Spinning and Rhabdomyolysis
In the last few years, Singapore has seen a sudden spike in the number of locally reported cases of recreational athletes suffering from rhabdomyolysis after participating in high intensity exercise classes such as weight-loss boot camps, calisthenics high intensity interval training and spinning. While we monitor these occurrences as they happen, we cannot fail to notice pertinent trends between them.
Why do people get rhabdomyolysis when they exercise intensively?
Recently, we were honored to have been invited by local chinese newspaper Zao Bao/早报 to comment on the topic of spinning and its correlation to the development of rhabdomyolysis in newcomer recreational athletes. The article is in chinese and linked in the image below.
Click image to access full article on zaobao.com.sg
For English readers, view this article on Google Chrome and right click to select ‘Translate to English’.
Excerpts of our interview were used in the above article.
Here is what we shared with Zaobao (and more), presented in English for the convenience of our English-speaking readers:
What is rhabdomyolysis?
Rhabdomyolysis is the result of widespread muscle tissue breakdown in one’s body. Chemicals from these broken tissues are released into one’s bloodstream and are required to be flushed out of body’s circulatory system through the kidneys. Risks of kidney injury are therefore present if treatment is not obtained early enough and the chemicals from muscle tissue breakdown remain in one’s circulatory system and kidneys for too long. [3]
Muscle tissues break down through a few possible reasons –
external trauma to the muscles tissues as in car accidents or crush injuries causing them (the muscle tissues) to physically break apart,
widespread burns deep enough to damage one’s muscle fibers,
insufficient blood flow to muscle tissues causing them tissue death
intense physical exertion over long periods of time causing harmful levels of physical stress to muscle tissues
How can one differentiate between normal muscle ache/soreness after exercise versus symptoms related to rhabdomyolysis?
It can be hard to differentiate the initial symptoms of rhabdomyolysis from generic post exercise muscle soreness (PEMS). This is because controlled degrees of muscle tissue breakdown (that result in muscle soreness) occurs during optimal levels of strength and endurance training. As a result, most people do aim to achieve a certain level of PEMS as an indication of having had a ‘sufficiently intense’ workout – whether or not this is the best method of self-evaluation remains to be debated.
The key differences in symptoms of PEMS vs rhabdomyolysis would be that of the intensity of muscle soreness bordering on being actual pain instead. Optimal levels of PEMS should not leave a person crippled; unable to complete simple tasks like walking, climbing stairs or even standing or moving their joints without debilitating pain or swelling of the muscles affected.
A more distinctive symptom would be the passing of dark coloured urine – a sign that an unhealthy level of muscle tissue breakdown has occurred in the body. Immediate medical attention is required should one be found with these symptoms after high levels of physical exertion.
Which areas/muscles of the body are typically used in a spinning?
The quadriceps muscle are one of the largest muscles in the human body and are utilized most in all forms of cycling.
The main muscle groups are those belonging to the legs – the quadriceps (front of thigh), hamstrings (back of thigh), glutes (buttocks) and hip flexors (front of hip) and lastly the calve muscles. The thigh and buttock muscles are the largest muscles in our body [1] with a high propensity to be developed with cycling movements.
The rest of the body serves to stabilize the rider on the stationary bicycle, where the arms may be used to assist in force generation when pedalling.
What are some potential issues associated with spinning?
Overexertion as a potential issue has been surfacing more frequently of late, leading to conditions like rhabdomyolysis as seen in articles spanning the past 1-2 years.
Other more commonly seen issues include that of musculoskeletal injuries like back, knee and neck pain. These conventionally stem from poor posture of the rider, incorrect bicycle set-up and poor pedaling technique.
What are the possible reasons spinning may result in rhabdomyolysis?
Spinning is a relatively low-skilled activity, allowing any individual, trained or untrained to be able to participate maximally in each class. This creates a low barrier to entry for most, where, as a growing fitness trend it is attracting those who have been out of the fitness scene for a while to consider spinning as the first step back to an active lifestyle.
However, few who have cycled before have had proper experience with cycling in cleats. Cycling in cleats differ from unclipped pedalling, requiring both an upstroke on top of the regular downstroke. This results in greater recruitment of large muscles groups of our legs. Additionally, the pedals of stationary bicycles used in spinning carry momentum accumulated with each rotation of the pedals. This is means that even though one’s legs might already be completely fatigued, the pedals continue to push the rider’s legs and result in the rider being unable to sense any loss in performance or muscle control i.e. does not feel leg heaviness or weakness as easily.
