A Runner's Death Puts a Rare Muscle Condition in the Spotlight

A 24-year-old woman named Rachel Apa died after collapsing near the end of the New York City Marathon on Sunday. Her father said doctors worked for more than six hours to save her life, but they could not. He said the cause of her death was a rare and dangerous muscle condition called rhabdomyolysis, often called "rhabdo" for short. Her death has drawn attention to a condition that many people know little about.

Apa was running her very first marathon and had been feeling great during the race. She texted her father to say she had "never felt this good" earlier that day. But she collapsed near the 24-mile marker, just two miles from the finish line. Bystanders, including two doctors in the crowd, ran to help and performed CPR until emergency crews arrived. She was taken by ambulance to Mount Sinai Medical Center but was declared dead that evening at 9:40 p.m.

Apa had played Division One field hockey at Bucknell University in Pennsylvania and was described as being in excellent health. Her father, Steve Apa, called her death "unfathomable," saying she was in "perfect health, perfect shape, 24 years old." Her story has brought new attention to rhabdo, a condition that sends thousands of people to the hospital in the United States every year.

Rhabdo happens when muscles break down too quickly inside the body. This can happen during very hard exercise, after a physical injury, from certain medicines, or because of other health problems. When muscles break down, they release proteins and minerals into the bloodstream. Two key proteins involved are called myoglobin and creatine kinase. A buildup of myoglobin can damage the kidneys, and high levels of a mineral called potassium can cause a dangerous heart rhythm.

About 26,000 cases of rhabdo are reported in the United States each year, according to the Cleveland Clinic. Around 1,500 people die from it every year, based on research from Vanderbilt University. About half of people who get rhabdo also suffer some level of kidney damage. It is a serious condition, even if many people have never heard of it.

This condition is not only a danger for marathon runners — college football players have also been seriously affected. More than a dozen University of Iowa players were sent to the hospital in 2011 after an extremely tough squat workout. In 2017, three Oregon football players were hospitalized following intense strength and conditioning sessions. Even ordinary people doing familiar exercises have landed in the hospital because of rhabdo.

A Virginia man named Justin Urban was shocked to find himself in the hospital for a full week after doing 40 pull-ups. Joseph Henson, who ran Alabama's Mercedes Half Marathon in 2019, went into cardiac arrest after developing rhabdo. "My takeaway from all of this is it can happen to anybody, I'm pretty young for cardiac arrest and consider myself pretty fit," Henson said. These cases show that rhabdo does not only strike the unfit or the unprepared.

Other causes of rhabdo include heat stroke, drug use, and certain medications such as statins and antidepressants. Some rare genetic conditions can also increase the risk, including McArdle disease and Duchenne muscular dystrophy, both of which cause muscle weakness. High temperatures speed up muscle breakdown, making it even more dangerous to exercise hard in the heat. Workers with demanding physical jobs — like firefighters, soldiers, and outdoor workers — also face higher risk.

Symptoms of rhabdo usually show up within one to three days after the muscles are damaged. Warning signs include muscle pain and weakness, dark urine that looks like cola, trouble urinating, nausea, and loss of consciousness. Anyone who experiences these symptoms should seek medical help right away. Rhabdo is treated with IV fluids and electrolytes, and patients with serious kidney problems may need dialysis.

Experts say the best way to avoid rhabdo is to increase exercise intensity slowly and stay well-hydrated. People should also skip hard workouts when they feel sick or when the weather is very hot. Most people who recover from rhabdo without serious complications feel better within a few weeks, but doctors may suggest waiting months before returning to intense training. Listening to your body, doctors say, is the most important thing you can do.