Go exercise in the spring, but be careful, the harder you exercise, the more "injured" you will be...

Take off the down jacket!

The woolen coat is off!

Take off the thick fleece sweater!

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Wear short sleeves to celebrate the coming summer

I got the gym membership!

Those who sit for a long time suddenly challenge themselves to a marathon!

300 squats!

I'm tired of adding and adding weight to the iron sheet!

…

Friends

Stop forcing yourself to exercise.

Otherwise rhabdomyolysis

It is really life-threatening!

There are about 639 muscles in our body. These muscles can be divided into two categories: striated muscle and smooth muscle.

Striated muscle mainly includes skeletal muscle and cardiac muscle. Among them, skeletal muscle can be called "the working muscle" - it is used to carry express packages during the day, lift weights in the gym, and even every action you take when you click "like" on your phone depends on it.

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But even the most dedicated muscles can break down at some point, such as rhabdomyolysis .

Rhabdomyolysis is a serious medical condition that occurs after skeletal muscle injury, when muscle cells are damaged and their contents leak into the bloodstream, triggering a range of health problems.

The typical symptoms of rhabdomyolysis can be summarized as the "triad":

⚠️ Continuous and worsening muscle pain

⚠️ Progressive muscle weakness

⚠️ Dark urine

However, it should be noted that about 30% of patients may not have obvious changes in urine color, so the condition cannot be judged solely based on urine color.

If there are triggers such as strenuous exercise, crush injury, limb immobilization, drug accumulation, etc., and if you also experience discomfort such as abnormal muscle pain and fatigue, you should seek medical attention promptly and have a creatine kinase (CK) test for a clear diagnosis.

When muscle cells rupture due to excessive damage, it often causes severe muscle pain and progressive muscle weakness. At the same time, harmful substances accumulated in the cells will rush into the blood like a "flood", triggering a series of life-threatening chain reactions.

Among them, a large amount of myoglobin released from the muscles will be excreted through the kidneys, but due to the large molecular weight of myoglobin, it is easy to deposit in the renal tubules and form a "blockage", just like a sewer being blocked by debris.

This can cause the urine to decrease in volume and become darker in color, even turning tea or soy sauce colored.

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Urine needs to be excreted from the body through the kidneys. Too much "debris" will block the kidneys' exit path, causing damage to the glomeruli and renal tubules. In severe cases, it can lead to acute renal failure!

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At the same time, when muscle cells rupture, a large amount of potassium ions are released into the blood, causing the blood potassium concentration to rise rapidly, thereby causing hyperkalemia.

Mild hyperkalemia may cause people to feel dizzy and have irregular heartbeats;

Severe hyperkalemia may cause very dangerous heart problems, such as ventricular fibrillation or even cardiac arrest, which can directly endanger life!

Rhabdomyolysis may sound strange, but it may actually be lurking in our daily lives. Its causes are varied and it can happen to anyone.

One of the most common causes is high-intensity exercise. For example, people who rarely exercise suddenly run a marathon, some people work for a long time in hot weather without replenishing water in time, or fitness beginners do too many squats at once (such as hundreds of squats), which can easily cause muscle injuries.

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In addition to exercise, trauma and compression are also important causes. For example, in a traffic accident or earthquake, if a limb is pressed by a heavy object, the muscle may die due to lack of blood.

Similar problems may also occur if the limbs are under pressure for a long time after being drunk or unconscious (such as sleeping on your stomach with your arms pressed down).

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In addition, drugs and toxins may also trigger rhabdomyolysis. For example, people who take statins or certain antibiotics for a long time, or people with metabolic diseases such as hypothyroidism, may be more susceptible to muscle injury. Some conditions, such as viral myositis or venomous snake bites, may also directly damage muscle cells.

If you unfortunately develop symptoms suspected of rhabdomyolysis syndrome, the golden time for emergency treatment is only two hours.

First of all, you should stop exercising immediately, drink plenty of light salt water, and then seek medical attention for examination and treatment as soon as possible.

In summary, the treatment principles of rhabdomyolysis syndrome can be summarized as: early detection, early treatment, and the focus is on protecting the kidneys!

It can be divided into the following four steps:

Step 1: Eliminate the cause

If it is caused by strenuous exercise, heat stroke or taking certain medications, stop exercising immediately, stay away from the high temperature environment, and stop taking the suspected medications.

Step 2: Plenty of fluids

This is the core part of treatment! Your doctor will give you lots of IVs to help flush the "bad stuff" out of your blood and prevent it from clogging your kidneys. The sooner you get fluids, the better!

Step 3: Preventing Complications

The most serious consequence of rhabdomyolysis is kidney damage. To prevent this, your doctor may alkalinize your urine with sodium bicarbonate or give you a diuretic.

If the situation is serious (such as high potassium levels or a sharp decline in kidney function), dialysis may be needed to save your life.

Step 4: Beware of other dangers

If the condition continues to worsen, the doctor will also check for compartment syndrome (muscle swelling that compresses nerves and blood vessels) or disseminated intravascular coagulation (disordered blood clotting). Although these conditions are rare, once they occur, they need emergency treatment!

1

The 10% Increment Rule for Exercise

The core of scientific exercise is gradual progress, just like building a house layer by layer. The improvement of athletic ability should also follow the "10% incremental principle".

For example, if you ran 5 kilometers last week, increase it to 5.5 kilometers at most this week.

2

Drink plenty of water during high temperature exercise

When exercising in a hot environment, it is very important to replenish 500 ml of electrolyte drinks every hour. This not only maintains fluid balance, but also dilutes toxins in the blood and reduces the risk of rhabdomyolysis.

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3

Lie down and recover blood

When the body sends out warning signals, it is more important to stop losses in time than to insist blindly. If the muscle pain after exercise lasts for 72 hours without relief, or it hurts like an electric shock when you touch it lightly, this may be a precursor to the collapse of muscle cells.

At this time, you should immediately stop activities, rest in bed, and seek medical attention as soon as possible to avoid worsening of the condition.

4

Patients who take medication for a long time should check CK value regularly

For high-risk groups such as those who take statins for a long time or suffer from metabolic diseases, creatine kinase levels should be monitored regularly.

5

Help drunk friends to recover

If you are drunk and fall asleep, you should adjust your body position every two hours to avoid prolonged pressure on your limbs which may cause muscle necrosis.

Real health management

It's not about the explosive power of the moment

It is about lasting scientific self-discipline

Find the perfect balance between self-discipline and rest

Statement: This article is a medical-related educational popular science article. It does not involve specific treatment methods or medical behaviors and cannot replace hospital visits.

Author

Feng Jiaming, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

Yang Xiuqi, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

He Jiahui, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

Yuan Xinyi, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

Jiang Xiangjian, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

Liang Bin, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

Chen Tingyu, 2021 undergraduate student of the five-year clinical medicine program at West China School of Clinical Medicine

This article is guided by the teacher

References

1. Baeza-Trinidad R. Rhabdomyolysis: A syndrome to be considered.

2. Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med. 2007;18(2):90-100. doi:10.1016/j.ejim.2006.09.020

3. Yang BF, Li D, Liu CL, et al. Advances in rhabdomyolysis: A review of pathogenesis, diagnosis, and treatment. Chin J Traumatol. Published online February 27, 2025. doi:10.1016/j.cjtee.2024.10.005

4. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury [published correction occurs in N Engl J Med. 2011 May 19;364(20):1982].

5. Zimmerman JL, Shen MC. Rhabdomyolysis. Chest. 2013;144(3):1058-1065. doi:10.1378/chest.12-2016

6. Zhang Z, Hu

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