Spin Class Newbies Should Pace Themselves To Avoid Rhabdomyolysis, Experts Say

Rhabdomyolysis, or “rhabdo,” as it is often called, is more than simply a spinning condition. Here’s what you should know about this uncommon ailment and how to avoid it.

Mary Wilson was determined to put a stop to her epidemic couch potato status, so she signed up for her first group spin class in September 2021.

At the time, it appeared that everyone else was doing the same thing. As the globe adapted to distant living, indoor cycling, or spinning, underwent a sort of revival during the epidemic. Those who were desperate to move bought Pelotons and other stationary cycles for their homes and then crowded spin classes when gyms reopened.

Wilson understood. The 32-year-old recalls arriving early for her first lesson, taking a seat in the front row, and discussing her rookie status with the teacher. Wilson informed us that the class was challenging, but nothing she couldn’t manage.

Her body was telling her otherwise.

“As I got off the bike, my knees crumbled. Everyone else was going, but I had to take my time since I couldn’t walk,” Wilson explained. “I even contacted my mum in case I tripped and needed assistance going to my car.”

Wilson could scarcely stand for the next two weeks, and nothing made her feel better. Anti-inflammatory medications, ice, and stretching exercises were all rendered ineffective. Suddenly she realized her urine had a dark brown color.

What exactly is rhabdomyolysis?

 

Wilson’s “no pain, no gain” mentality led her to acquire what she now believes was rhabdomyolysis – a very rare ailment that may occur when your muscles overexert themselves to the point where they break down and leak proteins into the bloodstream.

Muscle soreness, swelling, and weakness are common symptoms, as is dark-colored urine, but not everyone experiences it.

Pain normally appears soon after activity and intensifies over three days, at which time the majority of patients end up in the hospital. There is a delicate line between rhabdomyolysis (informally known as “rhabdo”) and regular muscular soreness, but your pain levels will most likely signal something more serious is going on, according to specialists.

Doctors seek for two primary muscle breakdown products: creatine kinase and myoglobin, the latter of which is filtered by the kidney. Myoglobin spills into urine, giving it a dark, tealike hue that can be mistaken for blood; it’s also the protein responsible for blocking the kidneys and, in extreme situations, causing renal damage or failure.

Rhabdo is mostly treated with IV hydration, although a delay in treatment might be fatal. Such consequences include kidney damage, cardiac arrhythmias, seizures, lifelong disability, and death.

Some rhabdo patients develop compartment syndrome, a subsequent consequence in which the muscles enlarge so excessively that they become trapped by the connective tissues lining the muscle. (That occurred to this 23-year-old woman, whose leg was nearly severed following a spin class.) The condition typically manifests as significant discomfort during passive stretching, such as knee bending. To relieve the pressure, emergency surgery is frequently required.

Although rhabdo might be dangerous for certain people, most can safely resume activity or sports after their pain and weakness have subsided.

Wilson says she regrets not going to the hospital or receiving an official diagnosis. In reality, she needed a month to recuperate. Yet, a short Internet search found startling parallels between her narrative and dozens of others documented by news sources and scientific case studies.

In 2004, the first case of spin-induced rhabdo was documented.

“After I completely understood that I literally might have lost my legs or my life, that’s when I was like, ‘OK, this is insane,'” Wilson said after discovering many other videos of individuals sharing similar spin class horror stories and posting a TikTok of her encounter around a year later.

And it’s not just whirling. Football, CrossFit, weightlifting, and military training — in fact, any extreme physical exercise, especially in hot weather — is known to produce rhabdo. (Hot temperatures direct blood flow away from important organs and toward the skin and muscles, increasing the likelihood of kidney damage.) As a result, firemen, police officers, construction workers, and farmers are more likely to develop the illness.

Rhabdo is more than just an exercise issue. Excessive alcohol consumption; certain diseases such as uncontrolled diabetes and thyroid disorders; various infections such as flu, salmonella, and strep; some medications such as cholesterol-lowering drugs and antidepressants; recreational drug use; and traumatic injuries from car accidents, falls, and the like can all cause it. (About 150 pharmaceuticals and poisons, ranging from snake and spider bites to cocaine, methamphetamine, and MDMA usage, have been related to rhabdo.)

