Rhabdomyolysis, a Recent Concern in Safety during Training

Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to the release of contents from the cells into the bloodstream; it is a scary name when heard for the first time, causing different reactions after the meaning is explained. The matter has been a topic of research by professionals involved in sports medicine, such as physical training instructors and combat trainers from major military training centers around the world.
WRITER-ID | 26 June 2013

Trainees at the Brazilian Jungle Warfare Training Center’s jungle operations course in Manaus, in the Brazilian Amazon, need to be constantly hydrated to avoid Rhabdomyolysis. (Photo: Ret. Col. Fernando Montenegro)

Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to the release of contents from the cells into the bloodstream; it is a scary name when heard for the first time, causing different reactions after the meaning is explained. The matter has been a topic of research by professionals involved in sports medicine, such as physical training instructors and combat trainers from major military training centers around the world.

The simple explanation for non-experts is that it is a syndrome characterized by muscle cell rupture that may occur during strenuous physical activity. When the person is either dehydrated or deprived from drinking water in extreme heat, their kidneys may stop working, leading to death. Members of the military are the more commonly affected population by Rhabdomyolysis.

Rhabdomyolysis caused a significant percentage of Soldiers’ deaths, hospitalizations, or cases in which they had to leave their training drills during combat in the military in the last 10 years. It is known that combat training military activities require physical fitness and periodic training. During this self-improvement process, which includes obstacles and intense exercise, it is essential that individuals remain hydrated and any intake of supplements must be followed by qualified professionals (doctors or nutritionists), in addition, of course, to alcohol or drugs being prohibited. Military trainings, especially combat classes conducted in tropical countries, require special attention to temperature, hydration opportunities for students and, during more critical outdoor activities, the elaboration of an efficient evacuation plan via a mobile motorized or airborne ICU.

Many variables may elevate the risks of accidents due to high temperatures, especially the following:

• Individual over 40 years of age;

• History of past accidents caused by high temperatures;

• Skin problems that may interfere with sweating functions, such as burns or rashes;

• Consumption of alcohol less than 24 hours prior to the activity;

• Consumption of food supplements without medical guidance;

• Use of drugs and/or supplements (allergy or cold medications, or pills containing ephedra, etc.);

• Obesity or overweight;

• Health problems such as diarrhea, virus, vomit, nausea;

• Poor physical condition;

• Exposure to two or three days of heat, intense physical activity, sleep deprivation, lack of water or rest;

• Non-acclimation to heat, especially in the Amazon region (less than 10 or 14 days of aerial activity).

Incidents that lead to trauma may also cause Rhabdomyolysis, such as: crushing; multiple fracture or long-term immobilization.

The following are among the main clinical signs and symptoms:

• Muscle pain (variable intensity);

• Dark urine (myoglobinuria);

• Muscle enzymes (CK) elevation;

• Muscle edema (swelling);

• Muscle weakness (advanced cases);

• Mental confusion (ARF)

Among the treatment methods, the most common and simple is vigorous hydration.

Therefore, it is important that all trainers are properly familiarized with the issue and that training conditions are planned based on scientific methods and that there are prearranged resources to identify and control such problems in a timely manner. On the other hand, students must be aware of the risks mentioned above to mitigate the possibility of incidences of the syndrome.

*Retired Colonel Fernando Montenegro – Brazilian Army Special Forces –the head of the Education Department of the Brazilian Jungle Warfare Training Center (CIGS), coordinator/instructor of the Command Actions courses and the Operations and Survival Actions courses in the Brazilian dry forest – Caatinga (COSAC).

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