A few weeks ago was the first time I’ve ever been admitted to the hospital.
The situation I found myself in…and the condition I was treated for…are both things I know you can avoid.
I knew to go get checked out after reading other people’s experiences in forums and blog posts, so I’m adding my story to the online collection.
If you read this post and are able to get catch something before it turns ugly…we’ll have done a good thing.
Okay, on to the post…
Make A List
Make a quick mental list of “Dudes I Know Who Will End Up In the Hospital From Exercising”…
…got your list made?
Now…tell me where “Leighton Hart” ranked on that list.
Wait…you’re saying I’m not on that list?
It’s okay. My feelings aren’t hurt.
I wouldn’t even put myself on a list of people who would end up in the hospital from exercising.
That’s exactly what happened to me the first week of July.
So how did that happen?
How did Leighton Hart end up in the hospital from exercising?
Did I drop a weight plate on my foot?
Did I get my earbuds wrapped around my neck?
Did I slip off a pullup bar and crack my noggin?
Those are all good guesses…but they’re all wrong.
Here’s a short version of what happened…
I shredded my abs at the gym and the muscle got into my bloodstream and started to poison me.
By the time I realized what was happening, my kidneys may have shut down or I could have had a heart attack.
That’s some real shit, right?
The word for that condition is rhabdomyolysis.
It’s a mouthful, I know. Rhabdomyolysis.
Let’s just call it rhabdo for the rest of this post.
I’m going to tell you a lot more about rhabdo, but first let me tell you about how I got it.
I already told you the short version: I shredded my abs.
But I think it’s helpful for you to know the road leading up to my rhabdo because I know a lot of you are asking yourselves: “Can this happen to me?”
How I Got Rhabdo
Here’s how it went down…
The last week of June my kids were at camp about an hour from here.
We were staying at our family’s mountain house near the camp and I was making the hour commute each morning.
I made it to the gym three times that week, which means I got up at 4 a.m. to make sure I didn’t miss the 6 a.m. class.
The lack of sleep took its toll. I could barely stay awake at work that week.
For Friday’s WOD, the strength/skill portion was GHD situps. The program was to accumulate 60 reps.
Here’s a YouTube clip of a lady doing GHD situps.
I’d encourage you to click over because it’s really helpful to know what a GHD machine is and what the full range of motion for a GHD sit-up is. Just promise you’ll come back after the video.
Are you back? Great!
It worked out there were four of us in the 6 a.m. class on Friday. Two guys and two ladies. It also worked out that there was a tall guy and a short guy…and a tall lady and a short lady.
We split up on the GHD machines. The tall-ies took one machine and I joined the other small-y on the other.
We swapped out every 10 reps.
I got about 25 reps done and then started having to really work.
Someone offered this pointer on my form: I wasn’t straightening my legs to initiate the upward part of the situp. The quads are part of the exercise, too.
I got to where I was doing three or four at a time, then needing to rest.
At 42 reps, I quit.
From there, it was on to the WOD…
50 ground-to-overhead with a 45-lb. plate
1 mile run
50 wall ball shots with a 20-lb. ball
The WOD was tough but not unusual.
I went home and showered then went to work.
I remember thinking about how sore I felt even 90 minutes after the workout.
Okay, so let’s pause for a minute and see how we’re doing.
If you’re a CrossFitter, you might look at that and think, “Where’s the rhabdo in that?”
If you’re not a gym person, the last 200 words sound like complete gobbledeegook.
It’s okay. I understand.
So let’s talk about rhabdo.
What Is Rhabdo?
Let’s talk about what rhabdo is and how you get it.
I’m going to go all clinical on you because I know you’re smart people and you can handle this.
I’ve already given you the super-simplified definition, so let’s work through what rhabdo really is:
“Rhabdomyolysis is the breakdown is muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.” – MedlinePlus
A good analogy I heard was this…
Think of your muscle like a Tootsie Roll, with a wrapper on the outside. With rhabdo, that wrapper breaks and various things inside your muscle spill out into your body that are harmful to you.
I mean, so some muscle tissue gets into your blood. Is that a big deal?
Is Rhabdo A Big Deal?
Let me tell you a little bit more about my story and you can figure out if it’s a big deal or not.
I mentioned I was sore almost immediately after working out.
I woke up Saturday morning and almost couldn’t move.
My entire mid-section…from my chest to my thighs…hurt when I tried to get out of bed.
