Dr. Emal Fakhri in Expert Interview: The Role of CK Values in the Context of EMS Training

Doing something for fitness and health in the most effective and time-efficient way possible - that's the reason many people choose to train with EMS technology. But is EMS training really suitable for everyone? Or is it true that this technology can quickly elevate CK levels and potentially lead to muscle damage? In our interview with Dr. Emal Fakhri, we clarify what the frequently cited 'CK' actually stands for, what normal values are, and what to keep in mind during EMS training to ensure that your own levels remain in the healthy range.

myostyle: Hello Dr. Fakhri could you please explain what CK values are and what factors can influence these values, especially in connection with sport activities?

Dr. Emal Fakhri: CK stands for Creatine Kinase, which is an enzyme in muscle metabolism responsible for providing energy in the cells. Elevated CK levels can indicate muscle damage.

In medicine, CK levels are primarily measured when diagnosing Heart and Muscle diseases. For instance, in cases of a Heart attack, where there is also the breakdown of heart muscle tissue, the severity of the Heart attack correlates with the level of CK.

However, sports activities can also lead to an increase in CK levels. This applies in particular to activities that put a lot of strain on the muscles - for example in Bodybuilding.

myostyle: In which range should the CK values ideally be and what role do they play in the assessment of Muscle health?

Dr. Emal Fakhri: When answering this question, it's important to differentiate based on Gender, Age, and Ethnic background^*. The measurement is always in units per liter (U/L). The reference range for adults is <170 U/L for women and <190 U/L for Men (Source: Laborverbund Dr. Kramer & Kollegen).

A mild and asymptomatic increase in CK levels doesn't necessarily indicate a medical concern. For instance, specific medications, particularly cholesterol-lowering drugs like statins, can lead to an elevation in these values.

In case of a significant increase, a repeated measurement should be done after 48 hours without any physical activity. If consistently elevated CK levels are observed, further investigation is recommended to explore potential neuromuscular disorders.

Some patients also exhibit high-molecular-weight CK variants (known as Macro-CK), leading to falsely elevated CK levels in laboratory tests. However, nowadays, these variants can be easily identified through the automated determination of CK subgroups in most cases.

myostyle: In the media, it is often reported that CK levels can rise rapidly into the unhealthy range during EMS training. Can you explain why this might occur and what factors could contribute to it?

Dr. Emal Fakhri: EMS training is considered highly effective because it allows for an intense and widespread stimulation of skeletal muscles in a relatively short time. However, an overly ambitious workout, whether with EMS or traditional strength training, can lead to overtraining, resulting in CK levels rising several times above normal.

In medicine, the breakdown of muscle fibers triggered by overexertion, leading to the release of muscle components into the bloodstream, is referred to as Rhabdomyolysis.

The following factors predispose to the occurrence of Rhabdomyolysis:

• Male gender
• Age < 10 and > 60 years
• BMI > 40
• Long-term use of medications for Lipid metabolism disorders
• Dehydration
• Poor Fitness condition

Another risk factor for Rhabdomyolysis is of Black African descent^*.

myostyle: How does an extreme increase in CK Levels affect the body significantly?

Dr. Emal Fakhri: A typical, but also non-specific symptom of elevated CK Levels is Muscle pain. Rhabdomyolysis usually requires hospitalization. In the worst case, severely elevated CK values can lead to kidney failure, whereby (usually temporary) Dialysis may be necessary if the disease is severe.

myostyle: Specifically in the EMS field, there is often discussion about how to avoid extreme increases in CK levels. What precautions or recommendations can you give to individuals who engage in EMS training and want to ensure that their CK levels remain within a healthy range?

Dr. Emal Fakhri: An important Factor in prevention is certainly primarily the Identification of Risk Groups. I have already listed the Risk Factors for Rhabdomyolysis; everyone can check these for themselves and the more points that apply, the more important it is to avoid the factors that can be influenced - i.e. Overexertion and Dehydration.

Additionally, a cautious start with a gradual increase in intensity is essential in EMS training - not only, but especially for individuals who belong to the risk group. Improper and excessive use of training equipment should be avoided as a general rule.

Furthermore, users should be educated about Warning symptoms to seek medical attention early if necessary. A typical Warning sign, in addition to Muscle pain, is reddish-colored urine due to flushed-out Muscle enzymes.

myostyle: In one of the previous questions, you mentioned the high intensity of EMS training. What kind of training preparation would you recommend here to achieve the best results without risking an excessive increase in CK levels?

Dr. Emal Fakhri: As with conventional Fitness or weight training, light warm-up sessions are also recommended as preparation for EMS training. In addition, sufficient fluid and food intake should always be ensured.

In consideration of the intensive strain on the muscles, it is very important to take sufficient breaks between the individual training sessions during EMS training. If your muscles are still sore, you should refrain from doing EMS training again and instead take another day off with light relaxation and stretching exercises.