In mid-January of this year, three Oregon Ducks football players were hospitalized after a series of punishing strength and conditioning workouts. The two offensive linemen and a linebacker experienced symptoms related to exertional rhabdomyolysis (ERM).
Exertional rhabdomyolysis is a metabolic dysfunction within muscle tissue that causes a loss of structural integrity allowing for mass leakage of proteins, electrolytes and myoglobin into the bloodstream. This can cause extreme muscle pain, nausea, fever, increased heart rate and can lead to kidney failure.
For the three Oregon athletes, as for other athletes who experience “rhabdo,” Push it, Keep going and Work through the pain could have had life-threatening consequences. The University of Oregon’s athletic department suspended the strength and conditioning coach responsible for the training, issuing apologies to the athletes and community. Unfortunately, apologies don’t protect athletes, informed coaching does.
A coach trains athletes to help them progress toward a performance goal, but pushing too hard, too fast, and using a “one size fits all” approach can curb an athlete’s progress and even end their career.The pain-is-weakness-leaving-the-body mindset doesn’t only expose athletes to the risk of injury and ERM, but it assumes that all athletes respond to training in the same way.
What is Exertional Rhabdomyolysis?
Rhabdomyolysis is the process of muscles breaking down. Referred to as rhabdo for short, Rhabdomyolysis can be caused by a number of things including traumatic injuries, body temperature extremes, severe dehydration, the list goes on.
Exertional rhabdomyolysis is commonly caused by intense and prolonged exercise, with prolonged exposure to heat as another major factor. In 1995, ERM made up 47 per cent of approximately 26,000 rhabdomyolysis cases in the United States.
How does ERM happen?
An athlete faces an increased risk of ERM if they’ve become detrained. This occurs when an athlete takes a break from a training program for a number of weeks or months.
Athletes are at higher risk for ERM after being exposed to novel, high volume, intensive training. Loading strategies and exercise progressions should be carefully planned in order to avoid exposing the athlete to exercise stressors that he or she is ill prepared for.
Recognizing ERM is essential
Tracking training load using metrics such as ‘rate of perceived exertion’, is a simple strategy a coach can use to monitor how an athlete is adjusting to the practice schedule, especially after a break in training.
Another key measure of potential ERM is muscle pain. Muscle soreness post-workout is pretty common for athletes but according to Jay Armitage, a fitness buff who experienced rhabdo in 2014, ERM causes agony rather than a common soreness. When ERM occurs, the muscles break down releasing myoglobin, a binding protein, creatine kinase and electrolytes. This can cause kidney damage or even failure.
Coaching to prevent ERM
Mike Boykin is the sports science lead and sprint and hurdles coach at ALTIS, the elite training facility in Phoenix, Arizona. A professional coach of eight years, Boykin believes the best way to mitigate the risk of ERM is coach and athlete education and common sense.
“This is what a coach is there for, to not provide a load that’s outrageous relative to what the individual can handle,” said Boykin about ERM. “There have been a couple cases within the past few years with of different universities and athletes getting rhabdo, but you hear about Crossfit athletes getting it too. You often hear it in training-camp scenarios where there is a massive, inappropriate load pushed upon the athletes in a very short time period.”
While Boykin says that it’s uncommon for an individual to subject their body to this level of intense stress, athletes are more likely to expose themselves to a risk of ERM when pressured by external factors, like a coach. Coach education plays a part in preventing athletes from experiencing ERM.
“It’s not so much the coach helping the athlete avoid (ERM) as it is the coach just having some common sense,” said Boykin. “Plenty of people train athletes really hard and the athletes don’t get rhabdo. It’s those scenarios where they’re doing outrageous volumes of intensity of one or two specific movements targeting a specific area.”
Coaches should avoid encouraging athletes to perform repetitive exercises like push ups, burpees, and dips that fatigue one specific muscle group beyond reason.
Using Iris data to prevent an athlete from pushing too far
Michael Bawol is the sprint coach at Dalhousie University and a sports biomechanist at Canadian Sport Centre Atlantic in Halifax, Nova Scotia. He has been using Iris to track his athletes’ performance and gain genetic insights since September 2016.
Bawol has been coaching professionally for six years. “A big part of what I look at on a daily basis is the acute to chronic ratio in the Iris Coach app.”
The acute to chronic training load (A:C TL) ratio is a helpful way to quantify an athlete’s fatigue-fitness relationship. “One of the athletes that I coach has had a previous history of hamstring injuries and so one of the things that we wanted to look at this year was making sure he doesn’t go over the 1.5 acute to chronic mark,” said Bawol.
Dr. Tim J. Gabbett summarizes the A:C TL ratios’ relationship with increased risk to injury in the graph below. Gabbett’s accompanying article was originally published in the British Journal of Sports Medicine.
“So this year, I’ve been following that quite heavily with (the athlete) and he’s been completely injury free so far this year, which has been great because last year he had a lot of injury issues throughout the whole season which prevented him from having a successful season,” said Bawol.
Bawol was able to use Iris’ short and long-term trend analysis of his athlete’s perceived exertion, soreness, and more to adjust training volumes and thus keep his athlete moving toward the goals they set together.
When training any athlete, a coach is responsible for ensuring that safety and well-being are the top priority. While every coach wants to see their athletes succeed, they can only do so if they remain injury free during a grueling training and competition schedule. Using tools to monitor an athlete’s physical and mental state on a daily basis, along with consistent check-ins, is the most effective way to ensure each athlete is reaching their performance goals.
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