Is 'ketuk ketampi' still safe? Medical experts urge schools to rethink physical discipline

SHAH ALAM – For generations, many Malaysians have grown up with ‘ketuk ketampi’—repeated squats performed while holding one’s ears—as a common form of school punishment.

It is often perceived as a harmless disciplinary measure, resulting in little more than brief discomfort and mild embarrassment.

However, medical experts are now warning that when pushed to extremes, such physical punishments can carry severe and potentially life-threatening health consequences.

Resident doctor Dr Noraida Halijah Badovaihido recently treated a 20-year-old student who experienced these dangers first-hand.

He arrived at her clinic reporting that his urine had turned a dark, alarming shade, which he described as looking like ‘Teh O’ (black tea without milk).

“At first, I suspected common causes such as a urinary tract infection or kidney stones, so I requested a urine test (UFEME),” she shared in a post on Threads.

However, when the patient entered the consultation room, it became clear that his condition was more complex.

“When the patient walked in, he said he could not sit down because both of his thighs were in extreme pain,” she said.

Further questioning revealed that two days prior, he had been subjected to rigorous physical punishment by a lecturer.

He was forced to perform 100 ‘ketuk ketampi’ followed by a ‘duck walk’ around the college compound.

The combination of intense muscle agony and discoloured urine prompted further testing, which confirmed a diagnosis of rhabdomyolysis. Urine results showed high levels of blood (3+) and protein (3+).

What happens inside the body?

In simple terms, rhabdomyolysis is a condition in which muscle tissue is severely damaged and breaks down rapidly, releasing its internal contents into the bloodstream.

When muscle cells are destroyed, they release a protein called myoglobin. While myoglobin is essential within the muscle, it becomes toxic when large amounts circulate in the blood. The kidneys, responsible for filtering waste, can quickly become overwhelmed.

“If this condition is not managed early, it can cause acute kidney injury, and in severe cases, may require dialysis.

“Another complication is electrolyte imbalance due to the release of intracellular contents from the damaged muscle,” Dr Noraida said.

The risk of repetitive punishment

While activities like squats are routine in physical exercise, Dr Noraida stressed that repetitive or intense movements can trigger rhabdomyolysis when muscles are pushed beyond their recovery limits.

The risk of developing this condition increases significantly based on the intensity and duration of the activity, as well as a lack of conditioning, where the individual is not physically trained for that level of exertion.

Environmental factors such as poor hydration and extreme heat can further exacerbate the breakdown of muscle tissue.

In the student’s case, the sudden demand of 100 squats followed by a prolonged duck walk overwhelmed his unconditioned muscles, leading to extensive tissue breakdown.

Warning signs and prevention

Doctors describe a ‘classic triad’ of symptoms associated with rhabdomyolysis, which includes severe muscle pain, muscle weakness, and dark, tea-coloured urine.

On this, Dr Noraida advised that anyone experiencing muscle pain lasting more than three days after vigorous activity, or noticing changes in urine colour, should seek medical attention immediately.

Fortunately, the 20-year-old sought help early. Immediate medical care prevented the condition from progressing to irreversible kidney failure.

Dr Noraida urged schools, trainers and the public to exercise caution regarding physical activities, especially those that are sudden or unfamiliar.

She stated that it is vital to avoid sudden high-intensity workouts for untrained personnel and cautioned against exercising in extreme heat while paying close attention to early warning signs.

Ultimately, she warned that one should not suddenly push the body beyond its established limits.