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Don't go until you Rhabdo!

Updated: Apr 3, 2020

*Please note: I am not a medical professional and this blog entry is purely to provide my insights on this topic. You should always seek professional medical advice.*

As many of us how come to learn, asking Google to define or explain an unknown subject is now the default not the 'follow-up, fact-check'; we all know that friend of ours who comes out with many false facts and the joy we have calling them out on it!

How does this tie in with this blog? Well, when a friend sends you a text saying a friend has had to go to hospital because they have been diagnosed with a case of rhabdomyolysis, your first thought, naturally, is omg I hope they are ok quickly followed by, what on earth is rhabdomyolysis?

A split second Google search and I find a wealth of information on the subject of this, thankfully rare, but in severe cases potentially life threatening condition.

"There appears to be a knowledge gap in the industry"

What amazed me is whilst there are several causes of Rhabdomyolysis, such as sudden trauma, genetics or illicit drug use, over exertion by novice and experienced athletes can also be a trigger. Despite this, there appears to be a knowledge gap in the industry as to the condition, it's causes and how to avoid it!

This isn't the case for the condition known as DOMS (the delayed onset of muscle soreness), in fact there are many videos and blog entries touting DOMS after your workout as a sign of a good workout (more on that later).

The danger, in my opinion, is that these two conditions, can be confused and as a result can pose a serious risk to the individual.

The purpose of this entry is to inform the reader of the two conditions, DOMS and Rhabdomyolysis, to help with proactive measures to mitigate their risk and inform trainers in particular how to better program for clients. As always, and as I mention several times throughout this blog entry, professional medical advice should always be sought when needed.

"Allow a period of adjustment and acclimatisation"

Just to be clear though, this article is not designed to scare you away from training or from pushing yourself in your workouts. Progressive and gradual overload combined with proper technique, adequate preparation and a healthy lifestyle are essential for the gains we strive for. Instead to introduce fitness or changes to your current routines gradually to allow a period of adjustment and acclimatisation.

So with the intro out of the way we turn a little 'textbook' and delve into the topics of DOMS and Rhabdomyolysis.


DOMS is the aching of our muscles after undertaking physical activity. It occurs when an individual undertakes a new or a modified exercise routine or increases the duration or intensity of their normal workout. For example, you introduce some new exercises to your workout plan, adopt a tougher progression in your calisthenics routine, lift heavier weights or simply increase the volume (reps x resistance) of your training.

If you’ve felt it you are certainly not alone, it can affect anyone regardless of their fitness level.


  • Duration: Typically lasts between 3-5 days

  • Occurs: 1-2 days after your workout

  • Pain Level: Mild to severe

  • Remedy: No single cure: Rest, ice packs, massage and painkillers are considerations.

Watch a video summary here.

"Natural response to new stimulus leading to strength and stamina adaptations"

DOMS can be seen positively as your body’s natural response to the new stimulus leading to strength and stamina adaptations as your muscles repair and recover. However, strong caveat here, the absence of DOMS after a workout does not mean you haven’t pushed yourself hard enough! There are many indicators of gains, to take a simple but obvious example, lifting heavier weights or completing more repetitions!

Practical Guidance:

  • Take your time: DOMS can be mitigated if changes to your exercise routine or intensity are introduced slowly.

  • Don’t skip the warm-up: Prioritise time at the beginning of your warm-up to ready your muscles and joints for your main workout; paying particular attention to those that shall be the focus of your routine.

  • You can exercise with DOMS however if you find it too uncomfortable then rest or focus on other less affected muscles.

  • Stay hydrated and rest when you need to. Your exercise is your decision and for your enjoyment, take breaks as and when you need to, you're in charge!

  • Seek immediate medical advice if you are unsure of your symptoms and diagnosis.

Useful Sources:

Rhabdomyolysis (Rhabdo)

"The breakdown of skeletal muscle"

Whilst DOMS can be seen as the positive adaptation of muscle to new stimuli, Rhabdo is certainly not! Simply defined, Rhabdo is the breakdown of the skeletal muscle, which unleashes a variety of muscle cell elements into the bloodstream. Instead of gaining muscle your body ends-up breaking down muscle!

Thankfully the occurrence of Rhabdo is rare however it is an important consideration for all who engage or prescribe physical activity as the consequences can be serious and, in severe cases, life threatening.

Watch a video summary here.


From my research common symptoms experienced by sufferers are:

  • Muscle swelling

  • Muscle soreness not only when moving but when at rest

  • Dark urine

  • Vomiting

For a more extensive list of symptoms see here.


  • Trauma, heat and exertion

  • Genetic and metabolic disorders

  • Infection and inflammation

  • Medications and toxins

As the focus of our blog is on fitness, we shall focus on Rhabdo and the causes from exertion:

"Don't go crazy"

  • New to Training or the Training Style: Similar to DOMS, the body will not be accustomed to training if you haven’t trained previously or have taken a prolonged break. Simply put, don't go crazy intense or jack-up the resistance far beyond your normal range, especially if you haven't exercised in a while!

  • Exercise intensity/Duration: The literature appears to split the upper and lower body here citing that lower body occurrences are the result of significant stress e.g. lots of squats or distance, the upper body can however experience rhabdo under intense unaccustomed exercises in periods as short as 10-20 minutes (think jump pull-ups, clap push-ups etc.)

Practical Guidance:

  • Acclimatise to an exercise routine and exercise restraint if returning to exercise, starting where you left off will be a shock to the system.

  • For trainers, the risk of Rhabdo should be recognised when instituting new and/or aggressive dynamic exercise routines, regardless of training status and especially among lesser-trained individuals.

  • Stay hydrated and rest when you need to. Your exercise is your decision and for your enjoyment, take breaks as and when you need to, you're in charge!

  • Seek immediate medical advice if you experience symptoms.

Useful Sources:

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