Rhabdomyolysis After a Marathon: Symptoms, Causes and Risks

A New York City Marathon participant died after developing rhabdomyolysis, according to statements from her father and reports from several news outlets. Some coverage identified the runner as Rachel Apa, a Pennsylvania woman. Her father told CBS News that rhabdomyolysis caused her death, while other reports linked the death to the same condition. Source 1 Source 3

Rhabdomyolysis, often called “rhabdo,” is rare but potentially life-threatening. It occurs when skeletal muscle breaks down rapidly and releases its contents into the bloodstream. Severe cases can damage the kidneys, disrupt the heart’s electrical activity and cause death. Source 5

A marathon does not automatically cause rhabdomyolysis. Most marathon runners do not develop it. However, prolonged, intense exercise may trigger the condition, particularly when combined with heat, dehydration, sudden training changes or another medical factor.

What Is Rhabdomyolysis?

Skeletal muscles support movement and posture. When muscle tissue is severely damaged, its cells release substances into the bloodstream, including:

• Myoglobin, a muscle protein that can injure the kidneys.
• Creatine kinase (CK), an enzyme that indicates muscle damage.
• Potassium and other electrolytes, which can disrupt nerve and heart function.

The condition can range from mild muscle injury to a medical emergency.

Why It Can Be Dangerous

The kidneys filter myoglobin from the bloodstream. Large amounts can obstruct or injure kidney tissue, causing acute kidney injury. Severe cases may require dialysis.

Electrolyte abnormalities can also cause dangerous complications. High potassium levels may interfere with the heart’s electrical system and trigger abnormal rhythms. Dehydration can worsen kidney stress and reduce blood flow to vital organs.

Potential complications include:

• Acute kidney injury or kidney failure.
• Dangerous heart rhythms.
• Severe dehydration.
• Compartment syndrome caused by pressure around swollen muscles.
• Shock.
• Death.

The severity depends on the amount of muscle damage, the underlying cause, the person’s health and how quickly treatment begins.

How a Marathon May Trigger Rhabdomyolysis

Extreme Exertion

Long-distance running places sustained demands on the leg, hip and core muscles. Prolonged, intense exertion may damage muscle fibers, especially when a runner exceeds their current conditioning.

Risk may increase when a runner:

• Exercises substantially beyond their training level.
• Continues despite severe muscle pain or weakness.
• Maintains high intensity for a prolonged period.
• Has inadequate recovery between demanding workouts.
• Competes in unusually difficult conditions.

Exercise-induced rhabdomyolysis remains uncommon. Finishing a marathon does not establish that rhabdomyolysis occurred, and one reported death cannot show how often the condition affects marathon participants.

Heat, Humidity and Dehydration

Hot or humid weather makes it harder for the body to release heat. Sweating also causes fluid and electrolyte loss. These stresses may intensify strenuous exercise and contribute to heat illness or muscle injury.

Dehydration is not the only concern. Excessive water consumption can dilute blood sodium and cause hyponatremia, a potentially dangerous condition. Runners should avoid both severe dehydration and overhydration.

Hydration needs vary according to body size, pace, weather, sweat rate and race duration. No fixed fluid amount is appropriate for every runner.

Sudden Training Changes

Muscles adapt gradually. A sudden increase in workload can raise the risk of injury and severe muscle breakdown. Contributing changes may include:

• Rapidly increasing weekly mileage.
• Adding frequent speed sessions.
• Increasing hill training.
• Beginning intense strength training.
• Combining higher mileage with harder workouts.
• Returning to strenuous exercise after illness or a long break.

Training plans should increase demands progressively and include recovery days. Athletes should adjust training when they experience unusual fatigue, poor sleep, infection or significant heat exposure.

Other Possible Causes

Rhabdomyolysis has many possible causes, including:

• Heat illness.
• Infection.
• Certain prescription medications.
• Alcohol or drug use.
• Seizures.
• Crush injuries or other trauma.
• Metabolic or genetic muscle conditions.
• Inadequate recovery between intense workouts.

These are possible contributors, not conclusions about the New York City Marathon case. Only clinicians reviewing medical records, examination findings and test results can determine the cause.

