Muscle Strain vs. Rhabdomyolysis: When to Seek Medical Help

Rhabdomyolysis

Hello, doctor.
On August 14, I strained my neck muscles due to chiropractic treatment.
Recently, I came across symptoms and causes of rhabdomyolysis online, so I have some questions for you.
My muscle strain has not healed yet.
When I initially got injured, I felt dizzy all day (for several days) and was very uncomfortable, unable to concentrate.
My eyes felt easily distracted when looking at things.
Since I only visited a small clinic at that time, I was unaware of the existence of rhabdomyolysis.
Could it be that I was experiencing rhabdomyolysis initially, or is it just typical symptoms of a neck strain? Should I go to the hospital to check my kidney function?

Hong, 20~29 year old female. Ask Date: 2006/11/04

Dr. Yao Quan reply Internal Medicine

Hello, I apologize for the delayed response to your email.
Rhabdomyolysis is a condition caused by damage to skeletal muscle, leading to the destruction and dissolution of muscle cells, which release myoglobin and other harmful substances into the bloodstream, affecting the entire body.
The injury can occur due to car accidents, intense exercise, exposure to toxic chemicals, or prolonged muscle compression.
When this condition occurs, symptoms may include muscle redness, swelling, pain, stiffness, generalized weakness, brownish urine, elevated creatine kinase (CK) levels in the blood, and imbalances in potassium and calcium ions, which can lead to myoglobin precipitation in the kidneys and, in severe cases, renal failure.

In your case, you mentioned that you experienced a strain in your neck but did not go to the hospital for an examination at that time.
Without laboratory data (such as elevated CK levels), it is not possible to determine whether you were experiencing rhabdomyolysis at that moment.
There are no reports in the literature of rhabdomyolysis resulting from a neck strain.
In my opinion, since the muscles in the neck are mostly medium or small in size, it is less likely to result in severe rhabdomyolysis.
Therefore, your situation seems more like a neck strain.
Regardless of whether it is rhabdomyolysis or a neck strain, after three months, you should have fully recovered.

As for your question about whether you should go to the hospital to check your kidney function, currently, testing kidney function would not help determine if you previously had rhabdomyolysis.
However, it can be considered as part of a routine health check-up.

Sincerely,
Dr.
Yao Quan, Department of Nephrology

Reply Date: 2006/11/04

More Info

When it comes to understanding muscle strain versus rhabdomyolysis, it's essential to recognize the differences between these two conditions, especially in the context of your recent neck injury. Muscle strain is a common injury that occurs when muscle fibers are overstretched or torn, often due to excessive force or improper movement. Symptoms typically include localized pain, swelling, stiffness, and limited range of motion in the affected area. In your case, the neck strain you experienced after a chiropractic adjustment may have resulted in discomfort and difficulty concentrating due to pain and muscle tension.

On the other hand, rhabdomyolysis is a more serious condition that occurs when muscle tissue breaks down and releases myoglobin into the bloodstream. This can happen due to severe muscle injury, prolonged immobilization, excessive exercise, or even certain medications. Symptoms of rhabdomyolysis can include muscle pain, weakness, swelling, and dark-colored urine, which is a result of myoglobin being filtered through the kidneys. Other systemic symptoms may include nausea, vomiting, confusion, and fatigue.

Given your symptoms of persistent neck pain, dizziness, and difficulty concentrating, it is crucial to assess whether you might be experiencing rhabdomyolysis. While muscle strain can cause discomfort and cognitive issues due to pain, the presence of systemic symptoms like dark urine or significant weakness would warrant further investigation.
In your case, since you mentioned that you have not fully recovered from the muscle strain and are experiencing ongoing symptoms, it would be prudent to seek medical attention. A healthcare provider can perform a physical examination and may order blood tests to check for elevated levels of creatine kinase (CK), which is an enzyme released during muscle damage. Additionally, kidney function tests can help determine if there is any impairment due to myoglobinuria, which can occur in rhabdomyolysis.

If you are experiencing any of the following symptoms, it is essential to seek medical help immediately:
1. Severe muscle pain or weakness, especially if it spreads beyond the initial injury site.

2. Dark, tea-colored urine or decreased urine output.

3. Nausea or vomiting.

4. Confusion or altered mental status.

In the absence of these more severe symptoms, it is still advisable to consult with a healthcare professional to discuss your ongoing neck pain and any cognitive difficulties you are experiencing. They may recommend imaging studies, such as an MRI or CT scan, to evaluate the extent of the muscle strain and rule out any other underlying issues.

In summary, while your symptoms may primarily indicate a muscle strain, the potential for rhabdomyolysis should not be overlooked, especially given the persistent nature of your symptoms. Seeking medical evaluation will provide clarity and ensure that you receive appropriate treatment, whether it be physical therapy, medication, or further diagnostic testing. Remember, early intervention is key to preventing complications and promoting a full recovery.

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