In and Out Express Care Blog

NSAID Use and Rhabdomyolysis in Endurance Athletes

By Dana MacCorquodale | Published Wednesday, September 05, 2018

When I competed in the Chattanooga Ironman in 2014, I did so in opposition to my doctor. I was recovering from an IT band release operation that got infected with MRSA. In addition to this, I reinjured my knee while running speed intervals on the track. An MRI revealed that I had a bone bruise in 3 places. It hurt, a lot. In order to do IM Choo, I did zero road running the last 2 months of training. My NSAID use would lead me down a dangerous path for an endurance athlete.

All of my running training was done on an Alter G anti-gravity treadmill. If you don’t know what that is, here’s the skinny…it is a chamber that you zip the lower half of your body into on top of a treadmill. The chamber then fills allowing you to run at say 50% of your body weight. This allows your body to replicate running without further damage to your knees or other injured body part. I ran on this treadmill 3-4 times a week leading up the race. My swimming and cycling were going great. Although I was very worried about the run.

I was taking NSAIDS for my knee pain. I have lost a lot of cartilage and arthritis is beginning to develop. So, I began IM Choo with my blood levels of NSAIDS at optimum levels to relieve my pain and swelling.

I had a great swim, 46 minutes with a strong current behind me. I was the 5th woman in my age group to complete the swim.

I had an awesome bike leg. The bike was always my cross to bear, I do not like it. My butt never stopped going numb from being in the aerodynamic position. I finished well faster than I had predicted.

Just to make sure I didn’t develop any pain on the run, I took 800mg of Ibuprofen as I left the transition tent. I was feeling better than I should have. I was having a good day. I wanted a slot to race in Kona at the Ironman Triathlon World Championships and I was willing to destroy my body to get there. So, I started to run. Clicking away the miles, I began to feel strange. I was running, I had no pain, but I kept forgetting where I was in the course. All I could do was continue running. I remember several times, completely forgetting where I was and what I was even doing. But I didn’t feel physically bad. I felt shockingly good. That should have been my first clue that something was terribly wrong. I don’t remember the entire last 1/2 marathon loop of the course. I finished in under 11 hours and 30 minutes. As I crossed the finish line, a volunteer grabbed me because I was going down. It wasn’t an overly dramatic collapse like you see on tv but I was unable to stand.

They took me to the medical tent and started an IV and gave me a nice, cold Coke. Nothing tastes better to me than a cold Coke after a long, hard race.

The doctors took a look at me, said I was okay and sent me along my merry way. I wasn’t hungry that night at all but I chalked it up to stomach distress from racing.

When I awoke the next morning, I noticed that my urine was brown, like watered down coffee. And I didn’t feel well. I knew something was wrong. I went to the local emergency room. When I gave them my urine sample, they were shocked. They immediately admitted me and started an IV to balance the levels of electrolytes in my blood and flush out my kidneys that were being poisoned with myoglobin from the intensity of an endurance event. They told me I had rhabdomyolysis and that I was lucky I had decided to come in.

It turns out that doing an 11 hour event and taking NSAIDS along the way is a recipe for disaster. As my body was tearing down muscle to burn for fuel, it was poisoning my kidneys which were already overloaded from my NSAID use.

Rhabdomyolysis occurs when there is damage to the muscle. Your body breaks down muscle during intense physical exercise or exertion. The injured cell leaks myoglobin into the blood. Myoglobin can be directly toxic to kidney cells and it can impair and clog the kidneys function.

If you’re competing in an extreme endurance event, herbs like turmeric can help keep inflammation and pain at bay without putting your health in danger. I was lucky, not everyone is. Please reconsider taking any NSAIDS before competing in a triathlon, marathon or any extreme distance event. It just might save your life.