Return to Physical Activity After Exertional Rhabdomyolysis

Abstract

Exertional rhabdomyolysis (ER) is a condition characterized by muscle pain, swelling, and weakness following some exertional stress, with or without concomitant heat stress. Athletes who experience ER often present to the emergency department, the training room, or the physician's office seeking guidance and care for this condition, often feeling it is simply normal delayed onset muscle soreness. The astute clinician must perform a thorough history and focused exam, in addition to ordering a serum creatine kinase (CK) and urinalysis. In this clinical setting, a CK equal to or greater than five times normal or a urine dipstick testing positive for blood with no demonstrable red blood cells upon microscopic assessment confirms the diagnosis. A urine or serum myoglobin is more definitive when expeditiously available. After treatment for ER, the provider must risk-stratify the athlete for risk of recurrence, consider further testing, and make the difficult decision on when, if, and under what conditions the athlete can safely return to play.

Return to Play After Exertional Rhabdomyolysis

“…The athlete progressed to phase II when the CK level was less than 5 times normal (1000 U/ L), as previously recommended in the literature. 3 An overview of activities in each phase of the return-to-play program is provided in Table 1. Advancement to subsequent phases was allowed only if clinical symptoms remained absent and laboratory data remained within normal limits.…”

“…1 Although diagnostic criteria for ER are based on a constellation of symptoms and laboratory values described by several groups, 2-4 the medical literature largely lacks specific return-to-play protocols for high-level athletes returning after this ailment. A general guideline is available in the literature, 3 but no published reports have illustrated specific return-to-play programs for elite athletes to guide sports medicine providers and athletic trainers. The purpose of our article is to provide the sports medicine community with a proposed template to safely return athletes to play after ER.…”

Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University of Iceland in the years 2008-2012

“…Einkenni geta takmarkast við vöðvaverki og mátt-minnkun 7 en önnur einkenni geta verið slappleiki, vanlíðan, þvagþurrð, hiti, ógleði, uppköst, óráð og óróleiki. 4,8,9 Haetta á rákvöðvarofi eftir áreynslu eykst meðal annars ef viðkomandi er ekki í góðu líkamlegu formi, ef umhverfi er mjög heitt og rakt eða líkams-beiting er afbrigðileg.…”

Case Report: Rehabilitation of a 65 Year-Old Female with Statin-Induced Rhabdomyolysis

“…Due to the wide variety of physical and functional impairments that these patients can present with, it may be difficult to develop a comprehensive plan of care based on the needs of the patient. Previous work has been done following acute exertional rhabdomyolysis in athletes and military personnel (Baxter & Moore, 2003;O'Connor, Brennan, Campbell, Heled, & Deuster, 2008;Randall, Butler, & Vance, 1996;Tietze & Borchers, 2014). A protocol based on the work of Randall et al has been used to treat acute exertional rhabdomyolysis due to intense push-up training, allowing the individual to return to physical activity (Baxter & Moore, 2003).…”

“…The Consortium for Health and Military Performance (CHAMP) guidelines are similar to the work of Randall et al The CHAMP protocol contains 3 phases; phase 1 is primarily rest, phase 2 is light activity with follow-up care, and phase 3 is gradual return to regular training/activity if no clinical symptoms are present (O'Connor et al, 2008;Tietze & Borchers, 2014). The consensus of the reports is to begin with low level exercises and gradually increase the level of intensity in order to help patients return to prior level of function.…”