Sore Muscles…Could It Be Rhabdo?

imagesLast year I had a patient in the hospital with a story like this: 15 year old football player, beginning of the pre season, hadn’t trained much during the early summer months and now training twice a day in the heat. A few days after summer camp started, he began complaining of calf pain, general muscle weakness and he noticed his urine had turned “dark.” He was sent to the emergency room by his pediatrician where bloodwork revealed he had extremely high levels of creatine kinase; he was diagnosed with Rhabdomyolisis and admitted to the hospital. He was monitored closely and started on IV fluids; he recovered nicely and was sent home several days later. What is Rhabdomyolisis? What causes it? How is it treated? How can young athletes avoid it?

“Rhabdo,” or rhabdomyolisis, is a potentially serious syndrome due to direct or indirect muscle injury. When muscles are stressed, muscle fibers can break down and a substance called myoglobin can leak out of the muscles and into the bloodstream. Let’s take a closer look at rhabdo.

  • What causes Rhabdomyolisis?

There are many causes of rhabdomyolisis. The most common causes are:

  • the use of alcohol or drugs such as cocaine or amphetamines (one more reason to stay away!)
  • extreme muscle strain, especially when exercising more intensely than normal (most common in teen athletes)
  • crush injuries such as from car accidents, falls or a building collapse
  • the use of certain medications like corticosteroids or statins (cholesterol medicines), especially if given in high doses
  • What are the most common Signs and Symptoms of Rhabdo?images
  • painful, swollen, bruised, or tender areas of the body
  • muscle weakness or difficulty moving the arms or legs
  • general feeling of illness (just “not feeling well”)
  • nausea or vomiting
  • confusion, dehydration, or even fever
  • dark-color urine (we call it “Coca-cola urine”), low urine output
  • How do you diagnose Rhabdomyolisis?
  • blood and urine tests along with the history and physical usually make the diagnosis of rhabdomyolisis fairly clearly.  The diagnosis of rhabdo is confirmed by detecting elevated muscle enzymes in blood including creatine phosphokinase (CPK), SGOT, SGPT, and LDH . The levels of these enzymes rise as the muscle is destroyed in rhabdomyolysis. This is just FYI for those of you who are “academics” and just like to know these things: don’t need to worry about it, your doctor will figure this out!
  • How do you treat rhabdomyolisis?
  • Early diagnosis and treatment are key to a successful outcome, but don’t worry,  most times you can expect full recovery with early treatment.
  • Treatment mostly consists of rest and aggressive rehydration with IV fluids, always with close monitoring.
  • What should I do if my child has symptoms of Rhabdo?
  • If your child has symptoms consistent with rhabdo, he or she needs urgent medical evaluation, but don’t panic! If diagnosed early, rhabdo can be treated with good results.
  • What can my young athlete do to avoid getting Rhabdomyolisis?
  • Good news! There are steps we can all take to avoid rhabdo:
  1. Stay Hydrated! Can’t stress this one enough! And it’s OK to only use water; if your sports or energy drink contains caffeine or too much sugar, they can actually lead to dehydration! Make sure your young athlete drinks adequate amounts and increases his/her intake to compensate for increased activity.
  2. Maintain Consistency in Training: avoid sudden strenuous workouts, especially those that target one muscle group in particular. Maintain consistency in your workouts and increase intensity gradually. 
  3. Beware of Protein Supplements! I talk about this all the time; we get PLENTY of good quality protein in the foods we eat every day, so skip the supplements!  Studies have shown over and over again that US teens get 1.5 – 2x more protein than they actually need from their diet, so save yourself the money! These supplements containing extra protein, creatine or whey can lead to dehydration, kidney stones or even high blood pressure, and can also increase the risk of rhabdomyolisis (one more reason to stop!)
  4. Exercise in a Well Ventilated Area: If the workouts are in a hot room or outside during the hot summer months, make sure to drink more!

Hope this helps! Always welcomed to email  me with questions, and share with those who might be interested! Let’s have a safe and successful sports season!

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