• muscle breakdown

  (Rhabdomyolysis) often occurs with runners who suddenly increase their training intensity.

  Exercising or strenuous exercise, such as running marathons, competing in high-intensity sports events and for much longer than you used to training, dehydration

• Athletes should weigh themselves the next day after a long distance run.

  If weight loss exceeds 2% of total body weight

  or notice significant weight gain

  May indicate residual electrolyte imbalance.

  or other health problems

• Knowledge, practice and proper drinking water

  will help trail runners

  ultra runner

  and long distance runners

  To avoid muscle breakdown, the important thing is to listen to your body.

  If you see any warning signs, you should see a doctor immediately.

2009, at the 100-mile (160 km) Western States 100-Mile Endurance Run (WS100), held in Squaw Valley, California.

Five of the 400 contestants were hospitalized for nausea, confusion, and low blood sodium levels.

and muscle breakdown

including the first signs of renal failure

The same year, four athletes competing in the 95-mile West Highland Way Race in Scotland finished with low blood sodium levels and kidney problems caused by muscular dystrophy.

in Thailand

There was also a case like this.

Not long ago, there was a foreigner joining a trail running in Koh Chang and suffered a Heat Stroke until kidney failure and muscle breakdown.

in a coma

request for blood donation

In addition, other exercises

can also cause muscle breakdown as well

especially intense exercise

Popular ones include P90X, CrossFit and Insanity Workout.

Get to know Muscular Dystrophy

Reported that about 25,000 cases of muscular dystrophy in the United States are found each year, with up to 5-30% having acute renal failure and accounting for 15% of all acute renal failure cases.

Muscular breakdown can occur at any age.

but mostly found in males

African-American ethnicity

people with obesity

and over 60 years of age with a mortality rate without renal failure of about 20% and deaths of up to 50% for patients with acute renal failure from muscle breakdown

Interestingly, 10 - 30% of cases of muscle breakdown

is caused by a muscle injury

caused by exercise

broken muscles

What is rhabdomyolysis?

broken muscles

Rhabdomyolysis is a serious medical condition.

in which muscle breakdown occurs as a result of direct injury to the muscle

or from intense muscle exertion

Especially long distance running and downhill running. In addition, muscle breakdown is caused by pressure from an accident.

including the effects of certain drugs and genetics

heat, dehydration, and extreme exercise or sports

It is the most common cause.

when injury

striated muscles

(Skeletal muscle is the most common type of muscle, about 40% of body mass, and is responsible for movement in various activities.) It releases the protein myoglobin (Myoglobin), which is large, red.

serves to store oxygen in the muscle cells

Including releasing the enzyme CK (Creatine kinase: CK), which cells

Used to help in work and release minerals such as potassium, calcium when myoglobin protein

CK enzymes and minerals

leak from damaged cells into the bloodstream

leading to many complications such as arrhythmias

cardiac arrest and renal failure

Cause of Muscular Dystrophy

(Rhabdomyolysis)

Causes of Muscular Dystrophy

Can be divided into 2 major types as follows

1. Physical causes

• A runner who suddenly increases the intensity of his training.

  after a period

  Improve physical condition, such as recovering from illness

  or a break from training

• Exercising or strenuous exercise, such as running a marathon

• Competing in sports at a more intense level and longer than you used to train a lot.

• Training or competing while dehydrated

  on a very hot day

  or hypothermia for a long time

• Crush injuries such as car accidents, landslides

• Ongoing seizures, such as epilepsy

  
  

2. Non-physical causes

• Effects of taking statins

  To reduce cholesterol, antihistamines, anti-nausea drugs

  and psychiatric drugs

  These include pain relievers and non-steroidal anti-inflammatory drugs (NSAIDS).

• viral illness

  or bacterial infection

  endocrine problems

  electrolyte imbalance

• Genetic Disorder

• muscular ischemia, such as long-term bedridden conditions

• drinking alcohol

• Surgery or receiving general anesthesia

Warning signs of muscle breakdown

Sore muscles after running

The basic symptoms associated with muscular dystrophy include muscle pain, weakness, and decreased urination.

or urine colored with coke

There are also other symptoms.

which may show up after exercise for up to 24 - 48 hours, for example

• abnormal heart rate

• joint pain

• confused

• elevated body temperature

• Nausea, vomiting

• dehydration

• stomach ache

• CK enzyme increased 5-10 times from normal level

  (Can only be measured by blood test)

Diagnosis of Muscular Dystrophy

(Rhabdomyolysis)

Despite muscle pain, weakness, and coke-colored urine

It is a characteristic of muscular dystrophy.

