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Old 04-18-2008, 10:06 AM   #1
Christian Mason
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My girlfriend has Rhabdo

(This was written for a climbing email list whe, so some of the references to Crossfit may be obvious to you guys)

Last Tuesday. Rayna and I did the workout below.

5 sets for time of
{30 GHD sit-ups
25 back extensions }

We scaled it to 3 sets, I took around 8 minutes, she took just under 11.
The next day we both had pretty serious abdominal soreness. Hers was worse than mine though - she could not stand fully erect and it hurt to breath. I pointed out the possibility of rhabo and suggested that she hydrate heavily and watch for discolored urine. (there was none).

The soreness gradually diminished over the next few days, however around Friday she noticed some swelling in the abdominal area. At this point we were concerned that there might be a minor muscle of ligament tear, but decided to wait and see how things progressed.

By Sunday night the swelling was about two inches thick (i.e. she looked pregnant) and had moved down to the pelvis area. We went to the ER.
As I mentioned before, there isn't a definitive line for rhabdo. However, generally a CPK level over 200 is considered high. The ER doctors indicated that they would want to hospitalize someone who was above 10,000. Rayna's was 70,000. They strongly suspect this was not its peak, and that it may have been as high as 80-85K before she checked in.

They started her on IV fluids and did a CT scan to try and determine the cause of the swelling. They also told her to plan on being in the hospital for a few days, and that surgery might be necessary. Initially they thought the swelling was due to an infection, but there was no obvious way for the area that was holding the fluid to have gotten infected.

This case will probably make its way into medical journals since it's so unusual. The CT Scan showed that the fluid was between the two layers of adnominal muscle. This is also pretty odd, since normally it's above the muscles, or in the abdominal cavity itself.

Rhabdo is fairly rare from exercise anyway, and very rare from short intense workouts. The Crossfit community is aware of about 6-8 cases of crossfit induced rhabdo. It's even more rare to get CPK levels that high from working a small muscle. Marathon runners who trash the big muscles in their legs can release much more protein into the blood for obvious reasons.

Her doctors were able to find only 3-4 cases of Rhabdo from abdominal exercise, all with much lower CPK levels. They are still not completely sure what the cause of the swelling was.

The good news is that 36 hours of IV fluids brought her levels down to the mid 20,000 range, and they discharged her. She's not able to do ANY exercise for about 2 weeks, and they expect it will be 4-6 weeks before she can return to high intensity training.

Another significant factor is training density. Lately, with school and work demands, Rayna had only been able to workout a few times a week.
Previously she had managed 3-4, in addition to our climbing.

To those of you who have experience with this. What is in intelligent schedule to return to normal activity? Her ER doctors admitted that they don't know.


-- Chris
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Old 04-18-2008, 10:20 AM   #2
Joey Powell
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Re: My girlfriend has Rhabdo

Doesn't sound like Rhabdo. Sounds like the story Coach tells of sit-up king rupturing the abdominal wall and his sack swelling up like a cantalope from GH sit-ups.
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Old 04-18-2008, 10:36 AM   #3
Susie Rosenberg
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Re: My girlfriend has Rhabdo

It does sound like rhabdo: basically all that means is dumping of muscle proteins into the circulation secondary to rupture of the muscle cell wall. In exertional rhabdomyolysis, it's due to the damage done by the mechanical forces on the muscle tissue.

It's not uncommon around Crossfit parts to hear people complain of severe DOMS following GHD situps. (Rhabdo exists on a continuum of damage to muscle fibers, it's not an "all or nothing" thing) There must be something about the arrangement of fibers of the abdominal muscles, or the way the shearing forces are applied in the GHD situp to account for all this. (Since I've been hanging out here, arms from pullups and abs from GHD seem to be the more common rhabdo-related sites/exercises. If the word "common" can be applied to so uncommon a phenomenon.)

We've had a number of people have excessive pain after GHD situps, so we've gotten a bit more cautious introducing people to the exercise, and we've insisted that newer folks scale the reps on the thing.

I wish I could tell you how long and how much is safe to do, but I don't know. All I can say is she should come back slowly and cautiously. You can get it again.

Best wishes for a speedy recovery.

Susie
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Old 04-18-2008, 10:41 AM   #4
Christian Mason
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Re: My girlfriend has Rhabdo

I think the elevated CPK levels are a pretty certain indication of Rhabo.

Some other injury to the muscles is possible/likely though, since the doctors had trouble explaining the fluid retention. It also moves. Since the muscles funnel things downward. I.e. if she stands for a long time the swelling moves to the pelvis/genital area. If she lays down, it moves to the abs.

Glad we scaled this one to three sets. I don't want to think about the shape she'd be in if she did all 5.
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Old 04-18-2008, 10:46 AM   #5
Joey Powell
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Re: My girlfriend has Rhabdo

Susan and Christian fair enough. Never seen it like that. The one time I saw i it was a general feeling of garbage into extreme discomfort all over and later heard his lower back/kidneys hurt alot trying to process all the waste from muscle protein break down. I did not see him after he left for medical care, do that was hear-say.

Either way sounds extremely painful. I know all of my guys were extremely sore for days from that workout.

Thanks for the clarification
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Old 04-18-2008, 04:58 PM   #6
Steven Low
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Re: My girlfriend has Rhabdo

Christian: if you search back through the threads on rhabdo here in the injury there's actually quite a few more than the 6-8 cases (that were like 3+ years ago anyway). People have had CPK levels of over 100,000 in some cases. More common than rare definitely IMO.

There's something about those GHD situps that really rape people. Jumping pullups with the forced negatives too.
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Old 04-19-2008, 12:45 AM   #7
Kirez Reynolds
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Re: My girlfriend has Rhabdo

That same workout inspired two other threads of abdominal injury. I responded and added myself as one of the walking wounded. For me it's now been 15 days; 2 days ago I was able to hang from a bar and lift my knees toward my chest -- pretty exciting progress. This morning I did Tabata Something Else, and was able to do 10 sit-ups in each of the 8 sit-up rounds. Slow and very weak and very sore, and scared to push it, but recovering.

I also had some of the swelling but mine only lasted about a day and a half.

I'd like to point out that DOMS was not really the case here. For me the extraordinary pain and soreness was immediate. As soon as I finished the workout, i couldn't use my abs, couldn't walk normally, etc, and kept worsening for another 2.5 days. I didn't have normal mobility for at least 8 days, could not sit up normally from bed or supine until yesterday.

The good news is, I'm able to do situps now. So ---- while your gf's injury seems to have been worse than mine, it seems a case of degree and not kind, so hopefully she'll also be able to recover mobility and some strength in a few weeks. I'm bothering to tell you this because I was worried about my own recovery time, afraid I might be healing for 6-9 months, as another comment I had read suggested. I believe there's reason for optimism and hope.

Last edited by Kirez Reynolds; 04-19-2008 at 12:47 AM..
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Old 04-20-2008, 04:50 PM   #8
Christian Mason
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Re: My girlfriend has Rhabdo

Steven - thanks for the clarification.
CPK levels over 100,000 are pretty impressive though, or at least my girlfriend's doctors were surprised that she was able to get hers as high as she did from a core workout.

I also wanted to thank everyone for the recovery wishes. She's doing pretty well now, just going crazy because she's not supposed to workout (at all) for another week or so.

-- Chris

Last edited by Christian Mason; 04-20-2008 at 04:51 PM.. Reason: spellcheck is good kids, mmmkay
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