Motivation Mondays | Rhabdo: Warning Signs for Runners
“It (Rhabdo) can kill you. I’ve always been completely honest about that.”Greg Glassman, founder of CrossFit
Motivation Mondays | Rhabdo: Warning Signs for Runners
Sabrina Pace-Humphreys, ultrarunner: During the 2026 UTMB, experienced ultrarunner Sabrina Pace-Humphreys became so seriously ill that she had to be airlifted from the course. She was later diagnosed with exertional rhabdomyolysis. Her experience is a powerful reminder that rhabdo can strike highly conditioned endurance athletes, too. Rhabdo: Real Runners, Real Stories: Listen to Sabrina’s story on the Runner’s World UK Podcast
Monday Motivation: The Danger of “Pushing Through” – What Every Runner Needs to Know About Rhabdo
Until I experienced the nightmarish Rhabdo episode that almost cost me my life, I had never heard of Rhabdomyolysis. Runners have been conditioned to believe that “grit” is the ultimate running virtue. We wear our blisters like badges of honor, celebrate pushing through the wall, and romanticize the mental toughness it takes to keep moving when everything hurts. I was one of those true grit runners, but at around Mile 19 of the Boston Marathon in April, I learned a terrifying lesson: sometimes, the very grit that gets us to the starting line can become dangerous when it keeps us from listening to our bodies.
Frankly, I wasn’t feeling tired. I wasn’t experiencing what some might see as normal late-race marathon fatigue. It was my 14th marathon, not a bad day or training cycle. I trained for it as I did for my other marathons. Yet, suddenly, I was losing control of my body, and I had no idea why. I was terrified. Up until Mile 19, I was having a typical marathon day, pacing, fueling, hydrating, jeffing to my run-walk-run Galloway method, when BOOM, I was listing to the right like a plane in free fall.
My muscles were no longer responding the way they should, and I couldn’t fathom what was happening to me. Other runners around me understandably thought I was exhausted from the marathon. I didn’t know enough to tell them otherwise. I only knew it felt frighteningly wrong. Cheri Whitt, my running coach, was equally baffled and concerned. She helped steady me as we headed for the finish line. None of us knew my muscles were rapidly breaking down. By the time I crossed the finish line, I was unconscious.
What followed was a serious medical crisis, a three-day stay in the ICU at Tufts Medical Center, and a diagnosis I had never expected or heard of in my life: severe exertional rhabdomyolysis known as rhabdo. I narrowly survived.
Today, part of my Motivation for sharing this post, other rhabdo stories, as well as my story, is to make sure all runners and other sports enthusiasts know something I didn’t know that day: what rhabdo is and how its warning signs can present. Learn the causes, hidden risks, and critical Rhabdo warning signs for runners. Let’s all learn to differentiate normal marathon fatigue from a life-threatening crisis.
According to the CDC, approximately 26,000 people experience an onset of rhabdomyolysis every year. You may not know what is happening to you. The runners beside you most likely won’t know and might assume you have bonked, hit the proverbial wall, or crashed out from fatigue. Some of the symptoms might even be mistaken for the exhaustion, muscle pain, weakness, or physical distress associated with endurance events. That is why recognizing when something feels different, sudden, severe, or profoundly wrong matters.
Rhabdo: Real Runners, Real Stories
Statistics tell us what rhabdo can do. The experiences of runners who have lived through it, and those whose stories ended tragically, remind us why recognizing the warning signs matters. Blockquotes throughout this post offer brief summaries of five athletes’ publicly reported experiences, with links to their full stories. Do read them to learn about our unique stories and experiences of rhabdomyolysis, aka rhabdo.
“After a few tests, he came back with a crisp prognosis: rhabdo. ‘Liver damage. Danger of seizing, acute renal kidney failure, heart attack.’ … And while they’re flushing you like a drainpipe, I told myself, maybe you can also figure out why you’re really here. It’s a strange bargain to drive the body that hard.” Anonymous Writer
Motivation Mondays | Rhabdo: Warning Signs for Runners
Aaron Kuen, marathoner: Aaron was having what seemed like the race of his life and was approaching the finish of the California International Marathon when he suddenly collapsed near Mile 26. What looked like an extraordinary athletic performance became a devastating medical emergency associated with rhabdomyolysis. Rhabdo: Real Runners, Real Stories: Read Aaron Kuen’s story at Outside
What Is Exertional Rhabdo?
