The Beat Podcast

Speaker: Kelly Kennedy
Organization: Fit-to-Enforce
Topic: Rhabdomyolysis

Interview Transcript

[00:00]  Welcome to The Beat—a podcast series from the COPS 
Office at the Department of Justice.  Featuring interviews with 
experts from a varied field of disciplines, The Beat provides 
law enforcement with the latest developments and trending topics 
in community policing.
      
[00:16]  Jennifer Donelan:  Hello.  I'm your host, Jennifer 
Donelan, and today we will hear from Kelly Kennedy, Ph.D.  She's 
the owner of an organization called Fit-to-Enforce.  They teach 
law enforcement physical fitness trainers how to instruct 
exercise sessions for their departments and/or academies.  And 
today we're going to be discussing rhabdomyolysis, which is when 
I first read the word I had never heard of it.  So, Dr. Kennedy, 
please tell me what is rhabdomyolysis.

[00:44]  Kelly Kennedy:  Rhabdomyolysis is the rapid breakdown 
of skeletal muscle from extreme physical exertion.  My 
background is in exercise science and, um, my Ph.D. is in 
research.  So, I had never heard of rhabdomyolysis.  I have a 
master's degree and several certifications in physical fitness 
and it was brought to my attention in 2002 from a defensive 
tactics sergeant who saw it in an article published.  And it 
wasn't something that was on the forefront of any curriculum 
that I had ever listened to in my formal education, but when I 
read about it I knew that it was something that was very rare 
and something that happened typically in military settings or in 
paramilitary settings and traditionally wasn't seen very often.  
In fact, if you do see it very often, then there's a huge 
problem.  

[01:39]  Jennifer Donelan:  So, you said you first read about it 
in 2002.  When did you first come across a real-life example? 
      
[01:46]  Kelly Kennedy:  I went on a vacation and when I came 
back I noticed one of the recruits was missing, so I asked them 
what happened and they said that he had to go to the hospital, 
that he had a problem with his kidneys.  And I said, "Well, do 
you know what the condition is called?"  Because I had been 
teaching about this unicorn for a long time but I had never seen 
it happen, I had never seen evidence of this in any of the 
training that I'd been associated with.  It had been in the 
first week of the academy, typically it happens in the first two 
weeks, and it was rhabdomyolysis and that was his diagnosis.  He 
had previously been very sedentary and they did a certain number 
of squats that evidently manifested for him in some damage to 
his skeletal muscle.  So, he experienced some swelling of his 
joints and inability to move and just an inordinate amount of 
discomfort, and so they took him as a normal protocol and that 
was his diagnosis, so he was admitted.  So that was the first 
time I'd ever had any experience with it and I always made sure 
that it was a part of the normal conversation when we were ever 
training any new instructors.
      
[03:09]  Jennifer Donelan:  Let's go a little more into that.  
Your interest on this subject is how it falls within the 
training of police officers and in training academies with law 
enforcement organizations.  Again, this is just so fascinating.  
I consider myself a well-versed person in a variety of subjects 
especially in this day of Google and the Internet where 
basically any topic comes up, you'll Google it immediately, but 
again, this is something I've never even heard of.  And the 
whole idea that it's caused by extreme physical exertion and 
physical fitness is such a big part of just the common lifestyle 
these days with everything from like spin classes to PDX or XP, 
those extreme workout classes that you read about and hear about 
or you participate in.  So, just expand if you can a little more 
about how this is caused or what causes it or who may be at risk 
and how you may be at risk of it and just try to educate us 
more.

[04:01]  Kelly Kennedy:  So, typically it will happen when 
you're doing unaccustomed or novel exercises in the first couple 
of sessions.  It can happen during one session.  A colleague of 
mine was telling me about a research study they were doing on a 
biceps curl.  And they had a female, active female, college-age 
female come to be a subject in the study and she was doing 
muscle contractions to fatigue and she ended up with rhabdo just 
from doing it from her biceps.  So, it can happen with small 
muscles or it can happen in a large number of muscles.  Um, 
typically in an academy setting, it will happen in the first two 
weeks of physical activity when the recruits are unfamiliar with 
the exercises and when there's a high volume of exercises done.  
So, it's kind of a critical time for the instructors to know how 
to scale exercises properly.  One of the issues that I believe 
is a contributing factor is the popularity, and there has been 
an increase since 2008 in the number of hospitalizations of 
rhabdo.  And this is likely due to just an increase in the 
popularity of workout styles that are short duration and very 
high intensity.  They're very effective, they provide an 
unbelievable result, and they can make you really fit, and they 
can also damage the body when they're used at the wrong time in 
a training program.  Typically this presents itself in recruits 
that have the highest amount of mental compliance with verbal 
instruction but a moderate amount of fitness.  The best way to 
try to avoid it is to have really good scalable instruction in 
the first couple of weeks of training and having their 
instructors understand what the signs and symptoms are so that 
when someone does complain of it, they're able to kind of do a 
further inquiry to discover what could possibly be life 
threatening and send them to the hospital.

