So You Got Rhabdo…Now What?

In December 2011, I got rhabdo.  Really, really bad rhabdo.  “Worst pain of my life, protein levels 5000 times higher than they should be, lose 9 pounds of muscle during 5 days in the hospital, lucky I’m not seriously broken” kind of rhabdo.  Suffice to say, I wrecked myself pretty badly.

By now, it’s hard for anyone related to Crossfit not to know what rhabdomyolysis (or “rhabdo” for short) is.  There have been plenty of articles written in recent months about “Crossfit’s dirty little secret” and how scary rhabdo is.  And to be frank, it IS pretty scary.

Think of your muscle fibers like water balloons filled with various items like sand, little rocks, and marbles; in actuality, they are proteins of varying sizes– myoglobin and creatine kinase (“cK” for short) and others.  When you work out normally, you break some water balloons and let some of the sand out into your blood stream.  Your kidneys are easily able to filter those out in small quantities.  But when you get rhabdo, you break ALL your water balloons, and ALL your sand and small rocks and marbles come flooding into your blood stream and can clog up the works and actually make your kidneys shut down.  Dialysis, death, and destruction can ensue.  Legitimately super scary stuff.

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A few days after the swelling started to subside. The chub went past my elbows!

While I lay there in my hospital bed (and during the following weeks of complete rest), I had plenty of time to scour the internet in search of information on rhabdo.  What I found were plenty of articles on what to do in the crisis – go to the hospital, get ridiculous amounts of IV fluids, pray your kidneys don’t shut down – but found nothing on what to do next.  Essentially, there is little to no information published about how to take an athlete who suffered a significant injury to one part of their body, but which had systemic effects throughout their entire body, and reintegrate them safely into physical activity.

So with the assistance of my coaches, we set off on a 7-month journey to fix me.

The first step in the process was rest.  Lots and lots of rest over the entire month following my release from the hospital.  To counter the utter exhaustion, I shortened my work hours, took a nap whenever I wanted, ate plenty of food, and went to bed early every night.  For an active person, this was the worst kind of torture!

The second step was to closely monitor my cK levels.  After a month of rest, I went to the doctor and had my cK levels checked; I was back in the normal range, so he cleared me to go back to the gym.  That first week, I went to the gym one time, carefully and cautiously went through the motions of a drastically scaled WOD – no weight, no jumping, no trying! – and had my blood tested again that weekend.  Once again in the normal range, the doctor cleared me to go twice the following week, still at a drastically reduced WOD.

The third step was Lather, Rinse, Repeat.  Over the course of the next several months, I very gradually increased the frequency and intensity of my workouts, all while paying weekly visits to the doctor to make sure my cK levels were in the normal range.  If they were high, I spent another week at the same intensity; if they were in the normal range, I scaled up my effort a bit.  Progress the first few weeks was very slow, and I woke up every day exhausted and feeling like I had been hit by a bus painted “RHABDO” on the side.

But after a few weeks, I was working out three times a week and graduated from “Karla’s special rhabdo WOD” to my gym’s “less than 3 months WOD”, which is scaled at about 60% volume of the RX WOD.  From there, I spent the next 3 months working my way up to actually conducting the “less than 3 months WOD” at full intensity.  Each time I kicked it up a notch in intensity, the Rhabdo Bus came to hit me again and that long-term fatigue that rhabdo patients talk about once again manifested itself.

As time went on, my weekly blood tests turned biweekly, then monthly.  In April, I completed my first RX WOD, bought a gym t-shirt to celebrate, and promptly went home to sleep off my workout.

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First RX WOD with my bestie.

But then one day in May, it all just clicked.  I started feeling great when I worked out, as if I was crushing the WODs instead of them crushing me.  In the space of just a few weeks, I found myself able to handle more weight, jump higher, run faster, do real pushups instead of on my knees, and I got my first kipping pullup.  The best part was that I was able to do all these things without having to be scared of wrecking myself again.

Finally in July, 7 months, 14 doctor’s appointments, and 75 WODs later, I graduated rhabdo.  My cK levels were back in the normal range, the doctor assessed I was past the point of reoccurrence, and sent me on my merry way.

