When Is Muscle Soreness Dangerous?

All of us have felt sore after a workout. That soreness is generally a good sign that our workout was effective. But can soreness ever be dangerous? In some circumstances it can.

Rhabdomyolosis is a serious medical condition that can be associated with sore muscles after exercise. It is important to understand the physiology, causes, symptoms, and management of rhabdomyolosis in the chance that you or someone you love are faced with this condition in the future.


What is Rhabdomyolosis? What are the symptoms?

Rhabdomyolosis is a syndrome characterized by muscle breakdown and cell death leading to the release of intracellular proteins and electrolytes into the bloodstream. The most important of these substances is myoglobin, which is normally responsible for binding iron and oxygen. Myoglobin is naturally filtered in the kidneys, but when present in excess, can lead to acute renal (kidney) failure.

The classic triad of symptoms is weakness, dark-colored urine, and muscle pain, although the latter of these symptoms can be variable. Other common symptoms include malaise (general ill-defined discomfort), fever, increased heart rate, nausea, vomiting, and abdominal pain. 


What are the causes of Rhabdomyolosis?

The causes of rhabdomyolosis can be divided into three general categories: traumatic, nontraumatic exertional, and nontraumatic nonexertional.

     - Examples of traumatic etiologies include crush injuries, prolonged immobilization (such as an elderly individual who lies motionless for many hours after a hip fracture), or burn injuries.

     - Nontraumatic exertional causes refers to individuals that have an insufficient energy supply to meet their muscles demands. This is common in athletes who over-exert themselves or exercise in particularly hot or humid conditions. Interesting new research suggests that even well-trained athletes may develop rhabdomyolosis when performing new workout routines to which they are not accustomed.

     - Nontraumatic nonexertional causes are generally attributable to certain drugs (both illicit and prescription), toxins, or infections.


If I am having the symptoms of Rhabdomyolosis, what should I do?

Rhabdomyolosis is a serious condition that requires urgent evaluation and treatment by a physician. If you are particularly concerned that you may be dealing with rhabdomyolosis, an emergency room visit is warranted. The workup for diagnosis will include a urine sample, blood work including a creatinine kinase level (creatinine kinase elevations are a hallmark of rhabdomyolosis), and an EKG.

Management is focused on stabilization of fluid and electrolyte (potassium, sodium, etc.) levels, identifying and treating possible underlying causes, and evaluation for additional complications.


While rhabdomyolosis is dangerous and life-threatening, early recognition and intervention leads to positive prognosis and outcomes. If you are suffering from symptoms that may be consistent with rhabdomyolosis, we recommend seeking medical attention right away. Dr. Carfagno and his staff are available to help answer your questions and guide you in your recovery.


Bryce Kirkman, MS-IV

David Carfagno, D.O., C.A.Q.S.M.



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Miller ML. Clinical manifestations and diagnosis of rhabdomyolysis. UpToDate. Last updated: 08/19/2014.

Miller ML. Causes of rhabdomyolysis. UpToDate. Last updated: 09/19/2014.


Disclaimer:  Articles are based on real cases seen at Scottsdale Sports Medicine. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Please consult your medical professional for individualized healthcare.