Exertional rhabdomyolysis

Exertional rhabdomyolysis

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  Exertional Rhabdomyolysis NICHOLAS GRIMES C.S.C.S. WEST VIRGINIA UNIVERSITY ACE 660 4/20/2012
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  Purpose and Objective The purpose of this webinar is to educate coaches and trainers about the dangers of exertional rhabdomyolysis  At the conclusion of this webinar coaches should be able to:  Define what exertional rhabdomyolysis is  Understand the complications and contributing factors  Recognize the signs and symptoms  Develop proper training programs that minimize the risk of rhabdomyolysis
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  What is exertionalrhabdomyolysis?  Exertional rhabdomyolysis is the degeneration of skeletal muscle caused by excessive, unaccustomed exercise  Cellular constituents are released into the extracellular fluid and circulation  Renal failure, compartmental syndrome, abnormalities in heart rhythm, tremors, and cardiac arrest
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  Cellular Constituents  Myoglobin  Oxygen binding protein found almost exclusively in muscle tissue  Damages the epithelium of the renal tubules  Forms casts that build up and block renal tubules  Leads to renal failure  Potassium  Predominantly an intracellular action  Interferes with the depolarization mechanisms in muscle tissue by lowering the resting membrane potentials  Results in skeletal muscle weakness, abnormalities in heart rhythm, and cardiac arrest
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  Cellular Constituents  Calcium  Deposits in damaged muscle tissue  Decreased levels of calcium in the blood can result in tremors, tetanus in the skeletal muscle, and depress the excitability of the heart muscle  Creatine Kinase  Muscle enzyme responsible for ATP synthesis and breakdown  Released proportionally with myoglobin, serves as an indicator of muscle damage
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  Contributory factors  SickleCell Trait  Low oxygen tension can lead to sickling  Sickling causes blood flow/supply to become restricted (ischemia)  Ischemia leads to the breakdown of muscle tissue and rhabdomyolysis  Dehydration  Decreased blood flow to muscle tissue due to cardiovascular strain and an increase in the blood flow to the skin for thermoregulation creates a hypoxic condition  Increase cell membrane permeability  Solubility of myoglobin is diminished
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  Contributory Factors  EccentricContractions  Muscle is forced to lengthen as it contracts  Exercises such as squats, bench, and lunges  Creates tensile stress which disrupts the organization of sarcomeric structures within individual muscle fibers  Muscle damage is intensified if individual is dehydrated
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  Signs and Symptoms Common signs and symptoms:  Muscle pain  Weakness  Edema/swelling  Range of motion (ROM) deficits  Muscle tenderness (doughy feeling)  Redness  Eccyhmosis (bruising)  Parathesia (pins and needles)  Absence of deep tendon reflexes
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  Signs and Symptoms Myoglobinuria  The presence of myoglobin in the urine  Urine will appear dark reddish-brown  Elevated levels in the blood:  Creatine kinase  Released proportionally with myoglobin  Potassium  Uric Acid  Released in conjunction with creatine kinase  Phosphate  Decrease levels of calcium in the blood.
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  Signs and Symptoms Individuals with SCT:  Cramping  Hyperventilating (due to lactic acidosis, not asthma)  Weakness (legs like jello)  Nausea  Signs of splenic infarction:  Pleurisy  Pneumothorax  Side stitch  Renal colic  Signs of musclar infarction:  Low back pain
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  Implications for Coaches Specificity of training  Is the individual accustomed to the required activity  Level of training  Level of physical fitness of the individual  Eccentric contraction exercises  Do the exercises performed have a strong eccentric component  Anatomical adaption  Helps prepare the body for the rigors of training  High temperature and humidity
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  Implications for Coaches Viral and bacterial infections  Ergogenic aids  Diet manipulations  Increased or decreased stores of muscle glycogen may impair muscle function  Overall stress  Medical histories  Does the individual have any conditions that may predispose them to rhabdomyolysis (i.e. SCT)  Readiness to return to play (RTP)  Symptoms of muscle pain, weakness, and swelling subside  Levels of myoglobin and creatine kinase return to normal
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  Conclusion  Exertional rhabdomyolysisis easily preventable and treatable  Education  Proper program design  Being aware of the warning signs of rhabdomyolysis
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  Coaching Resources  Coachesresources:  The National Strength and Conditioning Association (NSCA)  The Journal of Strength and Conditioning  The National Collegiate Athletic Association  Publish news releases and research articles  United States Olympic Committee  Publish news releases and research articles
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  References  References  Anderson, S. (Human Kinetics). (2011, December 8). ASEP successful coaching webinar series. Sickle Cell Trait Guidelines. Webinar retrieved from http://www.humankinetics.com/asep-successful-coaching-webinar-series  Beasley, K., Lee, E., McDermott, B., & Yamamoto, L. (2010). The effect of ovral vs. intravenous rehydration on circulating myoglobin and creatine kinase. The Journal of Strength and Conditioning, 24, 60-67.  Brudvig, T., & Fitzgerald, P. (2007). Identification of signs and symptoms of acute exertional rhabdomyolysis in athletes: A guide for the practitioner. The Strength and Conditioning Journal, 29, 10-14.  Claps, F. (2005). Exertional rhabdomyolysis. The Strength and Conditioning Journal, 27, 73-74.  Clarkson, P. (1993). Exertional rhabdomyolysis and acute renal failure. The National Strength and Conditioning Journal, 13, 33-39.  Cleary, M., Sadowski, K., Lee, S., Miller, G., & Nichols, A. (2011). Exertional rhabdomyolysis in an adolescent athlete during preseason conditioning: A perfect storm. The Journal of Strength and Conditioning, 25, 3506-3513.  Eberman, L., Kahanov, L., Alvey, T., & Wasik, M. (2011). Exertional rhabdomyolysis: Determining readiness to return to play. The International Journal of Athletic Therapy & Training, 7-10.  Fidler, E. (2012). Sickle cell trait: A review and recommendations for training. The Strength and Conditioning Journal, 0, 1-5.  Jguz17. (2012, March, 29). Ohio State [Msg 3]. Message posted to http://www.footballscoop.com/the-staff- room/topic?id=3877  Moeckel-Cole, S., & Clarkson, P. (2009). Rhabdomyolysis in a collegiate football player. The Journal of Strength and Conditioning, 23, 1055-1059.  Morehouse, M. (2011, January, 26). 100 squats, 17 minutes, rhabdomyolysis. The Gazette. Retrieved from http://www.thegazette.com/2011/01/26/100-squats-17-minutes-rhabdomyolysis/  Robergs, R. (2010). Catabolism in skeletal muscle: The phosphagen system [PowerPoint slides]. Retrieved from http://www.unm.edu/~rrobergs/426L7Phosph.pdf
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  Biography  My nameis Nicholas Grimes. I am currently working on my masters degree in Athletic Coaching Education from West Virginia University. I graduated from West Virginia University with a degree in a bachelors degree in Sports Management. I am currently the strength and conditioning coach at University High School and Fairmont Senior High School as well as a Personal Trainer for Certified Fitness Trainers (C:FT). I am a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association and I have also interned under renowned strength coaches Mike Barwis and Marcus Kinney while at West Virginia University.  Contact: [email protected]