From OT Europe

Hydration, education are keys to avoid rhabdomyolysis after intensive exercise

According to sources who spoke with Healio.com/Orthopedics, orthopedic surgeons should discuss the importance of hydration and educate patients who enjoy intensive exercise about rhabdomyolysis, a condition that results from a skeletal muscle injury that causes muscle cell material into the plasma.

Michael J. Leddy

“[It] is obvious that the sports medicine community is becoming more aware of the significance of this condition and the potential fatality of it,” said Michael J. Leddy III, MD, an orthopedic surgeon at Mid-State Orthopaedic and Sports Medicine Center, who discussed research being done on this topic with Healio.com/Orthopedics. “This comes on the heels of the emergence of high-intensity training, as well as competitions to identify the ‘fittest athlete.’ This has led to protocols to treat this condition as well as prevent it.”

Recent cases

Benjamin C. Taylor, MD, an orthopedic surgeon at OhioHealth Riverside Methodist Hospital, said rhabdomyolysis can occur from crushed-type trauma, use of statins and certain metabolic diseases.

In a recently published article in the British Medical Journal Case Reports, Faith Gardner, MD, and her colleagues looked at three women between 18 and 24 years old who presented to a general practice with symptoms of exertional rhabdomyolysis. These symptoms included severe muscle pain, a significant reduction in range of motion in the affected muscles and dark-colored urine in two of the patients. All three women attended the same gym, underwent an intense physical work out and were admitted to the hospital. They were treated with IV fluids and were discharged 1 day to 6 days later. All of the women recovered with no renal sequelae. The most common risk factor for rhabdomyolysis among the three patients was unaccustomed strenuous exercise.

Gardner said the cases and others have involved high-intensity exercise, but not everyone who exercises with extreme intensity will get exertional rhabdomyolysis. She added that not many people develop the condition.

Tips to prevent rhabdomyolysis

Leddy said education is the first step in the prevention and treatment of rhabdomyolysis.

athlete drinking water
Orthopedic surgeons should discuss the importance of hydration and educate patients who enjoy intensive exercise about rhabdomyolysis.
Adobe Stock

In addition, Taylor noted, “Hydration is key. So any vigorous exercise, especially as the weather is nicer or in fall when students are going back, if they aren’t hydrated, the muscles can break down from the vigorous exercise and cause [rhabdomyolysis]. That’s probably the biggest one. Sometimes this can lead to kidney failure or even death.”

In an interview with Healio.com/Orthopedics, Gardner said people who work out should gradually build up their exercise level, intensity and duration and keep hydrated so their urine is light- or straw-colored.

Leddy said there should be a focus on athletes who are vulnerable during transition periods such as coming from a new program, returning from an injury, illness or long periods away from programs.

“It is important to recognize these athletes and progress them slowly as they return to the intensity they were participating in prior to their layoff,” Leddy said. “It is also imperative that the athletic trainers or rehabilitation specialists are aware of the strengthening and conditioning programs these athletes are involved in. They should be proven programs, specifically designed to the athletic endeavor that is being undertaken.”

Taylor noted that although there has not been much research, the treatment for rhabdomyolysis has not changed in at least a decade. Treatment includes hydration, IV fluids and dialysis. Dialysis will help clear the muscle break down from the body especially when the kidneys begin to fail.

Stay alert

Gardner said orthopedic surgeons need to be aware of exertional rhabdomyolysis and not confuse it with compartment syndrome. Leddy said orthopedic surgeons should educate their staff on signs and symptoms of the condition to help them develop awareness to prevent potential risks and to set up protocols to address rhabdomyolysis.

“The condition is a serious one. One we often see even in minor levels in trauma patients here,” Taylor said. “We need to be on top of it and diagnose expediently in order to make sure patients have optimal outcomes.” – by Monica Jaramillo

 

Reference:

Mitchell F, et al. BMJ Case Reports. 2018;doi:10.1136/bcr-2017-223022.

