By Christa Sgobba and Kristin Canning
Spin class can crush an insane number of calories, but jumping into it if you’re not used to intense exercise may come with a serious risk. A new report in the American Journal of Medicine details three cases of rhabdomyolysis—the breakdown of muscle, which can leak toxic substances into the blood and lead to kidney damage—all of which occurred after someone tried spinning for the first time.
According to a report in the New York Times, Christina D’Ambrosio, who exercises regularly, had gone for her first ever spin class. At the end of it, she said her legs felt sore and wobbly.
In the article, it was mentioned that:
Over the next two days, her legs throbbed with excruciating pain, her urine turned a dark shade of brown, and she felt nauseated. Eventually she went to a hospital, where she was told she had rhabdomyolysis, a rare but life-threatening condition often caused by extreme exercise. It occurs when overworked muscles begin to die and leak their contents into the bloodstream, straining the kidneys and causing severe pain.
Spin class, which simulates hill climbs, flat-road cycling, and sprint cycles, is a high-intensity workout. And that can be dangerous for untrained or less-trained people, the researchers say.
Their advice to newbies? Work with your instructor to gradually increase your work, stay hydrated, and be informed of rhabdomyolysis signs: fatigue, nausea, and vomiting. Other symptoms include lightheadedness, weakness, and muscle tenderness or swelling.
Similarly, 37 year-old Robert Garay (above) had no reason to suspect that a Crossfit workout would lead to a trip to the ER—but it did. The real estate agent had been doing Crossfit for a year when he completed a regional event over Memorial Day weekend two years ago. It was a particularly rough workout (100 GHD sit-ups were just one component), and his Miami gym’s AC was broken, but Garay felt good.
“During the workout I was drinking water, and I didn’t feel pain or anything to stop me from continuing,” he says. “I did do the GHD sit-ups very fast, but my core is my strength. I think those are what sent me over the edge.”
The next day, he was sore, but he figured it was just the usual residual stiffness from a tough workout. When it became difficult for him to straighten out his body after sitting at his desk, he tried foam rolling. It wasn’t until three days after the initial workout, when he peed a Coca-Cola color, that he realized something was very wrong.
“I told my wife we needed to go to the hospital,” says Garay. “I ended up staying there for five days.”
Garay was suffering from rhabdomyolysis.
“I was completely surprised because I work out often,” says Garay. “I thought, ‘No way, this can’t be happening to me.’”
For Garay, the rhabdomyolysis diagnosis came as a total shock, as it does for most guys. Fortunately, it can be treated—as long as you take action fast. Even better: Take steps to avoid it. Here’s what you need to know.
What is rhabdomyolysis?
When muscles are severely damaged, the protein myoglobin is released into the bloodstream. This can cause problems in the kidneys, as this molecule is large and difficult to pass through the body’s filtration system, says Gordon Wang, M.D., a family medicine physician in Punta Gorda, Florida. This muscle damage and tissue breakdown can lead to kidney damage or failure if left untreated.
What causes rhabdomyolysis?
Rhabdomyolysis can happen for many reasons. Garay experienced exertional rhabdomyolysis, meaning he pushed himself extremely hard—to a point of muscle exhaustion and damage. The condition can also develop from trauma (such as getting hit by a car or having a limb crushed); cocaine, amphetamine, antipsychotic, statin, or cholesterol medicine use; or electric shock, says Dr. Wang.
Dehydration and high temps while you work out can increase your risk, says D. Alan Nelson, Ph.D., MPAS, who studies the condition at Stanford University School of Medicine.
Obesity, tobacco use, muscle enzyme deficiency and, a recent study found, sickle cell trait, can all increase your chances of developing rhabdomyolysis. Men are also more likely to get the condition than women.
“For exertional rhabdomyolysis, think of activities that engage the large muscle groups to an extreme degree, like long, hard and fast runs, Crossfit, rucksack marching, football practice, triathlons, marathons,” says Nelson. “It’s really strenuous acts, for a duration you wouldn’t normally do.”
Interestingly, Nelson says, fitness level does not impact the chances of someone getting rhabdomyolysis. So, whether you’re new to a workout or you’ve done it hundreds of times, it’s about the level of exertion.
How can you avoid rhabdomyolysis?
Rhabdomyolysis often sneaks up on you; there’s not one moment of pain that clues you in. “It’s insidious,” says Nelson. “By the time it’s fully happening to you, it’s too late to stop it.”
The best way to avoid it, he says, is to be aware of how hard you’re pushing yourself in a workout. “If you know you’re going way beyond your limits or doing something you’ve never done before, you’re at risk,” he says. “You have to be aware of muscle strain—when that becomes extreme or unusually painful, that’s when it could happen.”
You can also protect yourself by diligently hydrating before, during, and after workouts. Avoid exercise conditions that could also cause heat stroke, and gradually work your way up to new workouts.
What are the symptoms and what should you do if you have them?
Rhabdomyolysis shows itself through intense muscle pain, spasms, weakness, stiffening, swelling, and dark urine. If you begin to experience any of these symptoms, don’t wait—head to the ER immediately, says Dr. Wang. Keep up your hydration on the way there, says Nelson.
What are the treatments?
Once hospitalized, rhabdomyolysis patients receive intravenous fluids. Their levels of creatine kinase, an enzyme elevated when muscles are damaged, may be monitored through blood tests, while their myoglobin levels may be checked through a urine sample. Patients stay in the hospital until these levels have gone down significantly and kidney function is normal. This could take a few days or much longer; it’s different for everyone.
Fortunately, Garay got medical attention in time and left the hospital fully recovered. He was able to ease into exercise and get back to his normal routine after a month.
“It’s in the back of my mind that it could happen. Now, I always have water with me, and I try to drink more water during the day,” Garay says. “A lot of people don’t want to take breaks during Crossfit workouts because they’re timed, but when I work out I have my water jug with me, and I’ll stop and fill it up if I have to. I’m very aware of my body now.”
As for the GHD sit-ups? “I’ll do them every once in a while, but I’ll do less of them,” Garay laughs. “I haven’t done 100 straight since then, I’ll tell you that!”