Pushing The Limit – With Dangerous Results!

Rhabdomyolysis: the rapid breakdown (lysis) of skeletal muscle (rhabdomyo) due to injury to muscle tissue. The muscle damage may be caused by physical (e.g., crush injury), chemical, or biological factors. The destruction of the muscle leads to the release of the breakdown products of damaged muscle cells into the bloodstream; some of these, such as myoglobin (a protein), are harmful to the kidney and may lead to acute kidney failure. Treatment is with intravenous fluids, and dialysis or hemofiltration if necessary.” (Wikipedia)

So you’re probably thinking; “Yeah, that would stink!” And the answer is; “Yes, it does!”

Let’s back up:

I attended a fitness course similar to many that I have attended in the past. This one specifically is designed for intense exercise protocols to address the needs of individuals with a higher performance demand, including police, fire, military, and high level athletes; as well as “normal” people looking to really push themselves physically.

I’m in the beautiful state of Washington surrounded by people that fit the description I just mentioned. The purpose of day 1 is to introduce all of us, potential instructors, to the protocols that make up the foundation of the program. This means that although our clients will only perform probably two workouts per week, we are going to do six in one day!

Now, I knew about this course for a while and had been preparing for it starting about three months prior. Unfortunately, a fairly serious leg strain about 6 weeks before had halted the specific training I was doing for the course, not to mention that I continued to aggravate the leg by playing soccer every week (strike 1).

I continued with my standard training, which wasn’t too far of a stretch from what was going to be required of me. In my attempt to get my leg to heal quicker, staying away from soccer would have been the smart thing to do, but as one who rarely follows my own advice, chose instead to seek Active Release Technique treatment from a colleague, while at the same time taking anti-inflammatory medication (strike 2 – the medication, not Active Release).

I actually held off from playing soccer for the two weeks prior to the course and my leg was feeling pretty good. I was telling myself that I wouldn’t try to be a hero at the course and just stay within what I knew was a safe zone of intensity. Two days before the course was the wedding of a co-worker, where all of us from work were in attendance – having a great time. As someone who rarely drinks alcohol, it doesn’t take much for me to “be in the bag”and the night of the wedding, I was in about 10 bags (strike 3).

Day 1 of this course consisted of six hours of instruction and exercise. Each exercise session is only about 20-30 minutes in length, but as I said before, each session is extremely intense. As someone who knows my body, I chose to keep at a lower level for each routine than I normally would. Most of the workouts do not involve much extra resistance, only bodyweight to include hundreds of pushups, pullups, squats, jumping, and other variations of bodyweight moves.

For the exercises we did that involved external resistance. I chose to use much lower weight than normal, focusing on my technique.

As we went through the workouts, I was holding up well – tired, but no pain anywhere, especially in my leg. The first day ended, and I felt similar to many of the other courses I had been through and I was happy overall with my performance. As I went back to the hotel, I started to feel tightness in both arms, specifically in my elbows. By the time I went to dinner, I was unable to fully extend my elbows – nothing out of the ordinary considering the type of exercises and intensity we were doing. After dinner I went back to the hotel and went to bed early. The next day, I woke up with the same elbow stiffness as the day before.

Day 2 consisted of technique only, no actual workouts, so I went through the day and actually felt like my elbows loosened up a bit. My flight home was immediately after the course, so I changed at the gym and headed to the airport. As I arrived at the airport, my elbow stiffness had returned and was a little worse.

I also was feeling some pretty severe muscle soreness in by biceps and triceps – I just attributed this to normal muscle soreness from mild muscle damage following a hard workout. I planned to take it easy the next couple days, and I would be fine. My first flight was from Bellingham to Seattle, where I had a 4 hour layover. As I landed in Seattle, my arms were hurting so much that it was very difficult for me to hold my phone to my ear. I found a massage spa in the airport and decided to get a 15 minute chair massage and I asked the therapist to just work on my arms. While the massage was good, it did nothing for me. For the next seven hours, I was between layovers and flying. During that time I relaxed and ate a little, but did not hydrate as much as I should have (strike 4).

