Exertional Rhabdomyolysis - Epidemiology, Diagnosis, and Prevention

Introduction:

Every normal individual strives to have a fit body for better health. To achieve this, people exercise and put a lot of stress and exertion onto their muscles. Excessive strain on the skeletal muscles can cause breakdown or lysis of the muscle contents and may reach the bloodstream. Such a medical condition is termed as exertional rhabdomyolysis. This occurs in an individual with extensive physical activity and no underlying medical condition or comorbidity.

What Is the Epidemiology of Exertional Rhabdomyolysis?

The prevalence of epidemiology varies completely among various sects of people. It is highly prevalent in individuals who push their boundaries regarding their daily physical activity. Athletes, particularly those in endurance sports or high-intensity training, are more susceptible to repetitive muscle stress. Additionally, military recruits undergoing intense training, individuals starting vigorous exercise programs, and even those participating in extreme activities or events like marathons and triathlons are at higher risk.

What Are the Risk Factors of Exertional Rhabdomyolysis?

• The sudden increase in the intensity or frequency of performing physical activity and muscle workouts can put the individual at risk of developing exertional rhabdomyolysis.

• Some sports like marathons or weight-lifting demand the individual to put excessive strain on their muscles, which can result in this condition.

• Inadequate fluid intake or excessive sweating without replenishing electrolytes (sodium, potassium, calcium) lost through sweat can disrupt the balance essential for muscle function, potentially leading to rhabdomyolysis.

• Exercising in high temperatures or an environment with excessive humidity can increase the risk of heat-related illnesses and dehydration, contributing to muscle breakdown.

• Certain medical conditions such as sickle cell trait, metabolic disorders (like McArdle disease or carnitine palmitoyltransferase deficiency), and genetic muscle disorders can predispose individuals to rhabdomyolysis during exertion.

• Muscle damage can be elicited by intake of drugs and medications like Amphetamine, Cocaine, antipsychotics, or statins.

• Severe physical trauma, crush injuries, or prolonged inactivity and immobilization can cause muscle damage and lead to rhabdomyolysis.

• The altitude of the environment in which the exercise is performed is also equally responsible for the causation of exertional rhabdomyolysis. High altitude can cause low atmospheric pressure and oxygen saturation, which can strain muscles excessively, even for minimal activity. Strenuous exercise in such areas can predispose the individual to exertional rhabdomyolysis.

How to Diagnose Exertional Rhabdomyolysis?

• To diagnose exertional rhabdomyolysis, the patient should give a clear history of undergoing stressful workout sessions in recent days. Any events that may have triggered the breakdown of muscle components should be elicited.

• The primary diagnostic test involves measuring the levels of certain enzymes and proteins released into the bloodstream due to muscle breakdown. Elevated levels of creatine kinase (CK), myoglobin, lactate dehydrogenase (LDH), and aldolase indicate muscle damage. These enzymes are seen in skeletal muscles, and damage to the muscle causes lysis and release of these enzymes.

• Myoglobin in the urine (myoglobinuria) can cause the urine to appear dark in color. Hence, dark-colored urine indicates exertional rhabdomyolysis, which can be confirmed through a urine test. The dark color is often referred to as tea-colored or brown-colored.

• Kidney function tests are advised for diagnosing exertional rhabdomyolysis as testing or assessing kidney function is essential to know the level of kidney damage incurred by this condition.

• The extent of damage to the muscles can be evaluated through radiographic investigations like computed tomography and magnetic resonance imaging. If the muscle breakdown is due to other causes like compartment syndrome, that can be visualized through such imaging techniques.

• Electrolyte levels should be assessed.

All such tests can differentiate the cause of muscle breakdown and help diagnose exertional rhabdomyolysis.

How to Treat Exertional Rhabdomyolysis?

Immediate measures include cessation of strenuous physical activity to prevent further muscle damage and adequate hydration to flush out myoglobin from the kidneys to prevent renal damage. Medical care involves intravenous fluids to restore proper hydration status, support kidney function, and monitor electrolyte levels. Hospitalization might be necessary for closer monitoring and intravenous treatments in advanced cases. Pain management and addressing complications, such as electrolyte imbalances or kidney dysfunction, are essential treatment components.

How to Prevent Exertional Rhabdomyolysis?

Preventing exertional rhabdomyolysis becomes crucial to one’s workout routine as it can predispose an individual to develop muscle and kidney problems in later life. With proper treatment, exertional rhabdomyolysis can be reversed. However, it is necessary to prevent the condition to preserve the vital organs.

• Any activity in one’s day-to-day life should be brought into action at a slow and steady pace. This is applicable even for exercise, physical activity, or any kind of sports. The activity should be done slowly initially.

• The frequency and intensity of workout sessions should be increased gradually, not suddenly.

• Training that requires high-intensity and extensive muscle workouts should be done only under proper supervision and guidance.

• Physical activities should be followed by adequate rest so that the muscles get enough time to recover to their natural state. This also reduces the risk of muscle overexertion.

• Hydration before, during, and after any sport, exercise, or workout is mandatory, as dehydration is a major risk factor for the causation of this condition.

• The diet should be planned to be filled adequately with enough proteins, fats, vitamins, and electrolytes to prevent muscular damage.

• Engage in proper warm-up exercises before intense workouts to prepare muscles and gradually increase blood flow. Similarly, cool down with gentle stretching to aid muscle recovery.

• Body signals are very important to prevent the condition. If there are any signs of dark urine, muscle soreness, or weakness, especially after physical activity, it should be reported immediately.

• Breathing should be synchronized and should not be a struggle. This ensures proper oxygen supply to the muscles. Failure to supply adequate oxygen to the muscles can cause the muscles to undergo anaerobic respiration, further complicating the condition.

• Be cautious when exercising in extreme temperatures or high altitudes. These conditions can increase the risk of heat stress and dehydration, exacerbating the risk of rhabdomyolysis.

Conclusion:

Understanding the epidemiology, recognizing the symptoms, and implementing effective prevention strategies are essential in minimizing the risk of exertional rhabdomyolysis. Individuals engaging in physical activities, especially high-intensity workouts or endurance sports, must prioritize gradual progression, proper hydration, and attentive monitoring of their body's responses to exercise.