• Exertional Rhabdomyolysis: Case Study of an Athlete
    This case study investigates a situation where a high school wrestler presented signs of exertional rhabdomyolysis in as little as 24 hours.
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    Coaches at the high school level have a difficult task: pushing their athletes hard enough without overexerting them. Old school styles of coaching including heavy doses of wind sprints or exercise-induced vomiting are methods of the past.  

    Overexertion will not make your athletes tougher; too strenuous of an exercise protocol could be detrimental and even fatal for athletes.   

    A recent case study in the NSCA’s Journal of Strength and Conditioning Research addressed exercise-induced rhabdomyolysis–-a condition where skeletal muscle cells are damaged due to leakage of muscle cell contents due to overexertion exercise (1-2). This case study of rhabdomyolysis involved a 16 year-old boy participating in pre-season wrestling camp.  

    The following table is the timeline of events including the signs, symptoms, and diagnosis of exertional rhabdomyolysis for this athlete.   

    Day  Signs, Symptoms, and Diagnoses for Wrestler 
    1 First day of wrestling camp. The patient was recovering from previous concussion and not cleared to practice.
    Second day of wrestling camp. First half of the day included a physician’s appointment during which the patient was cleared to practice. Second half of the day he completed 60 min of short, intense intervals of wall-sits, squats, sit-ups, push-ups, lunges, and plyometric jumps. That night he felt weakness bilaterally in the quadriceps.
    3 Last day of wrestling camp. The patient participated in running drills. That night he voided dark brown urine.
    4 Reported to athletic trainers with chief complaint of severe bilateral leg pain in the quadriceps.
    5 Practiced with severe pain in quadriceps, difficult ambulation because of stiffness and pain.
    6 Admitted to the hospital with exertional rhabdomyolysis.
    12   Discharged from hospital with wheelchair and instructions for home physical therapy. Ambulating with pain and difficulty.
    18 Follow-up with primary care physician, laboratory results indicated exertional rhabdomyolysis resolving.
    21 Ambulating without crutches.
    3-6 months Full recovery with return to full activity.

    Adapted from J Strength Cond Res 25(12), 2012.

    This case study addresses the detriments of overexertion exercise and the rapid onset of rhabdomyolysis. The 3-6 months required for full recovery can be seen as a major setback for an athlete. It is crucial that coaches be aware of this exercise-induced condition and monitor the strenuousness of their training/practice sessions. For further reading on exertional rhabdomyolysis and its implications on exercise program design, please refer to the reference articles listed below.

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    About the Author:

    Derek Grabert, MS, CSCS,*D

    Derek Grabert, MS, CSCS,*D is an Education Content Coordinator for the NSCA. He holds a master's degree in nutrition and has experience as a university instructor for human nutrition, anatomy, and physiology classes. He has coached high school athletes, special populations clients, and general fitness enthusiasts on the health benefits of strength training, aerobic training, and the integration of proper nutrition.



    Cleary, MA, Sadowski, KA, Lee, SY, Miller, GL, Nichols, AW. Exertional Rhabdomyolysis in an Adolescent Athlete during Preseason Conditioning: A Perfect Storm. Journal of Strength & Conditioning Research 25(12): 3506-3513, 2011. 

    Knochel, J. Rhabdomyolysis and myoglobinuria. Annu Rev Med 33: 435-43, 1982.


  • Disclaimer: The National Strength and Conditioning Association (NSCA) encourages the exchange of diverse opinions. The ideas, comments, and materials presented herein do not necessarily reflect the NSCA’s official position on an issue. The NSCA assumes no responsibility for any statements made by authors, whether as fact, opinion, or otherwise. 
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      The understanding of this subject is proving more important as various high intensity programs increase in popularity among our athletes.

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      This is a great article to put out since it seems to me and many others in the field that this is a continued form of training if not an advancing trend in health/S&C with focus being high intensity without structure and most importantly appropriatemore» recovery«less

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