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John Scott
05-08-2010, 07:36 PM
I have researched on this condition, and am still a bit confused. How does the muscle get damaged at first when training too hard with Crossfit or any other intense training? How can I prevent getting this or from someone else getting it? Does anyone know any good sites that example this better?

Charles White
05-08-2010, 07:55 PM
Welcome!

Lookie here:

http://www.board.crossfit.com/showthread.php?t=38220 (wfs)

Ciao,

Charles

John Scott
05-08-2010, 08:29 PM
Thanks, I have already looked at this site

Katherine Derbyshire
05-08-2010, 09:03 PM
Have you looked at the specific thread linked? It's a definitive resource on what rhabdo is, how to avoid it, and what to do if you get it.

Katherine

John Scott
05-09-2010, 10:26 AM
Yes, I have looked at this link. My question is I want to know how the muscle gets damaged before the myloglobin enters the bloodsteams? Im trying to understand this more.

Katherine Derbyshire
05-09-2010, 12:08 PM
Yes, I have looked at this link. My question is I want to know how the muscle gets damaged before the myloglobin enters the bloodsteams? Im trying to understand this more.

Any hard workout causes muscle damage to some degree. That's where the inflammation that causes soreness comes from, and why adequate recovery is so important.

Katherine

Diego Sommariva
05-10-2010, 03:57 AM
John, Rhabdo tends to appear when you do eccentric type exercises, this means when you are making an effort while your muscle is stretching, as opposed to the normal concentric type exercises, like biceps curls. There are a number of exercises in CF to be wary of when doing them the first few times, a couple that come to mind are GHD sit ups (you are fighting against gravity as you come down, and your muscle is stretching at the same time) and jumping pull ups (because you concentrate on the negative, again, muscle stretching while under load). Another way to get Rhabdo is to over do the intensity. Returning CFers and sports people jumping straight into CF are a danger unto themselves for this reason. The muscle tear is greater than the damage you cause it by simply exercising. FYI only human males and racehorses (or just horses, can't remember for certain now) are known to suffer Rhabdo. Interesting...

If you need anything else shoot. There are a couple of journal articles that explain this condition much better. Killer Workouts and The Truth about Rhabdo.

Diego

Katherine Derbyshire
05-10-2010, 06:58 AM
The muscle tear is greater than the damage you cause it by simply exercising. FYI only human males and racehorses (or just horses, can't remember for certain now) are known to suffer Rhabdo. Interesting...


I think I've seen at least one thread from a female rhabdo victim. Don't remember the person's name, though.

Katherine

Diego Sommariva
05-10-2010, 01:24 PM
I think I've seen at least one thread from a female rhabdo victim. Don't remember the person's name, though.

Katherine

Just repeating what's in the two articles I mentioned. I also think I've heard of a female Rhabdo victim, but also not sure. The explanation for this was along the lines of the female body being stronger in certain aspects, or being capable of filtering more myoglobin, I really can't remember now... Should read those articles again.

Diego

Frank E Morel
05-10-2010, 01:38 PM
Direct Muscle Injury
Some of the earliest reported cases of rhabdomyolysis occurred during the bombing of London in World War II. Acute renal failure commonly developed in patients wounded in building collapses.8,27 This condition came to be known as the "crush injury syndrome," and this term is often used to refer to rhabdomyolysis despite current understanding of other precipitating factors.4,15 Direct muscle trauma after natural or human-made disasters remains responsible for large-scale occurrences of rhabdomyolysis.3,7 For example, after the 1988 Armenian earthquake, more than 1000 cases of rhabdomyolysis-induced myoglobin-uric renal failure were reported; 323 of these patients required dialysis.28 Such numbers have important implications for disaster planners in bomb-or earthquake-prone regions.9,28,29

Other common causes of crushing injuries are farm and industrial accidents and motor vehicle collisions. Particularly at risk for rhabdomyolysis are patients who are entrapped and whose access to care is delayed.14 Bite injuries can macerate and devitalize large areas of muscle tissue; in one instance, rhabdomyolysis occurred after a wolf attack.30 Deep burns are another source of direct muscle damage.31 Electrical injuries, including lightning strikes, are associated with a particularly high occurrence of rhabdomyolysis because electrical current travels through the body, devitalizing tissue all along the path of the current.9,14,32 The acute necrotizing myopathy of certain carcinomas can also destroy enough muscle mass to initiate rhabdomyolysis.4

