Rhabdomyolysis: too many pull-ups

[Chellegood]

While I'm not a trainer, my story is certainly important for trainers to hear.


Folks, this is no joke. I'm a 37 year old mother of 5 who was diagnosed with rhabdomyolysis after my trainer had me do a ridiculous amount of reps of a ridiculous exercise. If you are unfamiliar with illnease please take a moment to read my story and share it with your friends and family. Knowledge is power.

Real Housewife of Bluemont:

Mom of 5 Almost Dies From Pull-ups ~ My Story on Trainers, Rhabdomyolysis and Following Your Instincts
It was September 18th, 2013. I was just a little over a month away from my first marathon. I was in the best shape of my life. I was eating healthier than I ever had and felt great! I visited my trainer and we chatted over the half hour about how excited I was. How I knew I was ready. About how this was one of the last few sessions I would spend with him until after the marathon. And how I wanted to make sure I didn’t have any injuries.

“So take it easy, ok?’ I said to him.
“Of course!", he responded.

Our relationship wasn’t new. I had been seeing him for months. I had developed a deep trust of his knowledge. I knew he was taking more classes for certification. I also knew my gym had recently been bought by a huge conglomerate and they were busily “re-training” the employees. I felt safe. I felt protected.

On September 19th, I had a makeup session with my trainer. At the beginning of the session we did core exercises, which I expected to be my focus. I was surprised when halfway through the session we moved to the other side of the gym and started working on arms.

“We did arms yesterday, are you sure I’m ok to do it again?”, I asked.
He gave me the look of, come on I got this, and said, “I’m sure, Michelle”.

One of the exercises included jumping pull-ups. A jumping pull-up is when you use a booster (in my case a bench) to jump up into the pull-up, but then you must slowly lower your body, fully extending your arms. It is also called a negative pull-up. It's sort of like cheating a pull-up, but the lowering, and lengthening, puts an immense strain on your muscles. This was something we had never done.

After he demonstrated the exercise I said, “NO WAY I can do this”.
“Oh yes you can," he replied.
I was to do 20 reps. After 10, I said, “You’ve got to be kidding me!”.

He pushed me along. Assuring me I had no problem finishing it. And I did! Imagine my surprise at the end of the workout when he told me to do another set of 20. I pushed through 10 very sloppy ones. I couldn’t go on.

“Yes you can”, he says “10 more and you can go home.”

I trusted him. He had pushed me many times before. This wasn’t any different, right? Wrong! I learned later that the load he had me perform was out of the ordinary for the fittest of my male counterparts...let alone me, a 37 year old mother who hadn't done a pull-up since I was 12.

Immediately after leaving the gym, I was kicking myself. Wow, my arms hurt! I didn’t want to hurt this close going into the Marine Corps Marathon! We were supposed to be doing maintenance! “No injuries, remember”, I thought. I made it through my day with vague soreness. But, that night, I woke with a deep aching pain in my arms that prevented me to sleep. When Friday morning came, I couldn’t straighten my arms.

“What the hell”, I thought, “how am I going to get through my day taking care of 2 toddlers with gimpy arms!”




I was walking around like a T-Rex. Like the stereotypical meathead gym rat. I wondered, is this how it’s supposed to feel? I assumed the worst case of DOMS (delayed onset muscle soreness) of my life. After all, that IS the gym culture. Feel the burn. If it hurts then it’s working. In fact, my gym proudly displayed quotes of this nature in the training area. Lucky for me, I had leftover muscle relaxers and prescription strength ibuprofen in my medicine cabinet. Unlucky for me, it didn’t touch the pain.

Friday night’s sleep met with the same deep aching pain in my arms and I couldn’t find a comfortable position for the life of me. Saturday morning, I was unchanged. We were supposed to take the family to Great Country Farms, but it was foggy and misty, and my 2 year old was clearly needing an early nap. I decided to get on google to see if I could shed any light on my arm injury. I thought for sure I had torn a muscle. I typed in Jumping Pull-ups Can’t Put Arms Down. And what pops up? If You Exercise, Read This. Here I found a woman’s story of Rhabdomyolysis. "What the heck", I thought. Never heard of it. No way I had that, right?

