Insights by: Dr. Matthew Kornswiet, a pediatrician and pediatric sports medicine physician at Sea View Pediatrics, part of Rady Children’s Health, Orange County
Helping young athletes train safely
Whether they’re training for a marathon, gearing up for preseason conditioning or pushing themselves in the gym, many teens are taking on increasingly intense athletic challenges. While exercise offers tremendous physical and mental health benefits, there’s a rare but serious condition parents and athletes should know about: rhabdomyolysis, often shortened to “rhabdo.”
Though uncommon, rhabdomyolysis can affect even healthy, well-conditioned athletes who push their muscles beyond what they can safely handle. It has gained attention in recent years following reports linked to intense workouts, endurance events and competitive training.
So how can families tell the difference between normal post-workout soreness and something more serious? Dr. Matthew Kornswiet, shares what parents, athletes and coaches should know about rhabdomyolysis, including risk factors, warning signs and how young athletes can train safely.
What is rhabdomyolysis, and how does intense exercise sometimes lead to this condition?
Rhabdomyolysis, often called “rhabdo,” occurs when muscle tissue breaks down and releases proteins and other substances into the bloodstream. In severe cases, those substances can damage the kidneys and lead to serious complications.
While it’s normal for muscles to experience small amounts of damage during exercise, rhabdomyolysis happens when the level of muscle breakdown becomes more significant than the body can safely handle.
Many people associate the condition with extreme endurance events like marathons, but it can also occur during intense strength training, conditioning workouts and other strenuous activities. A teen athlete who suddenly increases training intensity, participates in an unusually demanding workout or jumps back into sports after time off may be at greater risk.
“Some muscle damage is normal with exercise. It’s actually part of how our muscles get stronger,” says Dr. Matthew Kornswiet. “The problem occurs when the amount of muscle damage is much greater than what our body is used to or can handle.”
One of the biggest misconceptions about rhabdomyolysis is that it’s simply extreme soreness after a hard workout.
“The important thing to understand is that rhabdomyolysis is not the same as being really sore after a workout,” Dr. Kornswiet says. “It’s a more significant breakdown of muscle tissue that can sometimes cause serious complications.”
Can teens and young athletes develop rhabdomyolysis?
Yes. Adults aren’t the only ones who can develop rhabdomyolysis after participating in extreme fitness challenges. It can affect children and teens, including healthy, well-conditioned athletes.
One of the biggest risk factors is increasing training too quickly, especially at the start of a sports season or when returning after an injury, illness or break from exercise.
“Even well-conditioned athletes can develop it if they push themselves beyond what their muscles are prepared to handle,” says Dr. Kornswiet.
Hot weather, illness and inadequate recovery can also increase risk. While dehydration is often associated with rhabdomyolysis, Dr. Kornswiet notes that it’s usually not the primary cause of muscle breakdown.
“Dehydration is not usually the primary cause of muscle breakdown,” he explains. “Instead, it can contribute to heat illness and make the kidney injury from rhabdomyolysis significantly worse.”
Certain medical conditions, medications and supplements may also play a role. Dr. Kornswiet notes that ADHD stimulant medications, isotretinoin (Accutane), excessive caffeine, energy drinks and stimulant-containing pre-workout supplements are all important considerations for young athletes engaged in intense training.
Ibuprofen (Advil, Motrin) and naproxen (Aleve), for example, do not typically cause muscle breakdown, but they can reduce blood flow to the kidneys and increase the risk of kidney injury, especially when an athlete is dehydrated. Children taking these medications can still safely participate in sports, but staying hydrated is especially important.
“The goal is to make sure we’re preparing their bodies for the demands we’re placing on them and recognizing when other factors may put them at increased risk,” he says.
How can young athletes reduce their risk of rhabdomyolysis?
One of the best ways to reduce the risk of rhabdomyolysis is to build up training gradually instead of making sudden increases in intensity.
“Our bodies are verry good at adapting to exercise, but they need time to do that,” says Matthew Kornswiet, MD.
Getting enough sleep, staying hydrated, eating well and allowing time for recovery are also important parts of training safely. Dr. Kornswiet recommends that teen athletes get 8 to 10 hours of sleep and take at least one or two days off from organized sports each week.
Athletes should also take extra precautions when exercising in hot weather.
“Athletes need time to adjust to exercising in hot weather, especially at the beginning of the season,” Dr. Kornswiet says. “This typically takes about 7 to 14 days, and coaches should gradually increase the intensity and duration of practices during that time.”
While hydration is important, it’s not a guarantee against rhabdomyolysis.
“I would also emphasize that staying hydrated doesn’t necessarily prevent rhabdomyolysis,” Dr. Kornswiet explains.
Young athletes who take medications that affect how the body responds to heat, including some ADHD medications, should be especially mindful during intense workouts and hot weather. Coaches can help, too, by encouraging athletes to challenge themselves while recognizing when it’s time to slow down and recover.
“We want athletes to work hard and challenge themselves, but there needs to be a balance between pushing them to improve and recognizing when they’re doing too much,” Dr. Kornswiet says.
When should athletes stop exercising and seek medical attention?
It’s normal to feel sore after a tough workout, especially when trying a new activity. But pain that seems unusually severe or continues to get worse is a different story.
“What concerns me is when the pain is much more severe than expected, continues to worsen, or is accompanied by significant swelling or weakness,” says Dr. Kornswiet.
Athletes should stop exercising and seek medical attention if they develop severe muscle pain, significant weakness, swelling, dark urine or decreased urination after strenuous activity. However, it’s important to know that not everyone with rhabdomyolysis develops dark-colored urine. Normal-colored urine does not rule out the condition, especially if an athlete is experiencing severe muscle pain, weakness or swelling after intense exercise.
“If an athlete is having that kind of pain, they should stop exercising and be evaluated promptly rather than trying to push through it,” Dr. Kornswiet says.
Some symptoms require immediate medical attention.
“If an athlete collapses, becomes confused, or has other signs of a serious heat-related illness, that’s an emergency. Call 911.”
Dr. Kornswiet says one of the most important lessons young athletes can learn is recognizing the difference between normal training discomfort and pain that signals something may be wrong.
“I always tell my athletes that the best athletes take the best care of their bodies,” he says. “Part of being a good athlete is knowing the difference between the normal discomfort of working hard and pain that tells you something may be wrong.”
What parents, athletes and coaches should remember
Rhabdomyolysis is uncommon, but it can happen to athletes of any age, including healthy, well-conditioned teens. While sports, exercise and strength training provide tremendous benefits, it’s important for young athletes to increase training gradually, prioritize recovery and pay attention to warning signs that seem unusual or severe.
As Dr. Kornswiet explains:
“The biggest takeaway for parents, athletes, and coaches is that there’s a difference between working hard and pushing your body beyond what it can safely handle. We want kids to be active and competitive, but we also want them to understand that stopping when something doesn’t feel right isn’t a sign of weakness, it’s actually a sign of strength.”
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