Participation in extreme sports workouts has jumped tremendously in recent years.Initially, many of these workouts were designed to test our Special Forces physical and mental strength, and/or workouts intended for our top athletes, whatever sport it may be. Needless to say, extreme sports-related injuries have also risen due to skeletal injuries, such as head and neck injuries or muscle injuries. Today, I would like to cover an extreme muscle injury called Rhabdomyolysis. It “only” affects the skeletal muscles. There are three types of muscles:

Smooth muscles, such as blood vessels, gastrointestinal tract, and bladder muscles. They are involuntary muscles (they work whether we “think” about it or not).

Skeletal muscles are muscles that move the body and they are voluntary muscles (I can move my arm or not).

Heart muscle, which fortunately is also an involuntary muscle (thank goodness, I can see myself getting too busy to remember the make my heart beat!) and pumps the blood through our body.

Unfortunately, with the rise of extreme workouts, Rhabdomyolysis is on the rise. Rhabdomyolysis, or commonly known as Rhabdo, is the rapid destruction of skeletal muscles resulting in leakage of the protein Myoglobin into the blood stream. The kidneys can only handle a certain amount of protein at a time and this surge of protein can lead to kidney failure or even death.

Myoglobin is an important protein in the muscles which stores oxygen in the muscles. Besides extreme workouts, the following can be a cause for Rhabdomyolysis (but is not limited to):

• Muscle trauma or crush injury — when my 1,100-pound horse fell on my leg, I had Rhabdomyolysis of my right leg and lower abdominals.

• Severe burns

• Physical abuse

• Prolonged lying down such as coma

• Certain medications

• Drug and/or alcohol intoxication

• Venom from certain snakes

• Genetic muscle disease

So what is considered “extreme workout”? To mind comes skydiving, motorcross, snowboarding and all other sports at the X-Games. How about marathons, ultra marathons, obstacle course races and workouts where you do as many repetitions as fast as possible? My son-in-law loves to do extreme workouts and is great at it. He loves for me to do them with him; he says “you can do it!” My response: “I know I can do it!” And I would stand out but my health is more important than to show that I can still “do it.” I have pushed my body to the limits and beyond and know that I dealt with overuse injuries and even Rhabdo symptoms at different times of my life. Back in the day, I was the “obstacle queen.” Even if I would try to do it for fun, I know my competitiveness would kick in and I would push my body beyond what it wants and needs at the age of 48. But to all its own, this new way of exercising has gotten people off the couch who would never do so before. With a caring trainer/coach and sense of fitness level, this might be the workout for you. Let’s face it — many people love to push the limits to get the natural “high.” Extreme workouts trigger the dopamine in the brain which gives you that natural high. However, if that is what keeps you going, you have to push your body further and more to get the same dopamine release. It is so important to know your body and when to slow down. Train smart for an event over months and check with your physician if you should even attempt it. Find a qualified, caring trainer or coach who knows how to train safely and effectively for these events. The “no pain, no gain” motto is true to a point but not to the point of self destruction. No one is immune to Rhabdo. Any extreme exercises performed with high repetitions under conditions of extreme fatigue can lead to Rhabdomyolysis.

Symptoms for Rhabdo can be:

• Painfully swollen tender areas of the body

• Muscle weakness and/or trouble moving the arms or the legs

• General feeling of being sick (and not having the flu)

• Nausea and vomiting

• Confusion, dehydration, fever or passing out.

• Dark colored urine, reduced or no urine.

Your doctor can diagnose Rhabdomyolysis very easily by checking your urine for Myoglobin levels.

If pushing your body to the limits is your cup of tea, be smart about it. Listen to your body, give it appropriate rest to recover, take your time to work up to a certain level, wear the appropriate clothing and shoes, hydrate and know when to say “this is enough.”

Ester H Marsh ACSM Cpt and Health and Fitness Director JF Hurley Family YMCA.