions are at a higher risk for developing it than others. The issue is closely linked to a few key underlying risk factors that make it more common for those who are at risk for muscle damage or deterioration.

Here are some of the groups that are at a higher risk for developing rhabdomyolysis:

  • Athletes: When you take on a rigid workout routine and regularly do strenuous exercises like F45 or pilates, or participate in endurance events, you have an increased chance of developing rhabdomyolysis. This is particularly true when you are completing without sufficient training.
  • Military: Doing rigorous training and pushing yourself too hard after a traumatic injury are some of the common reasons why soldiers have an increased chance of rhabdomyolysis.
  • Drug users: Certain types of drugs like cocaine, amphetamines, and heroin cause muscle deterioration, which then raises the possibility of rhabdomyolysis.
  • People with muscle disorders: If you are dealing with metabolic myopathies or muscular dystrophies, you are more prone to rhabdomyolysis. Your odds are further increased if you are doing an intense workout plan.

It is important to note, however, that anyone can develop this condition and you may have risk factors that you don’t realise. Each case is different so it’s crucial to get properly tested if you have any reason for thinking that you may be affected by rhabdo.

What Causes Rhabdo?

Rhabdomyolysis can be caused by a range of activities, lifestyle factors, and other conditions that harm or destroy muscles. While each circumstance is different, there are a few common causes of rhabdo, including the following:

  • Sudden trauma: Rhabdomyolysis is sometimes caused by severe muscle damage. This can come on suddenly during a wide range of accidents, falls, and direct trauma. During any kind of trauma that causes prolonged muscle compression, the oxygen and blood flow to tissues is limited and this can cause rhabdo.
  • Long-term immobilisation: Muscle breakdown is a potential effect of having your muscles compressed during any kind of long-term immobilisation. This happens in cases of prolonged bed rest, a coma, or being trapped during a catastrophic event.
  • Extraordinary physical exertion: Your muscle fibres can be damaged if you push yourself too hard with intense physical activity. When you are improperly prepared, which is the case of people new to spinning classes who are ready to push themselves by their limits, you are at risk.
  • Heat exposure: When you are facing extreme heat exposure and potential heat stroke, you are more likely to develop rhabdomyolysis. You are also likely to suffer from heat injuries so it is important to stay in the shade whenever possible and drink lots of water to prevent dehydration.
  • Drugs: Illicit drugs like cocaine and amphetamines, as well as some prescription drugs like cholesterol-lowering statins, can increase your risk of rhabdomyolysis.

What Are the Symptoms of Rhabdo?

Rhabdo’s symptoms can vary from person to person. The severity of these symptoms is often linked to the underlying cause as well as the extent of the muscle damage. While it is impossible to do a rhabdo diagnosis online, there are a few typical symptoms and signs of rhabdomyolysis that you should look out for:

  • Muscle pain: In most cases, severe muscle pain, tenderness, and stiffness are the very first symptoms. Sometimes the pain feels very acute and you can pinpoint its sources, maybe pain in the hips, or wrist aches. In other cases, you might experience discomfort throughout your entire body.
  • Muscle weakness: Your muscles may feel weak if you’re suffering from rhabdo. While a bit of weakness after a tough workout is common, it shouldn’t impair your ability to do daily tasks over a long period of time. 
  • Urine discolouration: Dark or red-brown is one of the key telltale signs of rhabdo. This colouring is caused by myoglobin, a muscle protein, being present in your urine.
  • Less urine: On top of changing the colour of the urine, rhabdomyolysis can reduce the amount of urine that your body produces. This makes it more important than ever to stay properly hydrated.
  • Fatigue: Feeling generalised discomfort and chronic fatigue is linked to a wide range of conditions so it’s tough to pinpoint rhabdo from this alone but it can help guide your diagnosis.
  • Swelling and tenderness: Your muscles may seem swollen or inflamed to the point where it is painful to touch if you are suffering from this muscle breakdown. If you are experiencing swelling in your joints, it could be arthritis or a possible ankle injury, which is best checked by an orthopaedic doctor for proper treatment.
  • Nausea and vomiting: Rhabdomyolysis can cause a range of gastrointestinal issues like nausea and vomiting as your body deals with the byproducts of this muscle breakdown.
  • Confusion: In extreme cases of rhabdo when your kidney function is seriously affected, you may experience confusion, disorientation, or even fainting.

As always, it is crucial to keep in mind that the rhabdo symptoms vary in each case. If you think that you may have rhabdo, it is essential to see a doctor. Likewise, if you have any of the symptoms listed above (which can be the symptoms of other conditions as well), you should see an orthopaedic doctor as soon as possible.

If you are experiencing pain in the knees, perhaps you might want to get a diagnosis from our orthopaedic doctors at Ray of Health and seek knee pain treatment if neccessary.

Can Rhabdo Cure Itself?

No. In most cases, rhabdomyolysis won’t cure itself and requires medical attention. When you are dealing with a muscle breakdown, there is a toxic substance in your bloodstream that, if left untreated, can have serious health consequences.