Both beatings and sport fighting, such as boxing and karate, can cause rhabdomyolysis.5 Tortured or assaulted patients, particularly those admitted to the hospital from jail, where attacks tend to be prolonged and vicious, should be considered at risk for rhabdomyolysis,4 as should victims of severe child abuse.33 Indeed, persons subject to repetitive blows of any kind are at risk. Incidents of rhabdomyolysis have occurred in bongo drum players,4 personal watercraft riders,34 computer keyboard users,35 jackhammer operators, and mechanical bull riders.25 Direct muscle injury can also be due to iatrogenic interventions. For example, a patient had rhabdomyolysis and myoglobinuric renal failure after 15 cardio-version attempts and prolonged chest compressions.36

Excessive Physical Exertion
Excessive physical exertion results in a state in which ATP production cannot keep up with demand, subsequently exhausting cellular energy supplies and disrupting muscle cell membranes.3,4,12 Rhabdomyolysis can be caused by any kind of intense physical exercise and has been documented in weight lifters, marathon runners, police cadets, and military recruits in boot camp.5,12,3741

Protracted tonic-clonic seizures not only pound the muscles repeatedly but also exert a tremendous metabolic demand that predisposes patients to rhabdomyolysis.4,12 Rhab-domyolysis due to extreme hyperactivity can occur in psychotic patients, both those with mania and those with drug-induced psychoses.4244 Rhabdomyolysis developed in an agitated patient after restraint in a straitjacket,43 in patients with delirium tremens,25 and in a patient with pronounced decerebrate posturing.45 Even racehorses are subject to a form of exertional rhabdomyolysis.46

Muscle Ischemia
Muscle ischemia, whatever its cause, interferes with oxygen delivery to the cells, thereby limiting production of ATP. Generalized ischemia from shock and hypotension are common factors contributing to rhabdomyolysis in trauma patients.9 By binding to hemoglobin, carbon monoxide causes a total body ischemia.4 Severe status asthmaticus,47 inhalation of hydrocarbons,48 and near-drowning also produce profound systemic hypoxemia,49 and each of these conditions can precipitate rhabdomyolysis.

Skeletal muscle ischemia can also be caused by localized compression.4 Sources include intraoperative use of tourniquets,50 tight dressings or casts, and prolonged application of air splints or pneumatic antishock garments,9 particularly in patients with hypotension.

Rhabdomyolysis can be caused by tissue compression due to extended periods of immobilization.2 This etiology includes immobilization related to intraoperative positioning, particularly the lithotomy position.51,52 Cases of rhabdomyolysis are common in intoxicated or comatose persons "found down" and in elderly patients unable to rise after a fall.53 Rhabdomyolysis has also been reported in a patient immobilized because of an acute spinal cord injury.54

Compartment syndrome is both a cause and a complication of rhabdomyolysis. As pressure within the fascial compartment increases, blood flow decreases, tissues become necrotic, and the dying muscle cells release osmotically active particles that draw additional water into the compartment, further exacerbating the condition.46,12

As devastating as ischemia is to tissue, evidence suggests that many of the events that eventually lead to myolysis occur during the reperfusion phase. Once circulation is restored, large amounts of toxic intracellular contents are released into the bloodstream.3,9,55 This ischemia-reperfusion treatment dilemma is a clinical conundrum for practitioners.

Muscle ischemia precipitated by arterial or venous occlusions has several causes. White clot syndrome due to severe heparin-induced thrombocytopenia,56 air emboli from diving injuries,57 and microvascular occlusion of severe sickle cell crisis or vasculitis can all affect blood flow to the tissues enough to cause muscle cell death.5,39,58

Julie DuBois
06-08-2010, 05:45 PM
I am a female and currently have my second case of rhabdo from pull ups. It happened back in October and now again. Trying to find the reason why it has happened again...My CK level is over 10,000 today. Scary!

Tamara Cohen
06-08-2010, 05:56 PM
I am a female and currently have my second case of rhabdo from pull ups. It happened back in October and now again. Trying to find the reason why it has happened again...My CK level is over 10,000 today. Scary!

How many pullups did you do? Were they unassisted, band assisted, jumping?

