In recent years, we have heard rare reports of a dangerous medical condition called rhabdomyolysis resulting from sports and exercise. In 2010, six high school football players on a team in Oregon were hospitalized for rhabdomyolysis and triceps compartment syndrome after intense preseason workouts. In 2011, 13 Iowa Hawkeyes football players developed rhabdomyolysis after an offseason workout session.
While exertional rhabdomyolysis is rare, it can develop into a very serious medical condition. Since you might not be very familiar with the problem, I thought it could be helpful to discuss the diagnosis and symptoms so that you can prevent or recognize it.
What is rhabdomyolysis?
Overexertion can cause injury to affected skeletal muscle. The damaged muscle can release its intracellular material, like creatine kinase, potassium and myoglobin, into the bloodstream. Calcium enters the muscle cells and can cause continual contraction of the muscle fibers. While some cases of exertional rhabdomyolysis can be mild, severe cases can lead to blood clotting disorders, dangerously high potassium levels, kidney failure, compartment syndrome and heart arrhythmias.
Who can suffer rhabdomyolysis?
It has been described in members of the military, police officers and firefighters. The exertional form of rhabdomyolysis occasionally occurs in football, bodybuilding, swimming and running.
What are the risk factors?
In athletic individuals, rhabdomyolysis often results from intense workouts, especially those that involve a significant increase from recent training. Other proposed factors include intense heat, heat illness, current or recent bacterial or viral illness, dehydration, sickle cell trait, and use of stimulants or anti-inflammatory medications.
What are the signs and symptoms?
The athlete might notice muscle pain similar to usual delayed-onset muscle soreness. Often, though, the muscle pain is more intense, with weakness and swelling of the muscle present as well. The athlete might also note that his urine looks darker than usual.
How is it treated?
Mild cases might only require rest and consumption of fluids. More severe cases can be medical emergencies. Often the athlete is admitted to the hospital for IV fluids and close monitoring of electrolytes and creatine kinase levels, kidney function and heart rhythms. If muscle pain and tightness of the muscle compartments suggest compartment syndrome, a surgeon can perform urgent fasciotomies. Kidney failure can require dialysis.
Can it be prevented?
While rare, exertional rhabdomyolysis can develop after intense workouts and other physical activity. While it might not be possible to completely prevent it, some steps might be advisable. Drinking plenty of fluids and trying to avoid extremely hot environments for the workout might help. Slowly increasing the intensity and duration of workouts over weeks or months might also help athletes avoid it. Cutting back on the workout when taking anti-inflammatory medications or recovering from an illness could be beneficial.
It might be equally important for athletes to understand the risks of rhabdomyolysis. They should alert coaches or athletic trainers if they develop any of the signs, such as muscle pain and swelling and dark urine. If there is a question, they should go to a hospital emergency department for evaluation and possible treatment.
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Oh JY, Laidler M, Fiala SC, Hedberg K. Acute exertional rhabdomyolysis and triceps compartment syndrome during a high school football camp. Sports Health: A Multidisciplinary Approach. 2012;4(1):57-62.
Tietze DC, James Borchers J. Exertional rhabdomyolysis in the athlete: A clinical review. Sports Health: A Multidisciplinary Approach. Published online ahead of print February 25, 2014.