Exertional rhabdomyolysis occurs through overexposure to severe or unaccustomed exertion, particularly within environmental conditions of extreme heat. Or long duration of repetitive movements such as marathon running, intensive and repetitious weight lifting, or military training [2].



Rhabdomyolysis, commonly known as “rhabdo”, is defined as a clinical and biochemical disorder categorized by the disintegration of striated muscle, which causes myoglobinuria.

The myoglobinuria associated with rhabdomyolysis is the most severe consequence of muscle disintegration and is reported to cause acute renal failure in 15-33% of hospitalized patients.

Due to the current increase in the application of popular extreme conditioning programs that propose high exertion and are typically directed toward the untrained general population, this discussion of exertional rhabdomyolysis is necessary.

Although rhabdomyolysis can occur from various causes such as exertion, trauma, infections, extreme temperatures, drugs, toxins, electrolyte and endocrine abnormalities, and congenital disorders (e.g. myopathies); we will refer to exertional rhabdomyolysis throughout the rest of this article [1].

We’ll identify the common signs and symptoms that overexertion and high-dose exercise programs can elicit that may lead to exertional rhabdomyolysis, what trainers need to know to recognize the disorder, and what preventative steps can be taken to reduce the likelihood of developing exertional rhabdomyolysis.

Causes risks of exertional rhabdomyolysis.

As mentioned previously, exertional rhabdomyolysis occurs through overexposure to severe or unaccustomed exertion (particularly within environmental conditions of extreme heat), long duration of repetitive movements (i.e. marathon runners), intensive and repetitious weight lifting, or military training [2].

In addition, the chances of exertional rhabdomyolysis increase when the modality of exercise consists of predominantly eccentric muscle actions (e.g. downhill hiking). This occurs typically because of adenosine triphosphate’s (ATP’s) failure to meet the supply and demand critical to maintain homeostasis. Essentially, the more strenuous or prolonged the exercise is; the more damage that occurs to the tissue.

Factors that have been demonstrated to increase the risk of exertional rhabdomyolysis are [3, 4]:

• Dehydration
• Hypokalemia (low potassium resulting from excessive sweating)
• Sickle-cell trait (especially in high altitude)
• Extreme heat and humidity
• Exercise-induced asthma
• Pre-exertional fatigue

Below are research-based guidelines that you should be aware of in order to avoid exertional rhabdomyolysis from occurring.

Guidelines to avoid exertional rhabdomyolysis

• Exposure to high volume training combined with high intensity enhances the chances of developing exertional rhabdomyolysis for individuals not accustomed to those volume or intensity levels.

• Chances for obtaining exertional rhabdomyolysis may drastically increase when additional variables (e.g. hydration status, temperature, humidity, frequency of training, training modality, diet, ant other health-related conditions) responsible for susceptibility of exertional rhabdomyolysis are present.

• Individuals should be closely monitored when suddenly changing training volume or exercise intensity, or introducing new exercises or training modality, particular exercises with high-intensity eccentric muscle action.

• Pay particularly close attention to the gradual exposure to intensive training if you are new to exercise or intense exercise over a period while closely monitoring for excessive soreness and other signs of exertional rhabdomyolysis (e.g. urine discoloration, redness, muscle edema).

• If these signs are present, clinical assessment by a medical professional is needed to confirm or negate the presence of exertional rhabdomyolysis. It’s prudent to seek medical attention immediately as early detection decreases strain of myoglobin on the renal system and reduces chances of obtaining acute renal failure.

• The two primary recommendations for exertional rhabdomyolysis prevention consist of proper hydration (pre, during, and post-exercise) and proper exercise programming (proper manipulation of training volume and intensity).

Summary

As you are aware, the need to apply the principle of progressive overload within your exercise programs is imperative for overall health and well-being. Not only could overexertion lead to overreaching and overtraining but could also be detrimental or even fatal for the participant.

It is imperative that those involved in the implementation of such programs be aware of this exercise-induced disorder and monitor the strenuousness of their training sessions. Although the possibility of someone having exertional rhabdomyolysis is low, it is best to be well-versed in the causes, the signs and symptoms, and what to do in order to prevent this from happening!

Dr. Paul Henning is leading scientist at the Military Performance Division, United States Army Research Institute of Environmental Medicine. Paul is also MP Level 4 Certified, lives the MP lifestyle and is a proud member of the MP Team. You can read more from Dr Henning here.

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