Effect of limb restraints on serum creatine phosphokinase activity in normal volunteers

Increased serum creatine phosphokinase (CPK) activity is sometimes found in acutely psychotic patients. In order to study factors affecting CPK activity, we investigated in normal subjects the effect on serum CPK activity of resistance to being restrained and to struggle against leather limb restraints (LLR) sometimes used for control of assaultive of self-destructive behavior of psychiatric patients. Blood samples were obtained 24 hr and immediately before restraint; and immediately, 6, 24, 48, and 72 hr after restraint. Serum CPK activity increases ranged from 3 to 16 times base line levels for all subjects. These increases exceeded the 95% upper limit of normal. Serum pyruvate kinase (PK) activity also increased significantly. In a second study, five male subjects were passively placed in LLR and then struggled against LLR for 1 hr. Serum CPK activity also increased significantly under these conditions, but less than after being forcibly restrained. Serum PK activity and lactic dehydrogenase activity also increased significantly, but serum aspartate aminotransferase (SGOT) activity did not. Since serum CPK activity is increased well above the normal limits in normal subjects after struggle against LLR, studies of serum CPK activity in psychotic patients must avoid the use of restraints as well as other types of trauma, which may produce serum CPK increases persisting as long as 72 hr.