Rachel Apa was only a couple of miles away from the finish line when she collapsed. According to a report, the 24-year-old runner from Pennsylvania had spent months preparing for the race.
Rachel was a former Division I field hockey player at her alma mater, Bucknell University. She said she was running to raise funds for the Parkinson’s Foundation in memory of her grandfather, who died from the disease in 2022.
US media reported that when Rachel collapsed, a bystander performed CPR on her. Marathon medical personnel eventually took over, and she was transferred to Mount Sinai Hospital. The doctors at the hospital tried to save her for six hours, but she eventually died.
Her father, Steve Apa, later told news organizations that doctors attributed her death to rhabdomyolysis.
Following the incident, Dr. Sudhir Kumar, MD, DM, a neurologist and distance runner, discussed the risks of exertional rhabdomyolysis in a series of posts on X (formerly Twitter) on November 3, 2026. He explained how prolonged and intense exercise can damage muscles, even in people who regularly participate in endurance sports.
Dr. Kumar also said that the condition can affect more than just the muscles. It can damage the kidneys and cause dangerously high potassium levels, which can interfere with the heart's normal rhythm. He emphasised the importance of understanding these risks within the running community.
Rhabdomyolisis, often referred to as rhabdo, occurs when muscles have been damaged and start to break down. This often happens after a serious injury, infection or extreme exercise.
When it occurs due to intense exercise it is called exertional rhabdomyolisis.
During exercise muscles use up energy. However, if your body is overworked especially during long sessions or endurance activities, the muscle cells can become damaged. This causes the cells to break down and release substances within them.
One of these is myoglobin, which is a protein found in muscle tissue. It can cause kidney damage when there is a lot of it in the blood. The kidneys work to remove the myoglobin from your blood.
When muscle cells are damaged they will also release potassium, this is a mineral which helps control your heartbeat. Having too much potassium can cause problems with your heartbeat.
According to Dr. Sudhir Kumar, when muscle cells break down, they release substances such as myoglobin, potassium, phosphate and creatine kinase (CK) into the bloodstream.
Dr. Kumar explained that myoglobin, a protein found in muscles, can damage the kidneys when large amounts enter the blood. The risk may be higher in people who are dehydrated or have reduced blood flow to the kidneys.
He also said that damaged muscles can release large amounts of potassium into the blood. Excess potassium, a condition known as hyperkalemia, can disrupt the heart's normal electrical signals and cause dangerous changes in its rhythm.
Rhabdomyolisis can cause serious issues because the initial symptoms can be confused with regular muscle soreness. Although, one may feel severe muscle pain. Along with this, your muscles may swell, you may feel weak and experience dark, cola coloured urine.
Symptoms may not appear immediately and can develop hours or even days after the initial muscle injury. Not everyone experiences all the characteristic symptoms, and the absence of dark-coloured urine does not rule out rhabdomyolysis. Anyone experiencing symptoms suggestive of the condition should seek immediate medical attention.
Dr. Kumar identified additional warning signs, including muscle tenderness and reduced urine output. He advised runners to seek urgent medical evaluation if they experience severe or unusual muscle symptoms after strenuous exercise.
Anyone can be affected by rhabdomyolisis. This includes those who do regular exercise. Just because you are physically fit does not mean you won’t get rhabdomyolisis. Especially if you are doing extreme amounts of exercise.
Dr. Kumar also pointed out that people may be at greater risk of exertional rhabdomyolysis if they suddenly start intense workouts, increase their running distance or speed too quickly, or do not allow their bodies enough time to recover. Although the condition is uncommon among recreational runners, it can occur during marathons, ultramarathons and other long-distance running events.
Dr. Kumar emphasised that such incidents should not stop people from running. Instead, runners should prepare well, gradually increase their running distance and intensity, and know which warning signs should prompt them to seek medical help.
Doctors diagnose rhabdomyolysis through blood tests that measure creatine kinase (CK), an enzyme released when muscle cells are damaged. Elevated CK levels can indicate muscle breakdown. Doctors may also assess kidney function, electrolyte levels and urine findings to identify complications. Repeat blood tests may be necessary to monitor CK levels and determine whether they are rising or falling. Urine tests alone cannot reliably rule out the condition.
Treatment depends on the severity of the condition. Early medical intervention is important to prevent complications, particularly acute kidney injury and electrolyte imbalances. Less severe cases may be managed with fluids, rest and cooling, under medical guidance. Patients with moderate to severe rhabdomyolysis may require hospitalisation and intravenous (IV) fluids to support kidney function and manage complications.
In patients who develop acute kidney injury or other complications, additional treatment may be required. Dialysis may be necessary when kidney failure leads to complications that require renal replacement therapy.
Although rhabdomyolysis cannot always be prevented, certain measures can reduce the risk, particularly during strenuous physical activity. These include:
Gradually increasing exercise intensity and duration rather than suddenly starting strenuous workouts.
Allowing adequate recovery between intense exercise sessions.
Taking regular breaks and avoiding overheating, particularly when exercising in hot conditions.
Maintaining appropriate hydration.
Avoiding excessive physical exertion, particularly when unaccustomed to strenuous exercise.
Dehydration does not independently cause every case of rhabdomyolysis, but it can worsen the condition by making it harder for the kidneys to eliminate substances released by damaged muscle cells.
Centers for Disease Control and Prevention. “Signs and Symptoms of Rhabdomyolysis.” Accessed November 4, 2026. https://www.cdc.gov/niosh/rhabdo/signs-symptoms/.
Centers for Disease Control and Prevention. “Treatment of Rhabdomyolysis.” Accessed November 4, 2026. https://www.cdc.gov/niosh/rhabdo/treatment/index.html.
Centers for Disease Control and Prevention. “Reducing Risk for Rhabdomyolysis.” Accessed November 4, 2026. https://www.cdc.gov/niosh/rhabdo/prevention/index.html.
Kodadek, Lisa, et al. “Rhabdomyolysis: An American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document.” Trauma Surgery & Acute Care Open 7, no. 1 (2022): e000836. https://pmc.ncbi.nlm.nih.gov/articles/PMC8804685/.
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