Rehabilitation: Exertional Rhabdomyolysis[edit]

Before Initializing Treatment[edit]

Exertional rhabdomyolysis (ER), the exercise-induced muscle breakdown that results in muscle pain/soreness, is commonly diagnosed using the urine myoglobin test accompanied by high levels of creatine kinase (CK). Myoglobin is the protein released into the bloodstream when skeletal muscle is broken down. The urine test simply examines whether myoglobin is present or absent. When results are positive the urine normally obtains a dark, brown color followed by serum CK level evaluation to determine the severity of muscle damage. Elevated levels of serum CK greater than 5,000 U/L that are not caused by myocardial infarction, brain injury, or disease generally indicate serious muscle damage confirming diagnosis of ER ^[1].

Initial Treatment[edit]

After ER is diagnosed treatment is applied to 1) avoid renal dysfunction and 2) alleviate symptoms. This should be followed by recommended rehabilitation program, exercise prescription (ExRx). Treatment involves extensive hydration normally done through IV fluid replacement with administration of normal saline until CK levels reduce to a maximum of 1,000 U/L ^[2]. Proper treatment will ensure hydration and normalize muscle discomfort (pain), flu-like symptoms, CK levels, and myoglobin levels for patient to begin ExRx.

Recovery Program[edit]

Before initiating any form of physical activity the individual must demonstrate a normal level of functioning with all previous symptoms absent. Physical activity should be supervised by a health care professional in case of a reoccurrence. However, in some low risk individuals supervision by a medical professional is not required as long as individual follows up with weekly check ups ^[3]. Proper hydration prior to performing physical activity and performing exercise in cool, dry environments may reduce the chances of developing a reoccurring episode of ER ^[4]. Lastly, it is imperative for urine and blood values to be monitored along with careful observation for redevelopment of any signs or symptoms. The recovery program focuses on progressively conditioning/reconditioning the individual and improving functional mobility. However, special considerations prior to participating in rehabilitation program include the individual’s 1) extent of muscle injury, if any 2) level of fitness before incident and 3) weight training experience ^[5]. These special considerations collectively are a form of assessing the individual’s capacity to perform physical activity, which is ultimately used to specify the ExRx design.