In fact, I couldn’t sit up. I had to roll off the side of the bed and then stand up.
My abs weren’t sore…I was in pain.
The pain stuck with me all through the weekend.
On Sunday after church I was walking up two little steps into our kitchen from the garage.
I paused to groan and I remember telling Mary Craig how hard it was to fully extend my hips…like, to fully straighten up.
Later in the day on Sunday, my youngest daughter wanted to have a “fitness challenge” in the front yard. It’s a thing we do.
To warm up, she wanted us each to do 10 pushups.
I found a spot on the sidewalk, laid flat, and as I felt my core tighten up to push up I felt incredible pain in my abs.
I couldn’t do a single pushup. The pain was too much.
I decided to rest for the balance of the day.
On Monday morning, I wrestled with myself about whether or not to go to the gym.
On one hand, I told myself my muscles needed time to heal.
On the other hand, I thought moving my muscles and getting some blood flowing might help me feel better faster.
I went to the gym.
For the strength portion of the class, we were testing our personal maxes in the back squat.
Back in April I set a personal best for myself by squatting 195.
During this class…messed up abs and all…I topped out at 205.
From there it was on to the workout, a classic CrossFit WOD called Cindy. Cindy is:
15 air squats
As many rounds as possible in 20 minutes
The clock counted down 3, 2, 1, GO and it was on.
Pullups weren’t terrible…squats were fine…but every single pushup felt like murder.
When the clock ran out, I’d finished 11 rounds.
That’s 55 pullups, 110 pushups and 165 air squats.
I was so happy when it was over.
When I was getting ready for work, I noticed that my belly seemed bloated.
I recalled the waist of my shorts feeling tight on Sunday, but I had chalked it up to eating junky food the prior week.
When I buttoned my suit pants, I noticed again that my waist felt really tight.
At this point, my abs were still completely shot.
To give you an idea, it was painful to bend over to put on socks.
When I got to the office, I started Googling to see what was going on with my abs.
I searched “GHD ab swelling” and clicked through to CrossFit’s message boards. I read a few posts about people getting rhabdo from the GHD.
I got nervous.
I clicked to a few other sites and read blog posts of people’s first-hand experiences with rhabdo and the stories sounded a lot like mine.
When I started reading about people being hospitalized for rhabdo, I thought I better go get checked out…just to be safe.
I wrote “rhabdomyolysis” on a sticky note, grabbed a bottle of water, and went to my doctor’s walk-in clinic.
The lady at the desk asked why I needed to be seen.
“Well,” I said. “I messed up my abs at the gym and now I think some other things are wrong…”
“You think something is wrong with your stomach?” she said.
I handed her my sticky note.
“I need to get checked for this,” I said.
“Oh,” she said. “You think you have this?”
“I hope not,” I said. “But I want to be sure.”
She gave me a little smirk.
“You know you shouldn’t go looking stuff up on the internet.”
“Mmm-hmmm,” I said.
A few minutes later a nurse called me back and I talked her through what was going on.
This nurse had seen rhabdo before, so she was kind enough not to look at me like I was an alien.
“Let’s get a urine sample and some blood, then the doctor will decide what to do from there,” she said.
Pretty soon a doctor came in and we chatted for a minute.
The doctor confirmed that I had blood in my urine…which they tell me is a bad thing…so they wanted to put a rush on the blood work.
She said I might just need to drink water and flush out my system…or she might call me back and tell me to go to the hospital if I had rhabdo.
Either way, the blood work wouldn’t be back for a few hours so I was free to go back to work.
I called Mary Craig on the way back to the office and filled her in.
She was worried.
By late afternoon I was feeling as if the storm had passed.
And then my phone rang.
“You’re going to need to clear your calendar,” the doctor said. “I need you to go check into the hospital.”
She explained the problem…
A normal level of creatine kinase (CK) in the blood is 50-400 units.
My CK was 46,000.
I explained the situation to the people at my office as quickly as I could and then headed home.
“I overdid it at the gym and the doctor says I need to go get IV fluids,” is the simplest explanation I could give to the people at work.
On the way home, I called Mary Craig.
At home I packed an overnight bag with a few books and my phone charger, then changed into a t-shirt and gym shorts.
I drove to the hospital and they showed me to a room that was already waiting for me.
Once I was in the room they weren’t speedy about getting in to see me.
So at this point, what did I know about the seriousness of rhabdo?
