Exertional rhabdomyolysis is a common consequence of intense strength training. This past fall, two dozen high school football players in Oregon were treated for it after intense workouts under extreme conditions with limited access to drinking water. It doesn't take conditions straight out of The Junction Boys to bring on rhabdomyolysis, however. A British medical journal reported on a case where more than 100 Taiwanese high school students developed the condition after a teacher forced them to do 120 pushups in five minutes on a cold day.
The common thread in exertional rhabdomyolysis is working muscles beyond the point of fatigue. If you've ever done any strength training at all, you've likely reached the point in a workout where your muscles simply can't lift weights any more. At that point, your muscle fibers have ripped and begun spilling their contents into your bloodstream.
One thing your muscles spill is a protein called myoglobin. Myoglobin is what gives red meat its color; the "blood" which leaks out of raw or lightly cooked meat is usually not blood but myoglobin. Your kidneys break down myoglobin but are easily overwhelmed by too much of it. This can cause them to shut down, allowing toxins to accumulate in your blood. The myoglobin then passes into your urine unfiltered, causing it to take on a dark reddish-brown color, not unlike tea or cola. This is usually the most obvious symptom of rhabdomyolysis, and it's a symptom some Iowa football players commented about on their Facebook pages.
None of us was watching Iowa's offseason workouts, so we don't know exactly what they were like. As Jon Miller of HawkeyeNation.com points out, though, winter workouts in football are usually very intense. "Last week was the first week back to classes, which also meant the first week of winter workouts, which is the most grueling segment of the calendar year for an Iowa football player. I have been told that by several former players that I know who are from the Kirk Ferentz era," he wrote. "Winter workouts suck, period. But they suck everywhere high-level college football is played. They suck at the FCS level. There are exponential gains made during a calendar year for football players and the foundation for those gains are laid in January, February, March and April."
That's true, but we're not used to hearing about 12 players from one team developing rhabdomyolysis. What happened this time? We can only speculate. Iowa has been open about creatine use by its football players in the past, which has led some to speculate that the mildly controversial supplement may be involved. The International Society for Sports Nutrition is on record as denying a link between creatine and rhabdomyolysis, but opinions differ.
What is beyond speculation is Iowa's record of player development. Kirk Ferentz and his strength and conditioning coach Chris Doyle have routinely taken undersized players from the lower reaches of midwestern high school football and turned them into NFL draft picks. That list includes players like Dallas Clark, a walk-on linebacker from a tiny high school in north-central Iowa who turned into an All-Pro tight end, and Robert Gallery, who turned from a tight end into an elite offensive lineman. Safety Bob Sanders was only recruited by MAC schools; linebacker Chad Greenway didn't get any Division I offers besides Iowa's. Because of their success, Doyle's reputation as a strength coach is solid. Miller told FanHouse, "Many former Hawkeyes that are in the NFL come back to Iowa to train out of season, with Doyle."
This doesn't sound like a staff that doesn't know how to handle its players properly in the weight room. The potentially serious consequences of rhabdomyolysis can't be ignored, but elite strength training usually involves pushing the body right to the jagged edge of breakdown. For 12 players to develop rhabdomyolysis simultaneously suggests Iowa may have pushed too far this time -- but it doesn't prove that it did.
It's better to leave judgment until all the facts are in, and to accept that we may never know what really caused this. Iowa swears it will learn from this incident. It had better. There are lives in the balance.
UPDATE: Iowa has confirmed 13 players have the muscle disorder.