I had just gotten health insurance in June, so I decided to run over to urgent care on a whim. I NEVER would have gone if I had no insurance. It’s just DOMS right? When I arrived I was running a fever. The nurse practitioner was puzzled, but unaffected. I mentioned the article I read. That raised her eyebrows and she recommended I head over to the ER for a better look. While I drove to the ER, I started feeling....funny. Different. Not quite right. The ER doc took one look at me and one look at my urine sample and chuckled at the thought I might have Rhabdo.

“No chance”, he said. “You just have a muscle strain. But, we’ll go ahead and do an x-ray if you really want to see if there is something broken.”

I guess I don’t blame his early, uninformed diagnosis. Everything on the internet said if you have rhabdomyolysis, you will have cola colored urine. Mine was almost clear. Of course it was! I’m a health nut! I drink tons of water and eat a clean diet! But there was a sensation I had that something wasn’t right...and I decided to push him for blood tests.

Thank God I did. For had I walked out of that ER that day, I can’t say with any certainty I’d be writing this.

The ER doc walked back in my room about 30 minutes later to say he was still waiting for my CK test to come back.

“Your liver enzymes are a bit elevated, but I still don’t see anything to indicate rhabdo. Again, it just looks like a muscle strain. Follow-up an orthopedist next Wednesday if it’s not better. But, we’ll go ahead and wait for the CK to come in...” Those last words he said in a way I expected him to continue....just for ****s and giggles.


The next hour in that room, I felt things really deteriorating. I was dizzy. I was out of it. I overheard nurses outside my room talking.

“Oh my God, I’ve never seen it that high in a heart attack patient”.
“I know”, said the other.

Were they talking about me? What was going on?! My ER doctor quickly appeared. His cocky, know it all demeanor had diminished.

“I’m sorry, but things just got a little worse for you. Your CK came back at 42,000.”
I asked, “What is it supposed to be?”
“Undetectable”, he responded.

Terror flooded my mind. I’m a mom. I’m needed. I’m only 37. I’m healthy. How is this happening to ME?!

“We are going to have to admit you to another hospital”.



Things started happening really fast then. I was being transported via ambulance. They did an EKG before I left. Then decided to monitor my heart on the way. As soon as I was put into the ambulance, I starting having chest pains. "What was happening", I thought. Tears filled my eyes as I stared up at the lights in the ambulance. Was I going to die right there? Without my family. Without saying goodbye. My kidneys were failing. My electrolytes were out of whack. And I was having heart arrhythmias. Because of PULL-UPS. Pull-ups! Unreal.

So, what is rhabdomyolysis? In layman’s terms, when your muscles are pushed beyond their limit, they virtually explode. Releasing dangerous myoglobin into the bloodstream. Your kidneys try to do their part in cleaning the blood, but are unable to properly filter the myoglobin out. They then begin to shutdown. If left untreated, rhabdomyolysis will kill you.

I was in the hospital for 6 days.

What if I had died? What if there is another mother, father, sister, brother out there who is just as uninformed as I was? What is the responsibility of the trainer? Of the gym? Should they be legally held accountable for pushing a client too far? Does there need to be more education on the part of trainers and their clients before beginning training sessions?

The nurses I talked to while I was in Loudoun Hospital (which provided me the most amazing care) told me that they see rhabdomyolysis all the time now. This is not acceptable. I want to make sure my story is heard. Nationwide. It is ridiculous that I almost died over something so small and careless.

[InsanelyFit]

Good to hear you are on the road to recovery. I wish you all the best.

