Acute Exertional Rhabdomyolysis
Stacy K. Dimoff
Acute exertional rhabdomyolysis, (AER), is a very serious condition and can occur in any individual that engages in physical activity. Diagnosis and treatment of AER begins with proper recognition from health professionals such as: athletic trainers, strength and conditioning specialists, personal trainers, and coaches.
What is AER?
During exercise it is necessary and normal for minor skeletal muscle damage to occur. However, when minor muscle damage occurring during and after exercise goes into an extreme accelerated form, it is a condition known as acute exertional rhabdomyolysis (AER). AER specifically affects the function of skeletal muscle, and transforms the entire muscle cell membrane.
Once the function of the skeletal muscle is altered, the intercellular components within the muscle such as: myoglobin, potassium, and creatine kinase are released into the bloodstream. After the myoglobin concentration in the bloodstream reaches an over elevated level, it is carried into the urine. If left untreated in the urine, the excess myoglobin will collect in the kidneys and ultimately lead to renal failure. AER also causes the leakage of potassium and calcium into the bloodstream, which can interfere with proper transmission of the heartbeat leading to an irregular heartbeat, and muscle spasms.
Who is at Risk for Acute exertional rhabdomyolysi?
Individuals who are untrained or exercise vigorously in hot and humid conditions are at a significantly higher risk for developing AER. However, there have been documented cases reporting AER in well-trained athletes. In fact, AER is most common in long-distance runners, those participating in weight training, football players, military trainees, and police and fire department recruits. AER has also been reported in people who have epilepsy, asthma, and more recently has been linked to those with sickle cell.
Acute exertional rhabdomyolysi what to look for?
What makes the diagnosis of AER so difficult is that the initial symptom consisting of immense pain and weakness in the muscles exercised mimics delayed-onset muscle soreness (DOMS). However, people experiencing AER usually present with a triad of symptoms including: severe muscle soreness, significant muscle swelling, and cola-colored urine. In fact, in many cases an individual with AER may presume that their pain is due to overuse and seek advice from an athletic trainer, strength and conditioning specialist, or a personal trainer. However, when an athlete complains of severe muscle soreness accompanied by problems with active range of motion, it is essential to determine the underlying causes of the pain. Upon evaluation, in trying to identify whether or not the athlete is experiencing acute muscle soreness, delayed onset muscle soreness (DOMS), or AER, focus must be placed on the time frame of the onset of symptoms, severity of symptoms, level of conditioning, and environmental factors. Acute onset muscle soreness and DOMS lasts on average no longer than 48 hours. Athletes suffering from AER will complain of bilateral pain and present with swelling in one or more limbs for an extended amount of time.
How to treat AER?
The best treatment for AER is education for prevention. People need to remember to increase the intensity of their exercise at a pace that allows muscle tissue to properly recover. It is also important for health professionals to instruct on proper exercise technique. If exercising in hot environments; acclimatization, diet, and fluid intake should be discussed. More research needs to be conducted on what factors are linked to AER within the athletic population. Regardless, research agrees that with prompt diagnosis and medical intervention, the prognosis for full recovery after suffering from AER is good, making it is essential for all health professionals to be able to recognize signs and symptoms of AER and make the proper diagnosis.
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Exertional Rhabdomyolysis . Frank Claps. Strength and Conditioning Journal. Lawrence:Jun 2005. Vol. 27, Iss. 3, p. 73-74 (2 pp.)
Identification of Signs and Symptoms of Acute Exertional Rhabdomyolysis in Athletes: A Guide for the Practitioner Tracy J Brudvig, Patricia I Fitzgerald. Strength and Conditioning Journal. Lawrence:Feb 2007. Vol. 29, Iss. 1, p. 10-14 (5 pp.)
Stacy Dimoff, is a first year graduate student and recipient of the Hughston Athletic Training Fellowship Program in Columbus, Georgia. Stacy, a naive of Pewaukee, Wisconsin, graduated from Concordia University Wisconsin with a Bachelor of Science Degree in Athletic Training in May 2008. She is an active member of the Wisconsin Athletic Trainers Association (WATA). Stacy has been assigned to and will oversee the healthcare of the athletes at Northside High School, Columbus.