[06:10]  Jennifer Donelan:  Oh my goodness.  This is just a 
fascinating subject and just to think that one exercise done 
intensely could cause something like kidney problems or kidney 
failure.  I'm personally aware that if your kidneys go, you can 
crash and go extremely quickly like [finger snap] that.  So, you 
know, it seems like there's personal knowledge, but it seems 
like there needs to be a lot of awareness raised with the 
instructors.  What is out there currently for instructors to be 
knowledgeable and compliant with recognizing this condition and 
what more may be needed especially in the area where you have 
your niche which is within the law enforcement training agency?

[06:50]  Kelly Kennedy:  It doesn't happen frequently.  It 
shouldn't happen frequently.  But when it does happen, it can be 
life threatening.  And we just need to be better aware that the 
condition exists.  And the popularity of these types of high-
intensity training styles, they influence the habits of 
instructors that are tasked with training their academies.  So, 
we all are going to be influenced by our own experience and so 
when you pick the best fit instructor who might be very highly 
inspired by these amazing forms of training, they implement them 
too early on in the program and they can send somebody to the 
hospital and kill them.  You know, and so, does that happen a 
lot?  I don't think it happens a lot but when it does happen it 
is catastrophic.  And so, if it is happening a lot, it is a red 
flag for the training program to make wide-sweeping changes.  
And what I have found in the course of me lecturing throughout 
the country is that over time I have people say, "One person had 
a problem but it was a preexisting problem with his kidneys," 
and they later find out, no, that was rhabdo.  And if they've 
had it once, they are more at risk of it happening again.  So, 
I've heard stories of other people who have suffered from it 
before.  They don't remember the name of it.  They just know 
that it was something wrong with their kidneys when they were in 
the military and they ended up being fine later on.  They go 
back into the academy and the same thing happens to them again.  
They still don't know the symptoms, they still don't know the 
signs, and they know, "Oh, it's something wrong with my kidneys.  
It must've been a preexisting condition," not realizing that 
it's from either sickle cell trait that is undiscovered or that 
they just don't have a great level of hydration and they're not 
aggressively rehydrating and trying to scale their workouts 
accordingly.  When it comes to a law enforcement training 
perspective, it's difficult to get that information out there, 
to let them know that this is also something that can happen.  
It's another layer of complexity that we have to look at and 
just use that filtering system to keep screening all of our 
candidates.  And it can happen in a specialized unit as well.  
So, the expectation is that in a specialized unit you will have 
a short-duration, high-intensity school.  It takes two weeks to 
adjust yourself to any novel or unaccustomed exercise.  So, the 
issue isn't necessarily that it's always the instructor's fault.  
The issue is we need to be better prepared to identify the signs 
and symptoms of when it does present itself so that we can help 
to save lives.

[09:35]  Jennifer Donelan:  And real quick, just to define for 
some of our listeners that might not know what exactly it means, 
what is scaling exercise.

[09:42]  Kelly Kennedy:  Okay.  So, scaling an exercise means 
that if I can do 100 push-ups, that doesn't necessarily mean 
that at the beginning of an exercise program that I can take a 
group of 40 people and expect them to do the same thing.  Um, if 
I just do 100 push-ups at my pace and I expect the entire class 
to be able to do 100 push-ups at my pace and rest as they need, 
there is a certain subsection of that class that will push 
themselves beyond what they feel is comfortable and sometimes 
they will compromise their own safety to do so.  And scaling an 
exercise means that you have to have enough experience to be 
able to observe the effect that these exercises are having so 
that when people start breaking form and their repetitions start 
getting ugly or they start changing the muscles that they're 
supposed to be using, that they have to recalibrate themselves 
and get back into the right position in order to keep going.