Katherine Derbyshire
06-08-2010, 06:05 PM
Did you program this workout for yourself, or did an affiliate program it for you? (If the former, scale more. If the latter, find a new affiliate.) And what was the workout, anyway?

Jumping pullups are a known rhabdo risk, reason being that you can keep jumping with your legs long after your arms reach total failure. There's a sticky post with other common rhabdo risks in the Running a CrossFit Facility forum:
http://www.board.crossfit.com/showthread.php?t=38220 (WFS)

Get well soon!

Katherine

Julie DuBois
06-08-2010, 06:11 PM
49 total with a green band... It was at a well respected affiliate. Not their fault by any means. I felt fine during the work out in both instances but had not done pull ups in a while and over did it I guess. Plus I dislocated my elbow somewhere in the process and that led to some of the swelling. Dr. currently has me pushing fluids and will recheck labs in the morning. If they do not come down enough, IV fluids it is. Liver enzymes are also high as a result. Luckily kidney function is OK.

The work out was 7 rounds of 50m run forward 50 m run backward 7 pull ups, 7 burpees, 7 squats with kettle bell.

Julie DuBois
06-08-2010, 06:15 PM
Both these explanations (which I have previously read) are likely the story behind my cases....I had taken off for a while with bronchitis before it happened in October and again now I hadn't done crossfit in about a month. I am a ballet dancer and athletic in that sense but lacking in upper body strength....

4. Learn to pick out people likely to get rhabdo. It has been documented that for the most part the people who are most likely to get rhabdo are either in good shape by everyone but CrossFit's standards, or who were once in good shape. People like prior athletes, prior military or law enforcement are very common. Generally, the more mentally tough the client and the more athletic the are or once were, the bigger the risk and the more you have to hold them back.


1. The final thing to watch for is people who have done CrossFit for a while, took a break and want to start up again. This is almost a sure recipe for rhabdo. I can think of 5 cases off the top of my head involving our gym and other local affiliates of people returning after a break with the mental ability to push themselves much harder than there body is able to safely accomplish. The classic story involves a woman who gave birth and came back to CrossFit, but it can happen with anyone who takes a break. The better the CrossFitter the more likely it is that they will give themselves rhabdo.

Ian Nigh
06-09-2010, 02:14 AM
I have heard of at least 2 cases of women suffering Rhabdo form CrossFit.
I wonder where this "only men and horses" myth came from? I read it in the CF journal too, and think it needs correcting.

Katherine Derbyshire
06-09-2010, 08:40 AM
I have heard of at least 2 cases of women suffering Rhabdo form CrossFit.
I wonder where this "only men and horses" myth came from? I read it in the CF journal too, and think it needs correcting.

Because women don't get rhabdo by curling 5# dumbbells, so it's inconceivable that they could get it at all? :shrug:

Katherine

Michael Dries
06-09-2010, 09:45 AM
Both these explanations (which I have previously read) are likely the story behind my cases....I had taken off for a while with bronchitis before it happened in October and again now I hadn't done crossfit in about a month. I am a ballet dancer and athletic in that sense but lacking in upper body strength....

4. Learn to pick out people likely to get rhabdo. It has been documented that for the most part the people who are most likely to get rhabdo are either in good shape by everyone but CrossFit's standards, or who were once in good shape. People like prior athletes, prior military or law enforcement are very common. Generally, the more mentally tough the client and the more athletic the are or once were, the bigger the risk and the more you have to hold them back.

1. The final thing to watch for is people who have done CrossFit for a while, took a break and want to start up again. This is almost a sure recipe for rhabdo. I can think of 5 cases off the top of my head involving our gym and other local affiliates of people returning after a break with the mental ability to push themselves much harder than there body is able to safely accomplish. The classic story involves a woman who gave birth and came back to CrossFit, but it can happen with anyone who takes a break. The better the CrossFitter the more likely it is that they will give themselves rhabdo.


Those explanations may be sound, though are you taking any medications?

Andrew Schechterly
06-09-2010, 10:05 AM
I have heard of at least 2 cases of women suffering Rhabdo form CrossFit.
I wonder where this "only men and horses" myth came from? I read it in the CF journal too, and think it needs correcting.


I know one woman personally and have heard of another through a friend who both had cases of rhabdo. I've never heard that men and horses thing.