With loud, high bass music and strobe lights mimicking that of dance parties, such an environment prevents the ability for our bodies to sense changes within it e.g. unable to hear our heart pounding louder or heavier breathing as we fatigue; joints clicking as we deviate from proper mechanics. This spirals towards a reduction in our ability to sense warning signs coming from our body.
‘Group think’ and peer pressure has the ability to make an individual perform feats beyond what is normal and otherwise would be impossible if done alone. A study among many others has proven this point, with a prisoner being able to override his natural inhibitions and consume up to 6L of water in 3 hours when participating in a game where drinking water was a penalty [2]. Unfortunately, exceeding one’s natural limit usually results in injury as did the prisoner who landed up in hospital eventually. The group setting that most spinning classes are conducted in, with an instructor who continually shouts above the loud music to motivate and encourage his/her participants to keep up with the session can make it hard for any struggling participant to deviate from the group and pause for a rest while the others are going on – sticking out from the group like a sore thumb.
Lastly, living in the current modern fitness world where ‘go hard or go home’ seems to be the ideal philosophy, individuals with high pain thresholds are particularly susceptible to reaching beyond their physical limits and increasing their risks of injury.
Can rhabdomyolysis possibly affect a spinning newbie who is fit and exercises regularly?
Being new to the activity of spinning itself may not pose a huge risk to the already physically active individual.
The main risks lie among individuals who are deconditioned prior to attempting spinning classes. A deconditioned individual is one who has been sedentary for a significant period allowing his/her body to weaken to a state where it is only strong enough to manage basic daily activities. Deconditioning is more commonly observed post-hospitalization where full bed rest may be required for recovery from a life-threatening illness. However, modern day lifestyles have become highly deskbound and public transport so accessible for commuting that one can easily pass through a day without much physical demands at all, allowing deconditioning to take place easily.
There are 2 main reasons that may determine one from overtraining:
1. Sufficient physical preparedness of the trained body. Physiological differences like muscle strength and endurance can greatly lower the risks of muscle damage from an intense workout.
2. The ability to self-regulate a workout is less in an untrained individual. Self-regulation is key to injury prevention, where one is mindful of when to stop or slow down; aware of what sensations are desired and what are not during the workout.
If one can possibly get rhabdomyolysis from spinning, can cycling cause this?
The risks of rhabdomyolysis with outdoor cycling is greatly lowered due to the following factors:
1. A heightened safety awareness when navigating traffic, pedestrians and road conditions
2. Lesser chance of ‘group think’ (making decisions as a group instead of an individual) due to limited group size allowed when on the road and when not in a peloton
3. Higher skill required by the rider on a moving bike, creating a natural limitation to how much one can exert when cycling in the light of multi-tasking
o As such, the rider is more aware of him/herself in relation to his/her environment and will be able to sense changes in his/her physical condition over time better. This allows for better auto-regulation of the intensity that the rider is cycling at and would be less likely to overexert beyond that of his/her safe zone.
Can you share some general tips for people who are starting out in spinning?
For those who have been sedentary for many months and are deciding to restart their fitness journey with spinning, I would suggest the use of a heart rate monitor while spinning to track your level of exertion and limit it to a healthy heart rate zone. This helps to enable some form of monitoring while most conventional ways of doing so are nearly impossible in the environment that commercial spin classes are conducted in.
Choosing to spin with regular shoes where available should be considered for first-timers so as to rely on a familiar way of pedalling that his/her body might be able to rely on from muscle memory.
Learn how to set up your stationary bicycle correctly before starting the class. This ensures movement efficiency and will keep other musculoskeletal mishaps from happening. General rules of thumb for a basic a set up are as follows:
Seat height adjusted so that one’s knee at the bottom most point of the downstroke is not fully extended and optimally at 5 degrees of knee flexion
Seat and handlebar distance adjusted to keep 90 degrees arm angle measured from torso with hands on the handle bar(s)
I strongly encourage those new to this fitness class to take the past incidences as an important word of caution. Recognizing firstly that you are new to the class should give you the right to pause or slow down during your first few sessions. There is no shame in prioritizing your health as we all only get one chance at living in this one body of ours.
Exercise is definitely beneficial for all of us. However, it needs to be done at the right intensity, duration and frequency for every individual. Our bodies are designed to know its limits and create natural inhibition to over-exertion. This inhibition may, however, be overridden by our desire to fulfil expectations set by either ourselves or a demanding instructor.
Thankfully, under the knowledgeable guidance of exercise professionals like those at Physiotherabeat, your chances of getting severe health conditions like rhabdomyolysis are low.
If you’re new to exercising or are returning from a long fitness hiatus, feel free to reach out to any of our exercise professionals for a quick consultation!
Contact us at ask@physiotherabeat.com or Telegram/Whatsapp +65 8322 0284 today