Issue link: https://www.massageandbodyworkdigital.com/i/329694
44 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 4 PATHOLOGY PERSPECTIVES The most extreme example of muscle injury- related kidney damage is called rhabdomyolysis, which can be life-threatening. It isn't common, but it needs to be on the radar of extreme exercise enthusiasts and anyone who treats them. Signs and symptoms of this medical emergency include a tender, weak affected muscle, along with dark red or brown urine. Rhabdomyolysis patients need medical treatment immediately, and it may be a prolonged period before they can resume physical activity. IMPLICATIONS FOR MASSAGE THERAPY Massage therapists are health-care advocates, and it is reasonable for our clients to turn to us for good advice. This puts us in a tight spot when our client— who we know has real problems with low-back stability, or knee pain, or high blood pressure—tells us how excited he is to be starting a demanding exercise program. While our unspoken thought might be, "Are you nuts?" our more measured reply needs to acknowledge the client's desire to work for good health, and offer our strictly within-scope advice for how he might safely achieve his goals. One of the most important pieces of advice we can offer is for clients to fully evaluate the trainers or leaders of the exercise program they want to start. Poorly educated leaders appear to be a major factor in injury risk: they can miss signs of poor form and posture, or they can specifically coach a person to go too far, in the belief that they are being appropriately challenging. It is also critical that the client report any known medical conditions (an old herniated disc, a history of knee surgery, etc.) to the class instructors, in case they need to make special accommodations. Not surprisingly, evidence suggests that aging is associated with longer healing times for basic muscle injuries. But it was also found that among ultra-distance runners, younger, less-experienced athletes sustain more injuries than their older cohorts. This illustrates the importance of careful training and appropriate building up to any demanding physical activity. Most of the injuries that were studied in runners were fairly minor and mostly related to knee problems or stress fractures in the feet. They led to a decrease in training days, but not in significant lost work time or hospital stays; they were not typically reported to primary care providers. This is appropriate, since most doctors can do little for minor musculoskeletal injuries beyond suggesting anti-inflammatories and temporary rest: a strategy we can do for ourselves. One exception to this rule occurs when muscle injury coincides with kidney damage. This can happen in a few different ways, but the basic sequence is when muscle damage (from any cause, including overaggressive exercise) leads to the release of inflammatory chemicals and—in extreme cases—the by-products of dying muscle cells. The body's effort to remove these substances can overload the kidneys, irritating them or even damaging them to the point of failure. Research suggests that this is a higher risk factor in hot conditions, like a summertime marathon or a dehydrated person exercising in an overheated gym. Evidence suggests that aging is associated with longer healing times. But it was also found that among ultra-distance runners, younger, less-experienced athletes sustain more injuries than their older cohorts.