At the New York City Marathon on Sunday, 24-year-old Rachel Apa of Lewisberry, Pennsylvania, collapsed two miles from the finish line. She later died at the hospital. The medical examiner’s office is still investigating her cause of death.
Her father, Steve Apa, told the New York Times that the cause was rhabdomyolysis, commonly known as rhabdo. The rare condition occurs when skeletal muscle breaks down, releasing its contents into the bloodstream, says Robert Glatter, MD, an emergency room doctor and an assistant professor of emergency medicine at Lenox Hill Hospital. Apa’s death comes amid growing conversations about rhabdo on social media.
People have shared their experiences with the condition after intense exercise, particularly at cycling classes. https://www.tiktok.com/@bryybell_/video/7693630991839153421?_r=1&_t=ZT-9Axae4rjSXu But while these stories are alarming, rhabdo is still relatively rare. Yet they raise questions about the risks of intense exercise, how to recognize when something is wrong, and just how concerned the everyday exerciser should be. Here’s what experts want you to know.
Rhabdomyolysis happens when skeletal muscle breaks down and releases its contents into the bloodstream. The resulting spill can produce dangerous electrolyte imbalances and kidney injury, particularly when someone is dehydrated, Dr. Although rhabdo is often associated with intense exercise, physical exertion is just one possible cause.
Exercise-related rhabdo typically happens when an individual suddenly performs an unusually difficult, repetitive workout involving large muscle groups—particularly when doing eccentric exercise, or when the muscle contracts while lengthening. The risk may be higher when the activity is unfamiliar or far more intense than the person is accustomed to. Some examples include high-repetition squats, lunges, downhill running, and intense cycling, Dr.
Symptoms include muscle pain "dramatically out of proportion to ordinary post-workout ache,” Dr. Glatter describes, as well as dark-colored urine, swelling, weakness, and difficulty moving the affected muscles. Other possible symptoms include dizziness, fainting, confusion, persistent vomiting or feeling generally ill, he says.
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