[10:45]  Jennifer Donelan:  Interesting.  Do you have a recent 
real-life example that would help educate our listeners more 
about the conditions and maybe things to watch out for or 
something that would educate them more about this?

[10:55]  Kelly Kennedy:  I do.  Last year I had somebody 
approach me that thought I was a nutritionist after giving a 
lecture on proper exercise and footwear and proper training 
techniques as well as sports nutrition.  So, I was talking to 
them about hydration and pre- and post-workout nutrition.  So, 
at the end of that block of instruction, one recruit asked me 
if, why he was having trouble eating and so I said, "Well, tell 
me what you mean why you're having trouble eating?"  And he 
said, "Well, yesterday I was unable to eat my lunch.  I usually 
have a strong drive to eat but I couldn't eat my lunch.  And 
then after work I went and got some more food and I couldn't eat 
it.  So, this morning I started vomiting water."  And I said, 
"You know, you could be dehydrated.  Have you been drinking 
water?"  And I knew that this was in the first week of the 
academy.  He was at, and any time you're asking these questions, 
I'm going down the list of do you have any stiffness in your 
muscles, do you have any swelling of your joints, have you had a 
change in your urine output -- so, reduced urine output, no 
urine output or a darkened color of your urine.  Using that as 
an example is usually the one that people remember but it only 
happens in a certain percentage of people who actually develop 
rhabdo, so it's not the only marker but it's the one that most 
people remember.  And so, he said that he did have a darkened 
color of his urine, that it had been that way for three days and 
that he had been drinking beet juice.  And beet juice can 
sometimes change the color of your urine, so it was difficult 
for him to discern what that was from, he attributed it to the 
beet juice.  And I felt like he had enough signs and symptoms to 
screen him into the hospital and I thought that he needed to be 
looked at by a physician and he was admitted for two weeks and 
three days and he was released only to be able to do outpatient 
dialysis for an additional two months.

[13:08]  Jennifer Donelan:  Oh my gosh.

[13:09]  Kelly Kennedy:  By the time he got to the hospital -- 
and he felt fine, his physical presentation was fine, he had no 
pain, his instructor felt he looked fine and neither of them 
felt like he needed to go to the hospital, I felt like it was, 
he had enough of the signs and symptoms to flag him for the 
possibility of this.  He ended up not having sickle cell trait 
but he uh, when he got to the hospital they said that his system 
was not functioning any longer and that he could have died 
within hours.  So, vomiting is one of like an extreme example of 
what can happen when your kidneys stop functioning.  

[13:55]  Jennifer Donelan:  So, so this is really important.  If 
any of our listeners want to find out more information about 
this, is it appropriate for them to contact you?

[14:02]  Kelly Kennedy:  Yeah.  They can e-mail me.

[14:05]  Jennifer Donelan:  And that would be at kelly, K-E-L-L-
Y, @Fit-to-Enforce.com?

[14:18]  Kelly Kennedy:  Yes.

[14:19]  Jennifer Donelan:  Fantastic.  We will list that on our 
appropriate materials that go along with this podcast.  For our 
listeners out there, are there any closing thoughts you might 
have.

[14:22]  Kelly Kennedy:  I think that it's important just to use 
all of the resources available so that they can constantly make 
themselves aware when they learn about something that they could 
to improve the quality of training.  Even if they think that 
it's never happened, the moment that they read all of the signs 
and symptoms and they know that people can be hospitalized or 
have some sort of dialysis from this, that maybe they can go 
back and think, "Has this really ever happened to us?"  Because 
it probably has.  If they're working in an academy setting, it's 
probably surfaced at least once or twice if they have a lot of 
volume.  So, I just think that it's great to keep kind of 
sharpening your skills and trying to improve the quality of 
training that we have to offer to all of our budding law 
enforcement academies.
      
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[16:15]  The opinions contained herein are those of the authors 
and do not necessarily represent the official position or 
policies of the U.S. Department of Justice. References to 
specific agencies, companies, products, or services should not 
be considered an endorsement by the authors or the U.S. 
Department of Justice. Rather, the references are illustrations 
to supplement discussion of the issues.

[16:39] END

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