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My rhabdo diploma from the School of Pain, which apparently only wants to be upside down.

SO WHAT?

This story isn’t intended to be about me and my journey.  Bur rather, it’s about sharing the principles that my coaches, my doctor, and I found to be successful as we all made this journey together.  We believe these principles are useful guides for any athlete looking to recover from rhabdo.

  1. Be smart.  During our first conversation about how to move forward, my coach made me write something on the whiteboard that became my mantra for every workout that followed:  “It’s easy to be hard; it’s hard to be smart.”  It was a difficult, but essential lesson to learn, which I repeated to myself often.  On more than a few occasions over the following months, I erred on the side of caution and ended my workout early on the premise of “being smart.”  I figured that even if I ended my workout early, it was still better than not working out at all, and was certainly better than overdoing it.  Thus, my second mantra became “Every day is progress” because in truth, it was.
  2. Take a long term view.  Crossfitters are goal-oriented people, and we like to see progress!  I wanted to be better NOW.  When I first got back in the gym and was forced to do every WOD with the training bar or 10-pound dumbbells, I felt as if I would never get past this thing.  But in the grand scheme of my life, the 7 months I spent recovering from rhabdo in a safe manner was nothing!  Assuming I live to be 75 (and these days, that is short), that half a year was less than one percent of my life.  So take the long term view of things and recognize that slowly and safely isn’t really as slow as it may seem.
  3. Seek medical advice and follow it.  I was my gym’s first case of rhabdo, and my coaches were smart enough to know the limitations of their knowledge and experience.  So we sought medical advice early and often from a trusted physician who specializes in osteopathic and sports medicine.  We let him set the pace for progress.
  4. Keep a journal and listen to your body.  For Crossfitters, tracking our workouts isn’t a grand revelation.  But in addition to tracking what I did, what weight I used, and how fast I did it, I also wrote down how I felt at the end of every WOD.  Then the next day I wrote down how I felt too.  More often than not, I felt tired as opposed to sore; if my body was telling me I was too tired, I took another rest day and went to bed early.  It’s common sense, but I believe those rest days were of more benefit to my body than trying to grind my way through another workout.
  5. Avoid high rep schemes.  The workout that gave me rhabdo was a chipper, with 50 push press followed by 40 pushups and a number of other things.  We believe it was the high number of consecutive reps targeting my weakest muscles that did me in, as opposed to high weight.  Therefore, all of my future WODs were modified so that I never did more than 10-15 reps of anything in a row.  For example, if the WOD called for 30 reps each of a variety of exercises, I cut it in half and did two rounds of 15 reps each.
  6. When in doubt, run or row more.  During the early weeks of my recovery, the coaches increased the amount of running and rowing in my WODs compared to the regular workouts, in an effort to provide a little more time for recovery for my muscles between weight-bearing movements. For example, my first “Fran” was a 12-9-6 rep scheme with a 250m row in between each round.
  7. Don’t completely avoid the muscles you injured.  Treat your shredded muscles with caution – they are weak after having been disintegrated.  But don’t avoid engaging those muscles completely; after all, the only way for them to grow is for you to use them!  In my case, I injured my shoulders and triceps, so we were more cautious with upper body exercises than we were with lower body.
  8. Don’t give up.  Progress will come.  You just gotta keep showing up!
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10 months post-rhabdo I did my first Crossfit competition. My partner and I finished 3rd place in scaled division. Not too shabby for the girl with broken muscles!

If you find yourself in the unfortunate circumstance of recovering from a bout of rhabdo, rest assured you’re not alone.  I welcome you to try our approach – it was conservative and perhaps a little slow, but it was safe.  You and your coaches may choose a different approach to your recovery, and that’s ok too, as long as it works for you and your body in the end.


2 thoughts on “So You Got Rhabdo…Now What?

  1. Karla, that sounds like quite an ordeal. Sorry you’ve had such a time of it. hope you are truly doing ok at this point in time. God bless..

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