“No pain, no gain” is a mantra many live by. But recognising when a workout is too tough and when you’re working out too much can be crucial to avoiding serious injury. But what if your gym trainer- the person you’d expect to know how to pace your efforts- is too inexperienced to know what might lead to rhabdomyolysis?
Marc Nair attended a beginner calisthenics session at a Singapore gym earlier this year, and ended up in hospital. On a Facebook note on his profile, he says: “The class, conducted by a youth trainer, started with warmups. Then, we were asked to do a pretty punishing pull-up routine. This involved three sets of five reps of four different exercises: flex-arm roman rings, pull-ups, negative pull-ups and assisted pull-ups. Some time during the second set of negative pull-ups I felt a sudden loss of strength and could not pull myself up any more even with the resistance bands.
“It felt as if all the strength had gone out of me. But all I thought at that point was man, this was hard! We then moved to the second half of the workout, one which was more HIIT based and involved planking, mountain climbers, etc. Those involved a different muscle group, so I was able to do them, although by that point I was feeling dehydrated and was perspiring far more than usual.
“When I got home I was really exhausted and was really thirsty. I just put it down to having had a really tough workout and figured I would be fine the next day.”
It got worse when he got home: “After just three hours of sleep that night, I woke with a start because my arms were on fire! My forearms and biceps hurt so much that I could not straighten them at all. The pain persisted all through the next day and the next night as well.
His arms started to swell and they “hurt like hell”. Worse, his urine turned a dark yellow, almost brown! “That was when I knew this was far more than just delayed onset muscle soreness (DOMS). I headed straight to the A&E at Tan Tock Seng Hospital. They took a blood test and as soon as the results came out, warded me immediately and put me on an IV drip. I was on the drip for three days.”
The diagnosis was rhabdomyolysis, a condition “involving the rapid dissolution of damaged or injured skeletal muscle, and he was only discharged after a week of treatment.
From Marc’s perspective, it got more frustrating when the gym then seemed to make good but flake. “As early as 4 January, the day after the class, Carolyn and I were in contact with one of the three co-founders of the gym. He visited me in hospital. In face-to-face conversations and over email, he confirmed that as a measure of goodwill, the gym was willing to extend some compensation. Over the phone one day, he offered an amount, which I accepted.
“But he never made the payment. And practically ghosted me thereafter. I didn’t know what was going on. Then, one of the other co-founders called for a face-to-face meeting with me on 12 February. He denied that I had suffered rhabdomyolysis in the class and insinuated that I could have been injured elsewhere, which was frankly ridiculous.”
(EDITOR): Push Pull Give got in touch with us to clarify that their trainers are FISAF and NCSF certified and well experienced, and they always inquire about the fitness levels of their members to ensure their safety, so that they can make an informed decision about joining their exercises.
In addition, they have released a statement on their Facebook page to talk about what happened in more detail.
Dear Fitness Community, A recent public service announcement on Facebook reports that a participant of our calisthenics…
Dear Fitness Community,
A recent public service announcement on Facebook reports that a participant of our calisthenics class on 3rd January 2019 suffered an episode of rhabdomyolysis and as a result questions the safety standards of our classes.
At PushPullGive we take those concerns seriously. We are a social enterprise that forges social impact through fitness. Health, safety and the trust of our members are the ultimate goals for our team. As such we are honoured to have served hundreds of customers over the last 2.5 years, helping them to stay fit and healthy. We would like to highlight that:
1. Our trainers are FISAF and NCSF certified and well experienced.
2. Our calisthenics classes are always run by our Head Trainer and are occasionally co-run by a youth trainer for talent development purposes.
3. Our training practice follows internationally recognised calisthenics standards.
4. At the beginning of a class, we always inquire about our members’ fitness level. We also ensure that our customers make an informed decision and realise all the benefits and risks of physical exercises. During the classes we are very attentive and always encourage to express any issues as and if they occur. In case of any issues during the class we offer regressions, ask the participant to rest, or to even abort the training.
5. Rhabdomyolysis is a complex condition and several factors can contribute to an onset, including genetic pre-disposition, substance abuse and physical strenuous activity. The symptoms of rhabdomyolysis do not show immediately and typically appear in a matter of days. It would therefore almost be impossible to spot this during the workout itself.
One member who attended the same class says:
“As it was a group class, there were different fitness levels within the group. Except maybe for one who could do endless pull-ups, most of us had to regress using elastic bands and assisted pull-ups, including negative pull-ups. There were breaks in between the sets for us to hydrate and catch a breather. Throughout the class, no one voiced out any discomfort nor pain. We even posed and took a group photo happily at the end of the class. That was how I remembered it being jovial with no complaints. Thus, I was surprised to hear that an attendee lodged a complaint a couple of days after the class.”, said Mr. Penny Lau, who attended the same class.
