Exertional Rhabdomyolysis

Rhabdomyolysis (sometimes called “Rhabdo”) is a medical condition resulting from the breakdown of damaged skeletal muscle tissue, which leads to the production of protein by-products. Breakdown of muscle tissue occurs regularly in the body from physical exertion; however, kidney damage can occur when the amount of breakdown exceeds our body’s ability to effectively eliminate by-products.

Exertional rhabdomyolysis can result from excessive exercise, physical training, or work. Due to the nature of our work which includes engaging in strenuous activities and prolonged exertion often under harsh environmental conditions and difficult terrain, wildland firefighters are at an increased risk for exertional rhabdomyolysis.

It is not possible to diagnose rhabdomyolysis in the field because specialized blood tests and a clinical evaluation by a medical professional are necessary. However, if one suspects rhabdomyolysis, it is important to stop activity and get to a clinic or hospital for evaluation.

Some of the most significant issues with previously diagnosed rhabdo cases in wildland fire have been the buildup of multiple risk factors, lack of symptom recognition, and delays in reporting and subsequent treatment. Rhabdo is often mistaken for heat stress, dehydration, or general soreness/fatigue. It can occur in well-conditioned athletes doing their usual workouts, therefore recognizing and monitoring risk factors as well as signs & symptoms is imperative.

Risk Factors:

• Poor conditioning and/or lower fitness levels

• Overexertion such as during high-intensity or long-duration activities

• Heat stress or working in extreme heat

• Excessive caffeine intake

• Dehydration

• Over the counter medications (decongestants, antihistamines, NSAIDs)

• Prescription medications (antidepressants, statins)

• Supplements such as creatine

• Inadequate rest/pushing the body too far

Signs and symptoms:

• Muscle aches and pains out of proportion with the amount of exercise

• Muscle cramping, swelling, and/or weakness

• Stiffness and decreased range of motion

• Rapid heart rate

• Nausea or vomiting

• Headache

• Confusion and disorientation

• Tea or Coca-Cola colored urine

Key Recommendations:

• Listen to your body!

• Maintain your physical training program, nutrition, hydration, and rest

• Introduce new exercises slowly

• Keep open lines of communication about fitness, rhabdo, and other injuries/ailments

• Ensure proper medical plans are in place

• Err on the side of caution and respond quickly

• When presenting for evaluation, make sure medical providers test for rhabdomyolysis (you can give them the hand-out linked below)

Discussion Topics:

• Given we have a very physical job, what would excessive pain, fatigue, and cramps look like to you?

• What is your crew’s medical plan for rhabdomyolysis?

• What are specific steps you and your crew can take to prevent and respond to this condition?

References:

• This video is focused on the awareness and prevention of Rhabdomyolysis with wildland firefighters. It was developed by the National Technology and Development Program – United States Forest Service.

• Department of Homeland Security Rhabdomyolysis information sheet