But more than 50% of patients do not have these symptoms.

Muscle pain is the most common symptom.

and is found in about 50% of adults with muscular dystrophy

While coke-colored urine is found in about 30 - 40%, weakness often involves nearby muscle groups.

There may not be specific symptoms such as muscle pain, stiffness, muscle swelling, dizziness, abdominal pain, nausea, palpitations, and fever, depending on the cause of myopathy.

The blood effect of musculoskeletal is an elevated CK level (normal CK level is 20 to 200 IU/L), a level that is at least 5 times higher, or an increase in the thousands or tens of thousands.

It's considered a muscle breakdown.

tissue breakdown

This causes changes in electrolytes such as potassium, phosphate and calcium levels.

Your doctor may perform additional laboratory tests, such as a complete blood count.

Check the functioning of the metabolic system.

liver function test

urine analysis

Electrocardiogram (EKG) and chest x-ray

In addition, if it is a hereditary muscle breakdown

Family members should also be screened.

Muscular Dystrophy Treatment

(Rhabdomyolysis)

in patients with traumatic muscular dystrophy

Should start with saline as soon as possible.

Delay in resuscitation may result in hypovolemic shock. Fluids up to 10 to 20 liters should be administered to maintain intravascular fluid and aid urinary excretion.

when the patient is hospitalized

Close monitoring of urine output is important.

including daily continuous monitoring of CK levels

Muscular breakdown is also related to kidney function.

Potassium, calcium, uric acid and phosphate imbalances are essential to maintain a balanced electrolyte level.

other types of care

proper use of antibiotics

In case of concomitant infection

changes in diet

May improve hereditary muscular dystrophy

patients with musculoskeletal disorders

They should be educated about risk factors and how to reduce them.

prevention of muscle breakdown

for long distance runners

• Make an appropriate water intake plan.

  Trail runners, in particular, should test their hydration plan during training.

  to find the best individual strategy

• Avoid increasing the intensity of exercise.

  or sudden training

• Avoid racing or intense training while you are sick.

• 24 hours after trail running

  or long distance running

  It is important for drinking water.

  dining

  This includes drinking water that contains electrolytes such as sodium, potassium, magnesium and calcium, fresh fruits and vegetables.

  which helps in replacing electrolytes

  and is also rich in antioxidants

  to assist in preserving other essential tissues

• Talk to a health care professional.

  About the risk of muscle breakdown

  related to the training and medication used

• Athletes should weigh themselves the next day after a long distance run.

  If weight loss exceeds 2% of total body weight

  or notice significant weight gain

  consult a doctor

  This may indicate an imbalance of residual electrolytes.

  or other health problems

• Many athletes weigh themselves before and after training to assess total fluid loss versus training transitions.

  to determine the amount of water that should be received

• Some experts advocate using the feeling of thirst as a dictator of drinking.

  More than drinking the amount recommended by scholars.

• And many other experts recommend paying attention to the amount and color of your urine.

• With awareness, training and proper hydration, trail runners, ultra runners

  and long distance runners

  can avoid serious consequences

  or death from muscular dystrophy

• The important thing is to listen to your own body.

  If you see the warning signs of muscle breakdown, you should see a doctor immediately. 

Reference

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515789

• https://www.ncbi.nlm.nih.gov/books/NBK448168

• https://www.aura.asn.au/rhabdomyolysis-a-big-word-with-an-ugly-meaning-for-ultra-runners

• https://ultrarunningcom/features/running-rhabdomyolosis-and-renal-failure-whos-at-risk

• https://www.irunfar.com/break-it-down-exertional-rhabdomyolysis-in-ultramarathons

• https://www.trailrunnermag.com/nutrition/race-day-nutrition-nutrition/warning-signs

Article by : Dr. Akanit Srisukwatana, cardiologist

Specialist in Sports Cardiology, Samitivej Srinakarin Hospital