[WoofieNugget]

Something like this should be required reading for any new trainer. It is really easy to push a body to the point of injury and deterioration, it is much more difficult to just take it far enough in order to encourage the body to adapt without having to deal with severe overuse based on the body that is presented to you on that day.

[jkdwarrior]

that why trainer should have a training program for their clients instead of just training their clients

[RevolutionFF]

Sounds like a Crossfit article I read a while back. I wish you a swift recovery.

A good trainer will get across the point to a client that exercise does not have to be a near death experience. There are too many guys out there who 'blitz' their clients with no care for technique or the client's safety. And there are too many client's who believe that is the way they have to train.

Have a reason for doing something.

[supersplish]

" I was just a little over a month away from my first marathon. I was in the best shape of my life"

This person was in training for her first marathon, and it's perhaps no coincidence that a typical marathon training cycle peaks (pre-tapering) about one month before the marathon. It's likely she was at a lifetime high point of training stress -- uncharted territory, for sure. I wonder whether this might have been more of a direct result of marathon training, or an indirect result of marathon training via an adverse impact on electrolyte balance, than a consequence of performing two sets of twenty-rep negative pullups.

[sonti]

I actually read this last night but didn't respond because I didn't (and still don't) know how to word this correctly.

Obviously doing 20 jumping pullups when you haven't done them since the playground is a foolish thing to do, and I can't help but wonder if this was some sort of knock-off Crossfit that some large chain gyms do. Don't get me wrong, I'm not excusing.

However-

I do think that writing such a detailed story about how Gold's Gym nearly killed you from 20 pullups/rhabdo and put you in the hospital for a week, when this was only a few weeks ago, might open yourself up to some nasty litigation. Possibly not, but possibly so. Since you were also training for a marathon (as previous poster noted), it's safe to say that this combined with personal training, you were pushing your body to the absolute limits and beyond (obviously).

Now, if you want your story heard nationwide then go ahead, just be aware that you are making some pretty serious accusations against a large corporation, and if you don't have expert medical testimony that this was directly caused by the GG employee at this incident and not perhaps, other training such as marathon training or whatever else you might be doing, you might consider the consequences. Your story is very detailed, probably too much so for the internet.

Good luck to you, I wish you the best of recovery and I'm a mom with a few kids myself, I truly do sympathize which is why I would also urge you to make legal consultation before opening yourself up to possible libel.

And yes, good lesson for trainers indeed, probably not so-much for rhabdo (as most trainers in this section seem to be on the ball) but for what can bite you in the ass.

[duck1dong]

I have recently learned that Olympic Lifting has been renamed and marketed by some guy and named crossfit. I am resentful at this so called phenomenon because I remember in the early 1990's how I was harassed at gyms when I would do Olympic Lifts. Now some idiot has come along and remarketed it and the masses now think that Olympic Lifting is worth paying $250 a month to be "crossfit". What a joke. It is no wonder that you have total idiots with bad joint injuries and overtraining. Most of these so called "trainers" took a two day course and now think they are qualified to teach Olympic lifting. And there are classes where it shows a bunch of people practicing Olympic Lifts. How pathetic. Olympic Lifting is about the individual, not a big massive class like aerobics. The whole crossfit fit thing is a disgusting pathetic attempt to remarket basic Olympic Lifting. Screw all the crossfit yuppies who practice it like it is their new god.

[attackdarack]

If Rhabdo were this easy to get, every soldier on the frontline would be going down. Every pro athlete would be collapsing at the gym.

I've trained hard and beasted myself many times. It seems to me like you were just weak and tried too much at once.

[sonti]

I've trained hard and beasted myself many times. It seems to me like you were just weak and tried too much at once.

Well, that might be true, but part of being under the watch of a personal trainer is that he is supposed to recognize physical limitations and not push a client to do something that might be out of their capability or could injure them. This isn't someone who just went off and did their own thing.

