Thera Gun Caused Rhabdomyolysis In A Cyclist

Picture by LLL@ Zouk

I've written in August about the effects of thera/ massage and vibration guns and whether they really work. I've also written about the scary effects of rhabdomyolysis before. 

Guess what? There has just been a published case report of a cyclist being administered thera/ massage gun treatment by her coach for recovery and ended up with rhabdomyolysis.

This 25 year old female cyclist rode in a gym for two consecutive days for only about 30 minutes each day. Her coach used a thera/ massage gun immediately over both her thighs for about ten minutes to help with her recovery. The coach did not check the medical history of the cyclist nor did he check with qualified health professionals about using the thera/ massage gun on her.

The cyclist subsequently developed significant pain/ tenderness in both thighs on that same evening and multiple hematomas (or bruises) were present. She also had urine discoloration (tea colored). She went to the hospital and her serum creatine kinase levels (> 30,000 U/L) were through the roof. This is an indication of severe muscle damage.

Normal values are usually 24-195 U/L. Not saying this with pride, but when I had hyponatremia back in 2000, my creatine kinase levels were 240,000 U/L. But that's another post.

Patients with rhabdomyolysis commonly present with muscle pain. weakness, aches and bruising. It is rare, can be life threatening and is often caused by extreme exercise. It occurs when muscles that have been overworked, dies and leak their content to the bloodstream. This ends up straining the kidneys and can cause severe pain.

Anyway, back to this cyclist. She has a medical history of mild iron deficiency which had been untreated and it's potential association to rhabdomyolysis must surely be considered. 

Her coach was unaware of her mild anemia. Cycling for two days in a row would not be considered as extreme exercise since she had previously cycled two days in a row and not developed rhabdomyolysis.

In her case, it is probably the repeated use of the thera/ massage gun after cycling that damaged her muscle fibers leading to rhabdomyolysis. The coach may also have used the thera/ massage gun incorrectly. She was in hospital for 2 weeks and thankfully recovered well.

A published study found 29 cases of exercise induced rhabdomyolysis admitted to the emergency department of a hospital between 2010-2014. The most common cause was indoor cycling classes.

A few of my patients have had rhabdomyolysis. All were active in sports and definitely not couch potatoes. They all felt that the exercise that they participated in (indoor cycling) did not seem strenuous at that time. 

Remember this when you try a new exercise. Start moderately first and and don't be pressured by the coach/ instructor if you're not comfortable.

References

Brogan M, Ledesma R et al (2017). Freebie Rhabdomyolysis. A Public Health Concern, Spin Class-Induced Rhabdomyolysis. AJM. 130(4):

J Chen, F Zhang et al (2020). Rhabdomyolysis After The Use Of Percussion Massage Gun: A Case Report. Phy Therapy. DOI: 10.1093/ptj/pzaa199

Thanks to my patient LLL for both the pictures. Never thought Zouk would end up hosting indoor cycling. Unprecedented times indeed!