A 24-year-old runner who collapsed near the end of the New York City Marathon died hours later after suffering from rhabdomyolysis, her father has revealed.
Rachel Apa had spent months preparing for Sunday’s race and was approaching the 24-mile mark when she suddenly collapsed in Manhattan, just two miles short of completing the marathon.
She was taken to Mount Sinai Medical Center, where doctors spent six hours attempting to save her life. She was pronounced dead at 9.40pm.
Her father, Steve Apa, told The New York Times that the cause of death was rhabdomyolysis, a condition in which damaged muscle tissue releases substances into the bloodstream that can cause serious organ complications.
“It’s unfathomable,” he said. “Perfect health, perfect shape, 24 years old.”
What Is Rhabdomyolysis and How Does It Damage the Body?
Rhabdomyolysis occurs when muscle fibres break down rapidly, releasing substances including potassium, myoglobin and creatine kinase into the bloodstream.
The kidneys normally filter waste products from the blood, but the large quantities released during severe muscle breakdown can overwhelm the organs and damage their filtering systems.
Dr Marc Levine, chair of orthopaedic surgery at Jersey Shore University Medical Center, told the Daily Mail that the proteins released by damaged muscles can clog the kidneys.
The condition can also affect the heart. Dr Eric S Levy, an emergency medicine physician and director of simulation at Northwell’s Staten Island University Hospital, explained that high potassium levels can trigger dangerous heart rhythms and sudden cardiac arrest.
Severe cases may lead to multiple organ failure when substances released by damaged muscle tissue interfere with the functioning of other organs.
The Cleveland Clinic estimates that approximately 26,000 Americans develop rhabdomyolysis annually, with a reported mortality rate of between 5 and 10 per cent.
Intense Exercise Can Trigger the Condition
Prolonged or extremely strenuous physical activity is among the recognised risk factors for rhabdomyolysis.
During ordinary exercise, small tears develop in muscle fibres before the body repairs them. However, excessive exertion can cause damage beyond what the muscle cells can withstand.
Extreme physical activity can also disrupt processes inside muscle cells, causing calcium levels to rise and triggering further cellular damage and death.
The condition is not limited to athletes. Traumatic injuries, including accidents in which muscle tissue becomes trapped under pressure, can also cause it.
Dr Alina Mitina, an emergency medicine expert at Hackensack Meridian Health, said rhabdomyolysis could also occur after someone has remained on the floor for an extended period or taken certain cholesterol-lowering medications associated with muscle breakdown.
She explained that sudden, intense activity without adequate preparation can increase the risk, particularly when someone moves from being inactive to exercising at a high level.
Dark Urine and Severe Muscle Weakness Are Warning Signs
Rhabdomyolysis can develop over several hours or days, and its initial symptoms may be mistaken for ordinary post-exercise discomfort.
Common warning signs include severe muscle pain, swelling, unusual weakness and dark urine that resembles cola or strong tea.
Dr Levine said the dark urine could indicate severe dehydration, while increasing muscle damage may leave someone struggling to stand, raise their arms or support their body weight.
He distinguished the condition from normal exercise soreness, explaining that rhabdomyolysis can cause deeper pain and significant difficulty moving the affected muscles.
He advised anyone experiencing extreme weakness, abnormal muscle swelling or dark-coloured urine after exercise to seek emergency medical attention rather than waiting for symptoms to improve at home.
Blood and Urine Tests Help Doctors Diagnose Rhabdomyolysis
Doctors can investigate suspected rhabdomyolysis through blood tests that measure creatine kinase, an enzyme released when muscle tissue is damaged.
Urine tests can also identify myoglobin, another substance released by damaged muscle fibres.
An electrocardiogram may be used to check for abnormal heart rhythms associated with elevated potassium levels.
Treatment generally involves intravenous fluids and medication to correct electrolyte imbalances. Patients with severe kidney complications may require dialysis while their kidneys recover.
Dr Mitina said most patients who receive treatment in time have a good chance of recovering fully.
She described Rachel’s case as exceptional, noting that the condition does not usually progress so rapidly.
Other Athletes Have Recovered From the Condition
Several professional athletes have experienced rhabdomyolysis or related complications and subsequently returned to their sports.
Former NFL defensive lineman Albert Haynesworth was diagnosed with the condition during the Washington Redskins’ preseason training camp in August 2010, according to a report by The Washington Post.
Although the team initially described his problem as a headache, he was later reported to have experienced dizziness, nausea, vomiting and muscle swelling.
He received treatment from team doctors and returned to action in a preseason game several days later.
WNBA player Kelsey Mitchell also experienced a serious health scare during last year’s semifinals. The Indiana Fever guard, who is a teammate of Caitlin Clark, suffered severe leg cramps and numbness and later revealed that she had been treated for rhabdomyolysis.
Mitchell recovered and returned to play for the Fever this season.
In 2024, 12 members of the Tufts University men’s lacrosse team were hospitalised with the condition following a workout involving a Navy SEAL trainee. More than a dozen players from the Iowa Hawkeyes football team were also hospitalised after an intense training session in 2011.
Doctors Advise Athletes to Increase Training Gradually
Dr Levy said reducing the risk of exercise-related rhabdomyolysis involves avoiding sudden increases in physical intensity and allowing the body sufficient time to recover.
He advised athletes to build up their activity levels gradually, remain hydrated and take regular breaks.
He also warned that severe muscle pain following exercise should not automatically be dismissed as normal soreness.
Unusual weakness, significant swelling and dark urine require urgent medical assessment, as early treatment can prevent life-threatening complications.
Dr Mitina similarly explained that the condition could become dangerous quickly, even though many cases respond well to treatment when identified early.
Rachel Apa Had an Extensive Sporting Background
Rachel had established herself as an accomplished athlete long before preparing for her first New York City Marathon.
She earned sporting honours in field hockey and lacrosse during high school before spending four years playing Division I field hockey at Bucknell University.
She had trained for months ahead of Sunday’s marathon, although it remains unclear whether she experienced any of the warning signs associated with rhabdomyolysis before the race.
According to a statement from race organiser New York Road Runners (NYRR), a social worker and physicians who were among the spectators rushed to help when she collapsed in Central Park.
Marathon medical staff arrived with a defibrillator, followed by paramedics and an ambulance that transported her to Mount Sinai Medical Center.
Doctors continued treating her for six hours before she was pronounced dead.
New York Road Runners Confirms First Marathon Death Since 2024
Following Rachel’s death, the NYRR confirmed that she was the first runner to die during the New York City Marathon since 2024.
The organisation also recalled the death of Ryan Shay, a five-time US national champion who died in Central Park in 2007 during the Olympic marathon trials.
The trials were organised by the NYRR on the day before that year’s New York City Marathon.