The trust of our members is the ultimate priority for our team! We care about each one of our customers. At PushPullGive we never compromise on the highest quality and safety standards. In the same way as we do not compromise on the highest ethical standards in response to accusations that attempt to publicly undermine the confidence in PushPullGive and suggest that the participants accident stayed unnoticed by us and fellow class mates.
PushPullGive is a fitness social enterprise. Our aim is to bring value to our customers and the community of Tiong Bahru. As a social enterprise we provide employment opportunities for marginalised young adults and support youth projects in Singapore. The success of training youth and our customers was confirmed multiple times and through overwhelmingly positive feedback about our work. We will continue our mission to forge social impact through fitness.
The Team of PushPullGive
Both sides certainly have their own view of the incident, but what is irrefutable is that Marc certainly attended a gym class where he worked out harder than what his body was capable of doing. Whichever side you take, it’s important for you to know if your trainers really know what they’re doing, as well as the signs of rhabdomyolysis.
How can you tell if you’re at risk of rhabdomyolysis during and after a workout?
Rhabdo pain sets in immediately after, or even during, a workout. Signs that your pains may be something more worrisome include swollen muscles, weakness, nausea, vomiting, pain exceeding three days, and dark urine.
Do certain exercises cause rhabdomyolysis?
In reality, any intense physical activity could cause the condition, including marathon training or spin class.
According to Dr. Guillem Gonzalez-Lomas, sports medicine orthopedic surgeon at NYU Langone Health, the problem typically occurs when people go beyond their personal thresholds.
It’s common to cheer on your gym mates during the community workouts at CrossFit, which makes some go-getters push themselves further than they would doing reps at a traditional gym. “So someone may normally have stopped, but they’ve got four of their buddies cheering them on, and it can be exhilarating,” Gonzalez-Lomas tells MensHealth.com.
He says newbies to a particular activity are susceptible to injuring themselves, because they might not know the difference between getting a good workout and pushing too hard.
“I think if you are a seasoned exerciser or athlete at your sport, you have a pretty good idea where your max level is at,” Gonzalez-Lomas explains.
How do I prevent rhabdomyolysis?
Gonzalez-Lomas says dehydration could increase your chances of rhabdo, so it’s important to drink plenty of water when doing strenuous exercises in hot environments. You may not know something is wrong while exercising, but Gonzalez-Lomas advises everyone heed a few warning signs: discomfort and weakness.
Our strength bounces back after resting between sets, so muscle weakness could also signal that something is awry. Basically, you want to work hard, but stop before you’re in agony.
“You really shouldn’t feel pain in your muscles during a workout,” says Gonzalez-Lomas.
And if you’re looking to suss out if your gym and its trainers are any good, here’s some tips.
Do your research
Just because your gym membership eats up a fat chunk of your salary every month, don’t assume every trainer circling its pristine equipment is worth his salt. “Make sure you search for evidence of results,” says strength and conditioning coach Phil Learney. “For example, have they got any before and after photos of their clients?” And if not, why not?
Assess their assessment
Never sign up for more than one session to start off. The first step-in at a gym is your chance to test out their expertise. A good trainer will check your movement patterns, posture and flexibility. “Without assessing a starting point everything else is pure guesswork,” says PT Greg Brookes. If there’s no attempt to collect baseline measurements, you’ll have no way of tracking your progress. Do one rep of leave-and-never-come-backs.
A real phony
When you’re straining to press plates equivalent to your body weight above your chest, your attention needs to be 100% on the task at hand. As does the trainers at your gym. You might sneak regular looks at the football gossip during office hours, but that doesn’t mean it’s OK for your PT to do so. “Every move must be closely scrutinised,” says Brookes. “Small adjustments should constantly be made to your technique, especially as you start to tire.” Looking at his phone while you judder under a barbell once is a warning sign. Twice is a fireable offence.
Tell me why
Modern health and fitness is full of fads, which means most PTs will have a preferred method and area of expertise. The danger comes when a trainer’s enthusiasm for a particular methodology becomes their one-size-fits-all solution for every client. “Question your trainer’s ability to communicate what they’re doing and why they’re doing it,” says Learney. “Make sure you’re not doing an exercise simply because that’s all your PT knows how to teach.” Kettlebells might be effective, but they aren’t for everyone. Like your PT, you should be constantly asking questions about what you’re doing and why.
If your gym class is structureless or, worse, you find yourself doing the same moves every session, you’re wasting your money. It’s a trainer’s job to do the thinking and come up with new ways to challenge and motivate you. “Doing the same thing week in, week out is a tell tale sign of a clueless trainer,” says PT Sean Lerwill. A quick test: watch your trainer with his other clients. If he’s doing the same supersets with a woman in her 60s there’s clearly some serious gaps in his muscle-building knowhow.
By Kelvin Tan, Editor for Men’s Health