Rhabdo: The Exercise-Induced Condition You’ve Probably Never Heard Of

Anyone else returning to the gym? It is January, after all. Following a break from exercise, it’s normal to hurt after your first session back — there’s nothing more humbling than struggling to bend down onto the toilet — and delayed onset muscle soreness (DOMS) is usually to blame. DOMS is common and sets in 24-72 hours after a workout. It may be a sign that you need to take it a tad easier next time. However, there’s also rhabdomyolysis, also known as rhabdo, which is a rare and serious condition that can occur after a workout. 

Rhabdo is when muscle cells leak into the bloodstream. It’s a serious but very rare condition. It can be caused by exercise and “the prevalence of exercise-induced rhabdomyolysis has increased”, according to a medical paper. (Though even with that rise, it’s still rare, and the rise is possibly a sign of how many of us now go to a gym.)

On TikTok, women have shared their experiences of rhabdo, thinking it was just DOMS after a workout only to find the pain becoming aggressively worse. These stories are scary and can often lead to misinformation being shared online, so it’s worth understanding more about the condition. Dr Babak Ashrafi from Superdrug Online Doctor, an online GP, says that rhabdo “occurs when your muscle fibres break down rapidly and release their contents into the bloodstream. This means that substances normally contained within the muscle cells — such as proteins (like myoglobin) and electrolytes — spill out and enter the bloodstream. It can lead to really serious health issues such as kidney damage if not managed.” There are various possible causes of rhabdo (like trauma from severe injuries and medication) and many of us aren’t aware that exercise is one.

TikTokers have shared that the pain of rhabdo felt like nothing they had experienced before, leaving them unable to move the slightest muscle without feeling extreme pain. Olivia Ancell, a popular makeup reviewer, described how she spent four days in hospital with rhabdo after returning to the gym after a break late last year.

Ashrafi says: “With DOMS, you’ll feel a dull, aching soreness that usually peaks a day or two after exercise. Rhabdomyolysis, however, involves intense muscle pain, swelling and weakness, often beyond what you’d feel with normal soreness. Other signs of rhabdo include dark, tea-coloured urine and feeling unusually fatigued or dizzy. If you notice these signs, seek medical attention right away.”

You’ll know it’s more than just post-workout muscle fatigue and soreness. Rhabdo is much more severe and develops rapidly.

Intense exercise can sometimes cause muscle breakdown that's too much for the body to handle. 

“When we push our muscles beyond what they’re used to — especially after a break from exercise — this breakdown can happen at a higher rate,” Ashrafi says. “If you’ve been away from the gym, it’s essential to start slow, even if you’re tempted to pick up where you left off. Your muscles need time to adapt again to the stress of exercise.”

“Too much” while exercising will vary from person to person. Ancell said she went into an “intense weights routine” after a few months off. Two days later, she couldn’t move her arms properly. Just because you lifted 45kg once doesn’t mean you should try to do it every time you work out, especially if you’ve had a break. Go lighter, go slower and reduce your reps until you’ve built your strength back up. 

Jurga Pikturnaite is a doctor and reconstructive surgeon with Emendo Surgical Group. She adds that dehydration, overheating and performance-enhancing drugs are all risk factors for exercise-induced rhabdo. Making sure that you’re fuelling yourself correctly before a workout matters.

You should seek medical attention if you think you might have rhabdo. Pikturnaite says mild cases may resolve with hydration at home but “severe cases require a carefully monitored intravenous fluid therapy to flush the myoglobin from the kidneys and to restore the electrolyte balance before it causes any further complications”. 

She adds that if left untreated, rhabdo can be dangerous and even life-threatening. 

Rhabdo is rare so the chances are you won’t run into it after your next gym session. But it’s important to be aware of the condition, just in case things go beyond soreness. Of course, DOMS can be very painful sometimes but it won’t come with swelling, dark urine and dizziness. 

Take it easy. There’s no need to rush into heavy lifting or HIIT this January.