Rhabdomyolysis can harm anyone who does intense exercise training, not just football players

I saw the report about the Oregon Ducks players who were admitted to the hospital and treated for rhabdomyolysis this week and knew instantly I should write about it. It’s a big medical term, and I doubt many people outside of medicine understand it. But it can affect all sorts of people outside of just college sports. Fortunately, you can take steps to avoid suffering the condition yourself. That’s why I made it the topic of my latest newspaper column.

Three University of Oregon football players have been hospitalized since last week after grueling workouts. SEC and ACC fans can skip their jokes about the Pac-12 teams being soft. These players’ medical conditions are no laughing matter. What happened to them can happen to you, and it could kill you.

University of Oregon football players hospitalized after intense workouts

According to Andrew Greif of The Oregonian, the mother of one of the hospitalized players said her son was diagnosed with rhabdomyolysis. The team had just returned from its winter break and started intense off-season workouts, which sources described to Greif as similar to military basic training.

What is rhabdomyolysis?

Rhabdomyolysis is a rare but dangerous medical condition that can result from muscle injury after intense workouts. It presents with a classic triad of symptoms – muscle pain, weakness and dark urine. As the muscle breaks down, cellular components of muscle spill into the bloodstream. These substances can interfere with kidney function, possibly leading to kidney failure and even death.

Also read:
Don’t increase your training too quickly

Rhabdomyolysis among University of Iowa football players

These three players are not the first young athletes to suffer rhabdomyolysis from hard workouts. In 2011, 13 University of Iowa football players were hospitalized after the start of January workouts. Reports at the time described players doing 100 bench presses and 100 squats within certain amounts of time.
Lifting weights with dumbbells

High school football players develop rhabdomyolysis and compartment syndrome

In 2010, 22 of 43 players of Oregon’s McMinnville High School football team developed rhabdomyolysis after a preseason workout with their new head coach. According to players, the August “football immersion camp” workouts were held indoors with no air conditioning despite temperatures exceeding 90° outdoors. They also drank a little water.

In one exercise, athletes had to do alternating chair dips and push-ups with consecutively shorter intervals – 30 seconds, 20 seconds, 10 seconds, seven seconds, and five seconds, all with no rest periods. Players performed chair dips and push-ups for 4 to 5 minutes straight.

College swimmers develop rhabdomyolysis after preseason workouts

In September 2007, seven of 41 members of the University of South Carolina men’s and women’s swim team developed exertional rhabdomyolysis after their first practices. Gamecock swimmers had to do as many push-ups as they could in one minute, as many squats as they could in one minute and then repeat that sequence for 10 minutes. After a short rest, they repeated that sequence with pull-ups and other exercises. Then they swam for two hours.

Rhabdomyolysis can occur in people other than competitive athletes, too

Rhabdomyolysis isn’t just limited to competitive athletes. It has been reported in firefighters, police officers, military recruits and weightlifters. A 2014 study even described the condition in two separate 24-year-olds after spin classes.

Also read:
Start a training or workout program safely
Rhabdomyolysis has been seen in people after spin class

Rhabdomyolysis and compartment syndrome

Rhabdomyolysis isn’t even the scariest outcome of these workouts. In a small number of people, these programs can cause compartment syndrome in the muscles. The athletes develop severe pain in certain muscles due to increased pressure within the muscle compartments in their arms or legs. That pressure decreases blood flow through the arm or leg, compromising the function and viability of that arm or leg. Immediate surgery is needed to release pressure and restore blood flow to save the arm or leg.

Three of the Oregon high school football players developed compartment syndrome in their triceps.

Tips to prevent rhabdomyolysis after hard workouts and conditioning programs

In 2015, the National Athletic Trainers’ Association and other sports medicine organizations shared recommendations for college athletes to prevent rhabdomyolysis in conditioning sessions. If you or your kids play sports or exercise, you should adhere to these tips.

Gradually introduce and ramp up your conditioning.

If you have had a break from training – after winter break, spring break, summer or an injury, take the first 7 to 10 days to work into new workouts slowly. Increase the volume, duration and intensity of your conditioning slowly.

Base your daily workouts on your fitness level, and don’t try to do the same workout as someone else.

If you are returning from injury or a break from training, don’t try to keep up with your exercise partner who is more prepared for grueling exercise.

Don’t use exercise as punishment.

Coaches should never use demanding workouts as punishment for poor performance or behavior.

Please understand that these rare events are not just possible in football, despite those cases gaining media attention. If your son or daughter plays high school or college sports, or if you participate in intense exercise programs, you can suffer rhabdomyolysis and compartment syndrome as well. Take steps to avoid these conditions, and seek immediate medical attention should you notice muscle pain, muscle weakness and dark urine.

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Note: A modified version of this article appears as my sports medicine column in the January 25, 2017 issue of The Post and Courier.

References:
Multiple Oregon Ducks football players hospitalized after grueling workouts. By Andrew Greif. The Oregonian. January 16, 2017

Iowa still learning from football team’s rhabdo incident. By Erin Egan. USA TODAY. June 27, 2012.

South Carolina swimmers had case similar to Iowa football. By Mark Emmert. The Des Moines Register. January 30, 2011.

Mysterious Football Injuries Rattle Oregon’s McMinnville High. By Katie Thomas. The New York Times. August 24, 2010.

DeFilippis EM, Kleiman DA, Derman PB, DiFelice GS, Eachempati SR. Spinning-induced Rhabdomyolysis and the Risk of Compartment Syndrome and Acute Kidney Injury: Two Cases and a Review of the Literature. Sports Health. 2014 Jul;6(4):333-5.

Casa DJ, Anderson SA, Baker L, Bennett S, Bergeron MF, Connolly D, Courson R, Drezner JA, Eichner ER, Epley B, Fleck S, Franks R, Guskiewicz KM, Harmon KG, Hoffman J, Holschen JC, Jost J, Kinniburgh A, Klossner D, Lopez RM, Martin G, McDermott BP, Mihalik JP, Myslinski T, Pagnotta K, Poddar S, Rodgers G, Russell A, Sales L, Sandler D, Stearns RL, Stiggins C, Thompson C. The inter-association task force for preventing sudden death in collegiate conditioning sessions: best practices recommendations. J Athl Train. 2012 Jul-Aug;47(4):477-80.

Oh JY, Laidler M, Fiala SC, Hedberg K. Acute exertional rhabdomyolysis and triceps compartment syndrome during a high school football camp. Sports Health. 2012 Jan;4(1):57-62.