It’s unknown how prevalent exercise-induced rhabdo is since many people, like Wilson, never develop severe instances that require hospitalization or are unaware that their significant muscular pain requires medical treatment.

According to Dr. Eric Coris, a family and sports medicine specialist and professor at the University of South Florida Morsani Faculty of Medicine, around 26,000 occurrences occur each year, although that figure is likely underreported.

This is where social media may help.

 

“This is certainly one area where social media is reporting a more accurate depiction of how frequently people acquire rhabdo,” Coris said. “There are definitely some people who believe they have rhabdo but don’t, but I believe there are cases out there that we never hear about.”

Why are rhabdo instances associated with spinning?

The truth is that spinning is difficult. The American Academy of Sports Medicine classifies it as a “intensive exercise mode” based on research demonstrating the levels of cardiovascular fitness required to complete a 45-minute class.

Some studies believe spin-induced rhabdo is a public health issue.

Pushing through resistance cycles that encourage climbing hills, flat roads, or sprints requires the activation of two of the body’s major muscular groups: the quadriceps and glutes. As a result, straining these strong muscles to their limits might have devastating effects.

The issue is that many people undervalue spinning. People attend courses despite having no prior understanding of the activity (or any exercise at all) because they are drawn to the loud music, strobe lights, and instructors who motivate them to go harder and faster.

After all, no one joins a football or track team without some prior preparation.

Thus it’s not unexpected that dozens of case studies suggest that most riders who acquire spin-induced rhabdo do so after their first lesson, presumably disoriented by adrenaline.

“It’s simply the usual too much, too soon,” Coris explained.

“You may be used to doing out and believe you’re quite fit, and then you go into class for an hour of an activity you’re not used to at a really high intensity level that’s meant to divert you purposefully so you’ll endure the exercise better — and then you get hurt,” Coris explained.

According to Neal Pire, an ACSM-certified exercise physiologist based in New Jersey, a similar spike in rhabdo happened when CrossFit became popular in the early 2000s.

“If you’re untrained and your muscles are ignorant in whatever it is you’re performing. “You can raise your chance of rhabdo,” Pire explained. “The concept of starting slowly and progressively increasing your tolerance applies to everything that pushes you beyond your limitations, including spinning.

“But, whether it’s spinning or not, there’s always an amount of activity that you can handle,” Pire explained. “You usually don’t know what it is until you do it. You just have to figure out where your boundaries are.”

Rhabdo does not just affect the unfit or out-of-shape.
One of the most common myths regarding rhabdo is that it mainly affects those who are unfit or out of shape.

Professional athletes, marathon runners, and other fitness aficionados are all at risk of getting the illness if they push themselves too far – even if they’ve done it hundreds of times before.

Adam Janusz enjoys cycling outside. He’s been recording his trip through the United States by bike on social media. (But, owing to winter weather worries, it was recently postponed.)

Janusz was biking up to 80 kilometers every day. He began in Chicago, cycled to Maine, and then arrived in Florida in early October when rhabdo occurred, according to the 27-year-old. Janusz tented on a beach during a sandstorm after four days of riding constantly at high mileage and temperatures in the low 90s, trying to recuperate after sleeping poorly the previous two nights.

Janusz awoke the next morning dizzy and nauseated. “I barely rode 20 miles before calling it quits and booking a motel room. “I fell asleep immediately and woke up soaked in sweat,” he stated in an email. “The bed was soaked. My eyes were bloodshot, and even going to the restroom seemed like a 10-mile marathon. “I felt aching all everywhere.”

He only went to the hospital when a family member called and scared the hotel personnel enough that they forced him to seek medical assistance. Janusz was diagnosed with rhabdo and spent barely four hours in the hospital receiving IV hydration.

