Exertional Rhabdomyolosis

The safety of athletes is always a priority. At January’s NSCA Coaches Conference, there was a session on Exertional Rhabdomyolysis which I thought was very informative. I wanted to share some of the points, made by physician Jeffery Anderson of UCONN, to ensure that athletes and coaches understand the different types of muscle pain and recognize the signs, symptoms, and risks of “Rhabdo” if it occurs.

What is Exertional Rhabdomyolysis?

Exertional Rhabdomyolysis is the breakdown of a muscle cell due to the repetitive stress of exercise. The breakdown of a cell results in the release of the cell’s contents into the bloodstream. When this happens in large enough quantity, or in major muscle groups, like the quadriceps, the result can become life threatening. This breakdown is not the same as the “micro-tears” of protein filaments inside muscle cells after normal strength training, thought to stimulate strength gains. Click Here to learn the difference between micro-tears and muscle tears.

Symptoms of Rhabdomyolysis include extreme joint and muscle pain and swelling, beyond that of DOMS, the soreness occurring 48-72 hours after unaccustomed exercise. Also, cola colored urine is an indicator of intracellular myoglobin being excreted from the body.

The major health risks of rhabdomyolysis include kidney failure, from the clogging effect that myoglobin has on the renal tubules, and cardiac arrhythmia due to hyperkalemia (an excess of potassium in the blood). The risks rhabdomyolysis are exacerbated by dehydration, due to the decreased blood flow to the kidneys.

Lets Make A Case Of “Rhabdo”

Dr. Anderson presented this section (below), and I thought it was a great way of showing what training variables and risk factors are of importance to avoid rhabdomyolysis:

 Start with:
o A reconditioned athlete, or
o An athlete coming off of a break, or
o A conditioned athlete performing a new exercise

 Add in a high volume of:
o Running (or marching in the Military)
o Resistance Training (especially eccentric exercise)

 Add in the following risk factors:
o Heat
o Dehydration
o Recent illness (flu, mono, etc.)
o Metabolic disease (diabetes or thyroid disease)
o Genetic muscle energy storage disease
o Autoimmune or inflammatory disease
o Alcohol or Drugs (statins or amphetamines)
o Sickle Cell Trait (not to be confused with sickle cell anemia)

 Mix these items together and you have a high risk for creating exertional rhabdomyolysis.

An Example

In 2011, a significant case of exertional rhabdomyolysis occurred with the University of Iowa Football Team. Thirteen players were hospitalized to be treated for the disorder after a workout including 100 squats (10 sets of 10 repetitions) at 50% 1RM, followed by a series of sled pushes. The squats were reportedly performed within a period of 17 minutes. The NSCA has since suggested that this workload was above and beyond the safe volume recommendations set forth by organization for athletes. For more examples of exertional rhabdomyolysis, Click Here.

Keep Your Athletes Safe

Be aware of the signs and symptoms of exertional rhabdomyolysis to prevent injury, hospitalization, or even death! Pay attention to volume and periodization in training programs with your athletes.

Exertional Rhabdomyolysis is 100% Preventable


Eric McMahon, MEd, RSCC
Minor League Strength and Conditioning Coach
Texas Rangers