Rhabdomyolysis in an elite dancer after training with electromyostimulation: A case report

Abstract

We report a case of lower limb rhabdomyolysis in an elite dancer after one training session of electromyostimulation (EMS). Due to immobilization after an overload injury in the left foot, EMS was used to counteract loss of muscle mass. The EMS training session was initiated shortly after the injury and consisted of two sets of activation of left leg quadriceps, shin, and calf muscles. Each set involved 25 repetitions with an EMS intensity varying between 15-30 mA (35 Hz). Workload was 6 seconds of activation and 7 seconds resting time. Each EMS-induced muscle contraction was stopped by voluntary co-activation of the various antagonist muscles to generate a maximal concentric-eccentric load on the muscle involved. About 36 hours after the training session, the dancer was admitted to hospital due to rhabdomyolysis. Creatine kinase (CK) levels reached a maximum of 26 200 IU/L, and the dancer was hospitalized for 4 days. With our case, we highly advocate for the development of safe and validated EMS training protocols. All personnel, manufactures, and athletes working with EMS should be aware of the potentially serious adverse events. K E Y W O R D S delayed onset muscle soreness, electrical stimulation, muscle function, muscle myopathy, repeated bout effect, risk factors

Rhabdomyolysis After Implementing Whole-Body Electromyostimulation: A Case Study

“…In this context, this is the earliest case reported in Bahrain. [13][14][15] Muscle tenderness and elevated CK levels were similar to previous studies. Mild elevation of CK levels in this patient compared to the soccer players indicate the character of athlete variability.…”

“…The patient described in this report underwent a small interval training once or twice a week. 14 The patient is under evaluation as WB-EMS training is resumed with appropriate fitness and precautions. Further assessment will be provided if the patient presents with any new symptoms.…”

Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application

“…The most severe side effects reported after the application of WB-EMS (e.g., severe exertional rhabdomyolysis) occurred in WB-EMS novices—largely independently of their general training status [e.g., ( Kastner et al, 2014 ; Finsterer and Stollberger, 2015 ; Hong et al, 2016 ; Teschler et al, 2016 ; Hettchen et al, 2019 ; Johannsen and Krogh, 2019 )]. As much as a 1000-fold (240.000 U/l) increase in creatine-kinase (CK) baseline levels was reported for a young professional soccer player after a (too) intensive initial WB-EMS application ( Kastner et al, 2014 ).…”

Editorial: Whole-Body Electromyostimulation: A Training Technology to Improve Health and Performance in Humans?

“…Based on its artificial application, physiological mechanisms that protect against overloading during conventional training do not come into play during EMS. Thus, considering that even local EMS application might induce severe rhabdomyolysis (Johannsen and Krogh, 2019), it is obvious that a technology able to stimulate up to 2,600 cm 2 of muscular area simultaneously entails a high risk of triggering unintended effects (Teschler and Mooren)-at least when inappropriately applied (Kemmler et al, 2016). Indeed, severe rhabdomyolysis was frequently reported (e.g., Stollberger and Finsterer, 2019) in particular after improper i.e., too intense, first WB-EMS sessions.…”