How Could a 24-Year-Old in ‘Perfect Health’ Collapse During a Marathon? An Expert Explains Rhabdomyolysis (Exclusive)
How Could a 24-Year-Old in ‘Perfect Health’ Collapse During a Marathon? An Expert Explains Rhabdomyolysis (Exclusive)
Cara Lynn ShultzWed, November 4, 2026 at 3:38 PM UTC
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Rachel ApaCredit: Rachel Apa/Instagram -
Rachel Apa collapsed near mile 24 of the New York City Marathon, a few hours after telling her dad she felt “amazing”
The former Bucknell hockey player died later that night from rhabdomyolysis, or muscle breakdown
An expert says gradual training and recognizing warning signs can help reduce exertion-related risks
A 24-year-old woman in “perfect health” collapsed while running her first marathon, and died later that night. Her cause of death was a life-threatening condition often associated with over-exertion: rhabdomyolysis.
Rachel Apa, an athlete and former hockey player for Bucknell University, was running her first marathon, the New York City Marathon, on Nov. 1. Early in the race, around 11:30 a.m., near the 9-mile mark, she texted her father, Steve Apa. Shortly afterward, she texted him “I feel amazing,” and “I’ve never felt this good,” he told NBC.
But around 1:30, her texts changed, with Rachel texting her father “ow.” Soon, her replies stopped, and she reportedly collapsed near mile 24, two miles shy of the 26.2-mile finish line. She later died at the hospital.
Runners at the New York City Marath on November 1, 2026Credit: kena betancur/AFP via Getty
“It’s unfathomable,” her dad told The New York Times. “Perfect health, perfect shape, 24 years old.”
It was determined that Apa died of rhabdomyolysis (often shortened to rhabdo). In simplest terms, it means “muscle breakdown,” Dr. Sohaib Imtiaz, Chief Medical Officer at People Inc., says.
“It can happen when extreme effort combines with other risk factors: heat, dehydration, painkillers like ibuprofen, a recent virus, or a hidden genetic condition, such as sickle cell trait or certain inherited muscle disorders,” Imtiaz, who did not treat Apa, explains.
There is no information about what specifically led to Apa’s rhabdo.
In the fatal condition, Imtiaz says, it’s not the damaged muscles that cause the problem, but what the muscle breakdown does to the body. It can cause “a dangerous spike in potassium that can stop the heart, as well as kidney failure, a sharp drop in blood pressure, or problems with blood clotting,” he says, adding that heat stroke can occur at the same time.
“Deadly exertional rhabdomyolysis in a young, fit runner is rare,” Imtiaz says, but it can happen — especially over hours of exertion.
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During “hard running, muscles take repeated strain,” he says. “Over time, the muscle cells run out of energy and die. As they break apart, they release their contents, including potassium and a protein called myoglobin, into the blood.”
Stock image of a runner drinking waterCredit: Getty
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While rhabdo is often associated with pain, it’s not uncommon for someone to feel great before it hits, Imtiaz says.
“Many people never have the textbook combination of muscle pain, weakness and dark urine, so serious damage can build quietly. Rising potassium causes no symptoms until it suddenly disrupts the heart’s rhythm,” he explains. Also, “rhabdo and early heat illness can cause confusion, which may change how someone judges how they feel before anyone around them notices.”
And, he adds, rhabdo may come on suddenly. “A heart rhythm problem caused by high potassium gives little warning, so someone can feel fine and then collapse.”
He urges people to be on alert for warning signs that indicate the pain is more than just normal soreness, like “muscle pain that’s worse or lasts longer than expected, especially with swelling, firmness, weakness or trouble moving,” as well as dark urine — or barely urinating at all — along with nausea, vomiting, fever, unusual tiredness, confusion or agitation.
Runners at the New York City Marathon on Nov. 1, 2026Credit: Lokman Vural Elibol/Anadolu via Getty
“Most cases happen when people push past what their body is used to.” So build up your endurance gradually, he says. And on hot or humid days, take it easy, as “heat is one of the biggest risk factors” in developing the condition.
And while hydration is important, Imtiaz warns not to overdo plain water that can dilute sodium to dangerous low levels in the blood.
Overall, he says, “Pay attention to the warning signs. It’s crucial to get medical help right away. Don’t wait it out.”
on People
Source: “AOL Breaking”
