IF YOU'RE LAZY, SCROLL DOWN TO THE TL;DR.
I've been fighting whether to put this up as it's own thread for some time now, but I feel it's a different enough topic that I didn't want to lose it in another thread. If you want to learn more about this condition, please read on, and discuss. If not, ignore it.
Now, I'm not going to pretend that I am a trained medical professional, or anything like that. But I am interested in medicine and science, and this curious case of 13 of our players being admitted for apparent exertional rhabdomyolysis intrigued me. I decided to look into cases of mass rhabdomyolysis in teams, and I found that there was a published study on the case of the 7 division I swimmers who were hospitalized for this condition. The study does a good job of explaining the events that led to the swimmers hospitalization, as well as their treatment. I'll present a summary here, and hopefully it'll help us gain a bit of insight on this condition. It won't answer all our questions, of course, but even a little information can go a long way...
The case study:
Exertional Rhabdomyolysis in Seven Division-1 Swimming Athletes
Rupert Galvez, DO, Jason Stacy, MD, and Ashly Howley, ATC
Patients: 7 Division I swimmers (school not named). 4 males and 3 females. Had severe pain and swelling in their triceps and pectoralis muscles, along with dark colored urine. Further testing showed elevated CK values and myoglobin in the urine of 3 of the 7 patients. Electrolytes seemed to be normal. All 7 had undergone the same training regimen (as had some 40 other swimmers) in the days prior. All seven claimed that they were well hydrated, and all denied alcohol or dietary supplements.
Swimmer 1 was admitted after day 1 of training, swimmers 2-5 three days after that, and swimmers 6-7 four days after swimmer 1. Note the staggered admissions.
Swimmers 1-4 were males, aging 21, 22, 18 and 19 years old (senior, senior, freshman, sophomore). Swimmers 5-7 were females, aging 19, 22 and 21 (freshman, senior, senior). Note the various ages, and classes of the patients.
My take: What I want to point out is that these athletes weren't, apparently, taking any dietary supplements, or consuming alcohol. There isn't any mention of pre-existing conditions or illnesses. This is interesting because unlike our case where supplements such as creatine could be an issue, this seems to be a case of purely exertional rhabdomyolysis, brought on by strenuous exercise. I say creatine is unlikely to be an issue with the swimmers because 'bulking up' isn't always conducive for swimmers. It may help with some things, and I'm sure there are swimmers who take it, but in my experience, I never met anyone who admitted to using it.
Training:
Summer training
1 week prior: Daily practice, along with dry land. Dry land exercises consisted of 3x10 pullups, 3x15 pushups and abs using medicine balls. It says alternating days, but not sure if it's all of the exercises, or just parts of it.
Day 1: Dry land: 1-minute max # pushups, followed by 1 minute max # body-weight squats, for a total time of 10 minutes. So, basically, 5 minutes of pushups, 5 minutes of body-weight squats. All this followed by swim practice.
Day 2: 40-minute typical upper-body weight training, followed by swim practice.
Day 3: Max pull-up test set, various ab exercises, followed by swim practice.
My take: I don't know how many of you are swimmers, but I can relate a bit to practices like this when I used to swim competitively for club and high school. We did abs every day (many, many ab exercises of various kinds) and on alternate days, did various dry land exercises including running stairs, upper body, abs and lower body exercises with medicine balls, etc. We followed that up with ~2hr swim practices, which included drills that put a lot of tension on certain parts of your body. I couldn't even count how many times I'd finish practice, and spend the rest of the night icing my sore muscles, and popping ibuprofens. And we'd do this 5-6 days a week. Occasionally, with two 2-hr swim sessions.
However, I do have to add that we never did timed max # pushups, pullups or squats. We did do those exercises, but they were always numbered sets and reps.
Iowa football players apparently did do a high number of squats, but I wouldn't be surprised if the did other timed high weight/high number or max # exercises.
Treatment:
IV fluids, close monitoring and pain control. Swimmer 1 was discharged after day 6 of treatment, swimmers 2-5 after day 4 and swimmers 6-7 after day 3.
My take: I just want to point out two things here. First is that you can see a spectrum of severity in these cases, as swimmer 1 was brought in first, yet stayed the longest. Swimmers 2-5 were brought in two or three days later, and left a couple days before swimmer 1. Swimmers 6-7 seemed to stay the least amount of time.
Second, I just wanted to point out how long it took for athletes who weren't facing renal failure or anything like that to be released. At first, I thought 48 hours was a long time, but it wouldn't be unprecedented for our guys to stay longer.
Discussion:
TL;DR
Basically...
1) It is possible for a large (relative) number of teammates to be hospitalized for 'purely' exertional rhabdomyolysis. These swimming cases seem to be driven primarily by the exercise, and without involvement of supplements, (as has been hypothesized with the Iowa players), pre-existing conditions, viral/bacterial infections, etc.
2) Severity varies. Swimmer 1 seems to have been the more severe case (admitted first, released last), and the rest came in and left at varying times.
3) Release times for these swimmers seemed to be 3-6 days after admission. It'll definitely vary on a case by case basis, but if one guy is still in there after a week, it doesn't necessarily mean he's on his deathbed.
I've been fighting whether to put this up as it's own thread for some time now, but I feel it's a different enough topic that I didn't want to lose it in another thread. If you want to learn more about this condition, please read on, and discuss. If not, ignore it.
