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Over-exertion leads to rhabdo

Staff Sgt. Sarah Cox and Airman 1st Class Austin Langlois, 90th Medical Operations Squadron Bioenvironmental Engineering technicians, run on a track on F.E. Warren Air Force Base, Wyo., Aug. 19, 2015. Exercise is recommended by health experts, but over-exertion can lead to a painful condition called Rhabdomyolysis, which is the build up of intracellular material in the blood from damaged muscle tissue. (U.S. Air Force photo by Senior Airman Jason Wiese)

Staff Sgt. Sarah Cox and Airman 1st Class Austin Langlois, 90th Medical Operations Squadron Bioenvironmental Engineering technicians, run on a track on F.E. Warren Air Force Base, Wyo., Aug. 19, 2015. Exercise is recommended by health experts, but over-exertion can lead to a painful condition called Rhabdomyolysis, which is the build up of intracellular material in the blood from damaged muscle tissue. (U.S. Air Force photo by Senior Airman Jason Wiese)

Capt. Nathan Smith, 90th Medical Operations Squadron Nuclear Operations Clinic element chief, puts on a glove as he poses in an examination room in the 90th Medical Group Medical Treatment Facility on F.E. Warren Air Force Base, Wyo, Aug. 19, 2015. Smith recommends patients seek medical treatment if they exhibit the “classic triad” of rhabdomyolyisis symptoms — muscle weakness, muscle pain an dark urine. (U.S. Air Force photo by Senior Airman Jason Wiese)

Capt. Nathan Smith, 90th Medical Operations Squadron Nuclear Operations Clinic element chief, puts on a glove as he poses in an examination room in the 90th Medical Group Medical Treatment Facility on F.E. Warren Air Force Base, Wyo, Aug. 19, 2015. Smith recommends patients seek medical treatment if they exhibit the “classic triad” of rhabdomyolyisis symptoms — muscle weakness, muscle pain an dark urine. (U.S. Air Force photo by Senior Airman Jason Wiese)

Capt. Jennifer Roper, 90th Medical Operations Squadron family physician, poses in the 90th Medical Group Medical Treatment Facility Aug. 18, 2015, on F.E. Warren Air Force Base, Wyo. Roper offered advice on how to prevent Rhabdomyolysis, the build-up of intracellular material in the blood from damaged muscles, which included staying hydrated and knowing one’s limits during exercise. (U.S. Air Force photo by Senior Airman Jason Wiese)

Capt. Jennifer Roper, 90th Medical Operations Squadron family physician, poses in the 90th Medical Group Medical Treatment Facility Aug. 18, 2015, on F.E. Warren Air Force Base, Wyo. Roper offered advice on how to prevent Rhabdomyolysis, the build-up of intracellular material in the blood from damaged muscles, which included staying hydrated and knowing one’s limits during exercise. (U.S. Air Force photo by Senior Airman Jason Wiese)

Poster describinbg ways to protect onesself from rhabdomyolysis.

Poster describinbg ways to protect onesself from rhabdomyolysis.

F.E. WARREN AIR FORCE BASE, Wyo. -- Rhabdomyolysis, a disease well-known to intense exercise circles, can be a painful and dangerous disease developed by doing what doctors have long recommended: exercising.

Airmen must meet Air Force fitness standards with intense physical training, but Airmen should also be aware of the risk of rhabdo so they can remain healthy and continue to execute a safe, secure and effective mission.

"Rhabdomyolysis is a process where there is damage to the muscles, specifically [voluntary] muscle," said Capt. Nathan Smith, 90th Medical Operations Squadron Nuclear Operations Clinic element chief. "What happens is breakdown of the muscle tissue releases more proteins and more intracellular components that your body has to deal with. It can affect your electrolyte balances, it can affect the way your kidneys filter and it can affect the rest of your organ's functions if it throws things off too much."

Kidneys normally filter the blood of intracellular materials from damaged tissue, but the amount of materials released in rhabdo overwhelms the kidneys' ability to filter the blood, he said. The condition can lead to kidney damage, electrolyte imbalances and cardiac arrhythmias -- abnormal or irregular heartbeats -- which can be fatal.

The causes of rhabdo include anything that damages the muscle, said Capt. Jennifer Roper, 90th MDOS family physician. This can mean over-exertion during exercise, which is the most common cause among Airmen.

Roper added that the risk of developing rhabdo from over-exertion increases for those who suddenly start an intense workout regimen instead of gradually working their way up in intensity. Other risk factors include high temperatures and high humidity.

The "classic triad" of symptoms for rhabdo is muscle pain, muscle weakness and dark urine, Smith said. Approximately 50 percent of rhabdo patients exhibit these three symptoms.

However, it is important to differentiate between normal effects of exercise and rhabdo, Roper said. After a good work-out, muscles may be sore or feel slightly weak, but with rhabdo the pain is severe and weakness can mean almost total loss of function.

Anyone with these symptoms should seek medical care, Roper said. Medical providers can test for the disease with blood tests to determine levels of muscle breakdown products.

Smith and Roper offered ways for people to prevent the development of rhabdo. First and foremost, they said to stay hydrated.

"That doesn't mean to just drink water an hour before working out," Roper said. "You should drink water throughout the day."

People should also be careful when developing exercise plans, they said. It is best to start slowly and progress in intensity over time.

Roper said she has encountered several rhabdo patients during her time in the Air Force, and said the sufferers endured extreme pain due to the disease.

"Imagine the worst muscle soreness after a workout, and with rhabdo it's tenfold," she said.

Luckily, treating rhabdo is a matter of hydration and balancing electrolytes, Smith said. This can be accomplished through medications, drinking water and administrating intravenous fluids.

Sometimes, the treatment can be done on an outpatient basis, where providers tell patients to stay hydrated and report back to the hospital for testing to ensure their condition is improving, Roper said. More severe cases require hospitalization.

In the majority of rhabdo cases, patients suffer no long-term effects once they recover, Smith said.

Upcoming forecasts predict hot weather on the horizon. Airmen are trying to stay fit and Frontiercade -- the Mighty Ninety's annual sporting competition -- is scheduled for this week, so risk factors for rhabdo are present. People can abide by Roper and Smith's advice to stay safe and healthy as summer comes to an end.

For more information about proper exercise and nutrition, visit www.hprc-online.org.