By Doyice Cotten
What is Rhabdomyolysis and why should I know about it? Rhabdomyolysis (sometimes referred to as Exertional Rhabdomyolysis) is a condition in which damaged skeletal muscle tissue breaks down rapidly and enters the bloodstream, bringing on a potentially debilitating or life threatening illness. Byproducts of damaged muscle cells are released into the bloodstream and can lead to kidney damage or even kidney failure. Why should you know about it? Anyone connected with conditioning – whether as a coach, personal trainer, physical educator, or exerciser – needs to be aware of this condition so that the disease and any associated liability can be avoided.
What Causes the Disease?
The condition is generally brought on by extreme, strenuous, unaccustomed, prolonged, and repetitive exercise. The onset of the condition is more likely when the exercise is far beyond that to which the party is accustomed. The football coach or basketball coach, anxious to get his team into “shape,” begins season practice with extremely strenuous conditioning drills that go on and on; the personal trainer pushes his or her client to exhaustion in a fitness test or a conditioning drill; or even the “weekend athlete” or “couch potato” decides to get into shape, and tries to do it in a day – all of these can result in extreme amounts of exercise that are far beyond that to which the exerciser is accustomed. Possible result: Rhabdomyolysis – possible serious illness – possible lawsuit.
The onset of Rhabdomyolysis seems to be more likely when it is accompanied by certain risk factors. Some of the risk factors include lifestyle factors (alcoholism, drug use, statins, nutritional supplements, extreme exercise), occurrences (trauma, crush injuries, seizures), and individual characteristics (genetics –sickle cell trait, heat intolerance, low phosphate levels).
What are the Symptoms of Rhabdomyolysis?
First, the severity of the condition can vary. In other words, one can have a mild case or an extreme case of the disease and the symptoms vary with severity. One with a mild case may not have any muscle symptoms and can be diagnosed only with a blood test. Severe cases usually display joint and muscle pain accompanied by general muscular weakness. There may be swelling and tenderness. Also, there is often extreme fatigue. Other symptoms may include nausea, vomiting, abnormal heart rate, and even coma. Often, the urine is dark and in the case of kidney damage, there may be decreased or no urine flow.
Is the Condition Rare?
No, even though the disease is new to most of us, the condition occurs fairly often. It can occur in healthy young adults who exercise regularly. It can occur in older, out of shape adults who exercise less frequently. Thomas, et.al. relate a number of occurrences in athletic situations. Some of them include: the University of Iowa football team after 100 squats followed by sled drills; high school football players after an endurance test; dancers at a camp during a heat wave; and a number of instances with military recruits.
Stan Reents reports several cases of Exertional Rhabdomyolysis at Athleteinme.com . He reports cases involving a college freshman after a 5-hour frisbee tournament; a 40-year old black male after doing several sets of negative curls; and an inmate after a hazing ritual. Reents’ article is very informative and is a “must read.”
Who Needs to be Aware?
Anyone who is involved with athletes or others in conditioning and training should be aware. This would include coaches, personal trainers, physical education teachers, and more. Also, administrators in charge of exercise facilities or who supervise those that are conditioning athletes and others. Administrators should be aware of the dangers involved and the associated liability. Finally, athletes and persons who are working to maintain or improve their level of fitness should be aware of the condition. Some recommend that a participant should be taught to keep a close eye on the color of his or her urine.
What is the Outlook for Victims?
Much depends upon early recognition and treatment. In many cases there is full recovery and no long-term problems. However, in more serious cases, kidney damage can be severe and permanent. Wikipedia reports a mortality rate of 20% when there is acute kidney impairment in patients with traumatic injury. So, this is a very serious condition and needs to be recognized as such by those in sport, fitness, and recreation.
Risk Management Guidelines:
- Start slowly on any training/conditioning program and don’t try to progress too quickly.
- Learn to recognize symptoms of severe stress and know when it is time to have the exerciser cease.
- Don’t push exercisers too hard and caution them about limits when exercising on their own.
- Listen to the complaints of exercisers – undue pain, swelling, tenderness, and general muscular weakness are not normal. Something is wrong.
- Remember that extreme heat adds to the stress and makes the onset of the disease more likely.
- Require the consumption of plenty of fluids.
- Recognize the fitness level of the exerciser and use gradual progression of load.
- Remember that the lower the fitness level, the more likely the onset.
- If you suspect the condition, see that the exerciser gets immediate medical attention.
- And ADMINISTRATORS – Be certain that your coaches, trainers, teachers, and others know about Rhabdomyolysis and supervise to be certain these guidelines are being followed.
Thomas, D.Q., et.al., Exertional Rhabdomyolysis: What Is It and Why Should We Care? JOPERD, Jan. 2012, p. 46.
Reents, S., Exertional Rhabdomyolysis, http://www.athleteinme.com/ArticleView.aspx?id=241