Mirth and Motivation

“It’s a common misconception that only unfit or out-of-shape people get rhabdo. People in great shape, such as firefighters, marathon runners, and professional athletes, get rhabdo. It can happen to anyone, even after activities you have done before without a problem.” Emergency Medicine Clinical Team, Centers for Disease Control and Prevention (NIOSH)

Motivation Mondays Rhabdo Update: Essential Warning Signs for Everyone

The condition can also result from injuries, seizures, certain infections, and some medications or drugs. For example, cholesterol-lowering statin medications have been linked to rhabdomyolysis, although this side effect is uncommon. The higher the dose of the statin drug, or if there is severe underlying dehydration, the greater the risk to the kidneys. Dr. John Graves, MD, Nephrology and Hypertension, Mayo Clinic News Network

People also falsely believe dehydration causes rhabdo. Dehydration doesn’t cause rhabdo, but it can make it worse. Dehydration impairs the body’s ability to get rid of the proteins and electrolytes in the bloodstream released from damaged muscle. These proteins and electrolytes cause organ damage.Emergency Medicine Clinical Team, Centers for Disease Control and Prevention (NIOSH)

It can happen when extreme effort combines with other risk factors: heat, dehydration, painkillers like ibuprofen, a recent virus, or a hidden genetic condition… Dr. Sohaib Imtiaz, Chief Medical Officer, People

On the Illusion of Physical Invincibility: As athletes, educators, and coaches, we must prioritize health literacy alongside our physical training. I invite you to read this latest update on my journey, research, and lessons learned from rhabdomyolysis; please share it with your local running, fitness, and family communities, and commit to listening to your body every single day. Rhabdomyolysis, or rhabdo for short, can happen to ANYONE. Many people think it happens only to extreme sports enthusiasts or workers, like firefighters, in pressure-cooker environments. We need to read the CDC and other reports so we don’t dismiss those signs when they happen to a family member or us.

Whether we are pushing through the final miles of a marathon, shoveling heavy snow, working a double shift in the summer heat, or recovering from a severe virus, human beings pride ourselves on toughing it out. As a runner, I see marathon running as the ultimate test of human endurance, and I know firsthand how easy it is to celebrate hitting targets and pushing past “the wall.” Still, my dedication to pushing through pain should never come at the cost of my life.

Similarly, people in heavy, manual labor-intensive jobs should watch for changes in their bodies, as the intensity could trigger an exertional rhabdo episode. We all need to remember that a life-saving difference exists between normal physical fatigue and a medical crisis. Unfortunately, while athletes have a higher propensity for developing rhabdo, no one is immune.

Recently, Rachel Apa, a 24-year-old former Division I field hockey player, collapsed near Mile 24 during her first-ever New York City Marathon and passed away from severe rhabdomyolysis after experiencing rapid, catastrophic muscle breakdown during the race. Her family described her as being in perfect health. The heartbreaking news spread quickly through the Internet and served as a somber reminder of a silent threat: rhabdomyolysis (rhabdo). Rhabdo is a condition, not a disease, that occurs when damaged skeletal muscle cells break down and release their contents, including myoglobin, creatine kinase (CK), potassium, and other substances, into the bloodstream. In severe cases, this process can disrupt the body’s chemistry and damage the kidneys. Complications can include acute kidney injury, compartment syndrome, dangerous electrolyte abnormalities, abnormal heart rhythms, and even death.

Knowing the line between grit and danger is one of the most critical skills we can bring to any physical challenge or race. It is a fine line, and many of us cross it from time to time; however, becoming acutely aware of the implications and potential medical crisis can save our lives.
READ: Motivation Mondays | Rhabdo: Warning Signs for Runners
Motivation Mondays: Running Marathons While Navigating Health Challenges

” There are several common causes of rhabdomyolysis, including medications (statins, SSRIs, diuretics), heat stroke, or any injury where the body is crushed (such as a car crash). But the one you’re worried about is intense exercise. Professor William Roberts, writing for Runner’s World

Motivation Mondays Rhabdo Update: Essential Warning Signs for Everyone

There are two distinct pathways: traumatic and non-traumatic. Traumatic rhabdo can be caused by blunt force, electrical shock, or crush injury. However, non-traumatic causes are far broader. Skeletal muscle tissue can break down from simple blood flow restriction or prolonged immobilization—such as when an individual is bedridden or unconscious following an accident—causing muscle cell walls to rapidly break down and leak toxic waste into the system. Dr. Boyd W. Haynes III, MD, Orthopedic Sports Medicine Specialist.