Rhabdomyolysis occurs when damaged skeletal muscle cells break down and release their contents, including myoglobin, creatine kinase (CK), potassium, and other substances, into the bloodstream. In severe cases, this process can disrupt the body’s chemistry and damage the kidneys. Complications can include acute kidney injury, dangerous electrolyte abnormalities, and abnormal heart rhythms. Severe rhabdo can be life-threatening, and that is how I ended up in the ICU at Tifts Medical Center for 3 days
Exertional rhabdomyolysis is rhabdo associated with strenuous physical activity. It can occur after unusually intense or unfamiliar exercise, a sudden increase in training load, or exercise combined with other contributing factors. Heat, inadequate hydration, recent illness, certain medications or substances, and some underlying genetic or metabolic conditions may increase risk. Yes, it can happen to trained athletes.
“It basically causes our muscles to break down and leak some of the muscle cell contents into the bloodstream,” Dr. Jane Thornton
Motivation Mondays | Rhabdo: Warning Signs for Runners
Stephanie Ehret, ultrarunner: After winning a 24-hour race in record time, Stephanie should have been celebrating. Instead, she landed in an emergency room and was diagnosed with rhabdomyolysis. Her experience illustrates how an extraordinary endurance performance can coexist with a serious medical crisis developing inside the body. Rhabdo: Real Runners, Real Stories: Read Stephanie Ehret’s story in Runner’s World
The Trap: When Something Is More Than Marathon Pain
This is where all of us as runners need to pay attention. A marathon is supposed to be hard. Legs get tired. Muscles ache. Energy disappears. That can make it especially hard to recognize a developing medical emergency not only for the runner, but also for the people around us. In my case, others thought I was fatigued. I knew only that something was terribly wrong. I didn’t have the words. I didn’t know what rhabdo felt like, and I had no idea that my muscles could actually be breaking down while I was still trying to move forward.
Rhabdo cannot be diagnosed by symptoms alone, but runners should never dismiss the following warning signs. Muscle pain that seems far more severe than expected. This isn’t simply “my legs are tired.” The pain may be severe, unusual, persistent, or accompanied by marked tenderness or swelling; it may also involve profound or unexpected muscle weakness or loss of normal muscle function. Your muscles may suddenly feel incapable of doing what they normally can. The CDC describes weakness or exercise intolerance as possible symptoms of rhabdo.
My muscles were shot like jelly. I could barely stand up. For me, this was especially frightening because I felt as though I was losing control of my body. I didn’t know why. I knew what was happening wasn’t normal for me.
Significant muscle swelling. Swelling, especially when accompanied by severe pain or weakness, deserves attention. Another important marker is dark, tea- or cola-colored urine. This is one of the best-known signs of rhabdo, but here is something every runner should understand: Do not wait for dark urine before seeking help. Why? Because not everyone with rhabdo develops this classic symptom, and symptoms may appear hours or even days after the muscle injury. That means a runner can be experiencing a serious medical problem without ever seeing the warning sign most commonly associated with rhabdo.
“It wasn’t a sudden injury. It was worse. It was the slow, chemical horror of my own muscles giving up the ghost, melting into my bloodstream, and poisoning me from the inside out.” Anon
Motivation Mondays | Rhabdo: Warning Signs for Runners
Holly Brooks, U.S. Ski Team athlete: Elite fitness offered no immunity. While competing in Alaska’s notoriously demanding Mount Marathon Race, Holly Brooks collapsed near the finish and was diagnosed with acute exertional rhabdomyolysis. She eventually recovered and returned to competition. Rhabdo: Real Runners, Real Stories: Read Holly Brooks’s story on Her Blog
How Do You Know It’s Rhabdo?
