A Dangerous Pull

11 March 2022

Giving a new exercise routine a try or jumping on a new fitness trend to get your weight loss game started sounds like a good plan and rather harmless, except for maybe a day or two of muscle soreness.

Body aches and muscle soreness after exercising happens to almost everyone when you push your fitness limits. With some rest, the pain will soon subside and you’ll be able to continue with your fitness plan. However, if such symptoms persist, it could be an indication of a much bigger health concern known as Rhabdomyolosis.

Sunway Medical Centre, Sunway City Head of Accident and Emergency as well as Emergency Medicine Physician, Dr. Lee Soon Han, explains why Rhabdomyolysis should not be taken lightly and who are at risk of it.

What is Rhabdomyolysis?

It is a clinical and biochemical syndrome that results from the injury to skeletal muscles with subsequent effects from the release of the intracellular contents. The breakdown of the muscle releases myoglobin, creatine kinase, potassium and other biochemical markers into the bloodstream, leading to further harm to our organ systems.

What causes it?

Common causes are trauma or injury to our body and limbs, such as ischemic, crush injuries or compartment syndrome. Another common cause is strenuous and excessive physical activity, especially in high ambient temperatures with high humidity levels. Other causes are electrical or lightning injuries, certain bacterial or viral infections, medications, excessive alcohol intake and drugs of abuse.

Who is more prone to developing Rhabdomyolysis?

Athletes, military recruits, outdoor labourers, alcoholics and drug abusers. injuries or Compartment Syndrome.

What are its signs?

The signs are usually acute in onset. They include muscle pain, weakness, stiffness, malaise, low- grade fever and dark coloured urine. In severe cases, there can be nausea, vomiting, abdominal pain and an elevated heart rate. Changes in mental state can also happen in severe cases. Occasionally, these signs may not be present in patients with rhabdomyolysis, and it is only diagnosed later based on history taking and blood tests.

When do symptoms of Rhabdomyolysis typically start appearing?

Within two to 12 hours after the initial insult. Symptoms may last for a few days.

Is it true that Rhabdomyolysis can damage vital organs?

Yes, the biochemical markers released into the bloodstream can damage the kidneys and cause acute kidney injury. It can also cause metabolic derangements that can be harmful such as sudden changes in the calcium, potassium, phosphate or uric acid levels in the body, which can affect our heart. Our coagulation system can also be affected, leading to bleeding complications.

How can a person differentiate Rhabdomyolysis from a muscle pull?

Muscle pull or soreness commonly happens after an intense physical workout and can last for a few days. However, if the symptoms continue to persist, do not improve or are severe, rhabdomyolysis must be considered. Also, if there is muscle swelling or persistent stiffness, this may differentiate between the two.

How is Rhabdomyolysis treated?

For victims of trauma or crush injury, calling an ambulance to get proper pre hospital care is necessary. Early and rigorous intravenous fluid resuscitation is key to reduce the risk of  organ complications, while safe extrication from the site of incident prevents further injury. In the hospital, intravenous fluid therapy is continued to maintain a good urine output. Blood tests are done to look for other complications due to the elevated biochemical markers. The injured limbs will also require proper definitive treatment. If it is due to other causes such as infection, the underlying cause must be treated to prevent worsening of the rhabdomyolysis. Majority of patients respond well to treatment and may need admission for monitoring. In severe cases, urgent dialysis may be needed.

Has current exercise trends contributed to a spike in Rhabdomyolysis cases?

Any intense exercise may cause rhabdomyolysis, but recent case studies suggest that it is more likely when someone does a form of exercise that they are not accustomed to. Trends such as HIIT, crossfit, calisthenics, marathon training and other grueling exercise regimens may put a person at risk if he or she is not accustomed to such training regimens.

Trends such as hiit, crossfit, calisthenics, marathon training and other grueling exercise regimens may put a person at risk if he or she is not accustomed to such training regimens.

How can Rhabdomyolysis be prevented?

For physical exercise, we should always do it in moderation and not push our body over the limit too suddenly, especially if we are not accustomed to such intense workouts. Progress gradually in your workout program according to your own fitness level. Stay hydrated and avoid overheating during exercise. Avoid excessive alcohol intake and drug abuse.

Source: 1Twenty80