Page 19 - JSOM Summer 2018

His regimen consisted of: BFRR should allow the exerciser to receive the benefits of
• Inflate cuff standard high-load resistance exercise while performing low-
• Both leg standing calf raises: 30, 3  15 seconds with load exercise. It makes sense then, physiologically, that the re-
30-second break between sets stricted blood flow low-load exerciser will be at the same risk
• 30-second break for rhabdomyolysis as the high-load exerciser, while placing
• Single leg balance 3  30 seconds with 30-second break less stress on the joints. This should be considered a recog-
in between sets nized, though rare, adverse effect of BFRR. These patients may
• Deflate cuff present back to their therapist or trainer, to their primary care
• Rest 4 minutes provider, or to an ED, and all practitioners should be aware of
• Inflate cuff the practice and of the risks.
• Double leg seated calf raises with a toe raise: 30, 3  15
seconds with 30-second break between sets Acknowledgments
• 30-second break We thank Jason Steere, PT, DPT, University of the Puget Sound,
• Seated resistance band ankle eversion 3  15 seconds Tacoma, Washington, for his contribution to this work.
with 30-second break between sets
• Deflate cuff Disclaimer
This article is the opinion of the authors and by no means
He did not express any discomfort during or immediately after reflects either opinions or interests of the US Army, Madigan
the exercises, but he came to the ED after 2 days of pain, re- Army Medical Center, the DoD, or the US Government.
fractory to massage. This was the first and only BFRR therapy
session he underwent. Disclosures
The authors have nothing to disclose.
On presentation to the ED, patient’s calves were noted to be
tight and exquisitely tender to light palpation, and he had Author Contributions
worsening pain with passive dorsiflexion and plantarflexion at JK initially saw the patient in the ED and wrote the manu-
the ankle. We had concerns for both compartment syndrome script. DS provided detail on the therapy involved and read
and rhabdomyolysis. He was evaluated by the orthopedics and approved the manuscript. CW was the staff physician see-
service in the ED, who thought that he did not have com- ing the patient with JK, conceived of the manuscript idea, and
partment syndrome. His CK returned at 16,500U/L, and his read and approved the manuscript.
urine had trace blood without red blood cells, consistent with
a diagnosis of rhabdomyolysis. His initial urine myoglobin References
was 2400ng/mL. He was admitted to the hospital for intra- 1. Lowery RP, Joy JM, Loenneke JP, et al. Practical blood flow
venous hydration and electrolyte monitoring. His initial ala- restriction training increases muscle hypertrophy during a peri-
nine and asparate aminotransferase levels, respectively, were odized resistance training programme. Clin Physiol Funct Imag-
ing. 2014;34(4):317–321.
86/344U/L, increasing to 155/513U/L on hospital day 3, and 2. Gaddour B. The fastest way to make your muscles grow. In.
down-trending to 119/133U/L on recheck 3 days later. He was Men’s Health. Online 2016. https://www.menshealth.com/fitness
discharged after 3 days with CK of 1890U/L and urine myo- /a19534758/blood-flow-restriction-to-build-muscle/
globin of 91ng/mL at discharge. His creatinine was 0.8mg/dL 3. Wilson J. Your Complete Guide to Blood Flow Restriction Train-
on admission and remained unchanged during his hospital ing. 2017. https://www.bodybuilding.com/fun/your-complete-guide
course. -to-blood-flow-restriction-training
4. Hyson S. The 8 best exercises for blood flow restriction training.
In. Muscle and Fitness. Online. https://www.muscleandfitness.com
Discussion /workouts/workout-tips/blood-flow-restriction-training-plan
5. biolayne. Blood flow restriction training. In: YouTube; 2016.
We present a case of an active duty Servicemember who suf- https://www.muscleandfitness.com/workouts/workout-tips
fered from severe rhabdomyolysis after undergoing blood flow /blood-flow-restriction-training-plan
restricted resistance training as part of his rehabilitation after 6. Kacin A, Rosenblatt B, Zargi T, et al. Safety considerations with
an ankle injury. His case is classified as severe based strictly on blood flow restricted resistance training. Allanes Kiseiologiae.
2016;6:3–6.
the elevation of serum CK, but he had no decline in his renal 7. Iversen E, Rostad V. Low-load ischemic exercise-induced rhabdo-
function and he had an excellent recovery, consistent with the myolysis. Clin J Sport Med. 2010;20(3):218–219.
described literature regarding exertional rhabdomyolysis. 8. Tabata S, Suzuki Y, Azuma K, et al. Rhabdomyolysis after per-
forming blood flow restriction training: a case report. J Strength
To our knowledge, this is the third reported case of BFRR-in- Cond Res. 2016;30(7):2064–2068.
duced rhabdomyolysis, and it indicates that all patients are 9. Khan FY. Rhabdomyolysis: a review of the literature. Neth J
Med. 2009;67(9):272–283.
vulnerable. One of the previous cases describes an obese man 10. Huerta-Alardin AL, Varon J, Marik PE. Bench-to-bedside review:
with both BFRR therapy and concurrent bacterial infection rhabdomyolysis—an overview for clinicians. Crit Care. 2005;9
likely contributing to his presentation, but the other case in- (2):158–169.
volved an ice hockey player who was recovering from injury 11. Latham J, Campbell D, Nichols W, et al. Clinical inquiries. How
and had been training with his team for 2 months before un- much can exercise raise creatine kinase level—and does it matter?
dergoing BFRR. Our patient was not obese, deconditioned, or J Fam Pract. 2008;57(8):545–547.
sick with a concurrent bacterial infection and would not rea- 12. Alpers JP, Jones LK Jr. Natural history of exertional rhabdomy-
olysis. Muscle Nerve. 2010;42(4):487–491.
sonably have been expected to develop rhabdomyolysis from 13. Clarkson PM, Kearns AK, Rouzier P, et al. Serum creatine kinase
this training. levels and renal function measures in exertional muscle damage.
Med Sci Sports Exerc. 2006;38(4):623–627.

Rhabdomyolysis Due to Blood Flow–Restricted Resistance Training | 17