Page 107 - Journal of Special Operations Medicine - Summer 2015

An Ongoing Series

“It’s What Color?”

Joshua Banting; Tony Meriano, MD

CONCEPTS AND OBJECTIVES
The series objective is to review various clinical con- One of your team members, a 31-year-old man, comes
ditions/presentations, including the latest evidence on to see you. The hike into camp was a bit of a “hump”
management, and to dispel common myths. In the pro- and he is seeking medication for some muscle soreness
cess, core knowledge and management principles are en- in his legs. He explains that he was feeling out of shape,
hanced. A clinical case will be presented. Cases will be as the hike usually wouldn’t bother him. The recent pace
drawn from real life but phrased in a context that is ap- of the unit had made it hard for him to maintain his
plicable to the Special Operations Forces (SOF) or tac- regular fitness training routine. He is looking forward to
tical emergency medical support (TEMS) environment. these next few weeks “being away from it all” and get-
Details will be presented in such a way that the reader ting a chance to workout each day, he has even started
can follow along and identify how they would manage an aggressive “new” workout routine. Your physical ex-
the case clinically depending on their experience and amination findings are unremarkable and you provided
environment situation. Commentary will be provided him with some ibuprofen and ask him to check back
by currently serving military medical technicians. The with you the next day.
medics and author will draw on their SOF experience
to communicate relevant clinical concepts pertinent to The next afternoon, the same team member comes limp-
different operational environments including SOF and ing into the cabin. He complains of bilateral calf pain
TEMS. Commentary and input from active special op- that started after his morning workout. He explains
erations medical technicians will be part of the feature. that his workout involved “pushing himself” to perform
maximum repetitions with a series of leg exercises. He
Keywords: muscle, fatigue; muscle, soreness; rhabdomyoly- expected to be tired, but now describes his legs as feel-
sis; workout ing “wobbly.” He describes his calf pain as a dull ache,
which is minimal at rest but worsened with walking. He
does not recall injuring himself during the workout and
was otherwise feeling fine this morning. He tells you
Clinical Presentation: he feels a bit nauseous now, but denies any episodes of
Post-workout Muscle Fatigue and Soreness
vomiting, although he does mention skipping breakfast
this morning to spend more time working out. He has
Situation no prior medical illness or history of surgery.
After a long series of taskings and deployments, you find
yourself training with your unit on home soil in a moun- What Are Your Next Steps?
tainous region. You have brought with you medical sup-
plies for emergent use specific to the training activities, Post-workout muscle fatigue and soreness are certainly
as well as some basic clinical supplies to support your not unusual; however, this patient has presented at the
team for the next couple of weeks. Your team’s complex extreme of the spectrum. A focused history is always a
terrain training is progressing and the hours are pretty good start. Inquiring about any recent medical illnesses,
reasonable. Although you are semi-isolated, you are set medication or supplements, or recent injuries would be
up in a cabin and settling into a regular routine; some helpful. In addition, a more precise clarification of his
of the guys have even set up a make-shift CrossFit-style workout regimen and the degree of change from his
gym next to the cabin. regular routine would be helpful in assessing just what

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