It is difficult to predict who will develop exercise-induced rhabdomyolysis before a race … The most important risk factor is unusually strenuous or unaccustomed exercise, particularly a sudden increase in training intensity or volume. Even well-trained athletes can develop rhabdomyolysis under extreme physical exertion. Dr. Marie Vangstad, Oslo University Hospital in TIME

Typically, in the strength training adaptation phase, you create a little bit of injury to the muscle, but the strength comes from when that muscle heals itself, and you recover. Rhabdomyolysis happens when you create more injury to the muscle than your body can adapt to. Dr. Chad Asplund, Orthopedic Surgeon, Mayo Clinic Minute

Key Warning Signs for Everyone: Rhabdomyolysis is a highly dynamic condition. What I learned firsthand is that rhabdo is never a static, “one-and-done” condition; instead, it is a fast-moving, constantly evolving process where your health, symptoms, and lab results can change drastically from one hour to the next. Warning signs can vary greatly from person to person. Still, there are some consistent ones to watch out for: extreme muscle pain, weakness, swelling and stiffening of the muscles, dark urine, dizziness, fainting, and an overall feeling of profound body changes, even extreme fatigue that shows as a loss of physical control or a strange sensation of floating out of your own body. I experienced some of these, but not all at once.

When my muscle tissue broke down, the aftermath triggered a multi-day chain reaction where cellular damage kept building and vital blood markers, like Creatine Kinase (CK), became moving targets. I was in the best shape of my life when it happened, and it was my 14th marathon with no prior incidents.

While a single blood test is the standard for diagnosing rhabdo, it only captures a tiny snapshot in time, and those numbers can skyrocket hours later before they finally peak. This fluid, shifting nature is also why the most dangerous complications often develop slowly. You might feel relatively stable when you first arrive at the hospital, only for your kidneys to come under severe, progressive stress 24 to 48 hours later as fluids aggressively shift into your injured muscles. Surviving rhabdo taught me that you cannot measure this condition by how you look or feel in a single moment; you have to closely watch the trajectory of where it is going.

To help look out for yourself, your training partners, and your loved ones, it is vital to understand the direct indicators of severe muscle breakdown that demand immediate emergency care:

• Extreme, deep muscle pain: Pain or throbbing that feels far more intense than standard delayed-onset muscle soreness (DOMS) or typical cramps.
• Severe swelling or tightness: A firm, “locked up” feeling in the limbs, often accompanied by a visible loss of muscle function.
• Profound, sudden weakness: An inability to lift or move the affected limbs, or a sudden, unexplained drop in physical capability.
• Coca-Cola or Tea-colored urine: A classic hallmark of rhabdo indicating that muscle breakdown products are overloading the kidneys, which can quickly escalate to acute kidney failure.
• Systemic symptoms: Sudden nausea, vomiting, severe dizziness, or an elevated heart rate that does not stabilize with rest.

What are some Actionable Prevention Tips? While no one’s risk can ever drop completely to zero, medical professionals emphasize several primary defensive behaviors for both athletes and everyday life:
• Gradual mile progressions: Avoid sudden, drastic jumps in physical exertion. Whether you are increasing your weekly running mileage (keep adjustments capped at a stable 10% increase) or tackling a strenuous weekend project like heavy yard work, moving furniture, or taking a high-intensity class for the first time, give your muscles time to adapt.
• Respect heat, humidity, and pacing: Heat and humidity drastically amplify muscle breakdown rates, whether you are racing or working outdoors. In warm climates, ditch rigid pace or productivity goals, take frequent shade breaks, and listen to your body.
• Intentional hydration and electrolytes: Don’t wait until you feel dizzy to drink. Formulate a steady hydration habit before and during prolonged activity or hot weather. Drink small amounts frequently rather than chugging massive volumes at once, and include sodium and electrolytes to maintain balanced cell integrity.
• Never push through an Illness or Injury: Do not exercise or do heavy physical labor while fighting a viral or bacterial infection. An active fever or lingering dehydration significantly lowers muscle cell stability, leaving your body highly vulnerable to acute trauma.
• Know your medications and medical triggers: Rhabdo isn’t always caused by movement. Certain prescription medications (such as statins), dietary supplements, prolonged immobility after a fall, or extreme dehydration can trigger muscle breakdown. Always review new medications with your doctor and seek care if unusual muscle pain develops.

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