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Friday, April 18, 2014

Exertional Rhabdomyolysis Prevention Strategy For Athletes

Exertional Rhabdomyolysis is the degeneration of skeletal muscle caused by excessive, unaccustomed exercise. Symptoms of rhabdomyolysis include muscle pain, weakness and swelling; myoglobinuira (presence of myoglobin in the urine); and increased levels of muscle enzymes and other muscle constituents in the blood.”

This condition is not well known or fully understood even though it has been around for a very long time. It is becoming more prevalent in the medical, sports and fitness settings as more people are learning about it and classifying it properly. In the past, most cases of Exertional Rhabdomyolysis were diagnosed incorrectly.

Photo: Crossfit Joe battling the tire sled

I had only heard of it after reading about cases of rhabdomyolysis with Crossfit athletes. Reading about rhabdomyolysis in relation to Crossfit, caused me to read more on the topic. Although I was aware of rhabdomyolysis after reading about it, I had never heard of it before that nor experienced it myself or with any of my clients.

As there is no clearly defined or universally accepted prevention strategy for rhabdomyolysis, I have compiled a list of components for a prevention strategy for athletes based upon the studies listed in my reference section. 

An optimal rhabdomyolysis prevention strategy should include the following multiple components:

a physical exam with cardiac testing and blood work
a screening for any illness or infection
a history screening for NSAID, medications and supplement use
an education session on the risks and symptoms of rhabdomyolysis
a gradual and progressive conditioning program
an acclimatization plan
a monitored hydration plan
a supportive nutrition plan
periodic blood and urine testing with emphasis on creatine kinase and myoglobin levels
planned frequent rest periods during exercise sessions in hot weather
the removal of equipment or excessive clothing during rest breaks to avoid overheating
refraining from exercising to muscle failure
avoiding excessive high intensity training bouts with interval sprints and exercises using eccentric contractions a programmed recovery plan. 
While it may be impossible or impractical for every athlete to follow every component that I have listed, the more components that are followed will greatly reduce the risk of Exertional Rhabdomyolysis.

There will always cases where athletes will be affected by Exertional Rhabdomyolysis even when a preventive strategy is followed.

This is a condition that anyone who participates in demanding sports or fitness events should be aware of.


Messonniera, L., Sambb, A., Tripette J., Goghe, B., Lokoc, G., Sallb, N., F´eassona, L., Huec, O., Lamotheg, S., Boguie, P., Connesc, P. (2012). Moderate endurance exercise is not a risk for rhabdomyolysis or renal failure in sickle cell trait carriers. Clinical Hemorheology And Microcirculation, 51, 193–202.

Lin, H., Chie, W., Lien, H. (2006). Epidemiological Analysis of Factors Influencing an Episode of Exertional Rhabdomyolysis in High School Students. American Journal of Sports Medicine, Vol. 34 Issue 3, p481-486. 6p.

Oh, J., Laidler, M., Fiala, S., Hedberg, K. (2012). Acute Exertional Rhabdomyolysis and Triceps Compartment Syndrome During a High School Football Camp. Sports Health: A Multidisciplinary Approach, 4: 57.

Smoot, K., Amendola, A., Cramer, E., Doyle, C., Kregel, K., Chiang, H., Cavanaugh, J., Herwaldt, L. (2013). A Cluster of Exertional Rhabdomyolysis Affecting a Division I Football Team. Clinical Journal of Sport Medicine, Volume 23, Issue 5, p 365–372.

Eric Dempsey
Master Sergeant, U.S. Army Retired
NASM Certified Personal Trainer & Weight Loss Specialist
Dempsey’s Resolution Fitness
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