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What Runners Should Know About Rhabdomyolysis

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There is a long list of injuries runners must be aware of and try to avoid during their training programs. Unfortunately, some come from accidental situations such as a trip and fall, while others can be directly prevented. Overtraining is often the cause of many of these injuries such as muscle and ligament tears and bone stress fractures. Keeping the muscles strong and gradually increasing exercise intensity and mileage are the key to helping prevent these conditions. One less common diagnosis runners are aware of is rhabdomyolysis. This condition is known to be common in bodybuilders and other athletes who train at extremely high intensities on a consistent basis. Since runners tend to train intensively at times, it is important to be aware of the signs and symptoms of this diagnosis and how you can prevent it.

What is Rhabdomyolysis?

Also known as rhabdo, this condition is when myoglobin and other muscular components get leaked into the bloodstream with muscle breakdown. Myoglobin is the protein that stores oxygen in the muscles. Some examples of causes and risk factors are:

  • too much high-intensity exercise, such as bodybuilding, when the body is not properly conditioned
  • prolonged training in the heat and heat stroke
  • crush injuries such as during a car accident
  • certain drugs and prescription medications

Marathoners are at a higher risk than other athletes due to their prolonged time spent running in the heat. Faster marathoners are considered to be at the highest risk due to their faster paces equating to a higher intensity workload.

Signs & Symptoms

The signs of rhabdomyolysis can be initially subtle as they mimic other medical conditions and overuse injuries. Muscle weakness, fatigue, and soreness are usually the first signs of this condition. Athletes usually fail to get diagnosed properly as many are accustomed to feeling sore and tired after hard workouts for several days. The difference is that the symptoms of rhabdomyolysis do not get better as regular soreness does. Infrequent, dark-colored urination, fever and nausea are often experienced as well. Muscle swelling is also a common result from the tissue breakdown and can lead to compartment syndrome, which is a serious medical emergency.

Are Runners Really At Risk?

Rhabdomyolysis is not a common condition in runners, but may very well occur in some circumstances. Athletes affected with electrolyte imbalances, hypothyroidism, certain infections, and medication use are at a higher risk of developing rhabdo if precautions are not taken. Runners who perform higher intensity training sessions such as sprinting and plyometric-type exercises may put themselves at risk if their bodies are not accustomed to these workouts. The same goes for runners who also perform heavy weight lifting, especially eccentric-type exercises. An example of an eccentric move is the slow lowering of a bicep curl—basically when there is high resistance without contraction.


The simplest way to prevent rhabdomyolysis is to gradually incorporate high-intensity exercise into your routine. For runners, this means making sure to stick with the rule of only increasing mileage by 5% to 10% each week. The same percentage rule applies to increasing speed work. You should not go from performing 4×400 meter sprints one week to 16×400 meters the next. These explosive workouts require muscles to be prepared for the intensity and are only possible by incorporating a gradual buildup of repetitions over time. Performing high-intensity exercise in the heat without proper hydration has also been linked to rhabdomyolysis. Muscle breakdown occurs at a faster rate when in a dehydrated state, therefore runners should practice adequate fluid intake if planning their training in more humid climates.

Diagnosis and Treatment

If your doctor suspects rhabdomyolysis, blood and urine tests will most likely be performed. Levels of creatine kinase, myoglobin, potassium, and creatinine are evaluated. If these contents are found in the blood or urine, it is a sign of muscle breakdown. Treatment for this condition includes IV infiltration of fluids in order to flush out the myoglobin from the bloodstream. The IV fluids will also help regulate the electrolyte imbalance. Medications may also be prescribed such as diuretics to aid in returning the kidneys back to functioning. If there is already kidney damage or failure, dialysis may need to be prescribed, which is where blood is removed from the body, cleaned of waste products, and filtered back into the body.

In the early stages of rhabdomyolysis, home remedies may be successful. These mild cases can be treated with complete rest and proper hydration. If you suspect any signs of this condition, such as significant soreness that does not relieve after a few days, be mindful of attempting to exercise and consult your doctor immediately. Rhabdomyolysis is a life-threatening condition that if left untreated, may result in kidney failure, wherein severe cases, may become permanent. Mild cases can be treated within a few weeks with lingering muscle aches for a prolonged period of time.


  1. Patrick A. Torres, MD, John A. Helmstetter, MD, Adam M. Kaye, and Alan David Kaye, MD, PhD, Rhabdomyolysis: Pathogenesis, Diagnosis, and Treatment, Journal

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