Dark urine, severe muscle pain and swelling are just a few of the symptoms associated with external rhabdomyolysis.
They're also symptoms that Lacey DellaPace never believed she would experience from a CrossFit type workout.
DellaPace, a 27-year-old University of Florida exercise science major turned photographer, said rhabdomyolysis is something you don’t think about when you’re working out.
“If it happens, it can be such a danger to your body,” DellaPace said.
On the day before her symptoms began, DellaPace said that she had be taking professional CrossFit classes for about a month. It wasn’t until she had an off day and time to workout on her own that her symptoms began to take affect.
“On my off day, I went to the gym with my friend and her mom and we went through a CrossFit workout on our own. They both had been doing CrossFit for about a year, but me only a month. I’m a pretty active person—I hike and bike a lot and play soccer every week for an adult league—so, I was certain I could keep up with them,” DellaPace said.
Chip Thorndike, owner and trainer at CrossFit Gainesville, said “lack of education” is the biggest problem when it comes to CrossFit training.
“I hate to say it but a lot of problems come from lack of education on the coach’s part. Rhabdomyolysis has been around before CrossFit, so level of coaching makes a difference,” Thorndike said.
Thorndike said it’s important to look for areas of weakness or fatigue in clients.
“I’ve never had anyone have it, but I’m fully aware of it, so I control the intensity of people’s workouts and their class levels,” Thorndike said.
DellaPace described that she should have listened to her intuition about doing the workout with such experienced Cross-fitters, but like most active people, she pushed on certain that she would be fine.
“We worked out for about an hour. My weights weren’t heavy but I was still pushing myself hard,” DellaPace said. “By the end of the workout my muscles were starting to shake on their own, so I knew it was time to quit. But, I still felt great afterwards,” she said.
Dr. Patricia Tripp, director and clinical associate professor for undergraduate athletic training education at the Univeristy of Florida, said External Rhabdomyolysis (ER) could result from intensive weight-lifting workouts.
Dr. Tripp explained “eccentric loading” might cause isolated incidents of External Rhabdomyolysis, like in the outer thigh from doing excessive or heavy squats.
DellaPace described her workout intensity increased rather suddenly. She also discussed her second biggest mistake, aside from not listening to her body, was not drinking enough fluids during and after the workout.
“I drank a little bit of water while working out but I’ve never been good about taking in enough fluids,” DellaPace said. “When we got back to my friend’s house, I drank some of a protein shake and hoped it would be good enough in repairing any muscle damage from the workout.”
The following day, DellaPace said she began having severe pains in her right elbow.
“I was definitely having soreness all over, but I figured I had just slept wrong and attributed the soreness to my workout, so I didn’t think much about it,” DellaPace said.
As the day went on, however, DellaPace said the pain and soreness increasingly got worse and more intense.
“My muscles were extremely swollen and I couldn’t extend my arm all the way. Something I also noticed was the color of my urine—it was extremely dark—but again, I brushed it off and figured I was dehydrated,” she said.
DellaPace said that on Sunday, only two days after her workout, she could barely move.
“I was in so much pain and by far the most sore I had ever been in my life. I could barely get dressed for church. When my husband and I returned home, we pretty much relaxed around the house all day,” DellaPace said.
It wasn’t until that evening that DellaPace knew something was really wrong.
“My urine was really dark by that point,” she said. “All of a sudden it hit me, it was tea-colored.”
Ironically enough, DellaPace said she remembered learning in school about some condition with tea-colored urine, but couldn’t quite remember what it was.
As many do, she turned to the Internet to research.
“Rhabdomyolysis instantly popped up and I had all the symptoms,” DellaPace said. “Even then I wasn’t fully convinced I needed to do anything about it right away. By this time I was 11pm and I was not about to make my husband take me to the ER,” she said.
“I started downing cup after cup of liquids with electrolyte tablets. I was going to hydrate and just wait until morning to go to the doctor,” DellaPace said. “It wasn’t until I began reading about all the kidney damage that could occur that we decided to go to the ER.”
It was then that DellaPace found out she did have Rhabdomyolysis.
“They started an IV right away. My CK (creatine kinase) levels were over 70,000 U/L. Normal levels for a female is 10-79 U/L,” DellaPace said. “It was the highest the hospital said they had ever seen, so they were worried I had possible kidney or liver damage,” she said.
DellaPace said the hospital kept her overnight to run tests and get her hydration level up through an IV. Following her hospital visit, she also had to see a doctor for blood work to ensure she didn’t have liver damage.
She also stated an important fact that just because you’re in good shape doesn’t mean you’re in “lifting or gym shape.”
“My doctor told me that even though you may be in good shape on the soccer field, this doesn’t translate into being in weight-lifting shape,” DellaPace said. “I was using my muscles differently and they just weren’t ready for the workout I was giving them.”
Dr. Tripp added there is call for alarm for athletes and individuals with a Sickle Cell Trait (SCT) who have cases of ER.
“When a person who has SCT completes a bout of intense activity (cardiovascular or resistance training) and is not afforded adequate recovery, the red blood cells begin to ‘sickle’ and the combined decreased delivery of Oxygen to the muscles, with the ‘sickled’ cells blocking vascular pathways can lead to further tissue damage and creatine kinase leaking, organ failure, etc.,” Dr. Tripp said.
Dr. Tripp encouraged patients and athletes to educate themselves to prevent such cases of ER and ways to recognize symptoms of ER versus regular muscle soreness.
“ER is not always associated with dehydration—hydration levels may not be a prevention method directly. Acute, onset swelling needs to be responded to, especially if patient or athlete has SCT,” Dr. Tripp said.
Dr. Tripp said if ER is suspected treatment needs to happen immediately because “delays in proper management may impact survivability.”
Thorndike encourages people, especially students, to be aware but not fearful of Crossift.
“It is all based on the individual. Being in a college town where students are staying up late, drinking and getting no sleep can be an issue when starting a workout,” Thorndike said.
He and Dr. Tripp reiterate listening to your own body, educating yourself and to pay attention to any changes, especially if you’re an individual with SCT.
It has been over a year since DellaPace was treated for Rhabdomyolysis and she said she is back to working out and being active.
“I was a little timid to workout again at first, but I am more aware now and more careful as to what my body can handle,” DellaPace said.