Thirteen University of Iowa football players remain hospitalized after becoming ill with what the university says is a little-known muscle syndrome called rhabdomyolysis. Rhabdomyolysis occurs when muscle is destroyed and the pigment in it that makes it red, called myoglobin, gets into the kidneys and can damage them.
At a press conference on Wednesday, a spokesman said it's unclear how the students developed the condition.
"The causes of rhabdomyolysis are extensive. There may be a hundred different causes for this problem," said Dr. John Stokes, director of Division of Nephrology at the University of Iowa. He is not involved in the care of the players. "When it occurs in young, otherwise healthy individuals, one of the common scenarios we look for is a recent exercise."
Stokes said that it's unusual for so many people with different body types and genetic predispositions to come down with rhabdomyolysis at once. Although it attacks the kidneys, the condition almost always goes away.
"It does appear to be a little unusual, but apparently the common denominator for each of these individuals had to do with the fact that they were undergoing a workout, a heavy exercise program, and heavy exercise is known to produce this syndrome," he said.
Paul Federici, the director of football operations at the University of Iowa, said at the press conference he didn't know the exact structure of players' workouts, but said there were breaks and also plenty of water available.
When asked whether players may have been taking dietary supplements, some of which can cause rhabdomyolysis, Federici said he didn't know if they were taking any, and if they were, they are only allowed to consume substances that meet NCAA compliance. Rhabdomyolysis can be also caused by certain medications, such as statins to lower cholesterol.
Biff Poggi, the father of one of the players, said his son experienced a lot of soreness, but is doing better. He said his son complained of pain on subsequent days after different workouts, at least one of which included a lot of squats. As a father, he said he's concerned about his son and his training, but he's also a football coach and said the workouts don't seem unusual to him.
"This time of year if you're a football player is the time where you're doing the most kind of strenuous work, kind of preparing for spring practice," Poggi said. "These kind of workouts would happen."
Majority of People Recover From Rhabdomyolysis
Experts say rhabdomyolysis can occur after extremely strenous exercise or after some sort of crushing injury that causes muscle to die.
"When you exercise, the muscles secrete potassium to help blood flow to those muscles to help get them the oxygen that you need," said Kate Mone, a sports nutritionist at the Cleveland Clinic. "Now, if you're doing continuous, repetitive bouts of exercise strenuously, your muscles are going to deplete that potassium. There won't be as much blood flow to those muscles and those muscles are going to begin to break down."
Although the myoglobin that's released after muscle death can cause kidney damage, rhabdomyolysis rarely leads to death or lifelong complications.
"Most people will recover no matter what, even if kidney damage is so severe that they need dialysis," said Dr. Lewis Teperman, director of transplantation at NYU Langone Medical Center in New York.
"It's treated early on by flushing the system with lots of fluid, and then people will alkalinize the urine and make it basic so deposits don't hurt the kidney as much," said Teperman.
While heavy exercise and trauma can lead to the condition, some medications can also cause it in a small number of people.
"High doses of drugs like statins are associated with this problem, especially among people with diabetes, or people who are organ transplant patients that take medications that interact in a way that increse the risks of getting rhabdomyolysis," said Dr. Bryan Becker, a spokesperson for the National Kidney Foundation.
Condition Can Be Mistaken For Other Illnesses
Experts say the condition is neither common nor uncommon. They see cases of it every year, but more often in the summer because lots of strenuous exercise in the heat.
Symptoms include extremely sore muscles and tea-colored urine. It can sometimes be mistaken for other illnesses that cause muscle aches, such as the flu. A blood test is generally the only way to distinguish rhabdomyolysis from other conditions.
Specialists strongly recommend getting enough hydration before, during and after workouts. Athletes should also take adequate breaks during training. They should also eat certain types of foods.
"A peanut butter and jelly sandwich, [or] a regular granola bar with a little bit of milk or cereal and milk, just before exercise. Or even just a handful of peanuts or pretzels., that would be fine," said Mone. "And after a workout, again, within 30 minutes of that workout you should refuel appropriately with something like chocolate milk or a balanced meal that's going to have carbohydrate, protein, and fat."
Federici said workouts have resumed for the other players, but he said he's not sure if the training regimen will change.
The Iowa Board of Regents, the governing body for five public education institutions including the University of Iowa, requested a 90-day investigation what caused the illnesses.
"The primary aim of this analysis will be to identify, to the extent possible, the root causes of this incident in order to create and implement effective preventative measures to ensure this does not happen in the future," the board said in a statement.