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Original Issue

When Pain Surpasses Gain

How to avoid the wrath of rhabdo

TWO WEEKS AGO three Oregon football players—offensive linemen Doug Brenner and Sam Poutasi and tight end Cam McCormick—were hospitalized after intense off-season workouts, and The Oregonian reported that at least one of them had rhabdomyolysis, a condition in which muscles break down rapidly and release the enzyme myoglobin (and creatine kinase) into the bloodstream. Rhabdo—as it's known—can cause severe muscle pain, swelling, discolored urine and kidney damage or even kidney failure.

The affected Duck isn't alone. In August, eight female volleyball players at Texas Woman's University were treated for the condition, and in 2011, 13 Iowa football players were hospitalized after an intense workout. "When you work out you do small amounts of muscle damage and that's fine, that's what makes you stronger. Your body repairs it and that's when hypertrophy occurs," says Michael J. Joyner, an expert in human performance at the Mayo Clinic. "But if you do too much and really break the muscle down, that's where the myoglobin gets in your system."

If it happens to college athletes working with professional trainers, how can regular gym-goers know how hard to push without putting themselves in danger? Some evidence shows that people with certain neuromuscular diseases or the sickle cell trait can be more susceptible. But Dr. Joyner says that for most people paying attention to four key factors can limit the risk of developing rhabdomyolysis.


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Jumping on Detrain

Often rhabdomyolysis occurs when people have taken time off then jump back in, Joyner says. Novice exercisers need to use caution, but even elite athletes who are coming off an extended break—known as detrained athletes—are at risk if workouts aren't adjusted. "Instead of doing 10 minutes of X on day one and 20 on day two and so on, they will go right back into 60 minutes of intense work," he says. "The key is to start slow and build into things."

Don't Be Eccentric

Also known as negative training, eccentric exercises are slow, downward movements that lengthen the muscle rather than contract it. (During a dumbbell curl, the eccentric movement is the lowering of the weight.) This technique allows athletes to train until failure, but Joyner warns that these movements can be particularly taxing, especially when done at high intensity and volume or after a break from working out.

Square Route

Trainers call a sudden and dramatic change in the style and/or intensity of workouts a square wave approach—referring to how such a routine would be charted. An athlete might suddenly dive into a Navy SEAL routine or maxed-out weight work. That change can cause problems. Joyner says that such situations often arise when competition is introduced to a fitness routine, either against another person or in a quest to set a personal record.

Drink to Your Health

Fitness experts often point to the importance of hydration even on off days, so it's little surprise that insufficient fluids during a particularly intense session can cause distress and contribute to the onset of rhabdo. "Adding concurrent heat stress or dehydration to [the aforementioned factors] can make matters worse," Joyner says. "And because dehydration reduces blood flow to your kidneys, it makes it harder for your kidneys to flush out the myoglobin."