 

Disclosures : Gardner, Leddy and Taylor report no relevant financial disclosures.

According to sources who spoke with Healio.com/Orthopedics, orthopedic surgeons should discuss the importance of hydration and educate patients who enjoy intensive exercise about rhabdomyolysis, a condition that results from a skeletal muscle injury that causes muscle cell material into the plasma.

Michael J. Leddy

“[It] is obvious that the sports medicine community is becoming more aware of the significance of this condition and the potential fatality of it,” said Michael J. Leddy III, MD, an orthopedic surgeon at Mid-State Orthopaedic and Sports Medicine Center, who discussed research being done on this topic with Healio.com/Orthopedics. “This comes on the heels of the emergence of high-intensity training, as well as competitions to identify the ‘fittest athlete.’ This has led to protocols to treat this condition as well as prevent it.”

Recent cases

Benjamin C. Taylor, MD, an orthopedic surgeon at OhioHealth Riverside Methodist Hospital, said rhabdomyolysis can occur from crushed-type trauma, use of statins and certain metabolic diseases.

In a recently published article in the British Medical Journal Case Reports, Faith Gardner, MD, and her colleagues looked at three women between 18 and 24 years old who presented to a general practice with symptoms of exertional rhabdomyolysis. These symptoms included severe muscle pain, a significant reduction in range of motion in the affected muscles and dark-colored urine in two of the patients. All three women attended the same gym, underwent an intense physical work out and were admitted to the hospital. They were treated with IV fluids and were discharged 1 day to 6 days later. All of the women recovered with no renal sequelae. The most common risk factor for rhabdomyolysis among the three patients was unaccustomed strenuous exercise.

Gardner said the cases and others have involved high-intensity exercise, but not everyone who exercises with extreme intensity will get exertional rhabdomyolysis. She added that not many people develop the condition.

Tips to prevent rhabdomyolysis

Leddy said education is the first step in the prevention and treatment of rhabdomyolysis.

athlete drinking water
Orthopedic surgeons should discuss the importance of hydration and educate patients who enjoy intensive exercise about rhabdomyolysis.
Adobe Stock

In addition, Taylor noted, “Hydration is key. So any vigorous exercise, especially as the weather is nicer or in fall when students are going back, if they aren’t hydrated, the muscles can break down from the vigorous exercise and cause [rhabdomyolysis]. That’s probably the biggest one. Sometimes this can lead to kidney failure or even death.”

In an interview with Healio.com/Orthopedics, Gardner said people who work out should gradually build up their exercise level, intensity and duration and keep hydrated so their urine is light- or straw-colored.

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Leddy said there should be a focus on athletes who are vulnerable during transition periods such as coming from a new program, returning from an injury, illness or long periods away from programs.

“It is important to recognize these athletes and progress them slowly as they return to the intensity they were participating in prior to their layoff,” Leddy said. “It is also imperative that the athletic trainers or rehabilitation specialists are aware of the strengthening and conditioning programs these athletes are involved in. They should be proven programs, specifically designed to the athletic endeavor that is being undertaken.”

Taylor noted that although there has not been much research, the treatment for rhabdomyolysis has not changed in at least a decade. Treatment includes hydration, IV fluids and dialysis. Dialysis will help clear the muscle break down from the body especially when the kidneys begin to fail.

Stay alert

Gardner said orthopedic surgeons need to be aware of exertional rhabdomyolysis and not confuse it with compartment syndrome. Leddy said orthopedic surgeons should educate their staff on signs and symptoms of the condition to help them develop awareness to prevent potential risks and to set up protocols to address rhabdomyolysis.

“The condition is a serious one. One we often see even in minor levels in trauma patients here,” Taylor said. “We need to be on top of it and diagnose expediently in order to make sure patients have optimal outcomes.” – by Monica Jaramillo

 

Reference:

Mitchell F, et al. BMJ Case Reports. 2018;doi:10.1136/bcr-2017-223022.

 

Disclosures : Gardner, Leddy and Taylor report no relevant financial disclosures.