[WoofieNugget]

" I was just a little over a month away from my first marathon. I was in the best shape of my life"

This person was in training for her first marathon, and it's perhaps no coincidence that a typical marathon training cycle peaks (pre-tapering) about one month before the marathon. It's likely she was at a lifetime high point of training stress -- uncharted territory, for sure. I wonder whether this might have been more of a direct result of marathon training, or an indirect result of marathon training via an adverse impact on electrolyte balance, than a consequence of performing two sets of twenty-rep negative pullups.

Of course then one could argue why she was even doing anything resembling a pullup when at the end of training for a marathon. I've trained dozens of people for marathons and can tell you I don't think a single one of them needed to be able to do a pullup to run one. Especially 40 of them.

[Chellegood]

I can just tell you my truths. I did have blood work about a month prior and my CK was not elevated. I can also say that the doctor specifically said that the injury from pull-ups caused the rhabdo. Unfortunately, my story of negative pull-ups and concentric exercises causing rhabdo seems to be more common than people realize. It's not just Golds Gym. It's not just crossfit. But there should be something done in order to, at the very minimum, raise awareness. People like me shouldn't be blindsided by something they had no idea even existed.

I actually read this last night but didn't respond because I didn't (and still don't) know how to word this correctly.

Obviously doing 20 jumping pullups when you haven't done them since the playground is a foolish thing to do, and I can't help but wonder if this was some sort of knock-off Crossfit that some large chain gyms do. Don't get me wrong, I'm not excusing.

Thanks again!!

However-

I do think that writing such a detailed story about how Gold's Gym nearly killed you from 20 pullups/rhabdo and put you in the hospital for a week, when this was only a few weeks ago, might open yourself up to some nasty litigation. Possibly not, but possibly so. Since you were also training for a marathon (as previous poster noted), it's safe to say that this combined with personal training, you were pushing your body to the absolute limits and beyond (obviously).

Now, if you want your story heard nationwide then go ahead, just be aware that you are making some pretty serious accusations against a large corporation, and if you don't have expert medical testimony that this was directly caused by the GG employee at this incident and not perhaps, other training such as marathon training or whatever else you might be doing, you might consider the consequences. Your story is very detailed, probably too much so for the internet.

Good luck to you, I wish you the best of recovery and I'm a mom with a few kids myself, I truly do sympathize which is why I would also urge you to make legal consultation before opening yourself up to possible libel.

And yes, good lesson for trainers indeed, probably not so-much for rhabdo (as most trainers in this section seem to be on the ball) but for what can bite you in the ass.

[TayRo]

We went over this in one of my classes recently. It's a very interesting and scary phenomenon. Extremely rare but it does happen. God speed and get well soon!

[SgtShoulders56]

Thank God you pushed for those tests and Im glad you are recovering.
I took a Personal Training Cert in NJ in June for some CEUs. The instructor's name was Joe Cannon, very experienced and knowledgeable man. You can look him up. The Cert was supposed to be an 8 hour course about 6 hours of study and review, then take the exam that day. Joe went over a lot of test material we needed to know, but took about 30 minutes to teach and aware us on something that would not be on the exam. He was talking about Rhabdomyolysis. He is one of the leaders in rhabdo research and awareness. He said we wouldn't be tested on it, but its something that every trainer NEEDS to know about. I thought the information was invaluable. So thank you for passing the word along because it is rare but far too important to ignore.

[JoeCannonMSCSCS]

I believe you wrote me at my website about rhabdo. I did try to email you back but the email didn't seem to work. I did leave a comment on your website.

http://www.joe-cannon.com/rhabdomyol...ness-bootcamp/

joe

[Squeaki]

Something like this should be required reading for any new trainer. It is really easy to push a body to the point of injury and deterioration, it is much more difficult to just take it far enough in order to encourage the body to adapt without having to deal with severe overuse based on the body that is presented to you on that day.

I mentioned rhabdo to the fitness manager at the gym I work at. He'd never heard of it. It's great that my gym doesn't have instances of rhabdo but upsetting that someone who manages a top gym with 4000 members didn't know about something so dangerous.

