In Killer Workouts, Eugene Allen discusses rhabdomyolysis, the out-of-control release of muscle fiber contents into the bloodstream:
My interest in this topic peaked when a very close friend of mine spent a week in the hospital after I put him through his very first CrossFit workout. Brian was no couch potato who suddenly jumped into exercise, but he did have a long layoff from intense exercise for nearly two years before that fateful afternoon with me. He was a state champion wrestler from Iowa, an Army Ranger, and a pretty serious weightlifter and member of our department’s SWAT team. Although he was not working out hard he had not degenerated to full-blown spudhood. He was running and “staying in shape,” as he said, but he did nothing that could be described as intense. Until he came to my house.Our workout was nothing crazy hard, but the thing that did him in was the swings. His second set of 50 swings (an eccentric contraction to be sure) was difficult for him and proved to be his undoing. Afterward, he was unable to kneel in my driveway to change from shoes to boots and had to sit. He could barely do that and had to use all the force of his will to get on his Harley and ride home. No pain to speak of during this time, just complete muscle weakness. Brian thought his muscles were tightening up (in fact they were dying) so he put on a heat pad to loosen things up. Instead of relaxing the muscles, the heat released even more fluid and within two minutes the pain started. Excruciating pain. Pain is frequently quantified in the medical community on a scale from 1 to 10. Brian said the pain was way past 10. Once he was at the hospital, our SWAT team doc, who works at the emergency room Brian went to, worked his morphine dose up to 16 mg every two hours, and Brian said that only dulled the pain enough that he didn’t scream.
The primary diagnostic indicator of rhabdomyolysis is elevated serum creatine phosphokinase or CPK. The normal value runs below 200; rhabdo brings the CPK level to at least five times this level. When Brian was admitted to the hospital his CPK level was at 22,000. Within two days it peaked at 98,000. He was pumped full of fluids to help flush the kidneys and he puffed up like the Michelin man. His head looked like a big fat white pumpkin from all the fluid and the medical staff was very concerned about mineral imbalances, which could cause heart problems. Any movement brought suppressed screams of pain through gritted teeth. He was out of the hospital after six days but was off from work for two months. The muscles in his lower back had been destroyed and no longer functioned. He was unable to sit or stand without leaning backwards or he would fall over. He brought an empty cereal bowl to the sink one morning and when he reached slightly forward with his arms to put the bowl in the sink he started to fall and would have gone straight to the ground had he not had the edge of the sink to stop his fall.