Rhabdomyolysis Makes the News in Texas Once Again!

It would be difficult to find a sane and rational person who disagreed with the statement that regular exercise is good for you, and that more is better within reasonable limits.

For the beginner exerciser however, or for those who are unaccustomed to certain exercises, the question of ‘how much is too much?’ becomes extremely important. Two important principles in exercise programming are overload and progression. 

Overload simply means that in order for a change in fitness to take place, the individual must perform more work than they are currently accustomed to performing. Take a beginner exerciser for example. Any amount of exercise would be considered overload because they have not been doing anything previously. However, when beginning a program or ramping up a current program, there is the risk of too much overload. That’s where the principle of progression comes into play. Progression means that in order for an exercise program to be safe and effective, the overload should be increased gradually over a period of several weeks. In other words, Rome was not built in a day. It actually took two days. Just kidding!

Over the past few years there have been a number of instances where several members of high school and college athletic teams here in Texas have been hospitalized with a potentially very serious condition known as rhabdomyolysis.

Rhabdomyolysis begins with severe muscle damage, which comes about as a result of too much overload combined with the absence of progression. When muscle fibers experience such damage, they release a substance called myoglobin into the bloodstream. Myoglobin is a protein that is almost exclusively found in muscle tissue, and that is where it should normally remain. When myoglobin finds its way into the blood, it eventually travels to the kidneys, where it can cause significant damage. If enough myoglobin is released from the injured muscles, this can lead to kidney failure, with an immediate need for dialysis.

During the summer of 2016, eight players from the Texas Woman’s University volleyball team were hospitalized with severe pain and swelling in the triceps muscle of both arms, as well as stiffness and weakness in those areas. Fortunately, all of the athletes recovered. A thorough investigation of the incident was launched, which led to an independent report stating that the cause was rhabdomyolysis.

So how did a group of University level female volleyball athletes damage their muscles to such an extent that they were hospitalized with rhabdo? The simple answer is that they did too many push-ups! Let me elaborate. For most people, the push-up is a safe and effective strength training exercise that incorporates several muscle groups including the pectoralis major (pecs), triceps, serratus anterior, and anterior deltoid. A variation of the traditional push-up is known as the triceps push-up, where the elbows are held closely to the sides of the body instead of flaring out. As its name implies, the triceps push-up utilizes the triceps to a greater extent than the traditional push-up. During an August pre-season training session, the women’s volleyball team was asked to complete 75 triceps push-ups during a fitness testing session. Since this was the pre-season, the athletes were in various states of conditioning; some had worked out regularly during the summer, while others had not. None of the players had put any particular emphasis on performing triceps push-ups during their workouts. So, the principle of progression was violated. Most players went from never/rarely performing triceps push-ups to performing 75 of them in a single training session! Within 72 hours, 8 of the players were hospitalized. The equation is simple: Too much overload + no progression = rhabdomyolysis.

In 2018, a dozen members of the University of Houston women’s soccer team were diagnosed with rhabdomyolysis, with some requiring hospitalization. This occurred following an exhaustive ‘punishment workout,’ which consisted of an excessive number of shuttle runs, burpees (also known as up-downs), and planks. While these exercises are very safe and effective for young and healthy athletic individuals, it is obvious from this situation that more is not always better. The strength and conditioning coach was relieved of his duties with the soccer team shortly thereafter.  

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Just a few weeks ago, several members of the Rockwall Heath High School football team were hospitalized with rhabdomyolysis. The culprit? Too many push-ups! During a Friday afternoon one hour training session, players were reportedly required by their head coach to complete as many as 400 push-ups. Some players and parents claimed that this was a punishment workout. The players were coming off the two-week holiday break, so it is likely that some, perhaps most, were not doing a significant number of push-ups during that time. Therefore, once again we have a situation where there is excessive overload and no progression. The head coach was placed on administrative leave. Stay tuned.  

So if you are just getting started on an exercise program, are about to incorporate a new exercise into your routine, or you are ramping up your existing routine, easy does it! Your muscles need time to adapt to change. If you overdo it and experience the signs and symptoms summarized below, then you should seek immediate medical attention.  

Signs and Symptoms of Rhabdomyolysis

• Cola-colored urine
• Severe muscular pain accompanied by swelling
• Stiffness and weakness in affected muscles

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