You don’t, at least not by symptoms alone, and this is why seeking medical attention matters. According to the CDC, a blood test measuring creatine kinase (CK) helps diagnose and monitor rhabdomyolysis. Because CK levels can change over time, repeated testing may be necessary. Medical teams may also evaluate kidney function, electrolytes, urine, hydration status, and other indicators depending on the circumstances.
So if you develop severe or unusual muscle pain, weakness, swelling, dark urine, loss of normal muscle function, or other concerning symptoms during or after strenuous exercise, stop exercising and seek prompt medical evaluation. Do not try to diagnose rhabdo from the racecourse. I learned this hard lesson: Don’t try to “run through” when your body is telling you something is profoundly wrong.
Who Is at Risk?
Rhabdo isn’t limited to elite athletes or beginners. Research on exertional rhabdomyolysis has identified several circumstances that may contribute to risk, including unusually strenuous or unaccustomed exercise; sudden increases in training intensity or volume; sustained very-high-intensity exercise; heat stress; inadequate hydration; certain medications, drugs, or supplements; recent viral or other illness; and underlying genetic or metabolic muscle disorders in some people. It is a complex condition that is not easy to ascribe to one factor in an athlete. We can identify where and when Rhabdo occurred, but the rest isn’t so clear-cut.
For marathon and endurance runners, several factors may occur at the same time. That is another reason not to assume that being well trained makes us immune. I cannot say this enough, as some runners assume being undertrained is the main reason; it is NOT. Read the other indicators mentioned by the researchers in the links provided at the bottom of this post. A wide range of factors can trigger Rhabdo.
“Exercise is great for health, but in rare cases, it can be taken to extremes. I feel like rhabdo is becoming more prevalent …” Dr. Jane S. Thornton
Motivation Mondays | Rhabdo: Warning Signs for Runners
Elizabeth Obih-Frank, marathoner: At around Mile 19 of the 2026 Boston Marathon, Elizabeth suddenly began losing control of her body. She wasn’t experiencing what one might recognized as ordinary marathon fatigue; she was terrified because her muscles were no longer responding normally, and she couldn’t understand what was happening. Instead, her muscles were rapidly breaking down from severe exertional rhabdomyolysis. After making it across the finish line, she was hospitalized and spent three days in the ICU at Tufts Medical Center. She survived the medical crisis and now shares her experience to help other runners recognize that sometimes the most courageous decision is not to push through, but to listen when the body is sounding an alarm. Rhabdo: Real Runners, Real Stories: Read my story in Women’s Health Digital Mag AND Watch/Read WCVB’s report on my Boston Marathon medical emergency
Can Rhabdo Happen Again?
I have thought about this deeply since my own experience because it happened to me twice. The answer is yes, rhabdo can recur, but one episode does not automatically mean every survivor is at high risk of another. Research suggests recurrence is relatively uncommon in people without evidence of an underlying genetic or metabolic condition. However, recurrent rhabdo, unusually severe episodes, persistently elevated CK, episodes triggered by exercise that would normally be well tolerated, or certain personal and family histories may lead physicians to investigate for an underlying muscle disorder.
Most importantly, returning to strenuous exercise after rhabdo should not be a test of willpower. Medical literature recommends a gradual, individualized return to activity after symptoms have resolved and appropriate laboratory markers have returned toward normal, with medical guidance particularly important after severe or complicated cases. I went back to my HIIT regimen too soon, so it is important to listen to the research and gradually build your body back up. Recovery isn’t the time to prove how tough we are; recovery is part of the training, and taking the requisite time to recover will pay dividends once we are fully healed.
