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Título

Rhabdomyolysis and muscle adaptation after whole-body electrostimulation (WB-EMS)

RESUMO

Clinical Case:
A 25-year-old woman (BMI 22kg/m2), without comorbidities, presented with an incidental high creatine kinase (CK) level (29.068 U/L) after starting whole-body electrostimulation (WB-EMS). She had been previously untrained and identified mild myalgia believing it to be expected due to training. There was no urinary complaint or muscle weakness.
Her neurological exam was normal. Her renal function was normal and urine sample one week after the event showed no changes. Muscle MRI demonstrated small foci of edema in gluteus maximus, vastus lateralis and intermedius muscles. We proceeded with a complete investigation including full rheumatological panel, thyroid function, serologies (HIV, hepatitis B and C, dengue, leptospirosis, toxoplasmosis) and whole-exome sequencing which resulted all negative.
Most plausible explanation was exertional rhabdomyolysis and we suggested a return to WB-EMS trainings with weekly serum CK measurement. The high CK level seen after individual WB-EMS session was progressively blunted and normalized after 2 months of regular training. A control muscle MRI five months after regular training showed resolution of muscular edema.
Discussion:
WB-EMS uses an electrical stimulator with several channels that can recruit more muscle fibers than normal exercises and attracts people for the belief of being more time-effective. The case illustrates the risks of WB-EMS related to muscle injury, especially in physically deconditioned people, and how to manage training-related CK level increase.
There are not enough data regarding the prevalence of rhabdomyolysis associated with WB-EMS. However, it has been previously reported especially after the first workout session and studies show a drop in CK levels after regular training. Our case reinforces that maintenance of WB-EMS training may be safe even after a very high CK level. Muscle ability to adapt through exercise training is the most probable explanation to justify serum CK increase attenuation.
Final comments:
Patients and health care professionals must be alert to intense muscle pain and changes in urine color, especially at the beginning of training. Clearer protocols are needed to guide physicians and neuromuscular practitioners to manage these patients as WB-EMS will become even more popular. Serial CK measurement may be necessary in subjects beginning WB-EMS training and an evaluation prior to WB-EMS is advised to identify potential individual risks.

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Área

Doenças Neuromusculares