Runner dies from rhabdomyolysis near NYC Marathon finish

A 24-year-old runner collapsed just two miles short of the finish line at the 2026 New York City Marathon on Nov. 1 and later died from rhabdomyolysis, a rare condition that can be triggered by intense physical activity. Rachel Apa was running her first marathon to raise funds for Parkinson's disease in memory of her grandfather. Although she had a background in Division I field hockey and had trained for months, she sent a text to her father at mile 18 saying "Ow," followed by "Ow ow" a mile later, after which she stopped responding.

Marathon officials and bystanders, including two physicians, attempted CPR and used a defibrillator before an ambulance arrived. Apa was transported to Mount Sinai Medical Center, where she received six hours of treatment but could not be revived. Her father later confirmed to the New York Times that rhabdomyolysis was the cause of death.

Dr. David Mariuma, a nephrologist at Stony Brook Medicine, explained that rhabdomyolysis occurs when damaged skeletal muscle releases electrolytes, proteins and enzymes into the bloodstream, potentially causing kidney failure and heart arrhythmias. While traumatic injuries are the most common cause, intense exercise can also trigger the condition. The Cleveland Clinic estimates about 26,000 cases annually in the United States, with up to 47% linked to physical exertion.

Risk factors include dehydration, heat, illness, certain genetic conditions, alcohol consumption, drug use, prior episodes of rhabdomyolysis, and some medications. The condition is more prevalent among men, smokers, and individuals with obesity. Experts advise gradual training, adequate hydration with electrolytes, and listening to the body’s warning signs such as severe muscle pain, weakness, confusion, nausea, or dark urine.

"When it happens, it tends to happen over minutes to hours," Dr. Mariuma said.

"We tend to push through pain; that's the mindset that we're encouraged to take," Dr. Jessica Tomazic of the Cleveland Clinic noted.

Treatment focuses on intravenous fluids to flush toxins from the kidneys, with dialysis required in severe cases. While most patients survive without kidney damage, the fatality rate rises when kidney injury occurs. Both physicians emphasized that exercise-related rhabdomyolysis is rare and should not deter people from participating in marathons or other physical activities, provided they take preventive measures.