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Jenna Morogiello and Rebekah Roessler

Key Points ▸ First case report of exertional rhabdomyolysis (ER) in a noncontact intramural sport. ▸ Early recognition and treatment is crucial to prevent potentially fatal complications. ▸ Recreational sports pose a unique challenge for health care professionals. ▸ Highlights the need for athletic

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Kadhiresan R. Murugappan, Michael N. Cocchi, Somnath Bose, Sara E. Neves, Charles H. Cook, Todd Sarge, Shahzad Shaefi, and Akiva Leibowitz

failure in the setting of hemodynamic instability and multipressor shock. Empiric antibiotics and hydrocortisone were administered. The patient was diagnosed with severe exertional rhabdomyolysis with pigment-induced renal failure likely related to profound volume depletion. Despite the maximal supportive

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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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Jeffrey Rosenberg

Edited by Katie Walsh

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Michelle A. Cleary

Column-editor : G. Monique Butcher

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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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Beau Kjerulf Greer, John L. Woodard, Jim P. White, Eric M. Arguello, and Emily M. Haymes

The purpose of this study was to determine whether branched-chain amino acid (BCAA) supplementation attenuates indirect indicators of muscle damage during endurance exercise as compared with an isocaloric, carbohydrate (CHO) beverage or a noncaloric placebo (PLAC) beverage. Nine untrained men performed three 90-min cycling bouts at 55% VO2peak. Subjects, blinded to beverage selection, ingested a total of 200 kcal of energy via the CHO or BCAA beverage before and at 60 min of exercise, or they drank the PLAC beverage. Creatine kinase (CK), lactate dehydrogenase (LDH), isokinetic leg-extension and fexion torque, and muscle soreness were assessed before and immediately, 4 h, 24 h, and 48 h post exercise. The trials were separated by 8 wk. CK activities were significantly lower after the BCAA trial than in the PLAC trial at 4, 24, and 48 h post exercise, as well as lower than the CHO beverage at 24 h post exercise. CK was lower in the CHO trial at the 24- and 48-h time points than in the PLAC trial. LDH activities were lower in the BCAA trial at 4 h than in the PLAC trial. As compared with the CHO and PLAC trials, ratings of perceived soreness were lower at 24 h post exercise, and leg-fexion torque was higher at the 48-h time point after the BCAA trial. The present data suggest that BCAA supplementation attenuates muscle damage during prolonged endurance exercise in untrained college-age men. CHO ingestion attenuates CK activities at 24 and 48 h post exercise as compared with a placebo beverage.