Exertional Rhabdomyolysis

Szczepanik, Michelle; Heled, Yuval; Capacchione, John F.; Campbell, William; Deuster, Patricia A.; O’Connor, Francis G.

doi:10.1249/jsr.0000000000000040

Cited by 27 publications

(17 citation statements)

References 6 publications

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“…65 The first clinical indicator is 'rhabdomyolysis in case of accustomed exercise': if the rhabdomyolysis occurs in a trained athlete who has worked out at a level of intensity that he is used to (in the absence of other provoking factors), the exercise is not 'unaccustomed'. The absence of team-related cases of ERM also points to the exercise that was not unaccustomed to the level of physical fitness.…”

Section: Box 1 Management Of Exertional Rhabdomyolysis (Erm)mentioning

confidence: 99%

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Scalco

Snoeck

Quinlivan

et al. 2016

BMJ Open Sport Exerc Med

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Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed.

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Section: Box 1 Management Of Exertional Rhabdomyolysis (Erm)mentioning

confidence: 99%

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Scalco

Snoeck

Quinlivan

et al. 2016

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

show abstract

“…There can be a cascade of events that lead to ER, such as physical injury of muscle, accelerated muscle metabolism due to substances (eg, drugs, supplements) or underlying metabolic myopathies, hemoglobinopathies, and/or hyperthermia. 46 These insults decrease intracellular adenosine triphosphate, which then leads to an increase in calcium in the sarcoplasm, which is coupled with a decrease in extracellular calcium and resultant hypocalcemia. 39 The breakdown of muscle fibers releases the intracellular myocyte contents into the circulation: myoglobin, potassium, creatine kinase (CK), free radicals, and organic acids.…”

Section: Exertional Rhabdomyolysismentioning

confidence: 99%

“…Finally, free radicals may contribute to tissue edema, increasing the risk of compartment syndrome. 46 The severity of the disease is directly related to the amount of muscle breakdown that occurs.…”

Section: Exertional Rhabdomyolysismentioning

confidence: 99%

“…In physiologic ER, the patient will develop an elevated CK but no other clinically significant signs or symptoms; while the athlete may have minimal muscle pain, the ER usually resolves without clinical sequelae. 46 ER becomes clinically significant when there is severe muscle pain, swelling, or weakness as well as myoglobinuria and other metabolic consequences as mentioned. Risk factors for significant ER after excessive muscle exertion include dehydration, any medications or supplements that increase metabolism, alcohol, underlying myopathies, and excessive environmental heat exposure.…”

Section: Exertional Rhabdomyolysismentioning

confidence: 99%

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Challenging Return to Play Decisions

Asplund

O’Connor

2015

Sports Health

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Context:Sports medicine providers frequently return athletes to play after sports-related injuries and conditions. Many of these conditions have guidelines or medical evidence to guide the decision-making process. Occasionally, however, sports medicine providers are challenged with complex medical conditions for which there is little evidence-based guidance and physicians are instructed to individualize treatment; included in this group of conditions are exertional heat stroke (EHS), exertional rhabdomyolysis (ER), and exertional collapse associated with sickle cell trait (ECAST).Evidence Acquisition:The MEDLINE (2000-2015) database was searched using the following search terms: exertional heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. References from consensus statements, review articles, and book chapters were also utilized.Study Design:Clinical review.Level of Evidence:Level 4.Results:These entities are unique in that they may cause organ system damage capable of leading to short- or long-term detriments to physical activity and may not lend to complete recovery, potentially putting the athlete at risk with premature return to play.Conclusion:With a better understanding of the pathophysiology of EHS, ER, and ECAST and the factors associated with recovery, better decisions regarding return to play may be made.

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“…Currently no evidence based guidelines exist to assist the provider in identifying who may return safely to play or activity from those who are potentially at higher risk for a repeat occurrence of rhabdomyolysis. 22 It is well established and accepted that the athlete should fully recover in order to decrease the risk of recurrent rhabdomyolysis. However, there does not seem to be an exact consensus on what "fully recovered" actually entails.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Rhabdomyolysis and Extreme Exercise-A Case Study

Wagner¹,

LeNorman²,

Dooley³

et al. 2015

JSMAHS

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Objective: To present the case of recurrent rhabdomyolysis in an active female. Background: A healthy 21 year old female developed severe fatigue and peripheral edema in the upper extremities after an extreme exercise workout session. 4 ½ months later she participated in a similar exercise session with a personal trainer and experienced the same symptoms. Differential Diagnosis: In the initial case, upon physical examination and review of blood work a diagnosis of rhabdomyolysis was made. After the second exercise session athlete was diagnosed with recurrent rhabdomyolysis and was advised to seek treatment at the local emergency room. Treatment: In the initial case the athlete was told by medical personnel to increase fluid intake and rest. In the second case athlete was treated at the emergency room with IV fluids. Uniqueness: The athlete was female, and most cases of rhabdomyolysis occur in males. Athlete was treated for rhabdomyolysis and recurrent rhabdomyolysis, however these diagnosis were made 4 ½ months apart. Also, both cases appear to be the result of the same type of exercise session. Conclusion: There does not appear to be a definitive protocol for an accurate diagnosis of rhabdomyolysis. Guidelines for return to activity should be evaluated on a case by case basis, and a conservative increase in intensity of exercise is warranted to prevent a case of recurrent rhabdomyolysis.

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Exertional Rhabdomyolysis

Cited by 27 publications

References 6 publications

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

Challenging Return to Play Decisions

Recurrent Rhabdomyolysis and Extreme Exercise-A Case Study

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