By Karim Hammam
The death of 24-year-old New York City Marathon runner Rachel Apa has brought renewed attention to rhabdomyolysis, a rare but potentially fatal muscle condition. Apa, a Pennsylvania native and former Division I field hockey player at Bucknell University, collapsed two miles from the finish line on Sunday. Despite more than six hours of medical efforts, she was pronounced dead at 9:40 p.m. EST; her father, Steve Apa, said the cause was rhabdomyolysis.
What is rhabdomyolysis?
Rhabdomyolysis, often called "rhabdo," occurs when muscle tissue breaks down and releases proteins such as myoglobin and creatine kinase, along with potassium, into the bloodstream. The buildup can damage kidneys and cause dangerous heart rhythms. The Cleveland Clinic estimates about 26,000 cases annually in the United States, with roughly 1,500 deaths each year, according to Vanderbilt University research.
Rachel Apa's collapse
Apa was running her first marathon and had texted her father that she had "never felt this good" earlier in the race. She collapsed near the mile-24 marker at 1:33 p.m. EST. Spectators, including two doctors, performed CPR until emergency crews arrived with a defibrillator. She was transported to Mount Sinai Medical Center at 1:50 p.m. and died later that evening. Her father described her as being in "perfect health, perfect shape."
Other reported cases
Rhabdomyolysis has been documented in other athletes. In 2011, more than a dozen University of Iowa football players were hospitalized after an intense squat workout. Three Oregon football players were hospitalized in 2017 following grueling conditioning sessions. Non-athletes have also been affected: Justin Urban, then 41, was hospitalized for a week after doing 40 pull-ups in 2021, and Joseph Henson, 34, suffered cardiac arrest after developing the condition during a half marathon in 2019.
How the condition affects the body
Extreme exercise can trigger muscle breakdown, releasing myoglobin that can injure kidneys and potassium that may cause fatal arrhythmias. About half of rhabdo patients develop kidney injury. Other causes include heat stroke, drug abuse, crush injuries, certain medications such as statins and antidepressants, and rare genetic disorders like McArdle disease and Duchenne muscular dystrophy.
Risk factors and prevention
Anyone who dramatically increases exercise intensity or duration is at higher risk, particularly endurance athletes and people in physically demanding jobs such as firefighters, police officers, and military personnel. Symptoms — muscle pain, weakness, dark cola-colored urine, inability to urinate, nausea, or loss of consciousness — typically appear within one to three days. Treatment involves intravenous fluids and electrolytes; severe cases may require dialysis. Recovery can take weeks to months. Experts recommend building exercise tolerance gradually, staying hydrated until urine is clear, avoiding hard workouts when ill or in high heat, and listening to the body's warning signs.
