Return to Play After Exertional Rhabdomyolysis

Abstract

Objective: To outline a 4-phase progressive program that safely and successfully enabled athletes to return to sport without recurrence of exertional rhabdomyolysis symptoms.Background: In January 2011, a large cluster of National Collegiate Athletic Association Division I football athletes were evaluated and treated for exertional rhabdomyolysis. After the athletes were treated, the athletic trainers and sports medicine providers were challenged to develop a safe return-to-play program because of the lack of specific reports in the medical literature to direct such activities.Treatment: A progressive 4-phase program based on existing recommendations, including guidelines for continued clinical and laboratory monitoring.Conclusions: Although the actual process of reintegrating players will differ based on each athlete's unique circumstances, this program provides a safe and effective foundation that can be modified based on the response to activity and sport.

Adenovirus Infection and Rhabdomyolysis as a Cause of Acute Liver Failure in a Healthy Collegiate Football Athlete: A Case Report and Proposed Return to Play Protocol for Rhabdomyolysis

“…Daily symptom checks with the athletic trainer in conjunction with scheduled serial lab monitoring were used to safely and effectively return this athlete to his normal state of health and athletic performance. There are two prior publications in the literature regarding return to play protocols after rhabdomyolysis [ 8 , 11 ]. We built upon these previous recommendations and sought to further develop a concrete, multi-disciplinary based return progression with training, clinical, and laboratory goals.…”

Exertional rhabdomyolysis in a 21-year-old healthy man resulting from lower extremity training

“…[28,29] To enable patients return to sport without recurring ER, Schleich et al outlined a 4-phase progressive program implemented to successfully return each athlete to sport after an ER diagnosis requiring hospitalization. [30] Athletes returned to activities of daily living for 2 weeks after discharge in phase I and were not allowed to train until the CK level was below 5 times normal (1000 IU/L). Then, it moved forward to phases II to IV, in which recovery training began from low-load exercise to high-resistance training.…”

Rehabilitation for Rhabdomyolysis Associated With Breast Cancer Treatment

“…Although rehabilitation for patients with rhabdomyolysis is not widely researched, Schleich et al proposed a therapeutic regimen with four phases for athletes with exertional rhabdomyolysis [12]. The first phase was returning to normal activities for two weeks with close monitoring.…”

“…When the individual could tolerate this without soreness or pain, phase 3 included light resistance activities, stationary bicycling, and body weight resistance activities to weak muscle groups. Phase 4 allowed the individual to return to the regular exercise routine with initiation of resistance training at 20%-25% of one-repetition maximum, agility exercises, and running [ 12 ]. No articles could be located related to rehabilitation after chemotherapy-induced rhabdomyolysis.…”