Challenging Return to Play Decisions: Heat Stroke, Exertional Rhabdomyolysis, and Exertional Collapse Associated With Sickle Cell Trait

Abstract

Context: Sports medicine providers frequently return athletes to play after sports-related injuries and conditions. Many of these conditions have guidelines or medical evidence to guide the decision-making process. Occasionally, however, sports medicine providers are challenged with complex medical conditions for which there is little evidence-based guidance and physicians are instructed to individualize treatment; included in this group of conditions are exertional heat stroke (EHS), exertional rhabdomyolysis (ER), and exertional collapse associated with sickle cell trait (ECAST).

Evidence acquisition: The MEDLINE (2000-2015) database was searched using the following search terms: exertional heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. References from consensus statements, review articles, and book chapters were also utilized.

Study design: Clinical review.

Level of evidence: Level 4.

Results: These entities are unique in that they may cause organ system damage capable of leading to short- or long-term detriments to physical activity and may not lend to complete recovery, potentially putting the athlete at risk with premature return to play.

Conclusion: With a better understanding of the pathophysiology of EHS, ER, and ECAST and the factors associated with recovery, better decisions regarding return to play may be made.

Keywords: heat illness; return to play; rhabdomyolysis; sickle cell trait.

Figure 1.

Evaluation of patient with exertional rhabdomyolysis for return to play.

Figure 2.

Recommendations for treating exertional collapse associated with sickle cell trait events. AED, automated external defibrillator, CPR, cardiopulmonary resuscitation; ECAST, exertional collapse associated with sickle cell trait; EMS, emergency medical services; ER, emergency room; IV, intravenous; RTP, return to play.