Episode 42 is dedicated to a particularly important topic that can affect some runners; Rhabdomyolysis, more commonly known as Rhabdo. It is a condition caused by damage to skeletal muscle. In sports, the muscle damage happens with excessively strenuous exercise, but it can also be caused by crushing injuries to the body, some medications, toxins, or infections. When the muscle is damaged, potentially toxic contents within the muscle cells (creatine phosphokinase or CPK, myoglobin, potassium, phosphate, uric acid) are released into the blood stream. In small amounts, the body is typically capable of filtering and clearing these toxins. If the injury is severe enough to cause a massive release of toxins, the body may be unable to adequately clear them. These toxins can cause irregular heartbeats, kidney damage, and, in severe cases, death.
Signs and symptoms of rhabdomyolysis include:
Classic Triad

Muscle pain (myalgias)
Muscle weakness
Dark-coloured urine

Other:

Decreased urination
Fever
Malaise
Nausea or Vomiting
Confusion and/or agitation (delirium)

My friend, Nicole Kew came down with Rahbdo following her participation in the 24 hour world championships in France in 2019. This is her story.
What a scary story! It would be good for everyone to stay on top of their hydration and urine out-put. Nicole told me later that the doctors had said to her that if she had waited another 24 hours she would very likely have died. Scary stuff.
The doctors haven't been able to pinpoint anything specific that caused her rhabdo. The Sports Physician called it 'a perfect storm' of small things that on their own were insignificant but combined may have all contributed. e.g. Nicole could have possibly picked up an infection/virus before the race, it was slightly warmer weather than expected, she may not have fully hydrated properly prerace, the hard surface and twisty/windy nature of the course could have taken its toll on her quads. Having a hard massage on the quads during the race probably sped up the muscle breakdown and release of the myoglobin into the blood stream (the muscle breakdown was already occurring and then rubbing the quads added to the trauma rather than relieving it), the flight home 2 days after the race would also have accelerated the dehydration process as she wasn't able to keep any fluids down and flights are dehydrating anyway. There wasn't any one thing that can be blamed. Other causes are if you have taken certain medications so they did blood tests in hospital to rule out NSAIDS as this is often a contributor but she hadn't taken any during the race so this wasn't a factor and the blood tests ruled out medications as an issue. It can also often be undertraining or over exertion, but Nicole was fully prepared, had ticked all the boxes in training. This was her 8th 24-hour event so her body and legs are used to the repetitive nature of a looped course. Nicole also had to have extensive testing with a Sports Cardiologist after her hospital admission to rule out any potential cardiac issues either pre or post race. So it's all a bit of a mystery but I guess it goes to show that you can do all the right things in training and during the race, follow the same nutrition and hydration plan as you have multiple times before and things can still go wrong.
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If you’re looking to get coaching for the looming huge race season, email me at isobel@peakendurancecoaching.com.au
Have a great weekend of training and spending time with your loved ones. Remember, we are all in this together. And together we will get through this.