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Rhabdomyolysis: When It's More Than Just A Bruise

Rhabdomyolysis: When It's More Than Just A Bruise

Bumps and bruises suck. Bumps hurt and bruises are ugly. They’re a testament to miscalculated steps or the chair that found its way into the middle of the room. Whether you bumped into something or something bumped into you, they just happen.

So, what happens when they’re more than skin deep? Quite a lot, actually, including a serious condition called rhabdomyolysis.

Not Sure What Rhabdomyolysis is? First, Learn More About Bruising

Bruising: Why does it happen?

Bruises are actually pretty simple in what they are and how they happen.

Your skin is made up of several layers. Blood vessels wind their way throughout these layers, creating a web of tiny veins and capillaries.

When these vessels are exposed to blunt trauma (such as wiping out and hitting your knees), they can rupture, causing a small amount of blood to leak out into the surrounding tissues. This is what causes that blue-purple tinge.

In the majority of cases, your body gets to work cleaning up the mess – as the blood gets broken down and is carried away, the bruise will start to fade (this is when the colors become really interesting – shades of yellow and even blue-green are not uncommon).

Once in a while, though, the bruising is more than skin-deep and serious muscle damage has occurred.

The Crash That Won’t Quit

Intense Workout Which Can Cause Rhabdomyolysis and Kidney FailureThis is when bruising can be associated with rhabdomyolysis (often referred to as rhabdo, pronounced “rab-doh”). Rhabdo-what? It sounds (and is) a bit scary. Kind of like something out a Stephen King movie, don’t you think?Okay, so the damage to your pride after your involuntary dismount was bad enough. Add to that the road rash and its angry black background. So, what happens when the muscles are banged up, too?

Rhabdomyolysis is a condition that occurs when muscle cells break down or die and release a substance known as myoglobin into the bloodstream. The body then tries to deal with this influx of myoglobin by sending it to the kidneys to be excreted.

While the kidneys are designed to filter a lot of stuff out of the blood, they can become overwhelmed by the sheer quantity of myoglobin being passed through and become clogged. Yes, clogged. This is the most serious problem associated with rhabdo but certainly not the only one.

One point to remember is that rhabdomyolysis is always brought about by some type of muscle injury. This injury can be due to physical, chemical or genetic causes. Quite simply, anything that can damage the muscles can cause this condition.

Although this condition is rare, it is very serious. Despite this, it does happen (approximately 26,000 cases are reported every year in the US alone) and it should not to be taken lightly.

Expect to be reminded of its seriousness at least two or three more times. Because, well… clogged kidneys.

The Hit List: The Three Biggest Causes of Rhabdo

You’ve got the gist on what rhabdo is. Scary? Check. Gross? Check. Bruise-inducing? You bet. So now on to the main causes of this condition.

Rhabdomyolysis can be caused by a wide variety of things. Despite the numerous possibilities, there exists a list of the three most common things known to bring rhabdomyolysis to surface (no pun intended).

Serious trauma resulting in crush injuries to the muscles

Of the most commonly seen causes of rhabdo, trauma is the number-one reason someone might develop this condition.

Blunt-force trauma and crush injuries are the key players here. Automobile accidents are responsible for many of these cases.

Other possibilities would be falls, being struck with an object (such as a baseball bat or being kicked by a horse), or collisions with other people during sports.

Medications, drugs, and alcohol

Believe it or not, that epic face-plant isn’t the only way rhabdo can occur. Drugs and alcohol can have a major impact on muscle health.

Risk of developing rhabdomyolysis from statin medications

Higher doses of commonly prescribed statin drugs have been linked to rhabdomyolysis. This is just one of many reasons that statin use must be regularly monitored by a healthcare professional.

Drugs and alcohol can impact muscle health and cause rhabdomyolysis

People that drink alcohol to excess or experience an overdose of prescription or street drugs such as cocaine, heroin, other opioids and even amphetamines may encounter severe muscle damage. This, in turn, can bring on rhabdomyolysis.

Overstraining the muscles

Athletes or anyone that engages in strenuous exercising can develop rhabdo. Wait, what? A lot of exercise is a bad thing?

The Extreme Workout that can cause Rhabdomyolysis

When talking about overstraining the muscles, the focus is on extreme exercising. What does that mean?

Think weightlifters or extreme CrossFit participants who push their bodies too hard and past their own physical limits. The CrossFit community jokingly calls it “Uncle Rhabdo”. And we all know they don’t joke about their sport – that’s how serious rhabdomyolysis is. There we go again with the serious thing…

Greater risk is added when these athletes create this kind of strain on their muscles within a poorly ventilated area or where they are more susceptible to getting dehydrated.

Marathon runners also tend to be at a greater risk for developing rhabdomyolysis. Research and studies have shown that at the end of running a marathon, runners’ kidney functions can drop by up to 60 percent. This, in addition to the extreme dehydration that many of the runners suffered from can rapidly, and without warning, bring on rhabdomyolysis.

These extraordinary examples of exercising are what puts athletes at a higher risk. So, don’t fret – you can keep up with your normal workouts.

