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Kelley D. Henderson, Sarah A. Manspeaker and Zevon Stubblefield

Key Points ▸ Diagnosis of exertional rhabdomyolysis includes a combined exam and laboratory findings. ▸ Exertional rhabdomyolysis during in-season tennis competition is rare. ▸ Return to activity following exertional rhabdomyolysis can occur swiftly OR in the middle of sport season if a progressive

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Michelle Cleary, Daniel Ruiz, Lindsey Eberman, Israel Mitchell and Helen Binkley


We present a case of severe dehydration, muscle cramping, and rhabdomyolysis in a high school football player followed by a suggested program for gradual return to play.


A 16-year-old male football player (body mass = 69.1 kg, height = 175.3 cm) reported to the ATC after the morning session on the second day of two-a-days complaining of severe muscle cramping.

Differential Diagnosis:

The initial assessment included severe dehydration and exercise-induced muscle cramps. The differential diagnosis was severe dehydration, exertional rhabdomyolysis, or myositis. CK testing revealed elevated levels indicating mild rhabdomyolysis.


The emergency department administered 8 L of intravenous (IV) fluid within the 48-hr hospitalization period, followed by gradual return to activity.


To our knowledge, no reports of exertional rhabdomyolysis in an adolescent football player exist. In this case, a high school quarterback with a previous history of heat-related cramping succumbed to severe dehydration and exertional rhabdomyolysis during noncontact preseason practice. We provide suggestions for return to activity following exertional rhabdomyolysis.

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John K. Su

Edited by Tracy Ray

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R. Mitchell Todd, Michelle Cleary and J. Susan Griffith

We present the case of an adolescent female collegiate distance runner competing in her first 6K race. She presented with multiple systemic symptoms of dizziness, nausea, confusion, muscle cramping, and syncope. The patient was immediately treated for heat stroke and, on follow-up, reported to the AT with a headache, lack of appetite, muscle aches, and dark-colored urine. Rhabdomyolysis should be considered following a heat illness event with necessary treatments performed immediately. Symptomatic patients must be referred to a physician for evaluation and laboratory testing. We present recommendations for a supervised return-to-participation protocol and acclimatization to safely return to competition readiness.

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Michelle A. Cleary

Column-editor : G. Monique Butcher

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Jeffrey Rosenberg

Edited by Katie Walsh

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Brendon P. McDermott, Douglas J. Casa, Susan W. Yeargin, Matthew S. Ganio, Lawrence E. Armstrong and Carl M. Maresh


To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).

Data Sources:

Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.

Study Selection:

Relevant peer-reviewed, military, and published text materials were reviewed.

Data Extraction:

Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.

Data Synthesis:

The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.


Future research should focus on developing a structured return-to-activity strategy following EHS.

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Lindsey Eberman, Leamor Kahanov, Thurman V. Alvey III and Mitch Wasik

Edited by Malissa Martin

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Johna K. Register, Jason P. Mihalik, Christopher J. Hirth and Thomas E. Brickner

Column-editor : Joseph J. Piccininni