Exertional Rhabdomyolysis in Athletes: Systematic Review and Current Perspectives

Clin J Sport Med. 2023 Mar 1;33(2):187-194. doi: 10.1097/JSM.0000000000001082. Epub 2022 Oct 20.


Objective: Exertional rhabdomyolysis results from a breakdown of skeletal muscle cells after intense exercise in otherwise healthy patients, causing increased levels of creatine kinase (CK) or myoglobin, as well as urine dipstick positive for blood, and may result in kidney insufficiency. The aim of this study was to outline the current perspectives of exertional rhabdomyolysis in athletes and subsequent treatment based on the current literature.

Data sources: We searched the MEDLINE/PubMed and Google databases for ([exercise] OR [exertional]) AND rhabdomyolysis following the PRISMA guidelines. All abstracts were reviewed by 2 independent examiners. Inclusion criteria consisted of original articles presenting studies on exertional rhabdomyolysis or exercise-induced rhabdomyolysis with 7 or more cases. All case reports, case series, or editorials were excluded.

Main results: A total of 1541-abstracts were screened, leaving 25 studies for final inclusion and analysing 772patients. Especially, young male patients were affected at a mean age of 28.7 years (range 15.8-46.6 years). Most of the athletes performed running, including marathons in 54.3% of cases (n = 419/772), followed by weightlifting in 14.8% (n = 114/772). At the time of presentation, the mean creatine kinase was 31 481 IU/L (range 164-106,488 IU/L). Seventeen studies reported the highest level of CK, which was 38 552 IU/L (range 450-88,496 IU/L). For treatment, hydration was the most common method of choice reported by 8 studies.

Conclusions: Exertional rhabdomyolysis seems to be underestimated, and it is essential to screen patients who present with muscle soreness/cramps and/or dark urine after heavy endurance events to avoid any further complications.

Level of evidence: II; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Athletes
  • Creatine Kinase
  • Databases, Factual
  • Exercise* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Muscle Cramp
  • Rhabdomyolysis* / etiology
  • Rhabdomyolysis* / therapy
  • Young Adult


  • Creatine Kinase