Exertional Rhabdomyolysis, what’s that?

Dr. Darrell Menard OMM MD, Dip Sport Med
Defence Stories

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One of our soldiers recently did an extremely intense workout and was hospitalized with rhabdomyolysis. Could you explain what rhabdomyolysis is and if it can be prevented? – Dedicated D

Dear Dedicated D:

Rhabdomyolysis (commonly called rhabdo) is a potentially life-threatening condition that can occur when muscle is damaged by factors like burns, electrocution, crush injuries, severe dehydration, medications, and substance use. Also, exercising too intensely for too long can cause exertional rhabdomyolysis. In rhabdomyolysis, damaged muscle cells release their contents into the blood where they cause serious problems such as:

• Kidney damage and kidney failure when muscle contents clog the kidney’s filter system and have a toxic effect on kidney tissue;
• Heart arrhythmias – triggered by electrolyte imbalances;
• Seizures;
• Blood clotting throughout the body; and
• Compartment Syndrome – swelling causing reduced circulation to muscle tissue.

The risk of developing exertional rhabdomyolysis is greatest for people who suddenly and significantly increase their activity levels. Exertional rhabdomyolysis is more common in military, police, and firefighting personnel who are often required to do heavily demanding physical work. Other risk factors include:

• Hot/humid weather;
• Previous history of a heat-related injury;
• Dehydration;
• Excessive alcohol use;
• Stimulant use;
• Certain medications such as statins;
• Infections;
• Diseases such as diabetes.

Exertional rhabdomyolysis symptoms range from mild to severe and don’t always occur immediately after the damage is done. They could include:

• Excessive muscle pain;
• Weakness;
• Dark coloured urine;
• Significant fatigue;
• Nausea and vomiting;
• Fever;
• Increased heart rate.

After an intense workout, if you develop some of the above symptoms, especially the first three, you should seek immediate medical attention. If you have exertional rhabdomyolysis, the sooner you get care, the better your chances of recovery.

The best way to deal with exertional rhabdomyolysis is to prevent it. The following advice can reduce your risk of experiencing this problem:

• Avoid sudden large increases in your fitness program;
• Be acclimatized before doing intense exercise in hot/humid weather;
• Stay hydrated when you exercise;
• Don’t exercise intensely if you are sick;
• Avoid using stimulants such as energy drinks prior to exercising.

Dr. Menard is the Surgeon General’s specialist advisor in sports medicine.

Strengthening the Forces is the CAF/DND’s health promotion program providing expert information, guidance, training, tools, and leadership support to improve CAF members’ health and well-being.