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Rhabdomyolysis is often thought of as a "rare" condition, but about 200,000 people a year develop it, just in the United States. Rhabdomyolysis involves the breakdown of muscle tissue, usually triggered by a crushing injury, dehydration, a bite from a venomous snake, a bite from a poisonous insect, or medications, but it isn't just the breakdown of muscle tissue.

Part of what is going on in rhabdomyolysis on the cellular level is damage to a microscopic structure known as the sarcolemma. Functioning on the membrane surrounding the cell, the sarcolemma houses even tinier channels for the flow of electrolytes in and out of the cell. One of these channels pumps sodium and potassium, both of which are positively charged ions, in and out of the cell as it makes energy in the form of ATP. To make energy, the cell needs glucose, which is transported with a net-negative charge. Every time a molecule of glucose enters the cell, three positively charged sodium ions go in with it. The cell maintains its charge by sending two positively charged potassium ions out. However, if the sarcolemma is damaged, either the sodium can't go in or the potassium can't go out, so the cell can't make energy.

Right after an injury, cells run down. They go into hibernation mode. However, when the injury that damaged the sarcolemma is treated, or when blood circulation is restored, suddenly they get lots of oxygen again. The problem is they can't use it. That oxygen forms free radicals of oxygen, which trigger inflammatory reactions, causing pain, and generating free radicals, which damage adjacent, healthy tissues.

As a result, when you start healing from the injury that caused your rhabdomyolysis, you begin to experience even worse pain. But what does that tell you about how to reduce the pain?

  • Changes in diet can help. Generally speaking, you need more potassium and less sodium (more fruits and vegetables, and less salt). This helps your muscles deal with the sodium-potassium imbalance that was started by the original injury.
  • Fructose is usually considered bad for your health, but in rhabdomyolysis, it can be beneficial. Cells use it for energy through a different pathway that doesn't involve insulin, potassium, and sodium exchanges (at least not in the same way). Fructose can relieve pain.
  • Medium-chain triglycerides provide your muscles with another energy source they can use easily as they recover from the injury that caused the tissue to break down. Also known as MCTs, these healthy fats are particularly abundant in coconut oil.
  • Caffeine, nicotine, and other stimulants should be avoided while you are recovering. These stimulants make your muscles twitch and interfere with their repair.
  • It's especially important to make sure you get enough water while you are recovering from rhabdomyolysis (unless your doctor has specifically told you to limit your consumption of water as your kidneys are recovering). If you haven't had kidney damage, the water helps your muscles repair. Muscles "pump up" with glycogen, which they make from glucose and water. Each muscle cell has to make its own glycogen, so each muscle cell needs both glucose and water. Also, muscles cannot use creatine without water. You simply cannot rebuild muscles if you are dehydrated.
  • Avoid high-CBD marijuana, Oxycontin, and opioids while you are recovering from rhabdomyolysis. These illicit drugs relax you, which isn't a bad thing in itself, whatever one says about the legality and morality of using these drugs, but if you are so "relaxed" that you develop pressure sores as you sleep, you can have still more damaged tissue for your kidneys to detox and your body to repair. 

You may not be able to prevent having rhabdomyolysis once, but you usually can avoid having it twice. Don't repeat the muscle injuries or expose yourself to the dehydration that caused the problem. If that means talking to or standing up to a coach who insists on workouts in the heat or working out so hard that your muscles break down in the weight room, that's what you have to do.


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