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Overview of Rhabdomyolysis

This condition is secondary to the breakdown of skeletal muscle fibers and seepage of the contents into the bloodstream. There are numerous causes, including traumatic crush, electrical injuries, ingestion of toxic substances, and exertional rhabdomyolysis, which occurs in endurance athletes and military personnel. A side effect of taking cholesterol-lowering statins can be the development of myopathies, which can progress to rhabdomyolysis.1,2 The resulting complications include hyperkalemia, cardiac arrhythmias, and acute renal failure, which may lead to death. Early recognition of rhabdomyolysis will prevent the long-term complications from the loss of skeletal muscle and decreased renal and liver function.3,4 Individuals who develop rhabdomyolysis will be counseled to avoid strenuous activities for a period of weeks to allow for return of kidney, liver, and cardiac function.5 Individuals who have suffered heat overexertion may have long-term intolerance to heat/humidity conditions and decreased blood lactase thresholds.4

Comorbidities to Consider

  • Clients may have suffered traumatic injuries or may develop renal and cardiac complications.

Client Examination

Keys to Examination of Clients

  • Clients suspected of having this condition have urine samples tested for the presence of myoglobin or hemoglobin.

  • Laboratory results for blood counts and levels of calcium, creatine kinase, sodium, and other contents are used in determining a client readiness to begin an exercise program.

Recommended Baseline Testing of Fitness Levels

  • Endurance athletes can be assessed for their response to exercise using set workload parameters on a treadmill or cycle ergometer in a controlled environment for temperature and humidity. The athlete's heart rate and respiration can be monitored for response to increasing workloads, along with perceived exertion rates, to help establish a safe training program.6 Athletes should be assessed for post-exercise muscle soreness and any changes to their urine output and appearance.

  • Clients with traumatic injuries should be assessed for strength and mobility in involved muscle groups.

  • Clients should be assessed for their functional levels to determine appropriate baseline tests.

Exercise Prescription


Type: Depends on the functional level of the client

Intensity: Low intensities with slow progressions

Duration: Varies

Frequency: Varies

Getting Started

Athletes who have developed rhabdomyolysis due to heat exertion illness should not participate in any strenuous activities for at least 1 week and must obtain clearance from their physician to return to training activities. Endurance athletes returning to their usual training activities should be encouraged to participate in a variety of activities to re-establish their training intensities with appropriate exertion levels. Exercise parameters will need to begin at levels that are low relative to the athlete's previous training levels. The athletes should avoid training in extreme heat ...

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