Symptoms of Rhabdomyolysis

Symptoms may begin during exercise or appear hours later. They often affect the muscles used most intensely, such as the legs after a marathon.

Common symptoms include:

• Severe muscle pain.
• Muscle tenderness.
• Swelling.
• Muscle weakness.
• Unusual fatigue.
• Difficulty moving.
• Reduced ability to continue exercising.

Ordinary post-race soreness usually improves gradually. Rhabdomyolysis may cause pain, weakness or swelling that is unusually severe or continues to worsen.

Dark Urine

Rhabdomyolysis can cause brown, tea-colored or cola-colored urine when myoglobin enters the urine. This is an important warning sign after intense exercise.

However, not everyone with rhabdomyolysis develops dark urine. Urine may appear normal even when significant muscle damage has occurred. Normal-looking urine does not rule out the condition.

Dark urine after strenuous exercise requires prompt medical evaluation, especially when accompanied by severe muscle pain, weakness or reduced urination.

Emergency Symptoms

Seek emergency care for:

• Very little or no urine.
• Confusion.
• Fainting.
• Severe or rapidly worsening weakness.
• Chest pain.
• Irregular heartbeat.
• Trouble breathing.
• Rapidly increasing muscle swelling or pain.
• Collapse.
• Seizures.
• Suspected heat illness.

Do not wait for severe or worsening symptoms to resolve. A person who is confused, faint or severely weak should not drive.

How Doctors Diagnose Rhabdomyolysis

Medical History and Examination

Clinicians ask about recent exercise, heat exposure, fluid intake, injuries and symptoms. They may also ask about medications, supplements, alcohol, recreational drugs, seizures, infections and existing kidney or muscle conditions.

The examination may assess muscle tenderness, swelling, weakness, dehydration, mental status, heart rhythm and signs of heat illness or compartment syndrome.

Symptoms alone cannot reliably confirm or exclude rhabdomyolysis.

Blood Tests

A creatine kinase, or CK, blood test is commonly used to detect muscle injury. CK levels may rise over time, so clinicians may repeat the test.

Additional blood tests can evaluate kidney function, potassium and other electrolytes, acid-base balance, the severity of muscle injury and related illness.

Urine Tests

Urine testing may identify findings consistent with myoglobin release. It can also help evaluate kidney function and rule out other causes of dark urine.

Additional testing may be needed when clinicians suspect heat illness, medication effects, infection, trauma, a metabolic condition or another trigger.

How Rhabdomyolysis Is Treated

Fluids and Monitoring

Treatment often includes intravenous fluids in a hospital setting. Fluids support circulation, help maintain urine production and reduce kidney stress. The amount and type depend on the patient’s condition.

Clinicians may monitor:

• Kidney function.
• CK levels.
• Urine output.
• Potassium and other electrolytes.
• Acid-base balance.
• Heart rhythm.
• Fluid balance.

Hospital treatment should not be attempted at home. Drinking large amounts of water without medical guidance can also cause dangerous electrolyte changes.

Treating Complications

Treatment addresses both the muscle injury and its cause. Care may include correcting electrolyte abnormalities, treating heat illness, reviewing a medication, managing severe swelling and treating infection, seizures or trauma. Dialysis may be necessary if the kidneys cannot adequately remove waste and excess fluid.

Recovery

Mild cases may resolve with timely treatment, rest and monitoring. Severe cases may require prolonged hospitalization and recovery.

After significant rhabdomyolysis, returning to exercise should occur gradually and with medical guidance. Recurrence risk depends on the original cause. A person with a genetic, metabolic or medication-related risk may need a different exercise plan from someone whose condition followed an isolated event.

How Runners Can Reduce the Risk

Train Gradually

Increase mileage and intensity progressively. Include rest days, and avoid adding several major training demands at once.

Do not sharply increase weekly distance while also adding frequent hill repeats, speed work and heavy strength training. A coach or qualified medical professional can help adapt training to an athlete’s experience and health.

Reduce or postpone intense exercise during illness, poor sleep, unusual fatigue or recovery from injury.

Prepare for Weather

Check temperature and humidity before training or racing. In difficult conditions:

• Slow the pace.
• Adjust performance expectations.
• Use shaded routes.
• Plan cooling breaks.
• Wear suitable clothing.
• Follow race medical guidance.

Race-day conditions may differ substantially from training conditions. A pace that feels manageable in cool weather may create excessive heat stress in high humidity.

Hydrate Appropriately

Use individualized hydration guidance rather than a universal target. Fluid needs depend on body size, pace, weather and sweat rate.

Avoid severe dehydration, but do not force excessive water consumption. Sports drinks or electrolyte products may help in some circumstances but are not automatically necessary for every run.

Respond to Warning Signs

Stop exercising when severe muscle pain, unusual weakness, confusion, dizziness or heat-illness symptoms develop. Seek medical care for dark urine, reduced urination, persistent vomiting or symptoms that worsen after exercise.

Trying to push through serious symptoms can delay diagnosis and treatment.

When to Seek Medical Care After a Race

Arrange prompt medical evaluation for:

• Severe or unusual muscle pain.
• Significant muscle swelling.
• Weakness that is worse than expected.
• Dark brown, tea-colored or cola-colored urine.
• Decreased urination.
• Persistent vomiting.
• Severe dizziness.
• Extreme exhaustion that does not improve with rest.

Tell the clinician about the recent race, training intensity, weather, fluid intake, medications and other symptoms.

Call emergency services for fainting, confusion, chest pain, trouble breathing, seizures, collapse, suspected heat emergency, a potentially dangerous heart rhythm or severe weakness that prevents safe movement. Do not drive if you are confused, faint, severely weak or having trouble breathing.

What This Death May Teach Marathon Runners

The reported death is a reminder that rare complications can occur even during organized athletic events with medical support. It does not mean marathon running is inherently unsafe or that every post-race symptom indicates rhabdomyolysis.

Ordinary fatigue and soreness generally improve with rest. Severe pain, major swelling, unusual weakness, dark urine or reduced urination requires medical attention.

Coaches, race volunteers, family members and medical teams can help by recognizing concerning symptoms early. A runner who becomes confused, collapses, has trouble breathing or cannot produce urine needs emergency evaluation.

Reports linked the New York City Marathon runner’s death to rhabdomyolysis based on family statements and news coverage. Public reporting does not provide enough information to establish every medical detail or the precise chain of events.

Frequently Asked Questions

What is rhabdomyolysis?

Rhabdomyolysis is the rapid breakdown of damaged skeletal muscle. The process releases myoglobin, CK and electrolytes into the bloodstream. These substances can injure the kidneys and cause dangerous heart and metabolic complications.

Can running a marathon cause rhabdomyolysis?

Prolonged, intense exercise can trigger rhabdomyolysis, but the condition is rare. Risk may rise with extreme exertion, heat, dehydration, sudden training changes or other medical factors. Most marathon runners do not develop it.

What does rhabdomyolysis urine look like?

Urine may become dark brown, tea-colored or cola-colored because of myoglobin. However, urine can look normal. Color alone cannot confirm or exclude rhabdomyolysis.

How can you tell whether muscle soreness is more serious?

Ordinary soreness usually improves gradually. Severe pain, major swelling, unusual weakness, worsening symptoms, dark urine or reduced urination suggests a more serious problem and requires prompt medical assessment.

Can rhabdomyolysis cause kidney failure?

Yes. Myoglobin and other substances released by damaged muscles can impair kidney function. Severe cases may require hospitalization and, if the kidneys cannot remove waste and excess fluid, dialysis.

How is rhabdomyolysis treated?

Treatment may include intravenous fluids, blood and urine monitoring, correction of electrolyte problems and treatment of the underlying cause. Severe complications require hospital care.

Conclusion

Rhabdomyolysis is rare but potentially fatal. It can develop after extreme exercise, heat illness, trauma, seizures, infection, medication effects or other medical conditions.

After strenuous exercise, warning signs include severe muscle pain, weakness, swelling, dark urine, reduced urination, confusion or collapse. Immediate medical evaluation can identify muscle injury, protect kidney function and treat dangerous electrolyte or heart problems.

News reports connected the NYC Marathon runner’s death to rhabdomyolysis based on family statements and reporting from multiple outlets. Medical details should not be inferred beyond what has been publicly confirmed. Source 7 Source 9

This article provides general health information and does not replace evaluation by a qualified healthcare professional.