Elevated Creatine Phosphokinase (CPK) is it a problem?

I had an athlete from our 40fit group private message me about elevated CPK levels from recent lab work. His doctor told him to stop crossFitting because his CPK levels were chronically higher than normal and he needed to stop exercising. In the past, he had levels ranging from 300-400 IU/L and recently it was 608 IU/L.

First, let me say that I am not an MD, I am a DPT with 25 years of clinical experience. But I can read labs and read the literature. My disclaimer here is to always find a “research and science” based doctor who makes decisions off of solid information. It amazes me how much dis-information there is out there and how few professionals read the literature.

The average male adult has a CPK level of 20-200 IU/L. It is not uncommon for athletes after strenuous events to have CPK levels above 20,000 IU/L without renal compromise.

What I recommended to this gentleman to do is to look deeper. In other words, besides an elevated CPK, did he have any other signs/symptoms of any disease or process that he should seek medical attention for. Was he resting enough, getting adequate nutrition, training within micro-macro-cycles, adequately hydrating and recovering as needed as an older athlete. Did he have the signs of over-training or some other condition with a related sequelae? Did he have a cardiac or kidney history and did he have pain in his joints, lack of function etc…? Did he have the signs of chronic inflammation?

In actuality, the idea that a medical doctor would ask a client to cease exercise in an individual who is older and highly fit, is ludicrous! An elevated CPK level has different clinical implications if the individual is 50 and healthy or 80 and suffering from chronic disease. If he has no other co-mordities and functioning at a high level, he is better off exercising than living a sedentary life with all of its associated problems and quality of life statistics, just read the literature there’s copious amounts of it.

Here is a summary statement from a an article reference and its link if you run into this same situation.

“In summary, renal injury with high serum CPK values becomes a true concern when levels of CPK reach 5,000 IU/L and the patient has serious co-morbid disease such as volume depletion, sepsis or acidosis. Otherwise, values of up to 20,000 IU/L may be tolerated without untoward event. The key pathophysiological events are volume depletion and aciduria, which should be corrected immediately and primarily with ample IV normal saline and secondarily with urinary alkalinization.”


This article also references mild, moderate or severe cases of elevated CPK levels. This athlete’s levels are no where near the mild level, so why would a doctor ask him to stop exercising. If he had a history of kidney or cardiac problems it might be something to monitor but otherwise it seems unwarranted. You decide…

Coach D


One Comment

  1. Kev June 18, 2014 at 11:43 am - Reply

    Hey coach, really great article. Sometimes Doctors are just not with the latest literature and so they espouse their theories which they have held onto for some time regardless of whether it’s out of date or not. Thanks for sharing.

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