When Exercise Is Not So Healthy
I was sitting
at home one day after a long shift in the emergency department when I received
a call from a family member seeking medical advice. She had been doing a new kickboxing
workout routine and was complaining of muscle soreness. Not sounding too
uncommon or serious, I initially recommended to her that she get rest and
increase the amount of water she was drinking.
just before hanging up she mentioned her urine was also very dark.
sore muscles after a workout is a very common symptom and most often not
dangerous. Delayed onset muscle soreness (DOMS) is the pain and soreness that
one feels after a new or strenuous exercise. It can occur hours to days after
the physical activity. Typically it will resolve within 3 days and treatment
consists of rest, low intensity exercise, and warm baths/ compresses.
concerning part of her story was the change in her urine color. I sent her to
the local emergency department. After a
urine sample and blood tests were completed, the diagnosis of concern was
confirmed. Her creatine kinase level was over 40,000 U/L. This level is
significantly elevated and seen with a process of muscle breakdown called
rhabdomyolysis. The urine changes color to a dark or even cola colored
can occur due to certain medications, including the statin group of cholesterol
medications, after traumatic crush injuries, significant overuse of the muscles,
or after prolonged compression of muscles. The mainstay of treatment is
intravenous fluid hydration to dilute and flush the muscle breakdown products
out through the urine. The diagnosis is important as lack of treatment can lead
to kidney failure.
when treated early, most patients make a full recovery. This family member was
admitted to the hospital and received intravenous fluids over the course of a
few days and made a full recovery.
high intensity workout programs are around and readily available to people at
various levels of conditioning. They should be encouraged to hydrate before,
during, and after workouts. Additionally, both participants and workout program
leaders need to be aware of the participant’s baseline activity level. This is
not to say that even those who are well conditioned are immune to the
development of rhabdomyolysis. This diagnosis has been described in the
literature even with young healthy individuals or with less than highly intense
rhabdomyolysis or DOMS? If the muscle soreness is severe or even incapacitating
— if there is a change in urine color — or if there are any other concerns —
you should speak with your physician. As always, we recommend that participants
in physical activity consult with their physician prior to new types of activity.
Hydrate regularly and slowly increase the intensity of physical activity. If
symptoms occur, know that emergency physicians can evaluate, diagnose serious
from benign issues, and treat patients with these diagnoses.
the author: Robert M. Bramante, MD, FACEP
is a clinical assistant professor of Emergency Medicine at New York College of
Osteopathic Medicine and Associate Chairman of Emergency Medicine at Good
Samaritan Hospital Medical Center in West Islip, NY