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Rhabdomyolysis through high-reps strength training

If athletes become aware that high-reps strength training can help them build up muscle mass and may also delay a wide range of aging processes then this form of strength training may well become popular. If this does indeed happen, then it's also important that trainers know that high-reps strength training taxes muscle fibre so much that untrained people can develop dangerous levels of muscle damage. Untrained individuals should give their body time to adjust to high-rep strength training by building workouts up slowly.

American sports scientists who are studying high-reps strength training got participants to train their biceps with 30 percent of the weight with which they could manage 1 rep. The participants did 3 sets of 30-40 reps.

Rhabdomyolysis through high-reps strength training
Things went drastically wrong with one of the participants, a fit 21-year-old woman who had never done weight training before. A few days after the workout the woman developed such sore muscles that she could no longer stretch her arms out, and her biceps swelled up. The researchers measured the concentration of creatine kinase in her blood and saw that this had risen to a dangerously high level.

Creatine kinase is an enzyme that should not be present in high concentrations in the bloodstream. It enters the bloodstream however when muscle cells tear open. A normal creatine level is 45-260 units per litre. At a concentration above 5000 units doctors start to think of rhabdomyolysis. The woman's level was way above that.

Rhabdomyolysis through high-reps strength training

When someone has rhabdomyolysis their muscle tissue is so badly damaged that the contents of the muscles enter the bloodstream, including the substance myoglobin [spatial structure shown below.]

Rhabdomyolysis through high-reps strength training
The body can neutralise small quantities of myoglobin. The blood protein albumin fishes up the myoglobin molecules and makes sure they are cleared away. But if there's more myoglobin in the blood than the albumin can cope with then the kidneys have to take over the operation of getting rid of the myoglobin. This can cause the kidneys to become damaged, as myoglobin is toxic to the kidneys.

The urine of people with too much myoglobin in their blood becomes the colour of tea or Coca-Cola. This was not the case in the 21-year-old woman. The doctors sent her home and told her to drink lots of water and take paracetamol - rather than aspirin, naproxen or ibuprofen. Paracetamol is milder for the kidneys than the other painkillers.

It took two weeks for the women's biceps to return to normal, which was confirmed by the doctors' scans.

Rhabdomyolysis through high-reps strength training

More cases
The case described in this article is not an isolated incident. In 2015 trauma doctors at Baylor College of Medicine in the US also published a case study about a young woman who had developed rhabdomyolysis after a high-reps workout. [Case Rep Emerg Med. 2015;2015:281540.] In that case study the protagonist was a 23-year-old recreational athlete who, after several months of not training, had the unholy idea of treating her biceps to an intensive high-reps workout.

Doctors have also published other similar case studies in scientific journals. [Case Rep Emerg Med. 2015;2015:281540.] Some relate to athletes who were doing Kaatsu [J Strength Cond Res. 2016 Jul;30(7):2064-8.], others to athletes who combined high-reps training with intensive cardio exercise. [BMJ Case Rep. 2011 Apr 1;2011.]

UCARE Poster session, University of Nebraska-Lincoln Research Fair, April 2016, Lincoln, NE.

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Vegetarian top athlete gets rhabdomyolysis 25.09.2009
New bodybuilding record: creatine kinase level of one and a half million 26.09.2008

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