Rhabdomyolysis sounds like a big scary word, but let’s break it down into something that we can understand. The prefix “Rhabd” means rod or spindle like. The root or middle of the word “Myo” means muscle and the suffix or ending of the word lysis means to sever, cut or break. Like hydro-lysis means to cut with water. So, we put it all together and the word Rhabdo-myo-lysis means a muscle spindle is being cut. Damaged muscle fibers are broken down and the contents are spilled into the blood stream. The cause of rhabdomyolysis (lets abbreviate it to “rhabdo” from now on) can be from anything that damages muscle. This could be from trauma, burns, viral infections, or over exertion of muscles especially in heat. When muscle is broken down it releases a protein that was once inside the muscle cell called myoglobin which can be detrimental to various tissues in the body. Myoglobin acts as a reservoir for oxygen in times of ischemia where blood flow through a tissue has become diminished especially during bouts of intense exercise. Myoglobin is structurally similar to hemoglobin but has a higher affinity (meaning a tighter hold) on oxygen. An interesting adaptation to altitude training is an increase in saturation of myoglobin. Sherpas and elite mountain racing endurance athletes possess a higher quantity of myoglobin in their tissues. Training produces the adaptation of increased vascularity to carry more oxygen to the tissues. Intracellularly, the cell produces more mitochondria which is (the power house of the cell no doubt) an aerobic meaning with oxygen enzyme. Meanwhile, myoglobin is an oxygen donor to the mitochondria which is increased as an effect of endurance training.
Myoglobin is a good thing if it’s on the inside of the cell where it should be. But in the event of muscular damage or trauma, the contents spill out into the blood stream. Myoglobin is destructive to some organs, especially the renal tubules of the kidneys. Myoglobin is an iron-containing protein that has the ability to catalyze or kickstart the formation of free radicals or reactive oxygen species, a molecule or structure that has the ability to bind to your DNA, RNA, proteins, and lipids and cause a whole host of other problems. When a protein has even 1 bond broken it can change the 3-dimensional shape, which then destroys the function of the protein. These proteins can aggregate, creating a blockage within the kidney which diminishes their function.
What are some signs and symptoms of rhabdo? The first and most noticeable is that the urine will have a darker coloration. This is the color of the protein in the presence of the urine. You have probably seen myoglobin before but were not aware of what you were looking at. When you buy a steak at the grocery store and it’s wrapped in plastic you probably notice the red colored juices. Some believe that the juice is blood, or watered down blood giving it the red color. However, this is myoglobin. Now a question you might think of is; well why doesn’t eating a steak hurt my kidneys? The answer is because the stomach acid gets to it first, breaking the protein down to be used for energy and rebuilding the body. Another sign of rhabdo is that the muscles feel achy, a different feeling than you get from a hard workout. Urinary tests will reveal an elevated CK level (creatinine kinase… different from creatine) and an elevated BUN (Blood urea nitrogen) level. Myoglobin behaves like a weak acid; it donates protons to solution defining its acidic nature.
The first and most prevalent treatment is rehydrating as soon as possible… as possible as yesterday. They say the solution to pollution is dilution so the solution to excess myoglobin is to keep its concentration low, which means utilizing water to dilute the protein in the blood. Acids are neutralized by bases; alkalinity. Good old baking soda has the ability to neutralize the acid in myoglobin. Intravenous injection of sodium bicarbonate is the easiest but also not as much accessible. Some sports nutrition brands have found creative ways to deliver bicarbonate to the body, bypassing the stomach acid. When an acid and base react, gas in the form of carbon dioxide is released. Maurten has made a hydrogel system that can coat the bicarbonate so that it gets to the small intestine without reacting with stomach acid. So, consuming some bicarbonate before and after a major output would be a strategy to overcome the effects of rhabdo. Depending on the severity, fully recovering from rhabdomyolysis can be from 2-6 weeks.
Strategies for overcoming rhabdo:
Short term: hours to days
- Hydration- both with water and electrolytes IV drip therapy if available
- Bicarbonate supplementation
- Cooling the core body temperature down
- Reducing training volume and resistance training
Mid-term: days to weeks
- Supplementing antioxidants; glutathione, vitamin C with bioflavonoids, vitamin E, CoQ-10
- Dietary addition of protein to rebuild damage muscle
- Dietary addition of more carbohydrates to restore stores of glycogen and glucose
Long-term:
- Heat adaptation training through sauna exposure
- Maintaining consistent iron supplementation
- ***Myoglobin is an iron containing molecule so replenishing ferritin levels is a key long-term strategy***
So, to summarize, rhabdomyolysis is damage to skeletal muscle and can happen in runners, especially when exerting for long durations in the heat. Proteins and membranes begin to denature, or lose form and function at around 105 degrees. So, heat can contribute further to the breakdown of muscle tissue while the muscle is performing its action. Myoglobin is the protein of concern when skeletal muscle is lysed or cut open. Myoglobin is a protein, which if not diluted (hydration) and neutralized (bicarbonate) and its effects systemically (antioxidants) can cause damage to sensitive tissues in kidneys.
I hope this article helps. If you have ever dealt with rhabdo or know somebody who has or if you have any questions don’t hesitate to reach out.
Ohio Sports Chiropractic and Rehab
📍 10360 Northfield Rd, Northfield, OH 44067
📞 (330) 908-0203
🌐 ohiosportschiropractic.com
