Exertional rhabdomyolysis among U.S. active component service members, 2021-2025.

Abstract

Exertional rhabdomyolysis is a pathologic muscle breakdown associated with strenuous physical activity. A largely preventable condition, it persists as an occupational hazard of military training and operations, especially in high heat environments among individuals pushing their endurance limits. A total of 521 cases of exertional rhabdomyolysis were identified in the U.S. Armed Forces in 2025, corresponding to a crude incidence rate of 39.7 cases per 100,000 person-years. This rate is consistent with 2023-2024 levels but remains higher than rates from 2021-2022. The percentage of inpatient cases rose to a 5-year peak of 46.3% in 2025, however, a 21.6% relative increase from the low of 38.0% recorded in 2022. In 2025, the Air Force demonstrated the most significant rate increase, 60.0%, followed by the Army, with a 16.4% increase. In contrast, the Marine Corps and Navy showed rate decreases of 32.4% and 34.8%, respectively, when compared to 2024. The Coast Guard's annual case numbers remained low, ranging 4-6 cases throughout the 5-year surveillance period. Consistent with prior reports, subgroup-specific crude rates in 2025 were highest among men, those younger than age 20 years, non-Hispanic Black service members, Marine Corps or Army members, and those in combat-specific or 'other' military occupations. In 2025, recruit trainees continued to experience the highest rates of exertional rhabdomyolysis, with a rate more than 6 times greater than officers and enlisted members.