I knew it was serious enough to require me to be admitted to the hospital.
I also knew it wasn’t so serious that they needed to rush right to me and start working on me right away.
I sat in my room for about 30 minutes before all the check-in stuff started.
They asked what happened to me.
Neither of the nurses knew much about CrossFit or had heard about GHD sit-ups, so I gave them a condensed version.
They asked about my medical history.
They asked about medications I take.
They asked if I’ve ever seen Dave Matthews in concert…and I said yes, about 12 years ago in Charlotte.
I’m kidding about that last question…just checking to see if you’re still reading.
The nurse and her trainee finished their 20 questions and then they left.
A while later a nurse practitioner came in and talked to me.
This was the first real “let’s talk about what’s going on with you” interaction I had at the hospital.
She was nice and had been working the same time another rhabdo case came in from my walk-in clinic…so it was good she’d seen it before.
I don’t think she’d ever heard of anyone getting it from sit-ups, though.
She said she was shocked at my CK numbers and asked me several times how I was feeling.
I told her that other than the muscle pain I didn’t feel all that bad.
This seems like a good place to stop and talk about what rhabdo can do to you…
Because since I didn’t feel all that bad aside from the muscle pain it would have been easy to dismiss the pain and soldier on.
We posed the questions earlier…
How is rhabdo harmful?
What are the risks?
Is rhabdo really a big deal?
Let’s tackle those head on…
Rhabdo can kill you.
It’s that serious.
That’s why they hospitalize you…because it’s a very serious condition.
But fatality isn’t the big risk from rhabdo.
There are plenty of other risks rhabdo poses to your body.
How Rhabdo Endangers Your Body
The biggest problem is this: rhabdo is very dangerous for your kidneys.
When muscle tissue disintegrates, it releases myoglobin into the bloodstream…and the kidneys and myoglobin don’t get along.
The big risk is that rhabdo will permanently screw up your kidneys…or that your kidneys will fail completely.
There are other risks…
Rhabdo throws your body’s chemistry all out of whack.
Here’s an example…
After I was settled in at the hospital and receiving IV fluids, the doctor ordered an EKG to check out my heart.
I guess someone asked for proof that there is, in fact, a heart buried somewhere deep within my chest.
Anyway, the nurse ran the test and the doc came back PRONTO.
“Have you had any chest pain?” he asked.
“Any pain or weakness in your left arm? Nausea or vomiting?”
He was working me over with the heart attack questions.
“I haven’t had any of that stuff,” I told him. “Why?”
“Your EKG looks like you had…or are having…a heart attack,” he said. “So I’m curious if you’ve had any other symptoms.”
They did some lab work and confirmed that I wasn’t having a heart attack…so that was good.
But that’s a tricky thing about rhabdo…it goofs up the electrolytes in the body to the point where it’s hard to tell what’s really going on.
And it is possible…because of a huge release of potassium into the system (a condition called hyperkalemia)…to have a heart attack during rhabdo.
What are the risks of rhabdo?
The risks of rhabdo are:
- kidney damage
- kidney failure
- heart attack
Is rhabdo really a big deal?
Judging by the looks on the faces of the healthcare providers who helped me, I’d say YES.
Who Gets Rhabdo
A lot of you who are active people have asked this great question: “Was there a point when you felt like you should stop but you kept going anyway?”
The short answer is: no.
From what I’ve read, rhabdo is most likely to bite you in a few scenarios:
- when you’re overheated, fatigued, or dehydrated
- when you dramatically increase your physical output from one level to another
- when you’re doing eccentric (also known as “negative”) movements
Here’s how that relates to your question and how it might relate to your workouts.
When I was doing the GHD situps, I did reach a point where my ab muscles started to wear out. I had to rest in the middle of 10-rep sets.
I didn’t really think anything about it. I chalked it up to having weak muscles…something I’m pretty accustomed to.
Think about a strict shoulder press.
You know the feeling when your shoulders wear out…and you rest, then get back to your next set?
That’s how I treated the GHD situps.
The trouble is that the GHD is a dramatic eccentric contraction…meaning there’s tension on the muscle as it lengthens.
I didn’t feel it at the time, but this type of contraction can be very tough on the muscle.
This deal with eccentric contractions is why people who do a ton of pullups in one workout can get stung by rhabdo.
But getting back to the original question…
No, I didn’t reach a point where I thought I was hurt but chose to “play through the pain.”