“We need to start aggressive IV fluids right now. Her muscles are essentially dissolving. If we don’t flush those proteins out of his system immediately, her kidneys are going to shut down before the sun sets.” Anon
Motivation Mondays | Rhabdo: Warning Signs for Runners
Sam Norton, marathoner, age 26: During the 2023 Boston Marathon, Sam collapsed near Mile 14 and was later diagnosed with rhabdomyolysis. Just four months later, he collapsed again, this time shortly before Mile 23 of the Santa Rosa Marathon, and died at the hospital. Published reporting did not establish rhabdomyolysis as the cause of his death, but his story is a heartbreaking reminder of why a serious exercise-related medical event deserves careful follow-up before returning to endurance competition. Rhabdo: Real Runners, Real Stories: Read Sam Norton’s story in Runner’s World
Monday Motivation: Listen to the Alarms
Running has taught me perseverance. It has taught me courage, patience, discipline, and how much more I can do than I believe. Rhabdo taught me something equally important: That there is a difference between discomfort that challenges us and distress that warns us. Sometimes you won’t know what is happening. I didn’t. All you might know is that something feels wrong, and that is enough reason to stop and ask for help.
True mental toughness isn’t pushing your body toward a medical crisis without thinking. Sometimes, toughness means stopping. I believe that courage means asking for help, and the smartest, strongest decision a runner can make is deciding that today’s finish line isn’t worth gambling tomorrow’s health. If during a race or hard training session something feels sudden, severe, unfamiliar, frightening, or profoundly wrong, pay attention.
Don’t wait for dark urine or assume every physical problem is “just the marathon.” Don’t be embarrassed to stop or ever let anyone, including that relentless runner’s voice inside your own head, convince you that seeking medical help makes you weak. We don’t need to know what is wrong before deciding something is wrong. There will always be another mile and another race. My kids kept reminding me during my recovery that there is only one me, and I need to give myself the grace to recover fully.
I will say the same thing to all my fellow runners/extreme sports enthusiasts: There is only one you. Run smart. Listen to your body. Look out for the runners beside you, and let’s keep logging those miles safely.
Disclaimer: This post shares my personal experience and general educational information about exertional rhabdomyolysis. It is not a substitute for professional medical advice, diagnosis, or treatment. If you experience severe or unusual symptoms during or after exercise, seek prompt medical attention.
RESOURCES:
- CDC/NIOSH — Signs and Symptoms of Rhabdomyolysis: This is probably your most useful reader-facing resource. It covers severe muscle pain, weakness/fatigue, dark urine, delayed symptoms, when to seek immediate medical attention, and CK testing. CDC
CDC: Signs and Symptoms of Rhabdomyolysis - CDC/NIOSH — Rhabdomyolysis overview: Good authoritative background on causes, organ complications, physical exertion, heat, and why early diagnosis matters. CDC
CDC: Rhabdomyolysis and Work - NIH MedlinePlus — Rhabdomyolysis: An accessible medical overview that includes severe exertion, such as marathon running, among possible causes and discusses myoglobin and kidney damage. MedlinePlus
MedlinePlus: Rhabdomyolysis - BMJ Open Sport & Exercise Medicine — Exertional Rhabdomyolysis: Particularly valuable for your runner audience. It discusses strenuous/unaccustomed exercise, marathon running, heat, hydration, medications, illness, genetic factors, recurrence, and return to exercise. BMJ Open Seminars
BMJ: Exertional Rhabdomyolysis—Physiological Response or Underlying Myopathy? - Clinical review — Exertional Rhabdomyolysis in the Athlete: Useful for readers interested in the sports-medicine side, including evaluation, risk stratification, and return to sport. PubMed Central (PMC)
Exertional Rhabdomyolysis in the Athlete: A Clinical Review
HERE
PHOTO CREDITS/ATTRIBUTIONS: Rhabdomyolysis urine photograph — Wikimedia Commons, Muscle breakdown and rhabdomyolysis illustration — Wikimedia Commons, CDC public-domain rhabdomyolysis image, RHABDO VIA OSMOSIS, RHABDO VIA ERWIN MIYASAKA, ADOBE STOCK ON RHABDO, Personal Collection and Courtesy of MarathonPhotos AND/OR AllSports
Until Next Time…
Ask. Believe. Receive. ©
Elizabeth Obih-Frank
Mirth and Motivation
Positive Kismet