Now, I'm not going to pretend that I am a trained medical professional, or anything like that. But I am interested in medicine and science, and this curious case of 13 of our players being admitted for apparent exertional rhabdomyolysis intrigued me. I decided to look into cases of mass rhabdomyolysis in teams, and I found that there was a published study on the case of the 7 division I swimmers who were hospitalized for this condition. The study does a good job of explaining the events that led to the swimmers hospitalization, as well as their treatment. I'll present a summary here, and hopefully it'll help us gain a bit of insight on this condition. It won't answer all our questions, of course, but even a little information can go a long way...
The case study:
Exertional Rhabdomyolysis in Seven Division-1 Swimming Athletes
Rupert Galvez, DO, Jason Stacy, MD, and Ashly Howley, ATC
Patients: 7 Division I swimmers (school not named). 4 males and 3 females. Had severe pain and swelling in their triceps and pectoralis muscles, along with dark colored urine. Further testing showed elevated CK values and myoglobin in the urine of 3 of the 7 patients. Electrolytes seemed to be normal. All 7 had undergone the same training regimen (as had some 40 other swimmers) in the days prior. All seven claimed that they were well hydrated, and all denied alcohol or dietary supplements.
Swimmer 1 was admitted after day 1 of training, swimmers 2-5 three days after that, and swimmers 6-7 four days after swimmer 1. Note the staggered admissions.
Swimmers 1-4 were males, aging 21, 22, 18 and 19 years old (senior, senior, freshman, sophomore). Swimmers 5-7 were females, aging 19, 22 and 21 (freshman, senior, senior). Note the various ages, and classes of the patients.
My take: What I want to point out is that these athletes weren't, apparently, taking any dietary supplements, or consuming alcohol. There isn't any mention of pre-existing conditions or illnesses. This is interesting because unlike our case where supplements such as creatine could be an issue, this seems to be a case of purely exertional rhabdomyolysis, brought on by strenuous exercise. I say creatine is unlikely to be an issue with the swimmers because 'bulking up' isn't always conducive for swimmers. It may help with some things, and I'm sure there are swimmers who take it, but in my experience, I never met anyone who admitted to using it.
Training:
Summer training
1 week prior: Daily practice, along with dry land. Dry land exercises consisted of 3x10 pullups, 3x15 pushups and abs using medicine balls. It says alternating days, but not sure if it's all of the exercises, or just parts of it.
Day 1: Dry land: 1-minute max # pushups, followed by 1 minute max # body-weight squats, for a total time of 10 minutes. So, basically, 5 minutes of pushups, 5 minutes of body-weight squats. All this followed by swim practice.
Day 2: 40-minute typical upper-body weight training, followed by swim practice.
Day 3: Max pull-up test set, various ab exercises, followed by swim practice.
My take: I don't know how many of you are swimmers, but I can relate a bit to practices like this when I used to swim competitively for club and high school. We did abs every day (many, many ab exercises of various kinds) and on alternate days, did various dry land exercises including running stairs, upper body, abs and lower body exercises with medicine balls, etc. We followed that up with ~2hr swim practices, which included drills that put a lot of tension on certain parts of your body. I couldn't even count how many times I'd finish practice, and spend the rest of the night icing my sore muscles, and popping ibuprofens. And we'd do this 5-6 days a week. Occasionally, with two 2-hr swim sessions.
However, I do have to add that we never did timed max # pushups, pullups or squats. We did do those exercises, but they were always numbered sets and reps.
Iowa football players apparently did do a high number of squats, but I wouldn't be surprised if the did other timed high weight/high number or max # exercises.
Treatment:
IV fluids, close monitoring and pain control. Swimmer 1 was discharged after day 6 of treatment, swimmers 2-5 after day 4 and swimmers 6-7 after day 3.
My take: I just want to point out two things here. First is that you can see a spectrum of severity in these cases, as swimmer 1 was brought in first, yet stayed the longest. Swimmers 2-5 were brought in two or three days later, and left a couple days before swimmer 1. Swimmers 6-7 seemed to stay the least amount of time.
Second, I just wanted to point out how long it took for athletes who weren't facing renal failure or anything like that to be released. At first, I thought 48 hours was a long time, but it wouldn't be unprecedented for our guys to stay longer.
Discussion:
So, even though they were physically fit, they may not have been as fit as their teammates.
Wholly possible in our case.
Again, even though our guys may have been switching muscle groups, certain groups may have been worked consecutively. Alternatively, excessive exercise of a particular group in one day could also lead to breakdown. Also, if you're out of shape, it takes you more than 1 day to rest and recover, I feel.
Similarly, if we were to go around testing all Iowa players, we may find that more were actually presenting with this condition. And if we were to expand that, and test all CFB players during winter training, we might find large numbers of players who have it.
TL;DR
Basically...
1) It is possible for a large (relative) number of teammates to be hospitalized for 'purely' exertional rhabdomyolysis. These swimming cases seem to be driven primarily by the exercise, and without involvement of supplements, (as has been hypothesized with the Iowa players), pre-existing conditions, viral/bacterial infections, etc.
2) Severity varies. Swimmer 1 seems to have been the more severe case (admitted first, released last), and the rest came in and left at varying times.
3) Release times for these swimmers seemed to be 3-6 days after admission. It'll definitely vary on a case by case basis, but if one guy is still in there after a week, it doesn't necessarily mean he's on his deathbed.
Last edited:
