Rhabdomyolysis

Voiceover

00:00

Welcome to The Beat—a podcast series from the COPS Office at the Department of Justice. Featuring 

interviews with experts from a varied field of disciplines, The Beat provides law enforcement with the 

latest developments and trending topics in community policing.

Jennifer Donelan

00:16

Hello. I'm your host, Jennifer Donelan, and today we will hear from Kelly Kennedy, Ph.D. She's the owner 

of an organization called Fit-to-Enforce. They teach law enforcement physical fitness trainers how to 

instruct exercise sessions for their departments and/or academies. And today we're going to be 

discussing rhabdomyolysis, which is when I first read the word I had never heard of it. So, Dr. Kennedy, 

please tell me: What is rhabdomyolysis.

Dr. Kelly Kennedy

00:44

Rhabdomyolysis is the rapid breakdown of skeletal muscle from extreme physical exertion. My 

background is in exercise science and my Ph.D. is in research. So, I had never heard of rhabdomyolysis. I 

have a master's degree and several certifications in physical fitness and it was brought to my attention 

in 2002 from a defensive tactics sergeant who saw it in an article published. And it wasn't something 

that was on the forefront of any curriculum that I had ever listened to in my formal education, but when 

I read about it I knew that it was something that was very rare and something that happened typically in 

military settings or in paramilitary settings and traditionally wasn't seen very often. In fact, if you do see 

it very often, then there's a huge problem.

Donelan

01:39

So, you said you first read about it in 2002. When did you first come across a real-life example?

Kennedy

01:46

I went on a vacation and when I came back I noticed one of the recruits was missing, so I asked them 

what happened and they said that he had to go to the hospital, that he had a problem with his kidneys.

And I said, "Well, do you know what the condition is called?" Because I had been teaching about this

unicorn for a long time but I had never seen it happen, I had never seen evidence of this in any of the 

training that I'd been associated with. It had been in the first week of the academy, typically it happens 

in the first two weeks, and it was rhabdomyolysis and that was his diagnosis. He had previously been 

very sedentary and they did a certain number of squats that evidently manifested for him in some 

damage to his skeletal muscle. So, he experienced some swelling of his joints and inability to move and 

just an inordinate amount of discomfort, and so they took him as a normal protocol and that was his 
diagnosis, so he was admitted. So that was the first time I'd ever had any experience with it and I always 

made sure that it was a part of the normal conversation when we were ever training any new 

instructors.

Donelan

03:09

Let's go a little more into that. Your interest on this subject is how it falls within the training of police 

officers and in training academies with law enforcement organizations. Again, this is just so fascinating. I 

consider myself a well-versed person in a variety of subjects especially in this day of Google and the 

Internet where basically any topic comes up, you'll Google it immediately, but again, this is something 

I've never even heard of. And the whole idea that it's caused by extreme physical exertion and physical 

fitness is such a big part of just the common lifestyle these days with everything from like spin classes to 

PDX or XP, those extreme workout classes that you read about and hear about or you participate in. So, 

just expand if you can a little more about how this is caused or what causes it or who may be at risk and 

how you may be at risk of it and just try to educate us more.

Kennedy

04:01

So, typically it will happen when you're doing unaccustomed or novel exercises in the first couple of 

sessions. It can happen during one session. A colleague of mine was telling me about a research study 

they were doing on a biceps curl. And they had a female, active female, college-age female come to be a 

subject in the study and she was doing muscle contractions to fatigue and she ended up with rhabdo 

just from doing it from her biceps. So, it can happen with small muscles or it can happen in a large 

number of muscles. Typically in an academy setting, it will happen in the first two weeks of physical 

activity when the recruits are unfamiliar with the exercises and when there's a high volume of exercises 

done. So, it's kind of a critical time for the instructors to know how to scale exercises properly. One of 

the issues that I believe is a contributing factor is the popularity, and there has been an increase since 

2008 in the number of hospitalizations of rhabdo. And this is likely due to just an increase in the 

popularity of workout styles that are short duration and very high intensity. They're very effective, they 

provide an unbelievable result, and they can make you really fit, and they can also damage the body 

when they're used at the wrong time in a training program. Typically this presents itself in recruits that 

have the highest amount of mental compliance with verbal instruction but a moderate amount of 

fitness. The best way to try to avoid it is to have really good scalable instruction in the first couple of 

weeks of training and having their instructors understand what the signs and symptoms are so that 

when someone does complain of it, they're able to kind of do a further inquiry to discover what could 

possibly be life threatening and send them to the hospital.

Donelan

06:10

Oh my goodness. This is just a fascinating subject and just to think that one exercise done intensely 

could cause something like kidney problems or kidney failure. I'm personally aware that if your kidneys 

go, you can crash and go extremely quickly like [finger snap] that. So, you know, it seems like there's 
personal knowledge, but it seems like there needs to be a lot of awareness raised with the instructors.

What is out there currently for instructors to be knowledgeable and compliant with recognizing this 

condition and what more may be needed especially in the area where you have your niche which is 

within the law enforcement training agency?

Kennedy

06:50

It doesn't happen frequently. It shouldn't happen frequently. But when it does happen, it can be life 

threatening. And we just need to be better aware that the condition exists. And the popularity of these 

types of high-intensity training styles, they influence the habits of instructors that are tasked with 

training their academies. So, we all are going to be influenced by our own experience and so when you 

pick the best fit instructor who might be very highly inspired by these amazing forms of training, they 

implement them too early on in the program and they can send somebody to the hospital and kill them. 

You know, and so, does that happen a lot? I don't think it happens a lot but when it does happen it is 

catastrophic. And so, if it is happening a lot, it is a red flag for the training program to make widesweeping changes.

