Exertional rhabdomyolysis in a collegiate american football player after preventive cold-water immersion: a case report.

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.

Sacral stress fracture in a distance runner.

Sacral stress fractures are uncommon injuries that are associated with repetitive load-bearing activities. The authors describe a 23-year-old male cross-country runner who presented with low back and buttocks pain. Radiographic findings were unremarkable, but a hop test identified a sacral stress fracture. The patient was instructed to stop running and to take calcium and vitamin D supplements. Four months later, his symptoms completely resolved and he began running again. The authors also present a review of the literature, which revealed that patients with sacral stress fractures are likely to have normal neurologic examinations and full active range of motions. However, they will likely describe discomfort with passive hip flexion. The authors recommend the hop test for patients with this type of history and these physical examination findings. If a sacral stress fracture is found, treatment regimens should consist of 4 to 6 weeks of rest with gradual return to activity.

Acute effects of The Stick on strength, power, and flexibility.

The Stick is a muscle massage device used by athletes, particularly track athletes, to improve performance. The purpose of this project was to assess the acute effects of The Stick on muscle strength, power, and flexibility. Thirty collegiate athletes consented to participate in a 4-week, double-blind study, which consisted of 4 testing sessions (1 familiarization and 3 data collection) scheduled 1 week apart. During each testing session subjects performed 4 measures in the following sequence: hamstring flexibility, vertical jump, flying-start 20-yard dash, and isokinetic knee extension at 90 degrees x s(-1). Two minutes of randomly assigned intervention treatment (visualization [control], mock insensible electrical stimulation [placebo], or massage using The Stick [experimental]) was performed immediately prior to each performance measure. Statistical analyses involved single-factor repeated measures analysis of variance (ANOVA) with Fisher's Least Significant Difference post-hoc test. None of the variables measured showed an acute improvement (p < or = 0.05) immediately following treatment with The Stick.