Rhabdomyolysis: the disease attacking super fit athletes

Brad Beer suspected something was slightly wrong when he felt small, needle-like piercing sensations up his leg as he ran.

And when, after the marathon, his urine was dark with traces of blood, he knew something was very wrong.

Beer, 35, from Mermaid Waters in Queensland, was suffering from rhabdomyolysis, known as 'rhabdo' – a sports-related disease that can result in kidney failure, and even death.

It was to be one of three separate occasions Beer would suffer from the disease.

Brandan McCann, a Brisbane-based exercise physiologist explains it this way: "In layman's terms, it's muscle wasting. It's not a common condition seen in my line of work, but it's becoming more prominent with incorrect exercise prescription from under-qualified exercise professionals.

It's a pretty serious condition with some very harmful side effects and complications associated with the kidneys.

Brandan McCann

"It's a pretty serious condition with some very harmful side effects and complications associated with the kidneys and cardiovascular system."

Muscle melt down

In Beer's case, each time could be traced back to depleted salt levels from three endurance races – a half marathon, a marathon and an ultra marathon (50km). By the end of the New York marathon, his muscles "melted down" and he went into hypothermia.

So what can be done to avoid it? Beer tells me: "I've now identified that to avoid future episodes, I need to supplement when completing strenuous endurance challenges with salt, like salt sticks. My hydration status on each of the three occasions has been very good. I haven't incurred it due to a failure to start the events hydrated or to remain hydrated while competing – as do some people."

Although rhabdo is rare, it has come to be associated with one type of organised sport in particular: CrossFit. There's no unified CrossFit voice on this, as it operates on a franchise system.

Beware of Uncle Rhabdo

However, some CrossFit boxes (gyms) have as their mascot 'Uncle Rhabdo': a cartoon clown who has worked out so hard, he has got rhabdomyolysis. The cartoon depicts the clown's kidney and part of his intestines hanging outside of him. He's panting, still in his gym gear, stood in a pool of his own blood and hooked up to a dialysis machine, with a dumbbell sat next to him.

It's supposed to be a fun way of saying 'go hard or go home' or 'no pain, no gain' – but it's a confronting image that does nothing to dispel CrossFit's reputation for intensity and injury.

Ellie Welsman, 25, head coach at CrossFit Tone at Sydney's Brookvale, denies CrossFit has a rhabdo problem: "I have never had a client that has rhabdo, it's quite rare. Our training systems aren't designed to do that."

Sign of the CrossFit

More broadly – outside of her own CrossFit box – has she heard of it being an issue? She concedes: "It has been the case where CrossFitters have got rhabdo but many other sports can cause it, too. In some ways it's good that CrossFitters know about it, as at least they will know the warning signs - whereas in other sports they may be unsuspecting.

"Within the CrossFit circle, I've only heard of two cases – one from competition, and one from someone who'd been on a bender then trained."

CrossFit can be competitive in nature – the CrossFit Games encourages that – but each 'box' is very different. I've previously written about CrossFit for Executive Style and, of the three boxes I trialled, I didn't see the 'Uncle Rhabdo' mascot anywhere. For a relative newcomer it would have been off-putting.

Crunching the numbers

Certainly, the CrossFit box to which I became hooked (CrossFit Ignite, Waterloo) doesn't promote the over-exercise, intense Rhabdo culture; far from it.

It's also telling that, in my research for this piece, I couldn't find a single CrossFitter (or previous CrossFitter) who'd had rhabdo – only Brad Beer, who got it from running, not the weights-style workouts CrossFit boxes tend to specialise in.

Welsman says some CrossFit boxes push things too far: "'No pain, no gain' isn't always the best way to train. Yes, training can hurt, but don't be stupid about it, which I believe we see in some CrossFit gyms."

Isn't it irresponsible, though, to use a mascot that mocks and even invites the disease? She says: "If you as a client are worried about CrossFit and this type of mentality, find a gym that doesn't showcase rhabdo but still follows the training system.

"CrossFit Inc. doesn't really endorse Rhabdo the Clown, it is an unofficial mascot. I would say if you have a gym that endorses this type of training, stay clear!"

Following publication a CrossFit Inc. spokesman provided the following reponse:
"First, Uncle Rhabdo is actually an official CrossFit HQ design, but he is intended to discourage people from getting rhabdo and raise awareness about the condition, not encourage it.
"Second, unlike most other sports and fitness programs, CrossFit warns all of its trainers about rhabdo and teaches them how to prevent it with their clients. 
"Third, CrossFit's rhabdo campaign has been extraordinarily effective at raising awareness about rhabdo and thus preventing it. Dr. Michael Ray discusses that here.
"Lastly, if the runner mentioned in the article thinks he needs to supplement with sodium, then he is likely hyponatremic. During exercise hyponatremia is caused by excessive hydration (not inadequate sodium intake during exercise). Drinking fluids to excess that have a salt content lower than your blood stream effectively dilutes the sodium content of your body. Hyponatremia induced through overhydration has been reported as a cause of rhabdomyolysis."