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.

1. Exertional Rhabdomyolysis
NICHOLAS GRIMES C.S.C.S.
WEST VIRGINIA UNIVERSITY
ACE 660
4/20/2012

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