A 1990 report from the Centers for Disease Control (CDC) noted that,<\/p>\n
On September 19, 1988, 50 police trainees from local police departments began a 14-week \u201dmental stress\u201d and physical training program at a state-sponsored academy in western Massachusetts. On the evening of September 21, the Massachusetts Department of Public Health was notified that five trainees had been hospitalized.<\/em><\/p>\n The first three days of the training program were physically strenuous and included push-ups, squat-thrusts, and running.<\/em><\/p>\n All 50 trainees had evidence of rhabdomyolysis (serum CPK greater than or equal to 10 times normal) and 33 (66 percent) had severe rhabdomyolysis (serum CPK greater than or equal to 200 times normal). Thirteen (26 percent) of the trainees were hospitalized with complaints of nausea, back and abdominal pain, and dark urine; each of those hospitalized had serum CPK levels greater than or equal to 32,000 U\/L (normal: 10-300 U\/L) and an abnormal urinalysis. Nine (69 percent) of those hospitalized had evidence of renal insufficiency (serum creatinine greater than or equal to 2.0 mg divided by L); six (46 percent) required hemodialysis. One trainee died 44 days after onset from complications of heat stroke, rhabdomyolysis, and renal and hepatic failure.<\/em>1<\/sup><\/p>\n More than two decades later in 2016, a Texas police recruit died in training, and it was reported that he passed from rhabdomyolysis.2<\/sup><\/p>\n Rhabdomyolysis is often misconstrued as a form of dehydration. Dehydration may occur at the same time as rhabdomyolysis, but rhabdomyolysis often occurs without dehydration. Conversely, dehydration can occur without rhabdomyolysis. Over the last 10 years, there have been many reports of cases of rhabdomyolysis published in lay and professional literature.<\/p>\n The occurrence of rhabdomyolysis doubled in the military from 2007 to 2011 with 435 cases in 2011 alone. These cases were deemed likely to have been caused by physical exertion and, in some cases, heat stress. The highest incidence was found in males, African Americans, non-Hispanics, and those under the age of 20.<\/p>\n According to a U.S. Army report,<\/p>\n Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat\/recruit training or major combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain, swelling, limited range of motion, or the excretion of dark urine (possibly due to myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.<\/em>3<\/sup><\/p>\n So what is \u201crhabdo\u201d? Rhabdomyolysis is the destruction of skeletal muscle. There are many causes of rhabdomyolysis. One cause is extreme muscle strain.4<\/sup> Extreme muscle strain can come from new exercises, too many sets and repetitions (reps) of an exercise, too much training to failure, too many \u201cnegative\u201d reps of an exercise, and high levels of exercise after a training layoff of even just a few weeks. Of course, if someone is dehydrated, the damage and symptoms can be even worse.<\/p>\n The extreme muscle strain actually damages the muscle membrane and connective tissue structure. The damaged muscle dumps a muscle protein called myoglobin into the blood stream. The high levels of myoglobin in the blood reach the kidney and can block the filtration system in the kidney, which can lead to kidney failure. When the myoglobin levels are this high, the myoglobin spills out into the urine, which can turn tea colored or dark brown.5<\/sup> This dark urine is a very bad sign, and if this occurs, the person needs to go to an emergency room immediately.<\/p>\n The muscle damage also dumps the electrolyte potassium into the blood. This high level of potassium in the blood is pathologic and can cause a heart attack and death.<\/p>\n The amount of a muscle enzyme known as creatine kinase (CK) in the blood can also skyrocket from muscle damage. This enzyme can also be elevated after a tough workout that does not cause rhabdomyolysis, but, in cases of rhabdomyolysis, the CK blood levels are incredibly elevated. One study of military personnel found that the length of hospital stay was related to the elevation of CK; the higher the CK levels, the longer the hospital stay. The patients in the 30 cases of rhabdomyolysis in this study were hospitalized for one to eight days and 20 percent had acute kidney damage.6<\/sup><\/p>\n Patients with rhabdomyolysis experience severe muscle pain and stiffness and sometimes describe having flu-like symptoms. Blood and urine tests confirm the diagnosis of rhabdomyolysis. Some patients are admitted into hospitals for intravenous fluids to keep kidney filtration going, and they may even require short-term dialysis. Time is required for the muscles to heal and resuming activity or training too soon can lead to further muscle damage.<\/p>\n Swelling from the damaged muscle can occur, and, if this occurs in a small anatomic compartment, then compartment syndrome can occur. The high pressure in compartment syndrome is a medical emergency, and the compartment must be surgically decompressed (opened) before other structures in the compartment such as nerves and blood vessels are crushed and permanently damaged or die.<\/p>\n Even though rhabdomyolysis is not a daily occurrence, as shown from the cases in the sidebar, it does occur. The literature is filled with many other reports of athletes being admitted to hospitals for rhabdomyolysis. Fortunately, this entirely avoidable problem is gaining more attention, which should lead to improved education to help athletes, military personnel, and first responders avoid it.<\/p>\n The President of the National Strength and Conditioning Association stated,<\/p>\n This type of injury is 100 percent avoidable. This should have never happened. That\u2019s absurd. People need to understand that rhabdo is not inherent with training. It\u2019s a good indicator of a training program that is inappropriate.<\/em>7<\/sup><\/p>\n Medical and strength and conditioning authorities note that conditioning specialists need to be educated about rhabdo. The severe consequences of rhabdomyolysis include emergent medical intervention. Legal action and consequences usually follow.<\/p>\n Steps can be taken to reduce the risk of the occurrence of rhabdomyolysis in training.<\/p>\n The body is capable of incredible adaptation, but it must be given the chance to recover and adapt.<\/span><\/p><\/blockquote>\n The body is capable of incredible adaptation, but it must be given the chance to recover and adapt. It\u2019s important to remember the goal of putting trainees through a conditioning program\u2014to increase fitness and performance. If an evidence-based program of progressive training loads and recovery is employed, the goal will be achieved. The result will be healthier trainees with higher fitness and performance levels and greatly reduced exposure to injury and litigation.d<\/span><\/p>\n\n