And what I have found in the course of me lecturing throughout the country is that over time I have 

people say, "One person had a problem but it was a preexisting problem with his kidneys," and they 

later find out, no, that was rhabdo. And if they've had it once, they are more at risk of it happening 

again. So, I've heard stories of other people who have suffered from it before. They don't remember the 

name of it. They just know that it was something wrong with their kidneys when they were in the 

military and they ended up being fine later on. They go back into the academy and the same thing 

happens to them again. They still don't know the symptoms, they still don't know the signs, and they 

know, "Oh, it's something wrong with my kidneys. It must've been a preexisting condition," not realizing 

that it's from either sickle cell trait that is undiscovered or that they just don't have a great level of 

hydration and they're not aggressively rehydrating and trying to scale their workouts accordingly.

When it comes to a law enforcement training perspective, it's difficult to get that information out there, 

to let them know that this is also something that can happen. It's another layer of complexity that we 

have to look at and just use that filtering system to keep screening all of our candidates. And it can 

happen in a specialized unit as well. So, the expectation is that in a specialized unit you will have a shortduration, high-intensity school. It takes two weeks to adjust yourself to any novel or unaccustomed 

exercise. So, the issue isn't necessarily that it's always the instructor's fault. The issue is we need to be 

better prepared to identify the signs and symptoms of when it does present itself so that we can help to 

save lives.

Donelan

09:35

And real quick, just to define for some of our listeners that might not know what exactly it means, what 

is scaling exercise.
Kennedy

09:42

Okay. So, scaling an exercise means that if I can do 100 push-ups, that doesn't necessarily mean that at 

the beginning of an exercise program that I can take a group of 40 people and expect them to do the 

same thing. If I just do 100 push-ups at my pace and I expect the entire class to be able to do 100 pushups at my pace and rest as they need, there is a certain subsection of that class that will push 

themselves beyond what they feel is comfortable and sometimes they will compromise their own safety 

to do so. And scaling an exercise means that you have to have enough experience to be able to observe 

the effect that these exercises are having so that when people start breaking form and their repetitions 

start getting ugly or they start changing the muscles that they're supposed to be using, that they have to 

recalibrate themselves and get back into the right position in order to keep going.

Donelan

10:45

Interesting. Do you have a recent real-life example that would help educate our listeners more about 

the conditions and maybe things to watch out for or something that would educate them more about 

this?

Kennedy

10:55

I do. Last year I had somebody approach me that thought I was a nutritionist after giving a lecture on 

proper exercise and footwear and proper training techniques as well as sports nutrition. So, I was talking 

to them about hydration and pre- and post-workout nutrition. So, at the end of that block of instruction, 

one recruit asked me if, why he was having trouble eating and so I said, "Well, tell me what you mean 

why you're having trouble eating?" And he said, "Well, yesterday I was unable to eat my lunch. I usually 

have a strong drive to eat but I couldn't eat my lunch. And then after work I went and got some more 

food and I couldn't eat it. So, this morning I started vomiting water." And I said, "You know, you could be 

dehydrated. Have you been drinking water?" And I knew that this was in the first week of the academy.

He was at, and any time you're asking these questions, I'm going down the list of do you have any 

stiffness in your muscles, do you have any swelling of your joints, have you had a change in your urine 

output—so, reduced urine output, no urine output or a darkened color of your urine. Using that as an 

example is usually the one that people remember but it only happens in a certain percentage of people 

who actually develop rhabdo, so it's not the only marker but it's the one that most people remember.

And so, he said that he did have a darkened color of his urine, that it had been that way for three days 

and that he had been drinking beet juice. And beet juice can sometimes change the color of your urine, 

so it was difficult for him to discern what that was from, he attributed it to the beet juice. And I felt like 

he had enough signs and symptoms to screen him into the hospital and I thought that he needed to be 

looked at by a physician and he was admitted for two weeks and three days and he was released only to 

be able to do outpatient dialysis for an additional two months.
Jennifer

13:08

Oh my gosh.

Kennedy

13:09

By the time he got to the hospital— and he felt fine, his physical presentation was fine, he had no pain, 

his instructor felt he looked fine and neither of them felt like he needed to go to the hospital, I felt like it 

was, he had enough of the signs and symptoms to flag him for the possibility of this. He ended up not 

having sickle cell trait but he, when he got to the hospital they said that his system was not functioning 

any longer and that he could have died within hours. So, vomiting is one of like an extreme example of 

what can happen when your kidneys stop functioning.

Donelan

13:55

So, so this is really important. If any of our listeners want to find out more information about this, is it 

appropriate for them to contact you?

Kennedy

14:02

Yeah. They can e-mail me.

Donelan

14:05

And that would be at kelly, K-E-L-L-Y, @Fit-to-Enforce.com?

Kennedy

14:18

Yes.

Donelan

14:19

Fantastic. We will list that on our appropriate materials that go along with this podcast. For our listeners 

out there, are there any closing thoughts you might have.

Kennedy

14:22

I think that it's important just to use all of the resources available so that they can constantly make 

themselves aware when they learn about something that they could to improve the quality of training.

Even if they think that it's never happened, the moment that they read all of the signs and symptoms 

and they know that people can be hospitalized or have some sort of dialysis from this, that maybe they 

can go back and think, "Has this really ever happened to us?" Because it probably has. If they're working 

in an academy setting, it's probably surfaced at least once or twice if they have a lot of volume. So, I just 
think that it's great to keep kind of sharpening your skills and trying to improve the quality of training 

that we have to offer to all of our budding law enforcement academies.

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16:15

The opinions contained herein are those of the authors and do not necessarily represent the official

position or policies of the U.S. Department of Justice. References to specific agencies, companies, 

products, or services should not be considered an endorsement by the authors or the U.S. Department 

of Justice. Rather, the references are illustrations to supplement discussion of the issues.