Twenty-four football players from the McMinnville High School team were sent to the hospital early in August suffering from swelling and muscle pain in their upper arms. Three athletes were hospitalized needing emergency surgery for their upper arms to relieve the pain and the pressure restricting blood flow to the forearm and hand.
Acute Compartment Syndrome
Acute cases of compartment syndrome are seen in sports, but rarely after a workout. Most acute compartment syndromes are seen in the lower legs as the result of a severe blow (as seen in soccer). The blow results in damage to the capillaries within the muscle compartments of the lower leg, creating increased swelling and pressure. The swelling within the muscles causes pressure on the blood vessels and restricts the blood flow to any area below the injury.
Acute compartment syndrome is relieved by surgically opening the skin and fascia that surrounds the muscle to relieve the pressure. Once the pressure is relieved, the blood flow can be restored to the extremities.
The question to be answered is “How did so many athletes from one team end up with the same condition?” Initially, suspicion was focused on the possibility that the athletes took creatine supplements. However, this was dismissed after interviews and blood tests.
Rhabdomyolysis: Physiological Result of Severe Muscle Damage
Rhabdomyolysis is defined as the rapid destruction of skeletal muscle resulting in the loss of the muscle protein myoglobin in the urine and is the result of severe muscle damage. Myoglobin is released when the skeletal muscle is destroyed.
Another enzyme known as creatine phosphokinase (CPK) is released by muscles when they are damaged and can be measured if rhabdomyolysis is suspected. Normal levels of CPK in the blood are between 200 and 2,000.
The three athletes that needed surgical releases had CPK levels of over 40,000 (Abcnews.com, 2010). The additional nine athletes who were hospitalized had levels of between 3,000 and 40,000.
The causes of rhabdomyolysis are many but include the following:
- muscle trauma or crush injury
- physical torture or child abuse
- severe muscle contractions from prolonged seizures
- extreme physical activity (running a marathon)
- venom from certain snake bites
According to a New York Times article (Thomas, 2010), “heat and dehydration can help trigger rhabdomyolysis.” It is interesting to note that the players became ill after intense upper body workouts in a hot weight room focused on the same muscle group: triceps.
The athletes performed intense, short-duration repetitions of chair-dips followed by push-ups as a “team-building” exercise. The likely problem was that both of these exercises rely on the triceps as the primary muscle involved for extension of the elbow.
According to a report by the Associated Press, if the exercises were done incorrectly, the entire exercise had to be repeated. The report stated that the team spent 20 to 25 minutes performing the exercises and did not have water available to them (Sports.espn.go.com, 2010).
Triceps Brachii Compartment Syndrome
Because triceps compartment syndrome is so rare (only 10 cases reported in the medical literature), an outbreak of this magnitude should draw attention from the sports medicine and athletic community. While the parents of the football players deny that the athletes’ training had anything to do with the incidents of triceps compartment syndrome, one medical expert disagrees.
According to Dr. Stephen G. Rice, director of Jersey Shore Sports Medicine Center in Neptune, New Jersey, “This is a textbook case of overexertion in insufficiently conditioned athletes” (Abcnews.com, 2010). Perhaps, first year coach Jeff Kearin’s “total immersion” football camp was too much for this group of athletes.
Preventing Exertional Compartment Syndrome in Athletes
Care must be taken when working with athletes to ensure that they are properly hydrated during conditioning training, especially if the ambient temperature is high or they are in a room that is not air-conditioned. Second, care should be taken when designing a conditioning program to alternate muscle groups when performing intense works so that one muscle group is not damaged.
The prognosis for these athletes was good because the condition was recognized and quickly treated to prevent more serious complications. Because the athletes received immediate medical attention when their symptoms began to increase, none of them suffered from irreparable damage (i.e., kidney failure).
References:
Abcnews.com, “Creatine a Culprit in Oregon Compartment Syndrome Cases?”, Accessed on October 19, 2010.
Abcnews.com, “Mystery Illness Strikes 12 High School Football Players”, Accessed on October 19, 2010.
Cbsnews.com, “Compartment Syndrome: Rare Disorder Tackles Oregon Football Team”, Access on October 25, 2010.
Komonews.com, “Officials Can’t Pinpoint Cause of Football Players’ Mass Illness”, Accessed on October 25, 2010.
Lubbockonline.com, “Cause of High School Players’ Ailments Unknown”, Accessed on October 25, 2010.
Medicinenet.com, “Rhabdomyolysis”, Access on October 25, 2010.
Nytimes.com, “Muscle Injuries Rattle an Oregon High School”, Accessed on October 25, 2010.
Sports.espn.go.com, “All High School Players out of Hospital”, Access on October 25, 2010.
Terry Zeigler - Educating through writing with over twenty-five years of experience as a Kinesiology Professor and Certified Athletic Trainer.
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