Author: Dr Patrick Goh
Date: August 2011
Delayed Onset Muscle Soreness, or DOMS, is a well-known condition which typically occurs after unaccustomed physical activity, such as resistance training. Usually harmless and self-limiting, but it is nevertheless associated with a rise in muscle enzyme (CPK) of 3 to 4 times compared to normal levels. Symptoms typically subside after 3 to 5 days without any long-term consequences.
Rhabdomyolysis (Rhabdo for short), however, is a far more severe form of massive muscle damage which may also occur after strenuous exercise. Deconditioned adults performing resistance training are prone, but so are trained athletes who push themselves hard in events such as triathlons. Those taking the popular statin drugs for high cholesterol are particularly at risk. Rhabdomyolysis is characterized by severe muscle pain and stiffness, with CPK levels reaching 100 to 300 times of the normal range, and there may also be the appearance of dark urine. There is a risk of liver and kidney failure, and even death in worst case scenarios. There is also a long-term impact on the muscles affected.
Most instances of exercise-induced rhabdomyolysis are preventable. In prescribing exercise to an unfit person, it is vital to adhere to basic principles of medical clearance before exercise and ‘starting slow, going slowly,’ with both the cardiovascular and resistance components of the program. Simple tools such as a PAR-Q questionnaire would help flag issues which may pose a risk. The programme must be individualised to the person’s current fitness level, no matter how low this may be, as what is ‘normal’ for an average person may be far too strenuous for an unfit person.
