What is rhabdomyolysis?
Much to her surprise, Wilson’s “no pain, no gain” mindset led her to develop what she’s now convinced was rhabdomyolysis — a relatively rare condition that can occur when you overexert your muscles to the point that they break down and release proteins into the bloodstream.
Symptoms include muscle pain, swelling, and weakness, as well as dark-colored urine, a hallmark symptom although not everyone experiences this.
Pain usually manifests immediately after exercise and worsens over the course of three days, at which point most people end up in the hospital. There’s a fine line between rhabdomyolysis (informally known as “rhabdo”) and normal muscle soreness, but experts say your pain levels will most likely indicate something more serious is going on.
The main muscle breakdown products that doctors look for are creatine kinase and myoglobin, the latter of which is filtered by the kidney. In excess, myoglobin spills into urine, giving it that dark, tealike color, which can be mistaken for blood; it’s also the protein responsible for clogging the kidneys and causing kidney injury or failure in the most severe cases.
Rhabdo is treatable mainly via IV hydration, but a delay in care could be life-threatening. Kidney damage, heart arrhythmias, seizures, permanent disability, and death are some complications.
Some people who get rhabdo go on to develop compartment syndrome, a secondary complication where the muscles swell up so much that they become trapped by the connective tissues lining the muscle. (It happened to this 23-year-old whose leg nearly had to be amputated after a spin class.) The syndrome usually feels like severe pain during passive stretching, like bending the knee. Emergency surgery is usually needed to release the pressure.
Although potentially serious for some people, most with rhabdo can safely return to exercise or sports once pain and weakness have resolved.
Wilson never went to the hospital or received an official diagnosis, a decision she said she regrets. In fact, it took her an entire month to recover. But a quick Google search revealed striking similarities between her story and those of dozens of others covered by news outlets and scientific case reports.
The first case of spin-induced rhabdo was reported in 2004.
“Once I fully realized that I literally could have lost my legs or my life, that's when I was like, ‘OK, this is crazy,’” said Wilson, who posted a TikTok of her experience about a year later after coming across several other videos of people sharing similar spin class horror stories.
And it’s not just spinning. Football, CrossFit, weightlifting, and military training — really anything that requires strenuous physical activity, especially in hot environments — are known to cause rhabdo. (Hot temperatures divert blood flow away from vital organs to the skin and muscles, making kidney injury more likely.) That’s why firefighters, police officers, construction workers, and farmers face higher risks of developing the condition.
Rhabdo isn’t just an exercise problem. It can be caused by excessive alcohol consumption; certain diseases such as uncontrolled diabetes and thyroid disorders; different infections like flu, salmonella, and strep; some medications like cholesterol-lowering drugs and antidepressants; recreational drug use; and traumatic injuries from car crashes, falls, and the like. (More than 150 medications and toxins have been linked to rhabdo, including everything from snake and spider bites to cocaine, methamphetamine, and MDMA use.)
It’s unclear how common exercise-induced rhabdo really is because many people, like Wilson, never develop cases serious enough to go to the hospital or aren’t aware that their severe muscle soreness warrants medical attention.
Estimates show that about 26,000 cases occur each year, but that number is likely underreported, according to Dr. Eric Coris, a family and sports medicine doctor and professor at the University of South Florida Morsani College of Medicine.
This is where social media comes in handy.
“This may be one area where social media probably is reporting the more accurate reflection of how often people are getting rhabdo,” Coris said. “They're probably some people that are thinking they have rhabdo and they don't, but I think there are cases out there that we never hear about.”
Why are rhabdo cases linked to spinning?
Truth is, spinning is hard. The American College of Sports Medicine deems it an “intense exercise mode” based on studies that show the levels of cardiovascular fitness needed to get through a 45-minute class.
Some researchers even consider spin-induced rhabdo a public health concern.
Pushing through resistance cycles that stimulate climbing hills, flat roads, or sprints involves the use of some of the largest muscle groups in the body: the quads and glutes. Therefore, pushing these powerful muscles to their max could bring serious consequences.
The problem is that many people underestimate spinning. They hop into classes without prior knowledge of the exercise (or any exercise at all) because they’re attracted to the loud music, strobe lights, and instructors motivating them to go harder and faster.
After all, people don’t just join football or track teams without some degree of prior training.
So it’s not surprising that dozens of case reports show that most riders who develop spin-induced rhabdo, likely dazed by adrenaline, do so after their first class.
“It’s just the classic too soon, too much, too fast,” Coris said.
“You may be used to working out so you think you’re pretty fit, and then you go into class for an hour of an activity that you're not accustomed to at a very high intensity level that’s designed to distract you purposely so you'll tolerate the exercise better — and then you get injured,” Coris said.
A similar increase in rhabdo occurred when CrossFit burst in popularity in the early 2000s, said Neal Pire, an ACSM-certified exercise physiologist based in New Jersey.
“If you’re untrained and your muscles are quote-unquote uneducated in whatever it is that you're doing. you can increase your risk of rhabdo,” Pire said. “The whole idea of starting slow and gradually building up your tolerance applies to anything that pushes you beyond your capabilities, including spinning.
“But it doesn't matter whether it's spinning or not, there's always an amount of exercise that you can tolerate,” Pire said. “Normally you don't know what that is until you do it. You just have to learn what those limits are.”
Rhabdo isn’t limited to people who are unfit or out of shape
One of the biggest misconceptions about rhabdo in general is that only people who are unfit or out of shape can get it.
Professional athletes, marathon runners, and other exercise enthusiasts are all subject to developing the condition if they do more than they can handle — even if it’s something they’ve done hundreds of times.
Adam Janusz is an avid outdoor cyclist. He’s been documenting his journey biking the four corners of the US on social media. (However, it was recently postponed due to winter weather concerns.)
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