Menu
What Happened to the Hospitalized Tufts Athletes? …All About Rhabdo
September 30th, 2024 by Administrator
by: Silas Pipson
What the Hell Happened?!
After participating in a 45-minute team workout led by an alum, nine players on the Tufts Men’s Lacrosse team fell ill with symptoms of severe dehydration/heat stroke. Upon being taken to the hospital, the players were diagnosed with exertional rhabdomyolysis. As of today, three players remain in critical condition, suggesting that the disease migrated from their skeletal muscles to their internal organs.
What is Rhabdo?
Summary
Rhabdomyolysis is a medical condition in which the body begins rapidly breaking down muscle tissue in response to a traumatic event. This could be a crush injury, infection, electrical injury, or—as in this case—strenuous exercise (especially in hot conditions). When the muscle breaks down, its core proteins are released into the bloodstream along with large quantities of electrolytes. They make their way down to the kidney and up to the heart, neither of which can function properly or process these types of substances.
Muscular Rope Analogy
To understand how Rhabdo works, you first have to understand the muscles it preys on. Skeletal muscle is made up of a nested structure of smaller and smaller pieces. To help you picture this, think of a muscle like a bridge cable.
The first and largest layer, the whole cable, is the muscle itself. Within the outermost casing of the muscle, called the fascia, sit bundles of muscle fibers called fascicles. Though the specific number varies, a muscle can contain anywhere from dozens to hundreds of fascicles. All of these are surrounded by a protective layer of connective tissue called the epimysium.
In this scenario, each fascicle is equivalent to a thinner rope called a strand. Fascicles are bundles of muscle fibers, bound together as a unit by another type of connective tissue called perimysium. Where the epimysium provides protection for the muscle as a whole, the perimysium provides support to the fascicle bundle.
Within each fascicle are ten to a hundred muscle fibers, depending on the muscle. Each muscle fiber, our “string”, is an individual cell. Muscle fibers are long and cylindrical, and come wrapped in a third and final layer of connective tissue called the endomysium. Almost a combination of the two tissues before it, the endomysium provides both structural support and protection, while also carrying blood vessels and nerves to the muscle cells.
At this point, we are beyond what you could see with your naked eye. Inside each muscle fiber string are thousands of individual yarns; cylindrical structures called myofibrils. These myofibrils run the entire length of the muscle fiber and are responsible for contraction. Each myofibril is made up of a repeating unit: the sarcomere.
This tiniest, innermost piece is the smallest functional unit of a muscle. They are analogous to the molecular structures that give fabric the ability to turn into rope in the first place. Sarcomeres are composed of two filaments, actin and myosin, which slide past each other to produce contraction. When a muscle contracts, thousands of sarcomeres shorten at the same time, in turn shortening the myofibrils, which shorten the muscle fibers, then the fascicles, and ultimately the whole muscle.
It is here, at the microscopic level, that we can finally begin studying how rhabdo works.
In the Kidney
After the muscle breakdown begins, actin and myosin from the dissolved muscles pass into the bloodstream. Your body knows that something is wrong now, so it swells up these areas to let repair cells in. Unfortunately, this only makes things worse, releasing creatine kinase and myoglobin into the bloodstream. Not good news for the kidney.
Since the kidney is not able to process these molecules, it eventually goes into a state of failure. But your body is stubborn, and it still wants to pump blood, so it does! These same proteins and electrolytes make their way through your bloodstream and up to your heart, which can be thrown into arrhythmia.
So there you are, sore and swollen. Your kidney is failing, and your heart can’t pump. All from a workout that was too hard.
Why it Matters
Generally
Now you might be thinking, “all of that information was great, but why should I care personally?” Here’s why. As trainers, the most important part of our job is to keep our clients safe. It doesn’t matter how good of a workout you can write. If your client ends up in the hospital afterward, you have failed.
With that said, it is absolutely possible to work hard without putting someone at risk for rhabdo. Just don’t do anything crazy. If you’re used to weight training and your friend wants you to come running, that’s great! But if that friend’s running workout is an hour of hills at race pace, it might be
The risk of exertional rhabdomyolysis can be lowered by engaging in prolonged lower-intensity exercise, as opposed to high-intensity exercise over a shorter time period.
In all athletic programs, three features should be present:
- Emphasizing prolonged lower-intensity exercise, as opposed to repetitive max intensity exercises.
- Adequate rest periods and a high-carbohydrate diet, to replenish glycogen stores.
- Proper hydration, to enhance renal clearance of myoglobin.
It is absolutely critical to listen to your clients. If you see or hear about any of the following symptoms, stop immediately:
- Severe muscle cramps, aches, or pains
- Dark, tea-colored urine
- Feelings of extreme exhaustion
Rhabdo can mimic the symptoms of related conditions like heat exhaustion and dehydration, as it begins as both of them.
As such, even “pushing through” these symptoms is unadvisable. Prioritize the health of the people under your guidance, practice safe programming, and only good things will follow.
