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Exertional rhabdomyolysis


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Exertional rhabdomyolysis

  1. 1. Exertional Rhabdomyolysis NICHOLAS GRIMES C.S.C.S. WEST VIRGINIA UNIVERSITY ACE 660 4/20/2012
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. Conclusion Exertional rhabdomyolysis is easily preventable and treatable Education Proper program design Being aware of the warning signs of rhabdomyolysis
  14. 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. 15. References References Anderson, S. (Human Kinetics). (2011, December 8). ASEP successful coaching webinar series. Sickle Cell Trait Guidelines. Webinar retrieved from 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 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 Robergs, R. (2010). Catabolism in skeletal muscle: The phosphagen system [PowerPoint slides]. Retrieved from
  16. 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: