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How prisoner weightlifting can turn deadly

Watch for rhabdo in the exercise yard and beyond

If you’re a manager, or an officer that pulls yard duty at your facility, you will want to be alert for the signs of rhabdomyolysis (rhabdo). This condition can sneak up on otherwise healthy-looking inmates due to overzealous weightlifting, erratic exercise patterns or competitive natures which push them past their physical limits. The condition can be exacerbated by heat – so it is at high potential during these summer months. Underlying medical conditions such as sickle-cell trait or even drug overuse can also lead to rhabdo.

What’s Happening?
An abrupt increase in the intensity of exercise can lead to vast muscle cell damage. The damaged cells spill chemicals and waste into the blood stream. Massive inflammation at the muscle cell level can cause severe pain due to pressure in the muscle capsule. The chemical concentration in the blood overloads the kidneys leading to renal failure.

Symptoms generated by the muscle breakdown include dark or bloody urine, back pain, and extreme muscle stiffness or soreness. This condition can be mis-diagnosed as standard delayed onset muscle soreness (DOMS) a normal outcome of increased weight-bearing exercise. However, rhabdo, unlike DOMS, can turn deadly.

Don’t Get There
Of course, prevention is so much better than treatment. Be wary of situations that can lead to rapid muscle injury and breakdown such as inmate hazing and physical competitions. Severe life-threatening rhabdomyolysis has been reported due to squatting competitions and new inmate ‘games’.

Consider periodic general inmate education, especially if competitive weight lifting is a part of your inmate population culture. Be sure sports and weight competitions are custody supervised and include plenty of hydration. Alert medical and nursing staff to any upcoming events.

If inmates complain of ‘cola’ or bloody urine, a sick call visit is necessary. Other symptoms include extreme muscle pain and lower back (kidney) pain beyond that which might take place after over exercising. Early intervention will reduce the complications associated with this condition.

Make It Go Away
The best treatment (and prevention!) of rhabdo is increased fluids and rest. The body needs to wash the muscle breakdown waste products through the system in a low concentration. The high concentration of waste product is what causes renal failure and possible system shock.

If undetected until later stages, a hospital visit and possible acute dialysis may be necessary.

What have you seen?
Have you had experiences of rhabdomyolysis at your facility? Tell us your story.

Dr. Schoenly has been a nurse for 30 years and is currently specializing in correctional healthcare. She is an author and educator seeking to improve patient safety and professional nursing practice behind bars. Her web-presence, Correctional Nurse, provides information and support to those working in correctional health care. Her books, Essentials of Correctional Nursing and The Correctional Health Care Patient Safety Handbook are available in print and digital on Amazon.

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