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Induction and Assessment of Exertional Skeletal Muscle Damage in Humans
Published on: December 11, 2016
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Exertional Rhabdomyolysis and Ultra-Trail Races: A Systematic Review Highlighting the Significant Impact of Eccentric
Miguel Lecina1, Carlos Castellar-Otín1, Alejandro García-Giménez1
1ENFYRED Research Group, Faculty of Health and Sports, University of Zaragoza, 22002 Huesca, Spain.
Muscles (Basel, Switzerland)
|August 4, 2025
Summary
Exertional rhabdomyolysis (ER) is rare in ultra-trail races despite significant muscle damage. Downhill running in these events elevates muscle and liver enzymes, but ER may be misdiagnosed, necessitating clear participant guidelines.
Area of Science:
- Sports Medicine
- Exercise Physiology
- Biochemistry
Background:
- Exertional rhabdomyolysis (ER) involves muscle breakdown after intense exercise, potentially causing acute kidney injury.
- Ultra-trail races (UT) involve extreme exertion, increasing risk of muscle damage and elevated biomarkers like creatine kinase (CK) and lactate dehydrogenase (LDH).
- Downhill running segments in UT are associated with greater muscle damage.
Purpose of the Study:
- To systematically review the impact of significant downhill elevation (>1000m) in ultra-trail races on muscle and liver damage biomarkers.
- To assess the incidence of exertional rhabdomyolysis in ultra-trail runners.
- To analyze changes in CK, LDH, aspartate transaminase (AST), and alanine aminotransferase (ALT) following UT events.
Main Methods:
- Systematic review of four databases (PubMed, Web of Science, Scopus, SportDiscus) following PRISMA guidelines.
- Inclusion of 15 articles published between January 2005 and March 2024.
- Analysis of data from 348 participants (294 male, 54 female, mean age 39.82 years).
Main Results:
- A median increase in CK of 5370.63% and LDH of 311.20% was observed post-race.
- Mean increases in liver enzymes AST (1009.94%) and ALT (207.02%) were recorded, with no reported liver injury.
- Only one participant (0.28%) was diagnosed with exertional rhabdomyolysis.
Conclusions:
- Ultra-trail races cause significant muscle and liver enzyme elevation, but exertional rhabdomyolysis is infrequent and potentially misdiagnosed.
- Downhill elevation in UT contributes to muscle damage biomarkers.
- Clear guidelines and participant preparation are essential for safe participation in extreme ultra-trail races to prevent potential acute kidney injury.
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