Consistent exercise prevents rare skeletal muscle condition

Published: Thursday, August 21, 2008 3:59 PM CDT
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Maj. Peter C. Glover | Munson Army Health Center

Exertional rhabdomyolysis is a rare condition caused by the breakdown of skeletal muscle. This may occur after an intense session of exercise that does not allow for rest and recovery and the proper progression of exercise intensity.

This condition is rare, but possible when muscles are pushed to the limits of their physical capacity rapidly and with great intensity. Four cases of rhabdomyolysis were reported at Fort Leavenworth in the last six months.

Exercise is a part of healthy living and increases our ability to perform physically and mentally. However, exercise that results in single or repeated extreme exertion may result in damage to muscle and lead to kidney failure.

Physical therapists Lt. Col. Richard Baxter and Col. Josef Moore point out in a case study the importance of progressive conditioning to increase strength and endurance. This is even more important when starting a new exercise program or starting to exercise again after prolonged periods of not exercising.

The breakdown of muscle in rhabdomyolysis produces the enzyme myoglobin, which can obstruct the filtration system of the kidneys. The kidneys filter the toxic waste products from our blood in the form of urine. The decreased filtration rate by the kidneys can result in damage to the renal and kidney system. The most severe complication of rhabdomyolysis is acute renal failure. Studies report acute renal failure for this condition between 5-16.5 percent of the time.

The primary symptoms of rhabdomyolysis are prolonged muscle pain, muscle weakness and brown or tea-colored urine. The diagnosis is confirmed with laboratory tests that show elevated amounts of creatine kinase in the blood and myoglobin in the urine. Creatine kinase, or CK, is an enzyme in blood that is produced during the breakdown of muscle. These chemicals are involved in the control and production of energy in the body.

Myoglobin is excreted during urination, but when there is an excessive amount in the blood, it will block the filtration system of the kidneys and lead to decreased urine output and the destruction of the tubes in the renal system of the kidney. The result is the inability of the body to get rid of toxins, a potentially fatal condition.

When rhabdomyolysis is confirmed, immediate medical management involves aggressive fluid replacement, monitoring urine output and maintaining good renal function. Return to pre-injury level of performance may take between two to three months.

In their study, Baxter and Moore provided a method to increase push-up performance that may be used after symptoms are resolved. This is also a good progression for anyone who is starting a push-up training program. (See box below.)

Exercise is a critical part of military readiness, physical performance and mental health for Soldiers and family members. Consistency is far more important than intensity. When starting an exercise program, it is important to implement the principles of progression, rest and consistency.

The Web page for the Physical Therapy Clinic at Munson Army Health Center has several helpful links for exercise and injury management, https://www.munson.amedd.army.mil/Information/Departments/physical_therapy.htm