But caution soon fell away. Upbeat music was booming and someone was always advancing beside me. When the instructor encouraged us to lower all the way down, I obeyed, even though my form suffered. I had rarely done more than a handful of pushups at a time, and in the final set, I was exhausted, collapsing on every rep and barely prying my torso off the floor.<\/p>\n
The rest of class was a blur. I became nauseated, told the instructor I needed to pause, and stepped outside to suck cold winter air into my lungs.<\/p>\n
Back in the studio, I sat on the sidelines and waited for the dizziness to recede before slinking to my spot for the core section and cooldown.<\/p>\n
Later that night, I felt what I thought was typical post-workout muscle soreness<\/a>. I was satisfied; the ache was proof of a successful workout.<\/p>\n But the next day, lifting my arms to wash my face was exhausting. Searing pain kept me awake that night. Two days after the class, my arms were so stiff I couldn\u2019t raise them more than a few inches, even to brush my teeth.<\/p>\n When I Googled my symptoms \u2013 pain, weakness and a new one, dark urine \u2013 something frightening came up: exertional rhabdomyolysis<\/a>, a condition wherein extreme exercise causes muscle cell contents to flood the bloodstream, potentially overwhelming the kidneys. One article<\/a> warned that debilitating pain after a new, intense activity was a sign to visit the emergency room.<\/p>\n I went to the ER but suspected I was overreacting. After all, the internet always offers the worst possibility.<\/p>\n Doctors use bloodwork to test for exertional rhabdomyolysis; typically, they diagnose it <\/a>if a patient has too much of a muscle enzyme called creatine kinase (CK) in their blood \u2013 at least 1,000 units per liter, or five times the normal range. However, there is little consensus on this number, says Dr Barry Boden, an orthopaedic surgeon at The Orthopaedic Center in Maryland, who specializes in sports medicine. Some recent guidelines suggest that only higher amounts \u2013 as much as 10,000<\/a> units \u2013 warrant diagnosis and inpatient treatment.<\/p>\n My CK count was so high the machine in the emergency room couldn\u2019t measure it; a nurse had to do a second blood draw and send it to a more precise lab. They put me on an IV drip and eventually reported the exact number: 57,000.<\/p>\n Thus began my seven-day hospital stay. My mom and sister traded shifts, acting as my arms for the week \u2013 scrubbing my teeth, feeding me, washing my face. I had never felt so helpless and irresponsible. What had I done to myself?<\/p>\n What is exertional rhabdomyolysis?<\/p>\n Normally, during exercise, muscles tear a little and then rebuild. There may be a little extra CK in a person\u2019s blood<\/a> as a result, which healthy kidneys can filter out.<\/p>\n But excessive exercise can harm muscle cells so much that their contents \u2013 including CK and a protein called myoglobin<\/a> \u2013 overload the system. \u201cWhen the cell membrane starts to break down, the chemicals within the muscle cells start to get released, which can cause damage to other organs around the body,\u201d said Boden. \u201c\u200aIf there\u2019s enough of those chemicals from the muscle that reach the kidney, it can cause damage to the kidney.\u201d<\/p>\n The symptoms are muscle pain (even while at rest), weakness and dark urine, though few people experience all three<\/a>. Treatment involves early and aggressive administration of IV fluids to help the kidneys filter the toxins. It\u2019s possible to manage a mild case with at-home oral hydration, but it\u2019s always important to consult a doctor because mild symptoms don\u2019t always mean low CK elevation, said Dr Petr Schlegel, a CrossFit trainer and professor at the department of physical education and sports at the University of Hradec Kr\u00e1lov\u00e9 in the Czech Republic.<\/p>\n Exertional rhabdomyolysis is dangerous and fatal in very rare cases; researchers estimate that 10% of patients develop acute kidney injury<\/a> (AKI), and some suffer other serious complications<\/a>.<\/p>\n How common is exertional rhabdomyolysis?<\/p>\n Before I had rhabdomyolysis, I had never heard of it; I thought the worst that could come from a workout was a broken bone or a regurgitated lunch. I now know it can happen to anyone, although people with certain conditions, such as sickle-cell trait and hypokalemia<\/a>, are predisposed. Despite the common misconception that only unfit people can get it, even elite athletes are susceptible<\/a>.<\/p>\n \u200a\u201cAnybody can get it \u2013 anybody that\u2019s pushed to an extreme, taking a big jump in their exercise level, or doing something they\u2019re not used to doing,\u201d said Boden. \u201cEverybody has muscles, and if the muscles are damaged enough, you can develop rhabdomyolysis.