[Looton]

I actually read this last night but didn't respond because I didn't (and still don't) know how to word this correctly.

Obviously doing 20 jumping pullups when you haven't done them since the playground is a foolish thing to do, and I can't help but wonder if this was some sort of knock-off Crossfit that some large chain gyms do. Don't get me wrong, I'm not excusing.

However-

I do think that writing such a detailed story about how Gold's Gym nearly killed you from 20 pullups/rhabdo and put you in the hospital for a week, when this was only a few weeks ago, might open yourself up to some nasty litigation. Possibly not, but possibly so. Since you were also training for a marathon (as previous poster noted), it's safe to say that this combined with personal training, you were pushing your body to the absolute limits and beyond (obviously).

Now, if you want your story heard nationwide then go ahead, just be aware that you are making some pretty serious accusations against a large corporation, and if you don't have expert medical testimony that this was directly caused by the GG employee at this incident and not perhaps, other training such as marathon training or whatever else you might be doing, you might consider the consequences. Your story is very detailed, probably too much so for the internet.

Good luck to you, I wish you the best of recovery and I'm a mom with a few kids myself, I truly do sympathize which is why I would also urge you to make legal consultation before opening yourself up to possible libel.

And yes, good lesson for trainers indeed, probably not so-much for rhabdo (as most trainers in this section seem to be on the ball) but for what can bite you in the ass.

+
I don't mean to confront you, but this almost seems threatening. There is NO WAY this gym could sue this poster for this. This is the internet. I know this for a fact because I am god. And I am super cereal too.
lol
Time for me to chill. No worries

[sonti]

+
I don't mean to confront you, but this almost seems threatening. There is NO WAY this gym could sue this poster for this. This is the internet. I know this for a fact because I am god. And I am super cereal too.
lol
Time for me to chill. No worries

Gold's Gym has been involved in lawsuits already, including for the death of a gym client. Settlement involved, and I doubt it was anything less than 6 or 7 figures. If you are going to publish online that they were negligent and nearly killed you, she should just be AWARE that something could come out of it, if her bases aren't covered.

[GetItBack]

Grok On OP!

[Jrod95]

So thats what happened to me huh, I was hoping to find a thread similar to my experience on thursday and and this one seems to be right on it.
Spent a whole 45 minute class period doing pullups, I dont even know how many I did but I started off with sets of 20, 20, 15, 10, 10 etc, lowering the increments of sets by 5 as they got harder and harder, until even doing 5 was crushingly hard. 2 mornings later I have the same flexed/t rex arms that you mentioned that just refuse to straighten out without forcing it and feeling like I'm pushing through pain and invisible resistance bands. Has anyone other than OP gone through rhabdo before? Would like some answers to a couple of questions. Now that I've identified what it is, would it be detrimental/dangerous to delay a hospital visit? Any specific nutrional treatment to follow at home? How long will my arms be in this angled position before returning to a natural straight arm? Thanks for the info you provided in the first post OP, doubt you still linger around here since you have 2 posts, to anybody else with relevant information or experience in this matter I would greatly appreciate your input too.

[cheerleader0720]

I'm so sorry for your experience! That had to be horrible.

That being said, I agree with the others. It's doubtful you got this condition solely from a few sets of negative pull-ups, and highly more likely that your marathon training had something to do with it.

It also should be stated that, whether you have a trainer or not, YOU are ultimately responsible for your body. I always tell my clients that, while I want them to push themselves to the limit, they need to remember that I am not feeling what they are feeling. If you are on the brink of an injury, tell your trainer, and refuse to do any more of the exercise in question (or lower the intensity, etc.) I know it's hard, because you don't want to disappoint him, and you don't want to look weak, but in the end, there's no way he can tell just how bad you're feeling unless you make it known.