Jamie J. Skibicki
06-09-2010, 10:08 AM
THe only person I've met in person that had rhabdo was a chick. I don't want to know about men and horses.

Julie DuBois
06-09-2010, 10:10 AM
I Take meds but none that cause rhabdo. My ck level is up to 14,267 today so I'm currently in the ER getting IV fluids... Not fun!

Carlos Cristan
06-09-2010, 10:15 AM
Antibiotics or statins?

I have heard the male/racehorse thing but I don't believe the language read only; it was something like most common in...

Julie DuBois
06-09-2010, 05:33 PM
It is not medication related according to my doctors. Just overdid it...I'm now admitted in the hospital on my 4th bag of IV fluids. Hopefully the levels will be down enough tomorrow to go home!

Ian Nigh
06-10-2010, 03:20 AM
I wish you a speedy and full recovery Julie. Hopefully we can all learn from your experience...

Julie DuBois
06-10-2010, 07:53 AM
Thank you Ian! CK levels are going down, just waiting on the doctor to review them and see if I can go home! Lesson learned---I will probably not do pull ups ever again!! Not worth it in my opinion!

adam adkins
06-10-2010, 08:15 AM
Thank you Ian! CK levels are going down, just waiting on the doctor to review them and see if I can go home! Lesson learned---I will probably not do pull ups ever again!! Not worth it in my opinion!

Julie I would highly recommend you look at changing your programming all together. This "go as hard as you can all the time" mentality is clearly not the bes for you - 2 cases in just over 6 months is ridiculous.

Back way off and look at Pavel power to the people, rite of passage, and program minimum.

You have got to break this cycle before you cause even more damage.

Darrell E. White
06-10-2010, 08:59 AM
Julie, there are actually some medical conditions that predispose to rhabdomyolysis. just doing pull ups, even lots of pull ups (assuming that you are not doing negatives, of course), really shouldn't give you Rhabdomyolysis. by strong suggestion would be to visit a physician, probably a kidney specialist, and ask for a workup specifically looking for underlying genetic or metabolic things that might predispose to this problem. Expect a bit of lab work, some of it probably expensive, as well as a muscle biopsy.

Good luck. Let us know how things turn out. We really are interested in really do hope the best for you.

--bingo

Julie DuBois
06-10-2010, 12:28 PM
Julie I would highly recommend you look at changing your programming all together. This "go as hard as you can all the time" mentality is clearly not the bes for you - 2 cases in just over 6 months is ridiculous.

Back way off and look at Pavel power to the people, rite of passage, and program minimum.

You have got to break this cycle before you cause even more damage.

What is Pavel power to the people? The scary thing is that I was not "overdoing it" in my opinion. It did not feel difficult and I was not more fatigued than normal. I agree that I will need to change my approach since this has happened.

Bingo, plans have already been made to see a rheumatologist after I get out since they think it may have an autoimmune factor. I have Celiac disease which is an autoimmune disorder and they said that there could be a link somewhere that we need to investigate. I completely agree, as does my primary care physician, that this shouldn't happen just from doing pull ups. Frustrating none the less since I have been active all my life and I absolutely hate being bed bound! Thank you for the get well wishes and I will keep you guys posted....hopefully I can figure out a way to keep incorporating crossfit into my workout regime without causing any further damage since I really do enjoy it and the benefits, rhabdo aside.

Jamie J. Skibicki
06-10-2010, 03:19 PM
Power to the people is a book on weightlifting written by Pavel Tsatsouline. It's a good book (I own it and used the program), though I think Starting Strength is superior. I would get SS first then PTP.

Ahh, what are your goals?

Emily Seabridge
06-11-2010, 03:34 AM
Julie, you seem to be in pretty good spirits considering Crossfit tried to kill you. Feel better!

Matth Challoner
06-11-2010, 03:46 AM
Julie, you seem to be in pretty good spirits considering Crossfit tried to kill you. Feel better!

:rofl:

seriously thought hope you find out the problem Julie,
Good Luck!

Julie DuBois
06-11-2010, 01:25 PM
Finally home and out of the hospital 8 bags of fluid later!! Levels were still around 4000 when they let me go home, but he said to continue to drink lots of water and follow up with my doctor... Thank goodness that it didn't effect my kidneys!