13 Iowa Football Players with Rhabdomyolysis: A Case of Coaching Incompetence

Thirteen University of Iowa football players were recently hospitalized for rhabdomyolysis caused by extreme physical exertion. Symptoms of the ailment include dark-colored urine, fatigue, muscle weakness, and muscle tenderness. Although the athletes have since been released from the hospital, information has not been released as to whether any permanent injury has resulted.

Rhabdomyolysis is a serious medical problem. It occurs when myoglobin leaks out of muscle cells due alcoholism, crush injuries, heatstroke, extreme physical exertion and other causes. Just as hemoglobin in red blood cells carries oxygen to the muscles and other body tissue to provide energy through oxidation of carbohydrates and fats, myoglobin carries oxygen within the muscle cells to the mitochondria, which are the oxidative energy-production units within the cells. Myoglobin is a large molecule and, when it leaks into the blood stream, it travels to the kidneys for removal. However, the myoglobin molecules are too large for the kidneys to readily clear, and can easily block the kidney’s filtration system. In addition, myoglobin breaks down into potentially harmful compounds. Permanent kidney damage or even kidney failure may result, which may require lifelong dialysis or a kidney transplant. See the National Institutes of Health for further information on rhabdomyolysis.

Extreme muscle soreness brings with it with a significant risk for rhabdomyolysis. Virtually all muscle soreness is attributable to the eccentric phase of exercise, which occurs when the muscle is lengthened while resisting. This occurs in the lowering phase of every weightlifting or calisthenic repetition, and also in the initial ground-contact phase of running, particularly downhill running. It also occurs during the deceleration phase of sports activities, as in braking for directional change and bringing a moving limb to a halt.

There is no excuse for any strength and conditioning coach to induce rhabdomyolysis. The press has reported that the workouts of the Iowa football players were extremely severe and may have been used as a punishment. One athlete said, “I had to squat 240 pounds 100 times and it was timed. I can’t walk and I fell down the stairs.” Another one said, “Hands Down the hardest workout I’ve ever had in my life!”. In addition, the severe workout occurred just after the athletes returned from winter break, during which most of them had not engaged in heavy resistance exercise. That made them particularly vulnerable to extreme muscle soreness and rhabdomyolysis.

Such an approach is totally unnecessary. Firstly, exercise should never be used as a punishment. Secondly, any knowledgeable and competent coach has to be aware that any exercise regimen that induces extreme muscle soreness presents a significant risk for rhabdomyolysis. Muscle soreness is not a prerequisite for muscle strengthening! The most effective way to increase strength is to start with light resistance and gradually increase the weight lifted over a period of time as the muscles strengthen. High repetitions are totally unnecessary for strength and power athletes like football players. Muscle fatigue following a workout is expected and desirable within limits, but muscle soreness is unnecessary and can actually slow down progress in strength development.

An extensive article and interview of coaches, doctors, and a parent of one of the players is available on the Internet.