Disclosures: Brian Higdon, MD: Nothing to disclose

Case Description: Patient presented for a scheduled rheumatologic evaluation where routine laboratory workup demonstrated elevated CK of 12,147 U/L and elevated LDH of 461 U/L. The patient had recently increased his physical training and his protein intake in preparation of the upcoming Spartan Race. He had been exercising 1-3 hours/day, five times a week, for the past 5-6 weeks, including resistance and endurance training. Recently, he began 1-hour sessions of e-stim to the lower extremities, biweekly, increasing his leg girth 3 inches around the thighs.

Setting: Veterans Affairs Outpatient Clinic and Inpatient Spinal Cord Unit

Patient: 53-year-old African-American male with a history of lupus and incomplete lumbar paraplegia.

Assessment/Results: ESR and CRP levels at baseline, and creatinine was 1.5 mg/dL. Patient was admitted for treatment of rhabdomyolysis. His CK down-trended to 664 U/L, which may be normal for his demographics. Although he returned to his previous exercise routine, he reduced the frequency of his e-stim therapies to once weekly. At 1-month follow up, his CK remained elevated at 719 U/L.

Discussion: Patients may be attracted to electromyostimulation training (voluntary exercise combined with electromyostimulation) because it can help achieve similar muscle strength at a lower workload than voluntary exercise alone. Compared to normal voluntary exercise, electromyostimulation training causes more muscle damage with no significant increase in muscle soreness, making it difficult for patients to recognize complications. A cardinal sign of rhabdomyolysis is dark-colored urine secondary to myoglobin spilling into the urine. Overuse of e-stim can lead to rhabdomyolysis, and consequently, organ damage. One study showed that unaccustomed electromyostimulation exercise can cause rhabdomyolysis after just one session in competitive athletes.

Conclusion: While e-stim may seem like a harmless modality for the spinal cord patient, it can contribute to the development of dangerous conditions like rhabdomyolysis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/e-stim-related-to-rhabdomyolysis-in-the-spinal-cord-athlete/