Okay, so you’re worried… that’s normal. Here are some general guidelines to be aware of when exercising:

Warm up muscles by stretching before intense activity to prevent injury

  • Always warm up by stretching those muscles first
  • Listen to what your body is saying. If it says stop, STOP. Overtraining can have adverse effects
  • Avoid strenuous exercises without properly working up to it. It is better to take the slow and progressive build-up approach
  • Stay within your physical limits
  • Keep yourself properly hydrated

Hydrate Before, During, and After a Workout

Surprisingly, there are some kind of crazy things that you might not ever think would cause rhabdo. Heatstroke, venomous snake bites and even some nutritional supplements can wreak havoc on your muscle tissue.

What are the complications of rhabdomyolysis?

Now, for a look at just what rhabdomyolysis can do to you. It’s not pretty, but you’ll want to read on anyway.

Kidney Failure

When the muscle tissue breaks down, it releases the protein known as myoglobin into the blood. As this happens, the filtering tubes of the kidneys – called nephrons – can become clogged, causing renal (aka) kidney failure.

This is undisputedly the main and most serious complication of rhabdomyolysis and is associated with high morbidity and mortality rates.

High levels of potassium in the blood

As if having backed-up nephrons isn’t bad enough, rhabdo can come with other, equally frightening problems.

When rhabdo occurs, high levels of potassium can be introduced into the bloodstream. The damaged cells release their stores of minerals, proteins and other substances. In this scenario, they are flooding your system with an overwhelming amount of potassium. This condition, known as hyperkalemia, is associated with irregular heartbeat and even cardiac arrest.

Acute Compartment Syndrome

Acute compartment syndrome is a less common issue that may accompany rhabdomyolysis. While not a cause of rhabdo, it is also brought on by a traumatic injury – in most cases fractures in the arms or legs.

This dangerous issue can actually be brought on by rhabdo, making it doubly important to get checked out if you have even the slightest worry that you may be experiencing rhabdomyolysis.

Why are the signs of having rhabdomyolysis sometimes hard to distinguish?

The initial symptoms of rhabdomyolysis can be so slight and subtle, they may get mistaken for other, more common ailments.

Often times, the symptoms of rhabdo can mimic those associated with urinary tract infections, stomach ailments or even flu.

If you’ve had any type of injury that may have caused trauma and are now experiencing rhabdo symptoms, don’t hesitate to get checked out.

The symptoms to watch for include the following:

  • dark, tea colored urine
  • muscle pain, which can be extreme and cause throbbing
  • muscle weakness, swelling or inflammation
  • extreme fatigue
  • irregular heartbeat
  • nausea with or without vomiting
  • confusion or feeling disoriented
  • feeling faint or dizzy
  • bruising

As a general rule of thumb, if you suspect you may have rhabdomyolysis, SEEK MEDICAL ASSISTANCE IMMEDIATELY! When in doubt, get it checked out!

Don’t be difficult – get to the doctor

Lots of muscle injuries benefit from rest and time. In the case of rhabdo, time can become your worst enemy.

If you suspect you have rhabdomyolysis, be prepared to give your doctor the most accurate information you can.

In this case, vague answers may lead to a misdiagnosis. This is why you need to be as detailed you can – all the way down to what you ate and drank the day in question.

Let the doctor know if any of the following apply to you:

  • What, if any symptoms have you noticed?
  • Have you had any trauma related incidents? If so when and what happened?
  • If you have trained recently, how and what did you do?
  • Did you overwork some muscle groups?
  • Did you warm up enough prior to exercising?
  • Did you, despite severe muscle pain, continue training without ample recovery time?
  • Did you train at extreme high or extreme low temperatures?
  • Has anyone in your family ever experienced rhabdomyolysis?
  • Have you recently had an acute infection?
  • Have you experienced chronic pain?
  • Do you have muscular restrictions?
  • What medications are you currently on? (including over the counter medicines)
  • Have you consumed an excessive amount of drugs and/or alcohol?
  • When did you notice the first symptoms began?

Depending on your answers, you may have to undergo blood tests, urine tests, and a thorough physical exam.

If I test positive for rhabdomyolysis, what are my treatment options?

The treatment for rhabdomyolysis will vary depending upon the cause and the severity, as this case study shows. If you suspect you may be experiencing symptoms of rhabdomyolysis, the haste with which you take action may determine the intensity of treatment needed.

Mild Cases

If a cause of rhabdomyolysis is established, it can be addressed accordingly, helping to prevent further damage. If you are not showing evidence of complications, management can take place at home by correcting the cause of it (such as discontinuing a toxic medication), and rehydration.

Severe Cases

In many more severe cases, hospitalization is required. Removal of the factor that provoked the onset of rhabdomyolysis (if possible) and immediate rehydration with intravenous fluids is an essential part of the treatment.

It is most crucial to monitor and manage kidney dysfunction, balance electrolytes, and monitor muscle enzyme levels to ensure that other problems don’t arise, such as hyperkalemia.

Rhabdo might be a rare and serious condition, but that doesn’t mean that it can’t happen to you. If you suspect – even have the slightest inkling – that something might be wrong, get in and make sure you’re not in the throes of rhabdo. Your kidneys will thank you.

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