NYC marathon runner was killed by a silent condition. Experts expose the deceptively subtle warning signs athletes must never ignore

Rachel Apa was in peak physical condition. 

The 24-year-old runner and former college field hockey player had trained for months to run the New York City Marathon, and at Mile 24 on Sunday, she had nearly done it.

But just two miles from finishing the race, Rachel suddenly collapsed. In a Manhattan hospital later that evening, she was pronounced dead. 

Rachel’s father, Steve Apa, told The New York Times that his daughter died from rhabdomyolysis, a rare but deadly condition that causes the muscles to break down and release toxic chemicals from muscle fibers into the bloodstream.

These chemicals overwhelm the kidneys, leading to organ failure and death within a matter of hours. 

‘It’s unfathomable,’ Steve said. ‘Perfect health, perfect shape, 24 years old.’

Doctors warn that the intense training elite athletes endure is often what causes rhabdomyolysis, as the exertion pushes muscle fibers to their limit, faster than the body can repair.

And the early signs are deceptively subtle – swelling, weakness, dark urine – making it all too easy for athletes to shrug off. 

About 26,000 Americans are struck by rhabdomyolysis each year, the Cleveland Clinic estimates, with a mortality rate of 5 to 10 percent. 

Doctors who were not involved in Rachel’s care told the Daily Mail that in rhabdomyolysis, fibers responsible for muscle movement rapidly begin to break down and disintegrate.

When this happens, those fibers release massive amounts of electrolytes and other components like potassium and myoglobin into the bloodstream. They also release creatine kinase, an enzyme used to measure the severity of muscle damage. 

While the kidneys can normally filter out these chemicals, the large amounts released in rhabdomyolysis clog vital organs like the kidneys.

‘Unfortunately, these large muscle proteins are incredibly thick and easily clog and damage that delicate filtration system,’ Dr Marc Levine, chair of orthopedic surgery at Jersey Shore University Medical Center, told the Daily Mail.  

These chemicals also travel to the heart, leading to abnormal heart rhythms.

‘Damaged muscles release potassium into the blood, which can reach dangerous levels and cause sudden cardiac arrest,’ Dr Eric S Levy, emergency medicine physician and director of simulation at Northwell’s Staten Island University Hospital, told the Daily Mail. 

‘Severe cases can also lead to multiple organs failing when dead muscle tissue floods into them and impairs their function.’

One of the major risk factors is intense or prolonged exercise. Normal workouts like a quick run or cycling session cause tiny, manageable tears in muscle fibers that the body then rebuilds and strengthens. 

But excessively strenuous workouts cause more stress than the muscle cell membranes can keep up with. 

Extreme exercise also disrupts cellular signaling, increasing levels of calcium in muscle cells. This triggers cell breakdown and cell death. 

Traumatic injuries like car accidents that pin down muscle tissue can also result in rhabdomyolysis.

Rhabdomyolysis can develop over just a few hours or days, and despite the havoc it wreaks, its symptoms can be surprisingly subtle. The condition typically causes severe muscle aches, profound weakness and dark urine the color of soda or dark tea. 

Levine told the Daily Mail: ‘The dark urine color suggests severe dehydration as the body holds on to water. These symptoms usually come on gradually in the hours following an intense workout or race. 

‘As the swelling and damage increase in the muscle tissue, the weakness becomes so bad that a person might struggle to stand up, lift their arms or support their own body weight.’

Levine notes that while normal soreness causes a stiff and achy feeling, rhabdomyolysis usually causes deep pain and trouble moving the muscle. 

‘If you experience that level of extreme weakness, notice your muscles swelling abnormally, or see dark, tea-colored urine, you must go to an emergency room immediately instead of trying to wait it out at home,’ he said.  

At the emergency room, doctors can diagnose rhabdomyolysis with blood tests measuring creatine kinase and urine tests looking for myoglobin, and an electrocardiogram can measure heart rhythm issues caused by high potassium. 

