rhabdo???

[John Scott]

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]

Welcome!

Lookie here:

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

Ciao,

Charles

[John Scott]

Thanks, I have already looked at this site

[Katherine Derbyshire]

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]

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]

Originally Posted by John Scott

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]

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]

Originally Posted by Diego Sommariva

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]

Originally Posted by Katherine Derbyshire

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]

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.5,12,37–41

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.42–44 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.4–6,12

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