Rhabdomyolysis

Rhabdomyolysis is extensive muscle breakdown that releases myoglobin, potassium and enzymes such as creatine kinase (CK) into the blood.^{1CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 8.} Acute kidney injury occurs in 13 to 67% of cases, and myoglobin can turn urine dark or tea-colored.^{1CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 8.} When exercise causes it, the condition is called exertional rhabdomyolysis (ER).^{1CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 8.}

Cases often follow high volumes of submaximal resistance or bodyweight exercise taken to fatigue or done against the clock, usually during an unfamiliar workout or after a layoff, often in heat.^{2CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 10.} Inexperienced clients, those who are dehydrated or heat-stressed, and anyone under severe exertion are at risk.^{3Zatsiorsky, Kraemer and Fry, Science and Practice of Strength Training, 3rd ed., p. 91.} Dehydration and sickle cell trait raise the risk further.^{2CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 10.} Many college cases involved coaches using exercise as punishment, a form of extreme overexertion Zatsiorsky, Kraemer and Fry call malpractice.^{2CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 10.},^{3Zatsiorsky, Kraemer and Fry, Science and Practice of Strength Training, 3rd ed., p. 91.}

In practice

• Build training loads progressively and keep clients hydrated, rather than starting with excessive, intense work.^{4National Strength and Conditioning Association, NSCA’s Basics of Strength and Conditioning Manual, p. 99.}
• Treat delayed onset muscle soreness (DOMS) as a clue that training may be too hard.^{4National Strength and Conditioning Association, NSCA’s Basics of Strength and Conditioning Manual, p. 99.}
• Watch for aching muscle pain, weakness, swelling, dark or cola-colored urine, exhaustion, dizziness, confusion and nausea.^{5CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 9.}
• Get the client to medical care right away if you suspect rhabdomyolysis.^{3Zatsiorsky, Kraemer and Fry, Science and Practice of Strength Training, 3rd ed., p. 91.} Without early treatment, severe cases can cause irreversible kidney damage.^{2CSCCa and NSCA, Joint Consensus Guidelines for Transition Periods, p. 10.}