I was scheduled to land at 6:00 am Wednesday morning, after which I needed to go straight to work due to a busy schedule (strike 5). As you’re probably gathering by now, I had far exceeded how many strikes I was allowed! By the time I got to work on Wednesday morning, both of my upper arms were swollen to the point of my co-workers calling me Popeye and Hulk (unfortunately not because of real muscles).

Thursday morning I awoke and the swelling had increased in my upper arms and had spread to my forearms. For those who have heard of “kankles,” I would say I had “shelbows.”

I called an orthopedic doctor first thing in the morning, but unfortunately, waited all day without a return call! After working for 12 hours, the swelling in my both of my arms was horrible. On the way home from work, I called my friend, a family practice physician, and told him the story. He convinced me to call another orthopedic doc that I know, who told me I needed to get to the ER immediately!

Let me tell you some things about hospitals that I learned (without going too far into my soapbox):

1. Call first – I was told by the ortho to make sure wherever I went, that they had a specific machine to measure compartment pressure and to make sure someone there knew how to use it. After calling 3 ER’s closer to my home and finding out none of them had the machine, or someone to use it, I ended up where I knew they had one.

2. Don’t go to an ER on Monday or Thursday. The nice intake nurse filled us in on that tidbit, although it was obvious after waiting for hours to be seen, and longer for anything to be done. But there were some interesting people that lead to some good entertainment while we were there!

3. Don’t get admitted to a hospital on the weekend. Let’s just say that nobody wants to work on weekends – enough said.

4. Take charge of your own care. If you feel something should be done or something doesn’t feel right, SPEAK UP. Don’t count on the doctors to think of everything or know how you’re feeling; they are just people. Also, when it comes to proper nutrition and/or rest in a hospital – unless that is directly what you are in for, don’t count on anyone encouraging it other than yourself.

So, while in the ER, I mentioned to the staff that I was worried about Compartment Syndrome, a condition where swelling accumulates in an area (most commonly the lower leg), often due to trauma, but occasionally to intense exercise. This swelling builds to the point that, if not surgically drained, can cause death to muscle tissue, and destroy blood vessel and nerve function. I also tell them that having a compartment pressure monitor is the reason why I went there.

Lucky for me, the orthopedic docs determined that I did not have Compartment Syndrome, and they felt it was unnecessary to use the monitor (glad I called first!). The problem that I encountered had to do with my kidneys.

Because of the muscle breakdown, the proteins being released from my muscles had to be filtered from my body, causing an elevated level of enzymes in my blood. This level, referred to as Ck or CPK, is normally around 150, I was told. My level was in the neighborhood of 58,000 (yes, that is the correct number of zeroes)! Now, this didn’t mean a heck of a lot to me, but apparently it was enough to freak out some of the doctors and nurses.

For the next five days, I was hooked up to IV fluids and on bedrest. I was seen by Internal Medicine, Orthopedics, Nephrology, and Vascular doctors. After seeing my CK levels go up and down a few times, they finally started to stabilize and I was able to go home with orders to rest and drink about a gallon of water per day.

As I finish writing this article, my CK levels have returned to normal levels and my arms have atrophied (lost muscle) to what I think looks like DJ Qualls in the movie Road Trip. Now begins the slow road to recovery, which is driving me crazy. While I would never push my clients to the level I was doing, everyone who pushes their bodies to a limit needs to be aware of situations like this, as I now am.

I would very much like to thank all the people who kept an eye on me in the hospital and offered some great advice regarding my care – I don’t think I’m allowed to name them, but they know who they are – and if anyone else wants to know who they are, contact me and I’ll let you know.  They are some of the best doctors in the area.

The moral of this article is very simple: don’t be stupid. Although Rhabdo is a rare, fluke occurrence that I realistically could not have seen coming, I still did some dumb things prior to and after the course that may have contributed to it. Hindsight is 20/20, but as people ask me if it was worth it, my response is: “the juice was worth the squeeze!”

Bob can be contacted with any questions or comments at bob@functional-strength-training.com, or visit his website at www.functional-strength-training.com