Exertional Rhabdomyolysis

Rhabdomyolysis, or “rhabdo,” is a medical condition where muscle tissue breaks down and the by-products of this process may lead to kidney failure and other complications. 

Rhabdo is commonly mistaken for heat illness or dehydration, so early recognition is critical. 

Exertional rhabdo can result from excessive exercise, physical training, or work. Wildland firefighters are engaged in strenuous activities and prolonged exertion often under harsh environmental conditions and difficult terrain–and so are at 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 professional are necessary. 

Contributing Factors:  

• Sudden intense increase in physical exertion after periods away from activity such as occurs with poor conditioning and/or lower fitness levels.
• Overexertion such as during high-intensity or long-duration activities without adequate recovery time.
• 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.

Treatment: Stop your current activity. Seek immediate care at the nearest hospital.

Rhabdomyolysis–Watch Out Situations:

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• Extremely sore for more than 3 days.
• Soreness extends beyond muscles that were exercised→ i.e., the full body. 
• Soreness that feels out of proportion to the exercise done.
• Stiffness and decreased range of motion.
• Nausea, vomiting, headache, confusion. 
• Swelling in the arms and legs. 
• Dark, cola colored urine; gradually getting darker.
• Extreme fatigue and/or weakness.

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.

Discussion Questions:

• 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?