Exertional rhabdomyolysis in a 21-year-old, healthy female after performing three sets of the biceps curl exercise to failure with 30% 1RM: A case report

Background: The optimal resistance training program to elicit muscle hypertrophy has been consistently debated and researched. Although 3 sets of 10 repetitions at 70-80% of the 1-repetition maximum (1RM) is widely recommended, recent studies have shown that low-load (~30% 1RM), high-repetition (3 sets of 30-40 repetitions) resistance training can elicit similar muscular hypertrophy. Therefore, this type of resistance training has gained popularity, perhaps because less weight is lifted for a longer duration. In the process of testing this hypothesis in a research study in our laboratory, a subject diagnosed with exertional rhabdomyolysis after completing a single resistance training session that involved 3 sets to failure at 30% 1RM. Exertional rhabdomyolysis is a condition characterized by the excessive breakdown of striated skeletal muscle that releases proteins from the muscle cell, particularly myoglobin, into the blood that can be toxic to the kidneys and is a significant health concern. Case Report: Reviewed were the events leading up to and throughout the diagnosis of exertional rhabdomyolysis in a healthy, recreationally-trained, 21-year-old female that was enrolled in a study that compared the acute effects of the traditional high-load, low-repetition versus low-load, high-repetition resistance training. The subject completed a total of 143 repetitions of the bilateral dumbbell bicep curl exercise. Three days post-exercise she reported excessive muscle soreness and swelling and sought medical attention. She was briefly hospitalized and then discharged with instructions to take acetaminophen for soreness, drink plenty of water, rest, and monitor her creatine kinase (CK) concentrations. Changes in the subject’s CK concentrations, ultrasound-determined muscle thickness and echo intensity were monitored over a 14-day period are reported. Discussion: This case illustrates the potential risk of developing exertional rhabdomyolysis after a low-load, high-repetition resistance training session in healthy, young, recreationally-trained women. The fact that exertional rhabdomyolysis is a possible outcome is enough to warrant caution when prescribing this type of resistance exercise