\u201d<\/p>\n Boden authored a study<\/a> estimating there were over 40,000 exertional rhabdomyolysis cases in US hospitals from 2000 to 2019. But he said it\u2019s impossible to get a precise count, as no organization collects the data.<\/p>\n This number is likely an underestimate, as the condition is probably under-reported, said Schlegel. Since the symptoms closely resemble those of delayed onset muscle soreness \u2013 the normal ache people expect after a workout \u2013 individuals may not seek care.<\/p>\n Data indicate exertional rhabdomyolysis is on the rise. In Norway<\/a>, Australia<\/a> and the US<\/a>, researchers have observed an increase in hospital records between the 2000s and 2010s. This year, hospitals in a Canadian province reported a surge<\/a> in cases.<\/p>\n Researchers suspect the popularity of high-intensity workouts<\/a> is behind the rise. They are efficient and produce measurable progress, but are risky if misused, said Schlegel: \u201cEvidence suggests that high-intensity exercise, especially when combining strength and endurance elements, carries the greatest potential to induce [exertional rhabdomyolysis].\u201d<\/p>\n skip past newsletter promotion<\/a><\/p>\n Sign up to Well Actually<\/p>\n Practical advice, expert insights and answers to your questions about how to live a good life<\/p>\n after newsletter promotion<\/p>\n Can you prevent exertional rhabdomyolysis?<\/p>\n Prevention guidance has been pretty consistent since the earliest studies from the 1960s<\/a>: vary exercises to avoid overloading one muscle group, incorporate rest, and gradually build intensity when starting something new or after time off.<\/p>\n Starting low is especially important when targeting large muscle groups \u2013 such as biceps, triceps and quads. \u201cIt\u2019s that hyperintense going from zero to 100, really intense workouts of large muscle groups, that puts people at risk,\u201d said Dr Bryant Walrod, a sports medicine physician and the head team physician for the Ohio State Buckeyes. Weight matters, but so do reps; an outrageous number of low-weight exercises<\/a> or calisthenics \u2013 hundreds of pushups or squats<\/a>, for example \u2013 is the trigger in many cases. Walrod also advises doing a different kind of workout from one day to the next.<\/p>\n Eccentric<\/a> exercises like push-ups \u2013 where muscles lengthen \u2013 are particularly likely to cause injury. In a 2024 article about how to prevent rhabdomyolysis in student athletes, the National Federation of State High School Associations called push-ups the \u201cNo 1 cause\u201d <\/a>of rhabdomyolysis. In April, Texas families filed a lawsuit against a charter school<\/a> after 20 children were hospitalized after hundreds of pushups.<\/p>\n Walrod said collegiate sports professionals became more vigilant about prevention after University of Iowa football players were hospitalized with exertional rhabdomyolysis<\/a> in 2011. \u201cThat case spurred better control of workouts, better monitoring, and better input from the trainers and strength coaches.\u201d<\/p>\n \u201cWhere we see most of the cases is that athletes are being pushed or threatened or punished [contrary to industry standards],\u201d said Dr Rebecca Stearns, COO at the Korey Stringer Institute for preventing sudden death in sports. Coaches are not exercise physiologists, and even when well-intentioned may not have adequate training to prevent overexertion, said Boden.<\/p>\n Similarly, there\u2019s no guarantee fitness instructors understand the risk. \u201cPeople may be going in unconditioned and doing too much too soon,\u201d said Walrod of these classes. CrossFit incorporated prevention into its trainer curriculum after reports of severe cases among participants<\/a>, but in general, class participants should self-monitor.<\/p>\n How do you identify overexertion?<\/p>\n I was discharged from the hospital with a firm instruction: no exercise except walking for a month. I had to learn what an appropriate challenge felt like \u2013 how to self-monitor, discern between safe discomfort and overexertion, and advocate for myself. But when is hard too hard?<\/p>\n Unfortunately, sensing that something is wrong is a subjective measure; there is no universal metric.<\/p>\n \u201cI never have a very satisfying answer to that, but I do think it\u2019s a line we need to be vigilant about always, and it changes from day to day,\u201d said Dr Natalia Petrzela, author of Fit Nation: The Gains and Pains of America\u2019s Exercise Obsession, longtime fitness instructor, and professor of history at The New School.<\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/il\/wp-content\/uploads\/2026\/06\/1782329891_453_500.jpg\")
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