Janusz’s advise to people concerned about exercise-induced rhabdo was simple: “Listen to your body.”

Rhabdo can occur more than once

 

While getting exercise-induced rhabdo once is unusual, getting it twice is much more unusual, especially because people afflicted are more educated on how to avoid it in the future.

Certain muscular diseases, such as McArdle disease, may give people “an intrinsic hereditary propensity toward rhabdo,” according to Coris. It is a hereditary condition that hinders muscles from breaking down glycogen, a complex sugar. During exercise, symptoms such as muscular cramps, weariness, and weakness are common.

Those with a history of rhabdo should be cautious while trying new activities or increasing the intensity of existing regimens, according to Coris.

That’s precisely what Jamie Bornscheuer, 23, believed she was doing when she was diagnosed with rhabdo for the first time in August 2021. Who is the perpetrator? A few crunches and a plank.

Yet, she had the disease three more times in six months. After avoiding exercise and relaxing for over a year, she ended up in the hospital for the seventh time last week after a lengthy stroll in New York City.

Bornscheuer’s original case was so out of the ordinary that her doctor wrote a report about it since her major symptom — abdominal swelling, which emerged with each subsequent diagnosis — isn’t a frequent indicator of rhabdo.

Bornscheuer has yet to provide an answer. Perhaps most frustratingly, the greatest advise she’s received is to avoid exercise, “which of course I can’t accept,” she explained.

“Nobody seems to know what’s going on, and I’ve been tested for everything,” Bornscheuer told BuzzFeed News. “Since I’m negative about everything, no one can explain why I’m experiencing repeating episodes.

“I’m seeing that this is a crippling aspect of my existence. I’m unable to exercise. “I can’t do anything,” she went on. “I’m coming to accept the truth that my body isn’t as healthy as it once was, and that I have no answers for it.”

How to Prevent Exercise-Induced Rhabdo

The chances of developing rhabdo from exercise, whether you’re new to it or not, vary greatly depending on your health, the sort of activity involved, the intensity of your workout, the atmosphere in which it’s done, and so on. As a result, there is no rubric or tolerance threshold to follow in order to avoid the disease.

Nonetheless, Pire emphasizes the need of following basic exercise guidelines, such as a good warmup before your primary workout, a cooldown afterward, and any extra stretches or range-of-motion rehab activities you may require.

Hydration is critical before, during, and after physical exercise. “It will allow you to better filter through the muscle breakdown products and allow your kidneys to have greater blood flow, which will protect them from harm,” Coris explained. “The best method to begin any fitness plan is with slow, consistent increases in physical activity.”

However, good preconditioning is essential before attempting new sorts of exercise, particularly spinning.

“Before taking an aggressive spin class, spend a few weeks building up your cardiovascular and muscular endurance on a stationary bike or your ordinary bicycle,” Coris suggests.

You’ll also want to get used to how the chairs and foot pedals feel, according to Pire. When you’re ready to take a class, don’t forget to inform the teacher that you’re new to spinning. This allows them to keep an eye on you.

Experts advise that dim lighting, loud music, and supportive instructors are fantastic methods to improve desire for exercise, but don’t allow the adrenaline take over too much. Check in with yourself every now and then to assess how your body is feeling. Is it too much? If you can, leave class until you’ve recovered sufficiently to continue.

Some ways to avoid rhabdo from exercise include:

 

• Massage guns should be avoided when you have severe muscular pain since they might harm your muscles even more.
• Give a few days between intensive workouts to allow your body to recover.
• Before exercising, avoid supplements such as creatine and caffeine.
• Seek for safe gym surroundings in general. Is the temperature in your spin studio comfortable?

You should also tell your doctor if you’re going to try a spin class or any other type of exercise for the first time, especially if you’re older, have a medical condition like heart disease, are taking medications, or live a more sedentary lifestyle — just to make sure you’re not putting your body under unnecessary stress and risk.

“Your body can adapt to really high amounts of activity,” Coris explained. “All you have to do is go slowly and cautiously. That does not occur overnight.”