I does sound like you had a crappy trainer who didn't know what he was doing, however. If you had sloppy form, he should have taken that as a cue, and stopped the exercise in question, perhaps moving on to an easier back exercise, if he wasn't satisfied with the back work already done. It sounds like some kind of crossfit workout, where quantity is valued over quality. I would definitely find a new trainer, as this mindset can lead to injuries, but I'm not so sure I would blame him for this particular condition.

[Jrod95]

Went to the ER around 3..despite drinking adequate water throughout the day when asked for a urine sample it took the color of apple cider, strong indicator aside from the bicep swelling and limited ROM. CK levels were at 87,000 on first check- kidneys are still kicking. Went through 2 iv bags, 3rd bag now is potassium and other electrolytes. No clue how many days im in for yet, I gotta say it isnt the best start to the school year but il persevere.

[Superh1]

" I was just a little over a month away from my first marathon. I was in the best shape of my life"

This person was in training for her first marathon, and it's perhaps no coincidence that a typical marathon training cycle peaks (pre-tapering) about one month before the marathon. It's likely she was at a lifetime high point of training stress -- uncharted territory, for sure. I wonder whether this might have been more of a direct result of marathon training, or an indirect result of marathon training via an adverse impact on electrolyte balance, than a consequence of performing two sets of twenty-rep negative pullups.

It was probably the pull ups. I've done the exact same thing to myself as a teenager.
When i was 16, i got a new pull up bar at home. That night i did as many as i could which was no more than 3 sets of 5. Determined to get stronger, i did "negatives" which some popular youtubers reccomended. what these youtubers failed to understand was that negatives are very dangerous in pull ups if you do more than 3 any given workout.

I did around 50-80 negatives.
The next day, arms were very swollen, it was ridiculous. i couldn't straighten my arms past a 90 bend at the elbow for at least 2 weeks, and it was another 3 weeks before i could straighten them, and a further 2 before all symptoms had gone. In that time i lead my normal life. cycled every day multiple times for commutes, went to school....

I didn't go to hospital because i was an idiot, luckily nothing came of it.

If Rhabdo were this easy to get, every soldier on the frontline would be going down. Every pro athlete would be collapsing at the gym.

I've trained hard and beasted myself many times. It seems to me like you were just weak and tried too much at once.

Rabdo is very easy to get with negatives no matter training experience. there is a difference between beasting yourself with weights and exercises and doing negatives. Negatives require NO force by the muscle. just contraction to slower gravity. You can do negatives a good 1000% over your limit for the concentric portion of the lift. This will cause severe muscle breakdown.

Overall i think things like this are a shining example into the mass ineducation and incompetence in the physical training industry. Standards need to be higher. Maybe then it wouldn't be 1 in 5 trainers who know what the hell they are doing.

[koganstyle1]

Where you taking pain killers to get through workouts, specifically nsaids ?

I used to train for hours and never came close to rhabdomyolysis

[RamsdenF]

Overall i think things like this are a shining example into the mass ineducation and incompetence in the physical training industry. Standards need to be higher. Maybe then it wouldn't be 1 in 5 trainers who know what the hell they are doing.

Amen

[heaneykid]

Hello, is rhabdomyolysis painful? I am a semi professional cyclist living in Belgium at the moment. I've just finished a 5 day stage race and the past few days if I ride 200meters or walk for 30 seconds I am in agonising pain in my legs, excruciating! It's never in one muscle group it moves around my legs to different parts. I went to the doctor and he took my blood, he says I have muscle breakdown aka rhabdomyolysis, it's been here for 7 days now, 7 days without training!! I take every vitiman etc and he perscribed me a stronger dose of iron and vitiman D. I've been drinking water like crazy the last number of days and there is absolutely no progress the pain is still there and my heads about to go! Can someone help

Bearing in mind, I'm used to 35 hour training and race weeks, it has happened me before on 3 occasions but the pain has been away in a day

[KyleAaron]

We're not doctors. Do exactly what your doctor tells you.