While mild cases of rhabdomyolysis do sometimes improve with adequate hydration and rest, it’s crucial to see a doctor regardless of the severity. On top of treating the condition, you also need to identify the underlying cause of your cases of rhabdo and be able to keep an eye out for any potential side effects.

Ultimately, you can’t properly assess the condition without professional help. Quick medical attention is vital to avoid complications like kidney failure or long-term kidney damage.

Related Read: Can ACL Tears Heal Itself?

How Is Rhabdo Treated?

Rhabdomyolysis treatment is focused on managing symptoms as well as assessing the underlying cause, stopping further muscle deterioration, and handling any related complications.

While there are different approaches to rhabdo treatment, depending on the severity of the condition and your health background, there are a few common rhabdomyolysis treatment methods that you can expect including the following:

  • Hydration: To help your kidneys to flush out myoglobin and other toxins, proper hydration is essential. Proper hydration also helps with muscle cramps, which is known to help you perform better athletically to burn fats and build more muscles.
  • Intravenous fluids: To help to ensure that your fluid intake and urine output are as high as possible, sometimes intravenous fluids are required.
  • Electrolytes management: Rhabdomyolysis can throw off your body’s electrolyte balance. Managing your electrolytes is a central part of rhabdomyolysis treatment so your doctor may need to track and treat electrolyte imbalances, like abnormal potassium or calcium levels.
  • Addressing the underlying cause: It’s important to figure out the underlying cause of your muscle breakdown. In this case, we would recommend an MRI scan. Dealing with the underlying cause might mean changing your prescription medication, treating any possible infection, or simply adjusting your lifestyle.
  • Monitoring kidney function: To calculate the extent to which your kidney has been affected by the muscle breakdown, it may be necessary for your doctor to do a range of ongoing tests. This may include keeping an eye on your kidney function, measuring how much urine you are producing, and doing blood tests to measure the creatinine level of your bloodstream.
  • Pain management: Rhabdomyolysis can cause intense muscle pain in some cases. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other painkillers can help manage pain and reduce discomfort as you’re healing. At Ray Of Health, we also offer other services like treatment for rotator cuff injury or torn meniscus treatment.

How Can I Prevent Rhabdo?

Although rhabdomyolysis can’t always be avoided, there are steps you can take to reduce your risk. Here are some precautions that you should keep in mind if you have risk factors or have had the condition in the past:

  • Pace your workouts: Your workout progression should be slow and steady. If you want to try out a new workout, it is crucial to increase the duration and intensity gradually. Be cautious as you give your muscles the chance to get used to the new demands. Whether it is a new routine or you are getting back into the swing of things, take it slow to prevent sports injuries like tennis elbow or even shoulder dislocation.
  • Keep hydrated: Staying properly hydrated is paramount and it is one of the easiest things that you can do. This is especially important when you’re doing a strenuous workout or anytime you are exposed to extreme heat. Make sure that you always stay hydrated before, during, and after exercise. If you are sweating, focus on dehydration because it is the building block of proper muscle function.
  • Listen to your body: Pay attention to your body’s signals. If you feel intense muscle pain, weakness, or fatigue, your body is trying to tell you that it is important to take a break and rest. Don’t push through that extreme discomfort! It will only increase your risk of muscle injury and rhabdomyolysis.
  • Pushing too hard in extreme conditions: If it is extremely hot or humid, be especially careful when you are doing any kind of physical activity. High temperatures greatly increase your risk of heat-related illnesses, including rhabdomyolysis. Be mindful to consistently take breaks, stay in the shade, and look to proper hydration.
  • Use proper technique: When you are working out or lifting weights, it is essential to always use proper form and technique. You can minimise your risk of straining or injuring muscles while boosting your results if you know what you are doing. Talk to a trainer or coach to learn the proper techniques as you build healthy habits. You can also consider some light exercises to relieve back aches and improve shoulder mobility.
  • Check your medicines and dietary supplements: Some medicines, such as statins, which are used to treat high cholesterol, can increase the risk of rhabdomyolysis. If you are taking any medicines or dietary supplements, you should talk about their potential side effects with your doctor.
  • Be aware of your risk factors: Along with understanding the risks that your medication and lifestyle may pose, it’s important to consider your health background. If you have a history of muscle disease or previous cases of rhabdomyolysis, or other medical conditions like bruising easily, it is vital to stay conscientious.
  • Focus on prevention and early diagnosis: While prevention is key, it is also important to be aware of the symptoms of rhabdomyolysis so that you can treat it as early as possible. Remember that severe muscle pain, weakness, or dark-coloured urine after exercising has your key symptoms to watch for. Early diagnosis and treatment can help to prevent complications and speed up your recovery time so stay vigilant.

Treating Rhabdo in Singapore

Rhabdo is not a condition that you can ignore. While it can start as a minor condition, it can get significantly worse with time. If you have any reason to believe that you have the condition or are suffering from symptoms that you can’t pinpoint, don’t delay. Visit our Singapore clinic today to get on the path to recovery with comprehensive treatments like PRP injections and shoulder pain treatment.

Check out our other articles:

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Dr. James - Orthopaedic Surgeon in Singapore

About the Author

Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

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