This document discusses exertional rhabdomyolysis, which is the breakdown of skeletal muscle from excessive or unaccustomed exercise. It defines rhabdomyolysis, explains contributing factors like sickle cell trait and dehydration, lists signs and symptoms, and provides implications for coaches to prevent rhabdomyolysis through proper training programs. The purpose is to educate coaches on this condition so they can recognize it and minimize risk through specific, gradual training.
2. Purpose and Objective
The purpose of this webinar is to educate coaches
and trainers about the dangers of exertional
rhabdomyolysis
At the conclusion of this webinar coaches should be
able to:
Define what exertional rhabdomyolysis is
Understand the complications and contributing factors
Recognize the signs and symptoms
Develop proper training programs that minimize the risk of
rhabdomyolysis
3. What is exertional rhabdomyolysis?
Exertional rhabdomyolysis is the degeneration of
skeletal muscle caused by excessive, unaccustomed
exercise
Cellular constituents are released into the extracellular fluid
and circulation
Renal failure, compartmental syndrome, abnormalities in
heart rhythm, tremors, and cardiac arrest
4. Cellular Constituents
Myoglobin
Oxygen binding protein found almost exclusively in muscle
tissue
Damages the epithelium of the renal tubules
Forms casts that build up and block renal tubules
Leads to renal failure
Potassium
Predominantly an intracellular action
Interferes with the depolarization mechanisms in muscle
tissue by lowering the resting membrane potentials
Results in skeletal muscle weakness, abnormalities in heart
rhythm, and cardiac arrest
5. Cellular Constituents
Calcium
Deposits in damaged muscle tissue
Decreased levels of calcium in the blood can result in
tremors, tetanus in the skeletal muscle, and depress the
excitability of the heart muscle
Creatine Kinase
Muscle enzyme responsible for ATP synthesis and breakdown
Released proportionally with myoglobin, serves as an indicator
of muscle damage
6. Contributory factors
Sickle Cell Trait
Low oxygen tension can lead to sickling
Sickling causes blood flow/supply to become restricted
(ischemia)
Ischemia leads to the breakdown of muscle tissue and
rhabdomyolysis
Dehydration
Decreased blood flow to muscle tissue due to cardiovascular
strain and an increase in the blood flow to the skin for
thermoregulation creates a hypoxic condition
Increase cell membrane permeability
Solubility of myoglobin is diminished
7. Contributory Factors
Eccentric Contractions
Muscle is forced to lengthen as it contracts
Exercises such as squats, bench, and lunges
Creates tensile stress which disrupts the organization of
sarcomeric structures within individual muscle fibers
Muscle damage is intensified if individual is dehydrated
8. Signs and Symptoms
Common signs and symptoms:
Muscle pain
Weakness
Edema/swelling
Range of motion (ROM) deficits
Muscle tenderness (doughy feeling)
Redness
Eccyhmosis (bruising)
Parathesia (pins and needles)
Absence of deep tendon reflexes
9. Signs and Symptoms
Myoglobinuria
The presence of myoglobin in the urine
Urine will appear dark reddish-brown
Elevated levels in the blood:
Creatine kinase
Released proportionally with myoglobin
Potassium
Uric Acid
Released in conjunction with creatine kinase
Phosphate
Decrease levels of calcium in the blood.
10. Signs and Symptoms
Individuals with SCT:
Cramping
Hyperventilating (due to lactic acidosis, not asthma)
Weakness (legs like jello)
Nausea
Signs of splenic infarction:
Pleurisy
Pneumothorax
Side stitch
Renal colic
Signs of musclar infarction:
Low back pain
11. Implications for Coaches
Specificity of training
Is the individual accustomed to the required activity
Level of training
Level of physical fitness of the individual
Eccentric contraction exercises
Do the exercises performed have a strong eccentric component
Anatomical adaption
Helps prepare the body for the rigors of training
High temperature and humidity
12. Implications for Coaches
Viral and bacterial infections
Ergogenic aids
Diet manipulations
Increased or decreased stores of muscle glycogen may impair muscle
function
Overall stress
Medical histories
Does the individual have any conditions that may predispose them to
rhabdomyolysis (i.e. SCT)
Readiness to return to play (RTP)
Symptoms of muscle pain, weakness, and swelling subside
Levels of myoglobin and creatine kinase return to normal
13. Conclusion
Exertional rhabdomyolysis is easily preventable and
treatable
Education
Proper program design
Being aware of the warning signs of rhabdomyolysis
14. Coaching Resources
Coaches resources:
The National Strength and Conditioning Association (NSCA)
The Journal of Strength and Conditioning
The National Collegiate Athletic Association
Publish news releases and research articles
United States Olympic Committee
Publish news releases and research articles
15. References
References
Anderson, S. (Human Kinetics). (2011, December 8). ASEP successful coaching webinar series. Sickle Cell Trait
Guidelines. Webinar retrieved from http://www.humankinetics.com/asep-successful-coaching-webinar-series
Beasley, K., Lee, E., McDermott, B., & Yamamoto, L. (2010). The effect of ovral vs. intravenous rehydration on
circulating myoglobin and creatine kinase. The Journal of Strength and Conditioning, 24, 60-67.
Brudvig, T., & Fitzgerald, P. (2007). Identification of signs and symptoms of acute exertional rhabdomyolysis in
athletes: A guide for the practitioner. The Strength and Conditioning Journal, 29, 10-14.
Claps, F. (2005). Exertional rhabdomyolysis. The Strength and Conditioning Journal, 27, 73-74.
Clarkson, P. (1993). Exertional rhabdomyolysis and acute renal failure. The National Strength and Conditioning
Journal, 13, 33-39.
Cleary, M., Sadowski, K., Lee, S., Miller, G., & Nichols, A. (2011). Exertional rhabdomyolysis in an adolescent athlete
during preseason conditioning: A perfect storm. The Journal of Strength and Conditioning, 25, 3506-3513.
Eberman, L., Kahanov, L., Alvey, T., & Wasik, M. (2011). Exertional rhabdomyolysis: Determining readiness to return to
play. The International Journal of Athletic Therapy & Training, 7-10.
Fidler, E. (2012). Sickle cell trait: A review and recommendations for training. The Strength and Conditioning
Journal, 0, 1-5.
Jguz17. (2012, March, 29). Ohio State [Msg 3]. Message posted to http://www.footballscoop.com/the-staff-
room/topic?id=3877
Moeckel-Cole, S., & Clarkson, P. (2009). Rhabdomyolysis in a collegiate football player. The Journal of Strength and
Conditioning, 23, 1055-1059.
Morehouse, M. (2011, January, 26). 100 squats, 17 minutes, rhabdomyolysis. The Gazette. Retrieved from
http://www.thegazette.com/2011/01/26/100-squats-17-minutes-rhabdomyolysis/
Robergs, R. (2010). Catabolism in skeletal muscle: The phosphagen system [PowerPoint slides]. Retrieved from
http://www.unm.edu/~rrobergs/426L7Phosph.pdf
16. Biography
My name is Nicholas Grimes. I am
currently working on my masters
degree in Athletic Coaching Education
from West Virginia University. I
graduated from West Virginia
University with a degree in a bachelors
degree in Sports Management. I am
currently the strength and conditioning
coach at University High School and
Fairmont Senior High School as well as
a Personal Trainer for Certified Fitness
Trainers (C:FT). I am a Certified
Strength and Conditioning Specialist
through the National Strength and
Conditioning Association and I have
also interned under renowned strength
coaches Mike Barwis and Marcus
Kinney while at West Virginia
University.
Contact: ngrimes@mix.wvu.edu