Exertional Rhabdomyolysis

I hope the blog readership has had a chance to take a look at the most recent issue of CJSM.  The September 2013 edition of the Journal has studies looking at conditions from concussion to osteoporosis and at sports from football to ballet.  It is a varied mix, and a testament to the wide range of conditions primary care sports clinicians treat and study.

The great Nile Kinnick,
University of Iowa
1939 Heisman trophy winner,
World War II hero

I spent a good amount of time in August talking about concussions, and I could easily continue this thread throughout September.  I started off the month, in fact, with a look at my friend Bill Meehan’s recent work on the “The Presence of Undiagnosed Concussions in Athletes.”  I thought I’d take a break from that topic, and look at a less common but also potentially dangerous condition:  exertional rhabdomyolysis.  It’s a particularly relevant topic at this moment, as exertional rhabdo often times strikes untrained athletes working out in hot and humid environmental conditions, and it’s an unseasonable 95 in Columbus Ohio today, where I am writing this post.

A Cluster of Rhabdomyolysis Affecting a Division I Football Team,” a study by Smoot, MK, Amendola, A, Cramer, E et al., looks at an ‘outbreak’ of the condition in January 2011 at the University of Iowa’s football (american) team after some intense off-season lifting workouts.  Ironically, we had a cluster of our own in Columbus, Ohio, home to Iowa’s Big Ten rival Ohio State, just this spring, in the women’s sport of lacrosse.  The LAX players were hospitalized after team members performed a new 20 minute workout involving repetitive pushups, situps and chin ups, without break.  Six female athletes were hospitalized for as much as a week.  The local newspaper reported,  “Five returned to play last season, all except sophomore Kelly Becker of Dublin…..who has since transferred to Michigan.”

The author’s son,
letting it all hang out
in the ‘Big House’
Ann Arbor, MI

Ok, stop!!  If that doesn’t suggest to you the gravity of the situation, nothing will.  As a consequence of her experience as an athlete who developed exertional rhabdo, a young woman traded in being a Buckeye for a Wolverine.  The ultimate protest!!!!

Returning to the study…..The authors set out to look for what might be risk factors for exertional rhabdo (ER) in collegiate football players.  They begin by doing a brief and excellent overview of the signs and symptoms, defining characteristics, and known risk factors for ER.  They proceed then to describe the workout the 16 football players did (e.g. 100 back squats at 50% of one rep maximum) and how the young men presented with ER.  Thirteen players were hospitalized for ER after this workout.

The authors were given permission to look at the medical records of 10 of the 13 cases. Nine of the 10 had urine screens negative for drugs (one had a positive opiate screen, but his urine had been collected after being administered narcotic analgesics); one of the 10 had sickle cell trait; and two of the 10 had consumed creatine before the workout.

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