Updated: 2 days ago
The marathon running community has been shaken by the tragic death of 24-year-old Rachel Apa, who collapsed near mile 24 of the 2026 New York City Marathon, just over two miles from the finish line. Apa, who was running her first marathon, was transported to a nearby hospital but sadly passed away. Her family reported that doctors attributed her death to rhabdomyolysis, commonly known as Rhabdo, although the medical examiner's investigation had not reached a final public determination. Her passing is a heartbreaking reminder that even seemingly healthy, physically active individuals can experience serious medical complications during extreme physical exertion. Whether you're an elite athlete, a recreational runner, or someone preparing for your first 26.2-mile race, this tragedy reinforces an important lesson: you have to respect the distance. A marathon is not simply another long run. It is an extraordinary physical demand that requires preparation, discipline, endurance, and an understanding of your body's limitations.
What exactly is rhabdomyolysis? Rhabdomyolysis is a potentially life-threatening medical condition that occurs when damaged skeletal muscle cells break down and release their intracellular contents into the bloodstream. These substances include myoglobin, creatine kinase (CK), potassium, and other cellular components. Myoglobin is particularly concerning because excessive amounts circulating in the bloodstream can damage the kidneys and potentially lead to acute kidney injury or kidney failure. Elevated potassium can also interfere with the heart's electrical activity, creating potentially dangerous cardiac arrhythmias. Although severe exertional rhabdomyolysis is relatively uncommon, it is not exclusive to marathon runners or endurance athletes. It can develop following unusually strenuous weightlifting sessions, excessive squats, intense exercise after prolonged inactivity, occupational activities involving repetitive heavy lifting, heat exposure, or traumatic injuries such as crush injuries. The common denominator is significant muscle damage that exceeds the body's ability to recover and maintain normal physiological function. Importantly, rhabdomyolysis does not always announce itself immediately, and symptoms can develop hours or even days after the initial exertion.
Preparation is one of the most important components of reducing your risk. Whether you're an experienced marathoner or someone returning to running after an extended break, your training should reflect your current fitness level, not the level you previously achieved. If you've been away from running for several months, consider allowing at least six months to progressively rebuild your fitness and prepare for a marathon, adjusting that timeline based on your experience, health, and starting point. Gradually increase weekly mileage, incorporate recovery weeks, and avoid making sudden increases in distance or intensity. Don't confuse being motivated with being physically prepared. Just because you can push through a demanding workout doesn't necessarily mean your muscles, connective tissues, cardiovascular system, and recovery capacity are prepared for that workload. Avoid stacking excessive high-intensity sessions, and do not attempt strenuous training while experiencing a viral infection or immediately after recovering from one. Illness can place additional stress on the body, and returning to exercise should be gradual. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may also increase the risk of kidney injury during or after strenuous exercise, particularly when dehydration or rhabdomyolysis is present, because they can reduce blood flow to the kidneys and compound the stress caused by muscle breakdown and the release of myoglobin into the bloodstream. Proper hydration, balanced nutrition, adequate carbohydrate intake to support endurance training, sufficient protein to support muscle repair, and consistent sleep are all important parts of the recovery process. Hydration deserves particular attention, especially in hot and humid conditions, but remember that drinking excessive amounts of plain water can also cause dangerous electrolyte imbalances. Your hydration and electrolyte strategy should account for your individual sweat rate, exercise duration, and environmental conditions.
Another important part of marathon preparation is learning to understand your body's signals. Anyone who has completed a marathon knows that discomfort is part of the experience. Fatigue, muscle soreness, heavy legs, and the mental challenge of pushing through the final miles are familiar experiences for many runners. However, there's a difference between normal endurance-related discomfort and symptoms that suggest something more serious. This is where monitoring your effort becomes valuable. A heart rate monitor can help you understand how your cardiovascular system responds to different levels of exercise intensity. Knowing your estimated maximum heart rate, individual heart rate zones, and appropriate training intensities can help you manage your workload more intelligently. Remember, maximum heart rate varies from person to person, and generic age-based formulas are only estimates. Your heart rate tells a story about how hard your cardiovascular system is working and can provide useful insight into your body's overall response to exercise. Unusually elevated heart rates at familiar paces, unexpected fatigue, or an abnormal response to a normally manageable workout may be reasons to slow down and reassess. However, a heart rate monitor cannot diagnose or rule out rhabdomyolysis. Pay attention to warning signs such as muscle pain that is significantly more severe than expected, unusual swelling, profound weakness, extreme fatigue, and dark, tea-colored or cola-colored urine. These symptoms warrant immediate medical evaluation, even if they develop after you've finished exercising. Diagnosis generally involves blood testing, including creatine kinase levels, and medical assessment. Do not assume that drinking more water and resting will resolve suspected rhabdomyolysis.
Ultimately, the goal of endurance training should be to build a stronger, healthier, more resilient body—not simply to chase another personal record. There is a time and place for challenging yourself, increasing intensity, and testing your physical limits, but those efforts should be supported by adequate preparation and recovery. Your muscles have physiological limits, and repeatedly demanding more from an already exhausted body can increase the risk of injury and other complications. Sometimes the smartest decision is to slow down, shorten a workout, postpone a race, or take an additional recovery day. No personal best is worth compromising your health. Rachel Apa's passing is a devastating loss, and my thoughts are with her family, friends, and everyone affected by this tragedy. Her story should encourage the running community to have more conversations about preparation, recovery, hydration, and recognizing when something isn't right.
About the Author
Coach Abe Crawford, NASM-CPT
Founder | Hygher Power Lifestyle Health & Wellness
A National Academy of Sports Medicine (NASM) Certified Personal Trainer and five-time marathoner with more than 24 years invested in health, wellness, fitness, and personal development. Coach Abe is passionate about helping individuals build healthier lifestyles through exercise, nutrition, endurance training, and sustainable lifestyle changes.
As an endurance runner and advocate for lifelong wellness, he believes education, preparation, consistency, and recovery are essential components of long-term health.
