Regular exercise helps build muscles. As people throng into gyms, pushing themselves to build muscle mass and achieve a certain ideal of a fit physique, they may end up overexerting without even realizing it. Exercise addiction is also a pitfall, along with a serious issue that jeopardizes the original goal itself: muscle breakdown due to overexertion.
Yes, exercise, if done indiscriminately, is one of the causes of rhabdomyolysis or breaking down of muscle tissues.
“The muscle breakdown is caused by various factors: trauma, excessive muscle exertion, certain medications, drug abuse and metabolic disorders,” says Dr Anil R Patil, consultant arthroscopy surgeon and sports medicine specialist, Sparsh Hospital, Bangalore. “It results in the release of myoglobin [a muscle protein] and other muscle components in the bloodstream.”
Symptoms and adverse effects of rhabdomyolysis
The mild symptoms include muscle pain, muscle soreness and cramps. Dark urine is also an indicator.
“Increase in the levels of the creatine phosphokinase enzyme in the blood and myoglobin protein found in urine indicates rhabdomyolysis,” says Dr Siddharth Shah, consultant, orthopedics and joint replacement surgery, SL Raheja Hospital, Mahim, Mumbai. “In severe cases, rhabdomyolysis causes renal failure. The electrolyte imbalance [because of the release of muscular content into bloodstream] can cause abnormality in the heart rhythm, which can be life-threatening and can result in death too.”
The swelling of the damaged muscle can lead to compartment syndrome in which there is a cascading increase in the inter-compartment pressure, resulting in nerve compression and muscle death.
“Rhabdomyolysis could trigger a systemic inflammatory response leading to disseminated intravascular coagulation, which is a condition characterized by widespread blood clotting and bleeding,” adds Dr Patil. “Also, it could lead to a condition called metabolic acidosis where the blood becomes too acidic, impairing bodily functions.”
Exertional rhabdomyolysis
Physical activity, exercises and workouts are necessary to stay healthy. But time constraints and busy lifestyles mean many people prefer working out at a stretch, in one intense session. This can result in exertional rhabdomyolysis.
“Exertional rhabdomyolysis, which is the most common type of rhabdomyolysis, is caused by excessive or strenuous physical activity,” says Dr Shah. “For example, it is seen in an athlete who runs a marathon without adequate training. If someone is de-conditioned and increases physical activity quickly in a short time, instead of increasing it gradually, then they can also develop rhabdomyolysis. This fatigues the muscles and cause them to break down.”
Planning key to prevention
Workouts must be planned based on the FITT principle or the progression principle, considering the frequency, intensity, type of exercise and duration. It’s also necessary to keep the fitness level of the person in mind.
“Try to gradually build up the intensity of the physical activity,” says Dr Shah. “Dehydration, consumption of alcohol prior to intense strenuous physical activity or even certain cholesterol-lowering medications can increase the risk of rhabdomyolysis. So, ensure adequate hydration and avoid alcohol and medications before physical activities to reduce the risk of rhabdomyolysis.”
People engaging in extreme endurance sports or fitness activities are at risk of rhabdomyolysis due to the intense and prolonged muscle exertion involved.
“To mitigate this risk, listen to the body’s signals of fatigue,” adds Dr Patil. “It is very important to incorporate rest days into schedules to allow for muscle recovery.”
Treatment of rhabdomyolysis
The treatment for this condition focuses on hydration.
“The person is given intravenous fluids like saline to ensure that the substances released into the blood after the muscle breakdown are cleared from the body,” says Dr Shah. “If the kidney is not functioning properly then one might have to undergo dialysis to remove the toxic products.”
Dr Patil adds: “Monitoring and correction of electrolyte imbalances is necessary. Addressing the underlying cause — such as discontinuing medications contributing to muscle breakdown — should also be done.”
Takeaways
- Rhabdomyolysis is a condition in which the muscles break down, releasing myoglobin and other cellular components into the bloodstream.
- This results in muscle weakness and soreness. In severe cases, it can cause renal failure and electrolyte imbalance, which results in abnormal heart rhythm.
- Exertional rhabdomyolysis is caused by overt exertion during strenuous physical activities.
- Treatment focuses on ensuring proper hydration and removing toxic components from the bloodstream.
