Document Detail

Exertional rhabdomyolysis in a collegiate american football player after preventive cold-water immersion: a case report.
MedLine Citation:
PMID:  22488291     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion.
BACKGROUND: A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids.
DIFFERENTIAL DIAGNOSIS: Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis.
TREATMENT: The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L).
UNIQUENESS: The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis.
CONCLUSIONS: In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.
Leamor Kahanov; Lindsey E Eberman; Mitchell Wasik; Thurman Alvey
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of athletic training     Volume:  47     ISSN:  1938-162X     ISO Abbreviation:  J Athl Train     Publication Date:    2012 Mar-Apr
Date Detail:
Created Date:  2012-04-10     Completed Date:  2013-01-15     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  9301647     Medline TA:  J Athl Train     Country:  United States    
Other Details:
Languages:  eng     Pagination:  228-32     Citation Subset:  IM    
Department of Applied Medicine and Rehabilitation, Indiana State University, Student Services, Room 201, Terre Haute, IN 47805, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Cold Temperature / adverse effects*
Creatine Kinase / blood
Muscle Cramp / etiology
Physical Exertion*
Rhabdomyolysis / etiology*,  therapy*
Young Adult
Reg. No./Substance:
EC Kinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Left ventricle fibrosis associated with nonsustained ventricular tachycardia in an elite athlete: is...
Next Document:  Application of statistics in establishing diagnostic certainty.