I knew my muscles were fatigued but I figured it was just like when I wear my arms out doing pushups or my legs out doing squats.
I’ve also had a lot of questions about my symptoms.
Some of you have even said, “I think I might have had rhabdo once, but I never did anything about it.”
I know I went over a lot of this in my story about how it all went down, but here’s a quick version of my symptoms:
- muscle pain (much more intense than soreness)
- decreased energy
The unrelenting pain and swelling were what caused me to finally dig into what was happening.
If I had some of the classic symptoms of rhabdo, I might have checked things out earlier.
The Symptoms of Rhabdo
Here are all the classic rhabdo symptoms:
- dark, red, or cola-colored urine
- decreased urine output
- general weakness
- muscle stiffness and aching
- muscle tenderness
- weakness of the affected muscles
I’ve talked to a few of you who have said you think you had rhabdo in the past but never did anything about it.
The stories I’ve heard go something like this: “I did a bunch of pull-ups and my arms swelled up and hurt like hell. I could barely move them for a week.”
I’m not a doctor…and I’m not diagnosing you…but I will say this…
From now on, when shit like that happens, please go to the walk-in place and get a quick blood test done.
Write “rhabdomyolysis” on a sticky note and show it to them and say, “I want to make sure I don’t have this.”
It will cost you a few bucks but your kidneys are worth it.
Exercise Might Kill You…But This Will Definitely Kill You
Can I share another question with you?
This one came from Facebook and I know it was meant as a joke, but I’m going to answer it anyway.
Here it is: Can I catch rhabdo from sitting on my couch?
You’re not going to catch rhabdo from sitting on your couch, unless you’re sitting on your couch banging lines of cocaine.
Cocaine and other hard drugs can contribute to rhabdo.
But I trust that most of you are safe for THAT reason.
While we’re on the topic of couches…
A common joke I’ve heard as I’ve explained this whole thing is this:
“See, that’s why I don’t exercise…because exercise can kill you!”
And I agree. Exercise can kill you.
But I would add…
I guarantee the hospital sees far more people every day for the consequences of sitting on the couch than it does for the consequences of exercise.
In other words: exercise might kill you, but sitting on the couch will definitely kill you.
I’ve also had some people ask if I’m going to keep doing CrossFit once I’m fully recovered from rhabdo.
Here’s the thing:
I got rhabdo at a CrossFit box, but CrossFit didn’t give me rhabdo.
You know what did give me rhabdo?
Not getting enough sleep.
Not being fully hydrated.
Doing too many reps of an exercise I wasn’t conditioned for.
I could have done that in my garage…or at any gym.
I was talked with a veterinarian friend a few weeks ago.
The vet said she has people who take out hunting dogs that have been laying around during the off-season and run them hard the first day of hunting season.
The dog owners bring the dogs in and guess what’s wrong?
Rhabdo isn’t unique to CrossFit and isn’t even unique to humans.
If you overload your muscles in the wrong way…you put yourself at risk.
Overloading muscles in the wrong way can happen anywhere.
Knowing all of that…am I done with CrossFit?
No. I’m not done with CrossFit.
It’s the only program that works for me.
I’ve been easing back in…and here’s how that looks.
I’ve been scaling EVERYTHING down.
When I went back to the gym after being out for six weeks, I knew it would be a long road back to where I left off.
I threw out my personal bests and I’m starting fresh with lighter weights, less intensity, fewer reps where necessary, and more recovery time between gym visits.
And I’ll tell you this…
This is the right plan.
The first few workouts have left me feeling like I’ve been chewed up and spit out.
Like I said, getting back to where I left off is going to be a long road.
Life After Rhabdo
So what is post-rhabdo life like?
It’s better now, but for the first ten days or so, all I could do was shuffle around like an old man.
I didn’t have any energy.
It felt like I had the flu.
But each day got a little better.
Now I feel “normal” again…but I get tired pretty easily.
Staying hydrated is always on my mind.
I still feel some soreness in my stomach…even a month and a half later.
And the “What if I get injured again?” question lingers in my mind.
We’ve covered a lot of ground.
I don’t know what you’re going to take away from this post, but here’s what I hope you get:
- rhabdo is serious
- if you think you have rhabdo, go get checked out
- rhabdo is avoidable
- most people won’t get rhabdo
Now that you know more about my unfortunate experience with rhabdo, I hope you’ll be better equipped to get fit safely!