It can be treated with IV fluids and medications to counter electrolyte imbalances. In severe cases, patients may need dialysis to help take over the work of the kidneys while they heal. 

Dr Alina Mitina, an emergency medicine expert at Hackensack Meridian Health, explained that rhabdomyolysis does not necessarily end an athlete’s career with most people having a strong chance of full recovery. 

‘The treatment is pretty straightforward,’ she explained to the Daily Mail. ‘Apa’s tragic case is an exceptional case. Rhabdomyolysis doesn’t happen this quickly. 

‘If we catch it in time, there is a really good and easy way to treat it. How fast it gets better is just dependent on every person, but the recovery is good.’

She noted that most people doing a casual jog, weekend bike ride or normal gym routine are not at increased risk of rhabdomyolysis.

‘A lot of the times this happens from very quick exertional activity,’ Mitina said, ‘such as being stagnant, not warming up, and then running right… from zero to 100.’

However, she also warned that it doesn’t always stem from strenuous exercise. Mitina explained that people could suffer with the condition after lying on the floor for a prolonged period of time, being in a traumatic accident, or even taking a medication that lowers cholesterol levels causing muscles to break down. 

Multiple professional athletes across various sports have suffered with the disease only to go on to make comebacks. 

Former NFL defensive lineman Albert Haynesworth, now 45, was diagnosed with rhabdomyolysis during preseason training camp in August 2010, the Washington Post reported at the time. 

While the Washington Redskins, his team then, played down the issue as a ‘headache,’ it later emerged that Haynesworth had suffered with symptoms such as dizziness, nausea, vomiting and muscle swelling. He was treated by team doctors and made a return to the field in a preseason game days later. 

Just last year, Indiana Fever player and Caitlin Clark teammate Kelsey Mitchell, 30, suffered a concerning health scare during the WNBA semifinals when she experienced severe leg cramping, which left her feeling numb. 

Mitchell, who said she experienced a brief episode of lower body paralysis, later revealed that she had been treated for rhabdomyolysis. She made a full recovery and returned to play for the Fever this season. 

Meanwhile, 12 members of the Tufts University men’s lacrosse team were hospitalized with the condition after a workout with a Navy SEAL trainee in 2024. Over a dozen players on the Iowa Hawkeyes football team were also left battling rhabdomyolysis in a hospital following an intense workout in 2011. 

Levy told the Daily Mail that preventing rhabdomyolysis lies with not going too hard too fast and taking vital rests. Athletes should generally increase exercise intensity, stay hydrated and take frequent breaks to avoid overexertion. 

‘The bottom line is that exercise-related muscle pain should not always be dismissed as normal soreness,’ he said. Severe muscle pain, unusual weakness or dark urine after exercise are warning signs that should never be ignored. 

‘Early treatment can prevent life-threatening complications.’

For Rachel, however, it was too late for treatment. The runner tragically collapsed in Central Park on the cusp of completing the iconic race in Manhattan. 

‘Rhabdomyolysis is a very, very dangerous condition, and it can go from being very simple and not dangerous to becoming dangerous pretty quickly,’ Mitina said.  

Rachel was an accomplished athlete, lettering in field hockey and lacrosse in high school before playing four years of Division I field hockey at Bucknell University. 

Rachel had trained for months ahead of Sunday’s race. It is unclear if she had had any of the warning signs outlined by Levine in the buildup to her first marathon. 

After a social worker and physicians in the crowd rushed to treat her, marathon medical staff arrived with a defibrillator, according to a statement by race organizer the New York Road Runners (NYRR).

The paramedics followed quickly with an ambulance, which brought Rachel to Mount Sinai Medical Center. It was there that doctors tried to save her life for six hours before pronouncing her dead at 9.40pm.

Following Rachel’s death, the NYRR confirmed she was the first runner to die during the New York City Marathon since 2024. In 2007, five-time US national champion Ryan Shay died in Central Park during the Olympic marathon trials, which were held by the NYRR a day before that year’s New York City Marathon.