Muscle mass is better the bulky muscle

Rhabdomyolysis: When the muscle breaks down after doing extreme sports

Highly intensive workouts are the trend: some pedal while spinning on the bicycle ergometer, others lift weights in a group at Crossfit. An article in the "New York Times" recently illustrated that such sports are not for everyone: The kindergarten teacher Christina D''mbrosio went to her first spinning class, a few days later she came with unbearable pain in her legs and nausea to the hospital, it says. Her urine had turned orange since the fitness session.

The diagnosis was rhabdomyolysis. The bulky name stands for the breakdown of muscle fibers. The myoglobin that is released in the process reaches the kidneys via the bloodstream and, in the worst case, can lead to acute kidney failure there. Doctors treating D'Ambrosio published a summary of three similar cases - including that of D'Ambrosio - in "The American Journal of Medicine" in April, in which muscle breakdown had occurred after extremely strenuous fitness sessions.

Robert Fritz, sports medicine specialist at the Vienna Sports Ordinance, also frequently comes to patients with extreme muscle pain after particularly strenuous workouts, for example after Crossfit units, in which many jumps and heavy weights are part of the training. Often the pain would occur after training with short, hard loads on the muscle.

Persistent pain

In principle, it is a matter of severe muscle soreness, i.e. micro-tears in the muscle fibers. It is now known that these cracks do not leave any scars, so that long-term damage cannot occur with normal sore muscles, explains Fritz. Water accumulates in the cracks in the muscles, making the muscles appear bigger and harder immediately after a hard workout. "This creates the supposedly good first impression that the training was effective," says Fritz. After 24 hours, however, this effect had disappeared, but the pain was sometimes much more persistent.

Sufferers whose pain lasts longer than 48 hours, who complain of nausea and dizziness, and whose urine has turned reddish, must consult a doctor immediately, emphasizes Fritz. In the hospital, fluids are given intravenously to flush out the kidneys.

The problem, Fritz emphasizes, is not the high-intensity sports, which - combined with less intensive sports such as leisurely running or swimming - can definitely bring training success. The problem is that people train as effectively as possible and therefore often much too intensively in the limited amount of free time.

More men than women

For those athletes who come to the sport ordination with extreme muscle pain, blood is drawn and sent to the laboratory. "Sometimes they call me from the laboratory because the creatine kinase levels in the blood are so extremely high," says sports doctor Fritz. The characteristic value allows conclusions to be drawn about how intense the stress is on the muscles. But even if the sore muscles are extreme and the creatine kinase values ​​are high: Fritz first made the diagnosis of rhabdomyolysis, the young man who wanted to prepare for his vacation with particularly tough training units ended up in the intensive care unit. In general, it is more men than women who overdo it in training, says Fritz.

Josef Niebauer, head of the Salzburg University Institute for Preventive and Rehabilitative Sports Medicine, also emphasizes that rhabdomyolysis is an "absolute rarity": "You always have to keep in mind how many people practice these sports - and how many end up having problems. " Often the cause of rhabdomyolysis would also lie in a genetic disposition, metabolic diseases and the use of certain medications. With regard to the case studies from the USA, Niebauer also points to a "loose definition" of rhabdomyolysis, because histological facts from a muscle biopsy would usually be missing.

Training without sore muscles

Even if the risk is low: According to Niebauer, the goal of training should never be to get sore muscles. It is a common misconception that sore muscles make muscles grow: "Sore muscles lead to a restriction in the next training session - this increases the risk of injury." It is better to plan the training so that the next day you feel a "certain tension" in the muscles, but no pain.

Niebauer advises you to slowly get into new sports, for example to cycle more often before the first spinning unit and "not to go from zero to a hundred". This also requires competent trainers. Of course, fear of rhabdomyolysis should not be a reason to forego high-intensity training. "We don't have to be afraid of sport, but of not doing any", says the doctor and adds: "But the drug sport has to be dosed sensibly." (Franziska Zoidl, August 8th, 2017)